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Malignant left-sided large bowel obstruction managed by subtotal/total colectomy
B M Stephenson1, A A Shandall, R Farouk
1Department of Surgery, Royal Gwent Hospital, Newport, UK.
The British Journal of Surgery
|October 1, 1990
Summary
Radical subtotal/total colectomy for obstructing left colon cancer offers lower morbidity and shorter hospital stays compared to segmental resection. This approach is deemed acceptable for managing such cases, ensuring good functional outcomes.
Area of Science:
- Colorectal Surgery
- Surgical Oncology
- Gastrointestinal Oncology
Background:
- Acute left colon obstruction due to carcinoma presents a surgical challenge.
- Management options include immediate resection with or without anastomosis, or staged procedures.
Purpose of the Study:
- To compare the outcomes of radical subtotal/total colectomy versus radical segmental resection for acute obstructing left colon carcinoma.
- To evaluate operative mortality, major morbidity, and hospital stay.
Main Methods:
- Retrospective analysis of 49 patients with obstructing left colon carcinoma undergoing immediate resection.
- Group I: 31 patients with radical subtotal/total colectomy.
- Group II: 18 patients with radical segmental resection.
Main Results:
- Operative mortality: 3% (Group I) vs. 11% (Group II), not statistically significant.
- Major morbidity: 6% (Group I) vs. 44% (Group II), P < 0.01.
- Mean hospital stay: 17 days (Group I) vs. 35 days (Group II), P < 0.05.
- On-table lavage associated with anastomotic leaks and stoma formation.
Conclusions:
- Subtotal/total colectomy is an acceptable surgical approach for obstructing left colon carcinoma.
- This method is associated with reduced morbidity and shorter hospital stays.
- Good functional results are observed postoperatively.