Surgical treatment of obstructed left-sided colorectal cancer patients.

Abstract

sibly associated with adverse oncologic outcomes compared with nonobstructed elective surgery [4]. Increasing amounts of data suggest that a primary anastomosis without a bowel preparation or with an on-table lavage, with or without a diverting ileostomy, may be equally safe. The postoperative morbidity for a single-stage operation with intraoperative lavage with a new intraoperative colonic irrigator (Dalim Co., Seoul, Korea) for obstructive left colorectal cancer was comparable to that for nonobstruction left colorectal cancer [5]. However, the postoperative mortality in the obstruction group was significantly higher than it was in the nonobstruction group [6]. A number of studies have demonstrated the safety and the efficacy of on-table colonic lavage for avoiding a colostomy without increasing the leakage rate (<5%) or the sepsis rate [7]. I usually do the primary anastomosis after irrigation of the proximal colon with a 24-Fr Foley catheter through the appendectomy stump in patients with a left-sided colon-cancer obstruction. However, I think if the bowel looks compromised or if the patient is unstable, malnourished, or immunosuppressed, a resection with diversion remains safe. If a suitable strategy for managing obstructed left-sided colorectal-cancer patients is to be established, further randomized controlled studies on the surgical morbidity and the oncologic outcome between the bridge to surgery using a stent and a singlestage operation with intraoperative lavage are needed.