[2-stage surgery of neoplastic left colonic obstruction remains the safest procedure]

From January 1989 to December 1996, 56 consecutive patients underwent emergency surgery for occlusive cancer of the left colon. Excepting 12 patients whose symptomatology and radiographic presentation required medial laparotomy, the elective procedure was initial colostomy. There were 11 men and 33 women, mean age 76 years (range 50-97). Two patients in poor general status (ASA III) died during the postoperative period. Among the 42 survivors, the second procedure was not performed because of poor general status or disease progression in 6. Mean delay to the second procedure for resection was 11.5 days; during the same hospitalization for 32 out of 36 patients. The second procedure was segmentary colectomy in 34 cases and limited to exploratory laparatomy because of inextricable lesions in 2. Among the 34 re-operations with segmentary colectomy, the ostomy was removed in 28 at the second procedure and a third procedure was required in 6 cases. All the anastomoses in this series were sutured manually. Mortality for re-operation was nil. Pathology results (Duke's classification) in the 36 reoperated patients was: stage B = 3, stage C = 19, stage D = 14. In this series, operative mortality only concerned those patients whose condition was incompatible with selective surgery for colostomy. This risk cannot be lowered by any, other surgical approach. For the 34 resection-anastomosis elective operations, no major complications or deaths were observed. These results led us to recommend two stage surgery as routine strategy since survival of all those patients capable of sustaining an elective colostomy in an emergency setting can be assured.