Obstructing left sided colorectal cancer. A retrospective single Center study

Area of Science:

• Colorectal Surgery
• Surgical Oncology
• Geriatric Medicine

Background:

• Increasing incidence of colorectal cancer with severe occlusion symptoms in aging populations.
• Approximately 75% of malignant colorectal obstructions occur distal to the splenic flexure.
• Left-sided colorectal carcinoma presents unique management challenges, particularly in elderly patients.

Purpose of the Study:

• To evaluate the optimal surgical therapeutic strategy for left-sided colorectal carcinoma in patients over 65 years old.
• To compare the efficacy of different surgical approaches regarding postoperative morbidity, mortality, and long-term survival.
• To address the controversy surrounding the management of left-sided obstructing colorectal carcinoma in the elderly.

Main Methods:

• Literature review of surgical management strategies for left-sided obstructing colorectal carcinoma.
• Evaluation of patient age, emergency condition, and postoperative outcomes (morbidity, mortality, 5-year survival).
• Comparison of primary anastomosis with intraoperative colonic wash-out versus Hartmann's procedure.

Main Results:

• Management of left-sided obstructing colorectal carcinoma is debated.
• Hartmann's procedure is identified as a suitable choice for elderly patients.
• Resection with intraoperative colonic wash-out and primary anastomosis shows favorable outcomes in low-risk individuals.

Conclusions:

• Primary resection and anastomosis is the preferred strategy for low-risk patients with localized, resectable left-sided obstructing colorectal cancer without peritonitis.
• Hartmann's procedure is advised for high-risk patients or in cases with diagnostic uncertainty.
• The choice of surgical strategy should be individualized based on patient risk factors and disease characteristics.