Premium
Management of malignant left colonic obstruction: is an initial temporary colostomy followed by surgical resection a better option?
Author(s) -
Chéreau N.,
Lefevre J. H.,
Lefrancois M.,
Chafai N.,
Parc Y.,
Tiret E.
Publication year - 2013
Publication title -
colorectal disease
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.029
H-Index - 89
eISSN - 1463-1318
pISSN - 1462-8910
DOI - 10.1111/codi.12335
Subject(s) - medicine , colostomy , surgery , perforation , colorectal cancer , colectomy , elective surgery , resection , cancer , materials science , punching , metallurgy
Aim The surgical management of obstructed left colorectal cancer ( OLCC ) is still a matter of debate, and current guidelines recommend Hartmann's procedure ( HP ). The study evaluated the results of the surgical management with a focus on a strategy of initial colostomy ( IC ) followed by elective resection. Method All patients operated on for OLCC were reviewed. Clinical, surgical, histological, morbidity and long‐term results were noted. Results From 2000–11, 83 patients (48 men) with a mean age of 70.3 ± 15.1 years underwent surgery for OLCC . Eleven (13.3%) had a subtotal colectomy owing to a laceration of the caecal wall. Eleven had a HP for tumour perforation ( n = 6) or as palliation in a severely ill patient ( n = 5). The remaining 61 (73.5%) patients had an IC , with the intention of performing an elective resection shortly after recovery. Postoperative complications occurred in six (9.8%) and there were two (3.3%) deaths. Fifty‐nine operation survivors had a colonoscopy shortly afterwards which showed a synchronous cancer in two (3.4%). Twelve of the 59 patients had synchronous metastases. The subsequent elective resection including the colostomy site could be performed in 45 (74%) patients during the same admission at a median interval of 11 (7–17) days. The overall median length of hospital stay was 20 days and the 30‐day mortality was 3/61 (5%). Conclusion IC followed by surgical resection is a technically simple strategy, allowing initial abdominal exploration with a short period of having a colostomy, and permitting elective surgery with a low morbidity and full oncological lymphadenectomy.