title: Emergency subtotal/total colectomy in the management of obstructed left colon carcinoma.
abstract: OBJECTIVE
  The treatment of acutely obstructed carcinoma of the left colon still represents a matter of controversy. The aim of the study was to evaluate the results of its management by emergency subtotal or total colectomy with immediate anastomosis without diversion.
  
  
  METHODS
  An emergency subtotal/total colectomy was performed in 72 patients (mean age 74.9 years). Inclusion criteria were reasonable operative risk, resectable acutely obstructed carcinoma, massively distended colon of dubious viability, and likely to contain ischemic lesions, signs of impending cecal perforation, and masses suggesting synchronous colonic cancers.
  
  
  RESULTS
  Postoperative mortality was 9.7% (7 patients). An 83-year-old woman died as a result of an anastomotic dehiscence; the six other deaths resulted of cardiopulmonary complications. Postoperative morbidity was 15% (11 patients) including two fistulas, which recovered without surgery. There were eight synchronous colon carcinomas. Six months after surgery, the mean daily stool frequency was two following subtotal colectomy and three after total colectomy.
  
  
  CONCLUSIONS
  Emergency subtotal colectomy achieves in one-stage relief of bowel obstruction and tumor resection by encompassing a massively distended and fecal-loaded colon with ischemic lesions and serous tears on the cecum. It ensures restoration of gut contiguity via a "safe" ileocolonic anastomosis and removes occasional lesions proximal to the index cancer.
authors.affiliation: Department of Digestive Surgery, Angers University Hospital, 4 rue Larrey, 49933 Angers, France.
authors.forename: Stéphanie
authors.initials: S
authors.lastname: Hennekinne-Mucci
authors.forename: Jean-Jacques
authors.initials: JJ
authors.lastname: Tuech
authors.forename: Olivier
authors.initials: O
authors.lastname: Bréhant
authors.forename: Emilie
authors.initials: E
authors.lastname: Lermite
authors.forename: Roberto
authors.initials: R
authors.lastname: Bergamaschi
authors.forename: Patrick
authors.initials: P
authors.lastname: Pessaux
authors.forename: Jean-Pierre
authors.initials: JP
authors.lastname: Arnaud
mesh_terms: D000208:Acute Disease; D000230:Adenocarcinoma / Q000150:complications / Q000473:pathology / Q000601:surgery*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003082:Colectomy / Q000379:methods*; D003110:Colonic Neoplasms / Q000150:complications / Q000473:pathology / Q000601:surgery*; D004630:Emergencies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007415:Intestinal Obstruction / Q000150:complications* / Q000601:surgery; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D016896:Treatment Outcome