[Emergency surgery for neoplastic left colon obstruction: resection and primary anastomosis (RPA) versus Hartmann resection (HR)].
This retrospective study compares: hospitalization time, morbidity and mortality (patients operated for neoplastic occlusion of the left colon in emergency, without perforation), considering hanestesiologic risk and surgical technique (RPA versus RH).


METHODS
From April 1999 to February 2003 the Emergency Surgery of AORN of Caserta has operated, in urgency, 60 neoplastic patients with left colon occlusion realizing: 46 (76.5%) RPA [36 ASA < or = III, low hanestesiologic risk (LAR), 10 ASA = or > IV high hanestesiologic risk (HAR)], 12 (20%) RH (2 LAR and 10 HAR) 2 (3.5%) palliative colostomics.


RESULTS
36 LAR patients with RPA had 5% of specific complications and 5% of medical complications. 2 LAR patients with R-H: no complication. 10 HAR patient with RPA brought 10% of specific complications and 10% of medical complications. 10 HAR patients with RH had 20% of specific complications and 10% of general complications. The middle hospitalization of LAR patients with RPA was 11 days versus 9 days of RH pz. (equal hanestesiologic risk ). The HAR pz., treated with RPA, had as middle hospitalization 15 ggs in comparison to the 9 ggs of the HRA pz. treated with RH.


RESULTS
1/36 for LAR pz. with RPA (3%), and 0/0 for LAR pz. with RH; 1/10 for HAR pz, with RPA (10%) and 1/10 for HAR pz. with RH (10%).


CONCLUSIONS
Resection and primary anastomosis, (correct indications and expert surgeon), gives prevalence of complications and mortality similar to the repeated surgical procedure, a better life quality, but an higher number of post-operating hospitalisation days.
Capasso
L
L
Azienda Ospedaliera S. Sebastiano di Caserta di Rilievo Nazionale ed Alta Specializzazione, U.O. di Chirurgia d'Urgenza. lorenzo.capasso@inwind.it
D'Ambrosio
R
R
Sgueglia
S
S
Carfora
E
E
Casale
L S
LS
De Pascale
V
V
Borsi
E
E
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003082:Colectomy / Q000379:methods; D003110:Colonic Neoplasms / Q000150:complications* / Q000401:mortality / Q000601:surgery*; D004630:Emergencies; D005260:Female; D006801:Humans; D007415:Intestinal Obstruction / Q000209:etiology* / Q000601:surgery*; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D010166:Palliative Care; D011183:Postoperative Complications; D012189:Retrospective Studies; D012307:Risk Factors