The surgical management of large bowel obstruction in patients with left colon and rectal cancer – a retrospective study

Abstract

The optimal surgical attitude towards obstructed left colon and upper rectal cancer remains elusive, one of the main postoperative endpoints being to avoid the most dreaded complication of this type of procedures - the anastomotic leakage. Material and methods: We conducted a retrospective analysis of all patients with left colon and rectal cancer admitted and having emergency surgery performed in the surgical departments of the University County Hospital of Craiova, Romania, between 2001 and 2018. The timeline analysis showed an increasing interest for single-stage resection and anastomosis in the second decade (2011-2018) compared to the first decade of the study (28% vs. 11.2%). Results: The incidence of anastomotic leak for these types of procedures remained higher than for the two-stage procedure (15% vs. 4.8%), similar to the overall postoperative morbidity (30.3% vs. 20%) and mortality (3% vs. 1.1%). Postoperative morbidity and anastomotic leak rate were statistically higher in the single stage procedure group when compared with the two-stage procedure (p <0.05). Conclusions: Deciding between single-stage resection with anastomosis and a two-stage procedure requires a careful patient selection due to the relatively high risk of anastomotic leak in this specific category of patients.