title: Emergency one-stage surgery for obstructing left-sided colorectal carcinomas.
abstract: A one-stage operation for obstructing left-sided colorectal carcinoma remains controversial. This study was performed to compare our surgical management of patients with left-sided colorectal cancer (at or distal to splenic flexure) obstruction presenting to the Kaohsiung Medical University Hospital from January 1995 to December 2000. Ninety-six patients underwent immediate operation within 24 hours of admission. Of these, 73 patients (76%) who underwent immediate tumor resection and anastomosis in one stage after appropriate resuscitation were enrolled into our study. In one-stage operation subtotal coloectomy with ileocolic or ileorectal anastomosis (group 1) was performed in 46 patients (63%), and intraoperative bowel preparation followed by immediate resection (group 2) was undertaken in 27 patients (37%). In comparing the two groups, there was no significant difference in the postoperative mortality (8.7% in group 1 vs. 7.4% in group 2) or cumulative 5-year survival rate (36.7% in group 1 vs. 35.7% in group 2) (all p > 0.05). However, mean operation time (178 +/- 12 min in group 1 vs. 238 +/- 12 min in group 2) and postoperative wound infection rate were significantly lower (10.9% in group 1 vs. 29.6% in group 2). The incidence of postoperative diarrhea was more prominent in the group 1 than group 2 (32.6% in group 1 vs. 11.1% in group 2) (all p < 0.05). The results of our current study showed that primary resection and anastomosis by subtotal colectomy is an acceptable means for the treatment of patients with obstructing left-sided colorectal carcinomas when the patient's condition is feasible.
authors.affiliation: Department of Surgery, Kaohsiung Medical University & Hospital, No. 100, Shih-Chuan 1st Road, Kaohsiung 807, Taiwan. cy614112@ms14.hinet.net
authors.forename: Tsung-Jen
authors.initials: TJ
authors.lastname: Huang
authors.forename: Jaw-Yuan
authors.initials: JY
authors.lastname: Wang
authors.forename: Li-Wei
authors.initials: LW
authors.lastname: Lee
authors.forename: Fang-Ming
authors.initials: FM
authors.lastname: Chen
authors.forename: Chieh-Han
authors.initials: CH
authors.lastname: Chuan
authors.forename: Hon-Man
authors.initials: HM
authors.lastname: Chan
authors.forename: Ming-Feng
authors.initials: MF
authors.lastname: Hou
authors.forename: Che-Jen
authors.initials: CJ
authors.lastname: Huang
authors.forename: Yu-Sheng
authors.initials: YS
authors.lastname: Huang
authors.forename: Jan-Sing
authors.initials: JS
authors.lastname: Hsieh
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003082:Colectomy; D015179:Colorectal Neoplasms / Q000401:mortality / Q000601:surgery*; D004630:Emergencies; D005260:Female; D006801:Humans; D007415:Intestinal Obstruction / Q000401:mortality / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications