Management of obstructive carcinoma of the left colon. Comparative study of staged and primary resection

Of 82 patients who had obstructing cancer of the left colon, 22% had incurable disease and 36.5% had advanced cancer at presentation. All methods of treatment carried a high morbidity and mortality. The mean survival rate with palliative operations was 8.7 months. Twenty-four poor-risk patients treated with staged operations had a 25% operative mortality and a 20.8% five-year survival rate. Forty primary resections, with or without anastomosis, were followed by a 27.5% operative mortality and by more than a twofold five-year survival rate (47.5%) compared with that of staged resection. These results suggest that delay of cure may reduce the late survival rate and justify primary resection as the operation of choice in selected good-risk patients.