SURGICAL MANAGEMENT OF ACUTE-BOWEL OBSTRUCTIONS CAUSED BY LEFT COLON TUMOR

Abstract

Surgical management of left-sided colorectal obstruction is associated with higher morbidity and mortality compared with elective colorectal surgery and the choice of operation is controversial. The aim of this study was to evaluate the results of management of malignant left colon obstruction by emergency resection with immediate anastomosis (RPA) or Hartmann's procedure during a 10 year period. Twenty-two patients were treated by RPA and 23 patients were treated by Hartmann's procedure. American Society of Anesthesiologists (ASA) grade and associated major medical problems were higher in the patients who undergone Hartmann's procedure. There were no statistical difference among the groups according to the mean operating time, operative blood loss and length of hospital stay. Only two patients (9 %) developed a leak at the anastomotic site. Operative mortality was 14% and 22% in patients underwent RPA and Hartmann 's procedure, respectively. Most common tumor histologic type was moderately differentiated adenocarcinoma and most common tumor grade according to modified Dukes clinicopathologic classification was stage B for the both groups. The overall 5-year survivall rates were 27% and 22% in patients undergoing RPA and Hartmann's procedure, respectively. As a result, a single stage resection and anastomosis of acute malignant left colon obstruction can be preferred in the patients with low operative risks.