The missing randomized trial of two surgical treatments for acute obstruction due to carcinoma of the left colon and rectum. An interim report.
Between 1978 and 1985, 55 patients with left-sided colonic obstruction presenting as an emergency were randomised to two treatment groups. In Group T (28 patients) a transverse colostomy was performed as a first stage. After recovery, a second stage of resection with anastomosis was carried out and 17 patients had a 'curative' resection. Of these the colostomy was closed as a third stage in 16. In Group R (27 patients) immediate resection with end colostomy and mucous fistula was carried out as a first stage. A 'curative' resection was possible in 25, of whom 5 died postoperatively. Of the 20 remaining patients, 15 underwent a second stage operation in which reanastomosis was carried out. There was no significant difference in cancer-specific survival between the two treatment groups. Six patients having a curative operation in Group T died with recurrence and 1 further death occurred unrelated to cancer, leaving 10 alive at present, 3 of whom have recurrence. Of the 25 patients treated for cure in Group R, 5 died postoperatively, 9 died with recurrence and 11 were still alive at the time of this assessment, 1 of whom has recurrence. The results at this intermediate stage of assessment indicate no advantage for immediate resection in terms of treatment mortality and long-term survival over an initial transverse colostomy.
Kronborg
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D000208:Acute Disease; D000328:Adult; D000368:Aged; D002986:Clinical Trials as Topic; D003082:Colectomy / Q000379:methods*; D003110:Colonic Neoplasms / Q000150:complications / Q000601:surgery*; D003125:Colostomy; D005260:Female; D006801:Humans; D007415:Intestinal Obstruction / Q000209:etiology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011897:Random Allocation; D012004:Rectal Neoplasms / Q000150:complications / Q000601:surgery*; D012086:Reoperation