Management of obstructing carcinoma of the left colon by extended right hemicolectomy

Abstract

In obstructing carcinomas of the left colon, primary resection with immediate colocolonic anastomosis is associated with a high risk of anastomotic dehiscence, and therefore, it has become traditional to manage such patients with staged resection. In obstructing carcinomas of the right colon, immediate resection of the lesion with ileocolonic anastomosis is acceptable. The scope of right hemicolectomy can be extended to encompass obstructing carcinomas of the left colon by performing subtotal or total colectomy with ileosigmoid or ileorectal anastomosis. Herein, we have reported the outcome in 16 patients treated in this manner. The operative mortality was 12.5 percent, which compared favorably the mortality of other methods of surgical management. Extended right hemicolectomy achieves in one operation relief of intestinal obstruction, tumor resection, restoration of gut continuity, elimination of the risks of synchronous or metachronous colonic tumors, and a possible increase in the 5 year survival rate. In our experience, the frequent passage of liquid stools is not a problem. This approach justifies further study.