title: 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 this retrospective study is to review the results of three surgical procedures used in our department of Visceral Surgery (subtotal colectomy, segmental resection following intraoperative irrigation, and Hartman's procedure) and to determine if there were advantages of one technique over the other.
  
  
  METHODS
  Ninety-three patients with acute left colonic obstruction were treated by subtotal/total colectomy (n=38), segmental resection following intraoperative irrigation (n=39), and Hartman's procedure (n=16). We assessed immediate postoperative results (mortality and morbidity rates, reoperation rate and hospital stay.
  
  
  RESULTS
  The overall mortality and morbidity rates were respectively 13% (n=12) and 30.1% (n=28). The mortality rate was 13% (n=5) in the subtotal colectomy group, 7.7% (n=3) in the intraoperative colonic irrigation and 25% (n=4) in the Hartman's procedure group. The morbidity rates were similar after subtotal or segmental resection (7.9% vs. 10.2%), bowel movements were more frequent after subtotal colectomy (range 1-5 day) than segmental colectomy (range: 1-2 per day).
  
  
  CONCLUSIONS
  Segmental resection following intraoperative irrigation is the preferred treatment for left sided malignant colonic obstruction. Subtotal colectomy is recommended for patients with ischemic lesions and serosal tears on the cecum, and when there is a synchronous neoplasm in the proximal colon.
authors.affiliation: CHU-Angers, Department of Visceral Surgery, Angers 49033, France.
authors.forename: Stéphanie
authors.initials: S
authors.lastname: Hennekine-Mucci
authors.forename: Jean Jacques
authors.initials: JJ
authors.lastname: Tuech
authors.forename: Olivier
authors.initials: O
authors.lastname: Brehant
authors.forename: Emilie
authors.initials: E
authors.lastname: Lermite
authors.forename: Patrick
authors.initials: P
authors.lastname: Pessaux
authors.forename: Paul
authors.initials: P
authors.lastname: Lada
authors.forename: Antoine
authors.initials: A
authors.lastname: Hamy
authors.forename: Jean Pierre
authors.initials: JP
authors.lastname: Arnaud
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002277:Carcinoma / Q000150:complications / Q000401:mortality / Q000601:surgery*; D003082:Colectomy / Q000379:methods*; D003110:Colonic Neoplasms / Q000150:complications / Q000401:mortality / Q000601:surgery*; D005260:Female; D006801:Humans; D007415:Intestinal Obstruction / Q000209:etiology / Q000401:mortality / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D016896:Treatment Outcome