Emergency subtotal/total colectomy with anastomosis for acutely obstructed carcinoma of the left colon.
OBJECTIVE
The operation of choice for acutely obstructed carcinoma of the left colon is controversial. The aim of the study was to evaluate the results of its management by emergency subtotal/total colectomy with immediate anastomosis without diversion.


METHODS
An emergency subtotal/total colectomy was performed in 44 patients (mean age, 72.4 years). Inclusion criteria were reasonable operative risk, resectable acutely obstructed carcinoma, massively distended colon of dubious viability and likely to contain ischemic lesions, signs of impending cecal perforation, and masses suggesting synchronous colonic cancers.


RESULTS
Postoperative mortality was 6.8 percent. Two patients over 90 years of age died postoperatively as a result of cardiopulmonary complications. An 83-year-old female died as a result of an anastomotic dehiscence. Morbidity was 6.8 percent including one fistula which recovered without surgery. There were three synchronous colon cancers. Six months after surgery, the mean daily stool frequency was two following subtotal colectomy and three after total colectomy.


CONCLUSIONS
Emergency subtotal colectomy achieves in one stage relief of bowel obstruction and tumor resection by encompassing a massively distended and fecal-loaded colon with ischemic lesions and serosal tears on the cecum, ensures restoration of gut contiguity via a "safe" ileocolonic anastomosis, and removes occasional lesions proximal to the index cancer. It is a safe procedure given that operative mortality rates are as low as with elective surgery.
Department of Visceral Surgery, University of Angers, France.
J P
JP
Arnaud
R
R
Bergamaschi
D000208:Acute Disease; D000230:Adenocarcinoma / Q000150:complications / Q000601:surgery*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000714:Anastomosis, Surgical / Q000379:methods*; D002429:Cecal Diseases / Q000209:etiology / Q000601:surgery*; D003082:Colectomy / Q000379:methods*; D012809:Colon, Sigmoid / Q000601:surgery; D003110:Colonic Neoplasms / Q000150:complications / Q000601:surgery*; D004630:Emergencies; D005260:Female; D006801:Humans; D007082:Ileum / Q000601:surgery; D007415:Intestinal Obstruction / Q000209:etiology / Q000601:surgery*; D007416:Intestinal Perforation / Q000209:etiology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009017:Morbidity; D011183:Postoperative Complications / Q000401:mortality; D012007:Rectum / Q000601:surgery; D017792:Surgical Stapling