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[Colorectal obstruction caused by cancer]
C Ammaturo1, F Cirillo, F Imperatore
1Divisione di Chirurgia d'Urgenza, USL 44, Ospedale Loreto Mare, Napoli.
Minerva Chirurgica
|June 1, 1996
Summary
Colorectal cancer obstruction requires emergency surgery, with resection feasible in most cases. However, obstruction significantly worsens 5-year survival rates compared to elective colorectal cancer surgery.
Area of Science:
- Oncology
- Surgical Gastroenterology
Context:
- Colorectal cancer (CRC) is a significant health concern.
- Intestinal obstruction is a common and serious complication of CRC.
- Emergency surgical management of obstructed CRC presents unique challenges.
Purpose:
- To review a decade of experience in managing colorectal cancer with obstruction.
- To analyze surgical outcomes and survival rates for obstructed CRC patients.
- To evaluate evolving surgical strategies for left-sided colonic obstruction.
Summary:
- This study analyzed 493 colorectal cancer cases, with 425 presenting with obstruction requiring emergency surgery.
- Resection was achieved in 91% of obstructed cases. Right colon obstructions were managed with right hemicolectomy.
- Surgical approaches for left colon obstruction evolved from Hartmann's procedure to single-stage resection-anastomosis with intraoperative colonic irrigation in selected patients.
- Subtotal colectomy with ileo-sigmoid anastomosis was successful in splenic flexure cancers.
Impact:
- Surgical management of obstructed colorectal cancer can achieve high resection rates.
- Intraoperative colonic irrigation offers a viable option for selected single-stage procedures in left-sided obstructions.
- Colorectal cancer with obstruction is associated with significantly poorer 5-year survival (24%) compared to elective cases (41%).