Back ground: Advanced colorectal cancer is commonly associated with colon obstruction/between 15-20% of patients with colonic cancer/ or/and tumor infiltration to adjacent organs. We set out to study in-hospital morbidity and mortality after operations of acute left colon cancer obstruction.
Methods: From 2000 to 2010 the medical records of 204 cases /15.1%/ of acute left colon cancer obstruction were reviewed from total of 1351 patients who were operated from colorectal cancer. Results: The types of operations were a Hartmann procedure in 78 patients /38.2%/, colostomy in 58 patients /29.4%%, a type of colectomy with ileo-coloanastomosis in 54 patients /26.5%/ and a standard resection in 14 patients /6.8%/. The following early complications were occurred: anastomotic leakage in 4 patients, wound infections in 5 patients, dehiscence of operative wound in 2 patients. The in-hospital mortality rate was 11.3%.
Conclusions: The emergency management of acute left-sided colonic obstruction remains controversial. The one-stage resection anastomosis which could be subtotal colectomy or segmental resection is useful and the preferred choice for low risk patients. Simple colostomy or Hartmann procedure should be re served for high risk patients. Colonic stenting is the best option either for palliation or as a bridge to surgery.
Meyer F, F. Marusch, A. Coch, L. Meyer, S. Fuh rer, F. Kockerling, H. Lippert, I.Gastinger, the Ger man Study Group ` Colorectal Car ci noma ( Pri mary Tu - mor). Emer gency op er a tion in car ci no mas of the left co lon: value of Hartmann`s pro ce dure. Tech Coloproctol 2004; 8(Suppl 1): S226-9.
De Salvo GL, C. Gava, M. Lise, S. Pucciarelli. Cu ra - tive sur gery for ob struc tion from pri mary left colorectal car ci noma: Pri mary of staged re sec tion? Cochrane Da ta base Syst Rev 2004; 2:CD002101.
Villar JM, AP Mar ti nez, MT Villegas, K. Muffak, A. Mansilla, D. Gar rote, et al: Sur gi cal op tions for ma - lig nant left-sided co lonic ob struc tion. Surg To day 2005; 35: 275-81.
Biondo S, D. Pares, R. Frago, J. Marti-Rague, E. Kraisler, J. De Oca, et al: Large bowel ob struc tion: pre dic tive fac tors for post op er a tive mor tal ity. Dis Co - lon Rec tum 2004; 47:1889-97.
Guenada K, AN Atallah, AA Cas tro, DDM Matos, P. Wille-Jorgensen: Me chan i cal bowel prep a ra tion for elec tive colorectal sur gery. Cochrane Da ta base Syst Rev 2009; 1:CD001944.
Kim J, R. Mittal, V. Konyalian, J. King, MJ Stamos, RR Kumar: Out come analisys of pa tients un der go ing colorectal re sec tion for emer gent and elec tive in di ca - tions. Am Surg 2007; 73: 991-3.
Bel lows CF, LS Webber, D. Albo, S. Award, DH Berger: Early pre dic tors of anastomotic leaks af ter colectomy. Tech Coloproctol 2009; 13:41-7.
Zorcolo L, L. Covotta, N. Carlomagno, DC Bartolo: To ward low er ing mor bid ity, mor tal ity and stoma for - ma tion in emer gency colorectal sugery: the role of spe cial iza tion. Dis Co lon Rec tum 2003; 46:1461-8.
Hsu TC: Comparsion of one-stage re sec tion and anas - to mo sis of acute com plete ob struc tion of left and right co lon. Am J Surg 2005; 189:384-7.
Hennekinne-Mucci S, JJ Tuech, O. Brehant, E. Lermite, R. Bergamaschi, P. Ressaux, et al: Emer - gency sub to tal/to tal colectomy in the man age ment of ob structed left co lon car ci noma. Int J Colorectal Dis 2006; 21:538-541.
Lim JF, CL Tang, F. Seow-Choen, SM Heah: Pro - spec tive, ran dom ized trial com par ing intraoperative co lonic ir ri ga tion with man ual de com pres sion only for ob structed left-sided colorectal can cer. Dis Co lon Rec tum 2005,48:205-9.
Kam MH, CL Tang, E. Chan, JF Lim, KW Eu : Sys - tem atic re view of intraoperative co lonic ir ri ga tion vs. mamual de com pres sion in ob struc tive left-sided colorectal emer gen cies. Int J Colorectal Dis 2009; 24:1031-1037.
Sebastian S, S. Johnston, T. Geoghegan, W. Torreggiani, M. Buckley: Pooled anal y sis of the ef fi - cacy and safety of self- ex pand ing metal stenting in maligmant colorectal ob struc tion. Am J Gastroenterol 2004; 99:2051-7.
Costi R, A. Mazzeo, D Di Mauro, et al: Pal lia tive re - sec tion of colorectal can cer: does it pro long sur vival? Ann Surg Oncol 2007; 14:2567-76.
Konyalian VF, DK Ros ing, JS Haukoos, et al: The role of pri mary tu mor re sec tion in pa tients with stage IV colorectal can cer. Colorectal Dis 2007; 9:430-7.
Cheung HYS, CC Chung, WW Wong, et al: Endolaparoscopic ap proach vs. con ven tional open sur gery in the treat ment of ob struct ing left-sided co - lon can cer. Arch Surg 2009; 144(12):1127-32.
Fernandez-Esparrach G, JM Bordas, MD Giraldes, et al: Se vere Com pli ca tions Limit Long-Term Clin i cal Suc cess of Self-Ex pand ing Metal Stents in Pa tients With Ob struc tive Colorectal Can cer. Am J Gastroenterol 2010; 105(5): 1087-93.
Fuccio L, A. Repici, V. Cennamo: Con cerns on the very high com pli ca tion rates re ported af ter self-ex - pand ing metal stent (SEMS) place ment for colorectal can cer in a Cata lan ret ro spec tive study. Am J Gastroenterol 2010; 105(7): 1670-1.
Singh H, S. Latosinsky, BM Spiegel, LE Targovnik: The cost-ef fec tive ness of co lonic stenting as a bridge to cu ra tive sur gery in pa tients with acute left-sided ma lig nant co lonic ob struc tion: a Ca na dian per spec - tive. Can J Gastroenterol 2006; 20:779-85.
Osman HS, HI Rashid, N. Sathananthan, MC Parker: The cost-effectiveness of self-expanding metal stents in the man age ment of ma lig nant left-sided large bowel ob struc tion. Colorectal Dis 2000; 2:233-7.
Ansaloni L, RE Andersson, F. Bazzoli, F. Catena, V. Cennamo, S. Di Saverio, L. Fuccio, H. Jeekel, A. Leppaniemi, E. Moore, A. D Pinna, M. Pisano, A. Repici, PH Sugarbaker, JJ Tuech: Guidelenines in the man age ment of ob struct ing can cer of the left co lon: con sen sus con fer ence of the world so ci ety of emer - gency sur gery (WSES) and peri to neum and sur gery (PnS) so ci ety. World J of Emer gency Sur gery 2011; 5:29.
Trompetas V: Emer gency man age ment of ma lig nant acute left-sided co lonic ob struc tion. Ann R Coll Surg Engl 2008; 90:181-6.
Cross KLR, JR Rees, RHR Soulsby, AR Dixon: Pri - mary anas to mo sis with out co lonic la vage for the ob - structed left co lon. Ann R Coll Surg Engl 2008; 90:302-4.
Kube R,Granowski D,Stuebs P, et al:Sur gi cal prac - tices for ma lig nant left co lonic ob struc tion in Ger - many.Eur J Surg Oncol, 2100 Jan;36(1):65-71
Pirlet IA, K. Slim, F. Kwiatakowski, F. Mishot, BL Millat: Emer gency pre op er a tive stenting ver sus sur - gery for acute left-sided ma lig nant co lonic ob struc - tion: a multicenter ran dom ized con trolled trial. Surg Endosc. 2011; 25(6):1814-21.
Email this article (Login required) 
