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Malignant large bowel obstruction.

R K Phillips, R Hittinger, J S Fry

    The British Journal of Surgery
    |April 1, 1985
    PubMed
    Summary
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    Bowel obstruction in large bowel cancer patients significantly worsens survival. Despite high in-hospital mortality, neither primary nor staged resection improved outcomes, though primary resection halved hospital stays.

    Area of Science:

    • Oncology
    • Surgical Gastroenterology
    • Colorectal Cancer Research

    Background:

    • Bowel obstruction is a critical complication in 16% of large bowel cancer cases.
    • Obstruction is associated with significantly poorer survival rates compared to non-obstructed patients.
    • The splenic flexure presents the highest risk site for obstruction.

    Purpose of the Study:

    • To investigate the impact of obstruction on large bowel cancer prognosis.
    • To compare the efficacy of primary versus staged resection for obstructed large bowel cancer.
    • To analyze factors influencing in-hospital mortality and survival in obstructed cases.

    Main Methods:

    • Retrospective analysis of 4583 patients from the Large Bowel Cancer Project.
    • Comparison of outcomes (survival, mortality, hospital stay, complications) between obstructed and non-obstructed patients.

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  • Evaluation of surgical approaches: primary resection versus staged resection.

    • Main Results:

    • Obstructed patients had markedly lower 5-year survival (25%) versus non-obstructed (45%).
    • In-hospital mortality for obstruction was high (23%) and not improved by resection strategy.
    • Primary resection halved hospital stay but immediate anastomosis in obstructed left colon had high leak rates (18%).

    Conclusions:

    • Bowel obstruction is an independent negative prognostic factor in large bowel cancer.
    • Neither primary nor staged resection significantly alters survival for obstructed cases.
    • Surgical expertise appears to influence outcomes in primary resection for obstruction.