Emergency subtotal/total colectomy in the management of obstructed left colon carcinoma.
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.
Hennekinne-Mucci
Stéphanie
S
Department of Digestive Surgery, Angers University Hospital, 4 rue Larrey, 49933 Angers, France.
Tuech
Jean-Jacques
JJ
Bréhant
Olivier
O
Lermite
Emilie
E
Bergamaschi
Roberto
R
Pessaux
Patrick
P
Arnaud
Jean-Pierre
JP
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