Primary vs. delayed resection for obstructive left-sided colorectal cancer: impact of surgery on patient outcome.
OBJECTIVE
By comparing surgical outcomes between primary and delayed resection, we addressed whether and how surgical strategies impacted prognosis of patients with left-sided colorectal cancer underwent emergency curative resection.


METHODS
Between January 1980 and December 2002, a total of 143 patients were identified who presented with obstructive left-sided colorectal cancer and received emergency curative resection in Taipei Veterans General Hospital. Patients were stratified according to the timing of tumor resection into two groups: primary resection and delayed resection. Demographic data of the patients, characteristics of the tumors, and short-term and long-term outcomes were analyzed and compared between the two groups.


RESULTS
The demographic data and tumor characteristics did not differ between the two groups except for more rectal cancers in the delayed resection group (P=0.021). Primary resection group had a higher anastomotic leakage rate (P=0.017) and a trend toward a higher mortality rate, which did not reach statistical significance (P=0.063). The median follow-up intervals were similar (60.4 vs. 58.3 months; P=0.79). The median survival tended to be longer in delayed resection group (66 vs. 105 months; P=0.088). Overall five-year and ten-year survival for primary resection were 43.7 and 31.9 percent, respectively, compared with 67.2 and 53.2 percent, respectively, for delayed resection.


CONCLUSIONS
Delayed resection seems to be a safer procedure and provided a better oncologic outcome compared with primary resection in obstructive left-sided colorectal cancer under emergency situations.
Jiang
J K
JK
Division of Colon and Rectal Surgery, Department of Surgery, Taipei Veterans General Hospital, and National Yang-Ming University, School of Medicine, No. 201, Sec. 2, Shih-Pai Rd., Taipei, Taiwan, 11217. jkjiang@vghtpe.gov.tw
Lan
Y T
YT
Lin
T C
TC
Chen
W S
WS
Yang
S H
SH
Wang
H S
HS
Chang
S C
SC
Lin
J K
JK
D000368:Aged; D017024:Chemotherapy, Adjuvant; D016009:Chi-Square Distribution; D015179:Colorectal Neoplasms / Q000150:complications / Q000473:pathology / Q000601:surgery*; D003131:Combined Modality Therapy; D005260:Female; D006801:Humans; D007415:Intestinal Obstruction / Q000209:etiology / Q000601:surgery*; D008297:Male; D009367:Neoplasm Staging; D011183:Postoperative Complications; D018714:Radiotherapy, Adjuvant; D015996:Survival Rate; D016896:Treatment Outcome