Emergency subtotal/total colectomy with anastomosis for acutely obstructed carcinoma of the left colon.

Abstract

The operation of choice for acutely obstructed carcinoma of the left colon is controversial. The aim of the study was to evaluate the results of its management by emergency subtotal/total colectomy with immediate anastomosis without diversion. An emergency subtotal/total colectomy was performed in 44 patients (mean age, 72.4 years). Inclusion criteria were reasonable operative risk, resectable acutely obstructed carcinoma, massively distended colon of dubious viability and likely to contain ischemic lesions, signs of impending cecal perforation, and masses suggesting synchronous colonic cancers. Postoperative mortality was 6.8 percent. Two patients over 90 years of age died postoperatively as a result of cardiopulmonary complications. An 83-year-old female died as a result of an anastomotic dehiscence. Morbidity was 6.8 percent including one fistula which recovered without surgery. There were three synchronous colon cancers. Six months after surgery, the mean daily stool frequency was two following subtotal colectomy and three after total colectomy. Emergency subtotal colectomy achieves in one stage relief of bowel obstruction and tumor resection by encompassing a massively distended and fecal-loaded colon with ischemic lesions and serosal tears on the cecum, ensures restoration of gut contiguity via a "safe" ileocolonic anastomosis, and removes occasional lesions proximal to the index cancer. It is a safe procedure given that operative mortality rates are as low as with elective surgery.