[The surgical treatment of obstructive cancers of the left colon. Apropos of a series of 66 cases].
From 1977 to 1989, 66 patients were operated on in emergency, without any bowel preparation, for acutely obstructing left-sided colon cancer. Two synchronous cancers were diagnosed and the 68 tumours were located as follows: 13 on the left transverse colon or at the splenic flexure, 7 on the descending colon, 37 on the sigmoid, and 11 at the rectosigmoid junction or below. According to Astler-Coller staging, 15 patients were classified as B, 17 as C and 25 as D. Initial treatment was a colostomy in 58 patients (88%), or a resection with or without anastomosis in 2 and 6 cases respectively. Most patients underwent a two- or more rarely a three-stage resection and 44 patients left the hospital without either tumour or stomy. Cumulative operative mortality was 12%. Five-year survival rates were 21% for the patients with a minimal potential follow-up of 5 years, and 39% for curative resections (disease-free survival of 33%). From these results, we think that two-staged resection, with close proximal colostomy followed by resection and anastomosis, remains an appropriate approach for most obstructing left-sided colon cancers; more tempting procedures such as resection with primary anastomosis or subtotal colectomy are probably indicated in selected patients.
Jamart
J
J
Centre de Coloproctologie UCL, Cliniques Universitaires Saint-Luc et Clinique de l'Europe, Bruxelles.
Detry
R
R
Vandenabeele
M
M
Kestens
P J
PJ
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000714:Anastomosis, Surgical / Q000379:methods; D003082:Colectomy; D003110:Colonic Neoplasms / Q000150:complications / Q000401:mortality / Q000601:surgery*; D003125:Colostomy; D005260:Female; D006801:Humans; D007415:Intestinal Obstruction / Q000209:etiology* / Q000601:surgery; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D016019:Survival Analysis
Le traitement chirurgical des cancers occlusifs du côlon gauche. A propos d'une série de 66 cas.