One-stage subtotal colectomy with anastomosis for obstructing carcinoma of the left colon

Fourteen cases of severe obstructing carcinoma of the left colon were treated by emergency subtotal colectomy and ileorectal or ileosigmoid anastomoses. There was one death after two months and a further two septic postoperative complications. Follow-up stretched from two to 39 months (an average 13.7 months). One patient died of a myocardial infarction after 11 months and another of liver metastases after 21 months. Two patients were lost to follow-up at 12 and 25 months, and nine patients remain alive and well, free of disease. The last nine cases were consecutive, and two additional patients with obstruction had only colostomy performed due to their poor conditions. A staged approach to treatment reduces long-term survival as well as inducing a high cumulative mortality and morbidity rate. Colostomy also reduces the quality of life for the elderly patient. Results of this form of treatment are surprisingly good, and it is advocated as the treatment of choice for the vast majority of patients.