[The role of subtotal/total colectomy in the urgent treatment of obstructive cancer of the left colon].
OBJECTIVE
The aim of the study was to evaluate the results of management of acutely obstructed carcinoma of the left colon by emergency subtotal/total colectomy (STC) with immediate anastomosis without diversion.


METHODS
STC was performed in 48 patients (mean age 72 years). Inclusion criteria were reasonable operative risk, resectable acutely obstructed carcinoma, massively-distended colon of dubious viability, signs of impending cecal perforation.


RESULTS
Postoperative mortality was 6.2% (n = 3): 2 patients over 85 years of age died postoperatively as a result of cardiopulmonary complications: an 83 year-old female dies as a result of an anastomotic dehiscence. Morbidity was 12.4% (n = 6) including one fistula which recovered without surgery. There were 4 synchronous colon cancers. Six months after surgery, the mean daily stool frequency was 2 after STC, and 3 after TC.


CONCLUSIONS
Emergency STC achieves in one stage relief of bowel obstruction and tumor resection by encompassing a massively distended and fecal-loaded colon with ischemic lesions, ensures restoration of gut continuity via a "safe" anastomosis and removes occasional synchronous carcinoma.
Département de Chirurgie Viscérale, CHU-Angers.
J P
JP
Arnaud
C
C
Cervi
R
R
Duplessis
F
F
Cattan
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000714:Anastomosis, Surgical; D002277:Carcinoma / Q000150:complications / Q000601:surgery*; D002423:Cause of Death; D002429:Cecal Diseases / Q000601:surgery; D003082:Colectomy / Q000009:adverse effects / Q000379:methods*; D003106:Colon / Q000098:blood supply; D003108:Colonic Diseases / Q000209:etiology / Q000601:surgery*; D003110:Colonic Neoplasms / Q000150:complications / Q000601:surgery*; D003672:Defecation; D005069:Evaluation Studies as Topic; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007412:Intestinal Fistula / Q000209:etiology; D007415:Intestinal Obstruction / Q000209:etiology / Q000601:surgery*; D007416:Intestinal Perforation / Q000601:surgery; D007511:Ischemia / Q000601:surgery; D008297:Male; D008875:Middle Aged; D011655:Pulmonary Embolism / Q000209:etiology; D013529:Surgical Wound Dehiscence / Q000209:etiology; D016896:Treatment Outcome
Place de la colectomie subtotale/totale dans le traitement en urgence des cancers occlusifs du côlon gauche.