[The role of subtotal/total colectomy in the urgent treatment of obstructive cancer of the left colon].

PURPOSE

The aim of the study was to evaluate the results of management of acutely obstructed carcinoma of the left colon by emergency subtotal/total colectomy (STC) with immediate anastomosis without diversion.

METHODS

STC was performed in 48 patients (mean age 72 years). Inclusion criteria were reasonable operative risk, resectable acutely obstructed carcinoma, massively-distended colon of dubious viability, signs of impending cecal perforation.

RESULTS

Postoperative mortality was 6.2% (n = 3): 2 patients over 85 years of age died postoperatively as a result of cardiopulmonary complications: an 83 year-old female dies as a result of an anastomotic dehiscence. Morbidity was 12.4% (n = 6) including one fistula which recovered without surgery. There were 4 synchronous colon cancers. Six months after surgery, the mean daily stool frequency was 2 after STC, and 3 after TC.

CONCLUSION

Emergency STC achieves in one stage relief of bowel obstruction and tumor resection by encompassing a massively distended and fecal-loaded colon with ischemic lesions, ensures restoration of gut continuity via a "safe" anastomosis and removes occasional synchronous carcinoma.