title: The missing randomized trial of two surgical treatments for acute obstruction due to carcinoma of the left colon and rectum. An interim report.
abstract: 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.
authors.forename: O
authors.initials: O
authors.lastname: Kronborg
mesh_terms: 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