[Must we reject primary colostomy in left colonic obstruction caused by cancer?]

Treatment of left colonic cancer obstruction is not still clear. Many procedures can be done, simple decompressive colostomy by a local incisionnal way to subtotal colectomy with primary anastomosis. What can we do today? Retrospective study from 1983 to 1988 at Centre de Chirurgie Digestive de l'Hôpital Saint-Antoine (Paris) with 36 datas was done. The emergency treatment was 20 decompressive colostomies, 10 primary resections without anastomosis, 2 subtotal colectomies with ileo-sigmoid primary anastomosis, 2 left colectomies with primary anastomosis (2 with decompressive colostomy, one without) and one Hartmann procedure. One patient is dead after decompressive colostomy. After emergency decompressive colostomy, 16 patients (80%) were reoperated for colonic cancer resection, with suppression of the stomy fifteen times. There were 7 extra abdominal complications and 3 stomy complications (2 incisionnal hernias after closure of the stomy and one prolapse of a definitive colostomy). After emergency primary resection without anastomosis, 9 patients (90%) were reoperated for secondary anastomosis. Morbidity was 3 extra abdominal complications. The mean hospital stay was 28 days for these 2 groups. For all the patients with primary or secondary anastomosis there was no anastomotic leak. Decompressive colostomy as emergency procedure for left obstructing carcinoma is simple, efficiency and safe. It can be associated with low mortality and morbidity. To day, we still recommend this procedure.