[Urgent management of obstructing colo-rectal cancer: authors' experience].
OBJECTIVE
The aim of this retrospective study is to compare the different surgical approaches in obstructing colo-rectal cancer in terms of mortality, morbidity and quality of life.


METHODS
We observed 379 patients with colorectal cancer, 354 of which underwent surgical treatment, 189 M (53.4%) and 165 F (46.6%), with a median age of 72.6 years. Complicated tumors were 150 (42.4%), with 126 obstructions (84%). For 95 obstructing left-sided colorectal cancers we performed: 9 defunctioning colostomies; 62 two-stages operations: 55 Hartmann's procedures, 5 primary anastomosis with colostomy; 2 primary anastomosis with on table wash-out and ileostomy; 24 single-stage operations: 17 primary anastomosis with on table wash-out and 7 colectomy.


RESULTS
The overall operative mortality rate was 8.7% (11/126). The overall leak rate was 8% (5/62), 12.9% (4/31) in left colon and 3.2% (1/31) in right colon, all treated conservatively. The wound infection rate was 23.8% (30/126).


CONCLUSIONS
Obstructing colo-rectal cancer is associated with a high operative mortality and a worse prognosis. Defunctioning colostomy can be regarded as a valid option only in extreme circumstances. Hartmann's operation has indicated in case of metastatic disease, unsure anastomosis, simultaneous colonic perforation. The gold-standard is primary anastomosis, as colonic resection with on table wash-out or subtotal/total colectomy, in case of largely distended colon or synchronous lesions.
UOSC Chirurgia d'Urgenza Ospedale San Giovanni Bosco, ASL Napoli 1.
D
D
Giglio
A
A
Di Muria
A
A
Marano
G
G
Cione
G
G
Arciero
R
R
Rossi
M
M
Aveta
V
V
Formisano
D000328:Adult; D000368:Aged; D000714:Anastomosis, Surgical; D003082:Colectomy / Q000379:methods / Q000401:mortality; D003106:Colon / Q000601:surgery; D015179:Colorectal Neoplasms / Q000150:complications* / Q000000981:diagnostic imaging / Q000401:mortality / Q000503:physiopathology / Q000601:surgery*; D003125:Colostomy; D004638:Emergency Treatment; D005260:Female; D006801:Humans; D007415:Intestinal Obstruction / Q000000981:diagnostic imaging / Q000209:etiology* / Q000401:mortality / Q000503:physiopathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011788:Quality of Life; D011859:Radiography; D012007:Rectum / Q000601:surgery; D012189:Retrospective Studies; D013529:Surgical Wound Dehiscence / Q000209:etiology; D013530:Surgical Wound Infection / Q000209:etiology; D016019:Survival Analysis; D016896:Treatment Outcome