title: Subtotal colectomy for malignant left-sided colon obstruction is associated with a lower anastomotic leak rate than segmental colectomy.
abstract: OBJECTIVE
  To compare subtotal colectomy to segmental colectomy for malignant left-sided colonic obstruction.
  
  
  METHODS
  Obstruction was defined by failure to trespass a colonic stenosis during endoscopy, by truncation of the contrast column during contrast enema, by severe colonic dilatation (cecum >10 cm, transverse colon >8 cm, descending colon >6 cm) or by serosal tears. From 53 consecutive patients treated for malignant left-sided colon obstruction at our surgical department from July 2002 to July 2010, 19 patients had subtotal colectomy and 30 patients had segmental colectomy. Four patients were excluded: two of them had non-colorectal primary cancer and the other two had a two-stage procedure.
  
  
  RESULTS
  The rate of severe colonic dilatation and serosal tears, the physiological severity score and the expected morbidity were higher in the group with subtotal colectomy than in the group of segmental colectomy (p<0.05). However, the anastomotic leak rate was lower in the group with subtotal colectomy (0/19) than in the group with segmental colectomy (6/30) (p=0.042). Overall, there were no statistically significant differences regarding mortality or morbidity between the two groups.
  
  
  CONCLUSIONS
  Despite worse preoperative conditions, patients who underwent subtotal colectomy for left-sided obstructing colonic cancer had a significantly lower anastomotic leak rate than those who underwent segmental colectomy. This fact supports the concept of subtotal colectomy for this entity. However, perioperative mortality seems to be independent of the presence or absence of an anastomotic leak.
authors: Department of General, Visceral, Vascular and Thoracic Surgery, Hospital of Liestal, University of Basel, Liestal, Switzerland.
authors: S A
authors: SA
authors: Käser
authors: P M
authors: PM
authors: Glauser
authors: B
authors: B
authors: Künzli
authors: R
authors: R
authors: Dolanc
authors: G
authors: G
authors: Bassotti
authors: C A
authors: CA
authors: Maurer
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000714:Anastomosis, Surgical; D003082:Colectomy / Q000009:adverse effects / Q000379:methods*; D003110:Colonic Neoplasms / Q000150:complications / Q000601:surgery*; D005260:Female; D006801:Humans; D007415:Intestinal Obstruction / Q000209:etiology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000209:etiology; D012189:Retrospective Studies