The treatment of colonic cancer presenting with intestinal obstruction.

The factors affecting the prognosis of patients presenting with colonic obstruction caused by carcinoma were examined in a retrospective study of 66 patients undergoing emergency surgery for obstruction. The findings in these cases were compared with 176 patients with colonic cancer undergoing elective surgical treatment. Obstructed patients had a significantly higher surgical mortality (37.9 per cent) than elective cases (11.9 per cent). There was a significantly higher incidence of lymph node metastases in obstructed patients and those who survived surgery had a significantly lower 5-year survival rate (22.9 per cent) than elective cases (41.5 per cent). Primary resection of obstructing tumours was followed by a higher 5-year survival rate (31.8 per cent) than staged resections (7.7 per cent), but these operations were used selectively and the 5-year survivors following primary resection all had tumours of the proximal colon. Primary resection and anastomosis of the distal colon was associated with a surgical mortality of 50 per cent. Further progress in the cure of patients with obstructing cancer of the colon may be limited by the aggressive nature of the disease, but the use of primary resection in these cases should be examined in a prospective clinical trial.