Large-bowel obstruction caused by cancer: a prospective study.

Area of Science:

• Colorectal Surgery
• Surgical Oncology
• Gastrointestinal Oncology

Background:

• Obstructing large-bowel cancer presents a surgical challenge.
• Treatment options include primary tumor resection or staged tumor resection.

Purpose of the Study:

• To compare the postoperative outcomes of primary versus staged tumor resection for obstructing large-bowel cancer.
• To evaluate the impact of surgeon experience on patient outcomes.

Main Methods:

• A prospective study was conducted on 174 patients with obstructing large-bowel cancer.
• Patients were divided into two groups: primary tumor resection (90 patients) and staged tumor resection (47 patients).
• Postoperative outcomes, including mortality and hospital stay duration, were analyzed.

Main Results:

• Overall mortality was similar between primary and staged resection groups.
• Primary resection resulted in a significantly shorter hospital stay (half the duration) compared to staged resection.
• Mortality for primary resection was higher for proximal splenic flexure lesions and lower for distal lesions.
• 35% of patients with distal tumors undergoing staged resection died after loop colostomy.
• The postoperative death ratio was 3:1 for trainee surgeons versus fully trained surgeons.

Conclusions:

• Immediate primary tumor resection should be considered for all patients with obstructing large-bowel cancer.
• Treatment should be performed by a fully trained surgeon to minimize postoperative mortality.
• Staged resection, particularly with loop colostomy, carries significant risks for distal tumors.