title: Surgical options for malignant left-sided colonic obstruction.
abstract: OBJECTIVE
  We evaluated the clinical results of different techniques of resection for malignant left-sided colonic obstruction.
  
  
  METHODS
  The subjects of this prospective nonrandomized study were 63 consecutive patients who underwent surgery between 1995 and 2000 at a single institution. Patients with nonprimary colonic tumors, lesions located proximally to splenic flexure, peritonitis, perforation, or cecal necrosis were excluded.
  
  
  RESULTS
  Segmental colectomy with primary anastomosis (CPA) was performed in 35 patients; with intraoperative colonic irrigation (ICI) in 19, and without ICI in 16. Total or subtotal colectomy (TSC) was performed in 8, and Hartmann's procedure (HP) was performed in 20. There were no differences in age, sex, comorbidity, time of symptoms, preoperative hospital stay, or tumor staging among the groups of patients defined by the different surgical techniques. The overall incidence of postoperative complications was 43%; postoperative mortality, 5%; anastomotic dehiscence, 12%; urgent reoperations, 12%; and readmissions, 5%, without significant differences among the treatment groups. However, the postoperative and total hospital stay were significantly shorter after ICI (P = 0.016 and P = 0.012, respectively). The overall 5-year survival was 42.7%.
  
  
  CONCLUSIONS
  We think that segmental colectomy with anastomosis after intraoperative colonic irrigation is the most effective operative treatment for neoplastic left-sided colonic obstructions, considering its safety and cost-effectiveness.
authors.affiliation: General and Digestive Surgery Service, Virgen de las Nieves University Hospital, Granada, Spain.
authors.forename: Jesus M
authors.initials: JM
authors.lastname: Villar
authors.forename: Ana P
authors.initials: AP
authors.lastname: Martinez
authors.forename: Maria T
authors.initials: MT
authors.lastname: Villegas
authors.forename: Karim
authors.initials: K
authors.lastname: Muffak
authors.forename: Alfonso
authors.initials: A
authors.lastname: Mansilla
authors.forename: Daniel
authors.initials: D
authors.lastname: Garrote
authors.forename: Jose A
authors.initials: JA
authors.lastname: Ferron
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000714:Anastomosis, Surgical; D016009:Chi-Square Distribution; D003082:Colectomy / Q000379:methods*; D003110:Colonic Neoplasms / Q000601:surgery*; D005260:Female; D006801:Humans; D007415:Intestinal Obstruction / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D011446:Prospective Studies; D018709:Statistics, Nonparametric; D015996:Survival Rate; D016896:Treatment Outcome