Comparison between resection and primary anastomosis and staged resection in obstructing adenocarcinoma of the left colon

Abstract

The surgical option to deal with obstruction of the left side of the large bowel is still controversial. To report the experience of our group in the treatment of malignant left-sided colonic obstruction focusing on the immediate results using either one-stage resection and primary anastomoses or staged resection. Twenty-three patients (median age = 52 (39-84) years; 10 males and 13 females) with potentially resectable obstructed adenocarcinomas of the left colon entered the study. The patients were submitted to different surgical procedure: 14 (60,9%) underwent one stage colonic resection (intra-operative lavage of colon (n = 10) or subtotal colectomy (n = 4); resection and primary anastomoses group) and 9 patients (39,1%) underwent staged resection (Hartmann's operation (n = 4) or loop colostomy (n = 5); staged resection group). Two patients (8,7%) died. All were from the staged resection group. Four patients (44,4%) of staged resection group did not complete the treatment with the closing of the colostomy. The incidence of complications was 28,6% in resection and primary anastomoses group (4/14) and 66,7% in staged resection group (6/9). Hospital stay was 15 (9-45) in staged resection patients and 8 (6-20) in resection and primary anastomoses group. There was one case (7,1%) of anastomotic dehiscence in resection and primary anastomoses group and two cases (22,2%) in staged resection group. The treatment of obstruction of left colon in one stage is safe and may be indicated for the management of the majority of cases.