title: Malignant left-sided large bowel obstruction managed by subtotal/total colectomy.
abstract: Of 60 patients presenting with acute obstructing carcinoma of the left colon, 49 underwent immediate resection either by radical subtotal/total colectomy (31 patients, group I) or by radical segmental resection (18 patients, group II) of whom three had immediate anastomosis after on-table bowel irrigation and 15 had a planned staged procedure. The operative mortality rate was 3 per cent in group I and 11 per cent in group II (not a statistically significant difference). However, substantial differences were found for major morbidity (6 versus 44 per cent in groups I and II respectively; P less than 0.01) and mean length of hospital stay (17 days in group I versus 35 days in group II; P less than 0.05). All three patients who had on-table lavage developed anastomotic leaks which necessitated a second operation to form a stoma. Six patients (19 per cent) in group I required antidiarrhoeal medication in the immediate postoperative period. However, subsequent improvement in stool frequency was noted in all patients. It is concluded that subtotal/total colectomy is an acceptable means of managing patients with obstructing carcinoma of the left colon in that it is associated with a low morbidity and mortality rate and good functional results.
authors.affiliation: Department of Surgery, Royal Gwent Hospital, Newport, UK.
authors.forename: B M
authors.initials: BM
authors.lastname: Stephenson
authors.forename: A A
authors.initials: AA
authors.lastname: Shandall
authors.forename: R
authors.initials: R
authors.lastname: Farouk
authors.forename: G
authors.initials: G
authors.lastname: Griffith
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D003082:Colectomy / Q000379:methods* / Q000401:mortality; D003108:Colonic Diseases / Q000209:etiology / Q000401:mortality / Q000601:surgery*; D003110:Colonic Neoplasms / Q000150:complications / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D004739:England / Q000453:epidemiology; D005260:Female; D006801:Humans; D007415:Intestinal Obstruction / Q000209:etiology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D015996:Survival Rate