Emergency subtotal colectomy as treatment of choice in obstructing carcinomas of the left colon

To assess the morbidity, mortality and function following emergency subtotal colectomy (ESC) with primary anastomosis in obstructing carcinomas of the left colon, to determine whether this technique is warranted as the current treatment of choice for this condition.

Retrospective review of a series of 70 patients with obstructing carcinomas of the left colon who underwent an ESC with primary anastomosis between September 1989 and December 1996. Morbidity, mortality, hospital stay and functional results were analysed, as well as the percentage of patients submitted to this technique.

The use of ESC has steadily increased at our institution over the last few years, from 22% in 1990 to 84% of all the procedures performed for obstructing carcinomas of the left colon in 1995. The mortality rate of the series was 4.2%. Anastomotic leak rate was 10%, with only three major leaks. A prolonged obstructive ileus was a frequent and distressing complication (26%), and the main determinant of hospital stay. Average daily stool frequency on discharge from hospital was of 2 (range 1-6), with many patients having discontinued anti-diarrhoeal medications.

Emergency SC with primary anastomosis has evolved into the treatment of choice for most patients with acutely obstructing malignancies of the left colon at our institution. It can be performed with low mortality, a reasonable morbidity and good functional results.