Management of malignant left colonic obstruction: is an initial temporary colostomy followed by surgical resection a better option?

• Published in: Colorectal disease Vol. 15; no. 11; pp. e646 - e653
• Main Authors: Chéreau, N., Lefevre, J. H., Lefrancois, M., Chafai, N., Parc, Y., Tiret, E.
• Format: Journal Article
• Language: English
• Published: England Blackwell Publishing Ltd 01.11.2013
• Subjects: Aged; Aged, 80 and over; Colectomy; Colon, Descending - surgery; Colon, Sigmoid - surgery; Colonic Neoplasms - complications; Colonic Neoplasms - pathology; Colonic Neoplasms - surgery; Colorectal cancer; Colostomy; Female; Hartmann procedure; Humans; Intestinal Obstruction - etiology; Intestinal Obstruction - surgery; Kaplan-Meier Estimate; Length of Stay; Liver Neoplasms - secondary; Lung Neoplasms - secondary; Male; Middle Aged; obstruction; Retrospective Studies; Time Factors; Hartmann procedure; obstruction; colostomy; Colorectal cancer
• DOI: 10.1111/codi.12335
• ISSN: 1462-8910

Aim The surgical management of obstructed left colorectal cancer (OLCC) is still a matter of debate, and current guidelines recommend Hartmann's procedure (HP). The study evaluated the results of the surgical management with a focus on a strategy of initial colostomy (IC) followed by elective resection. Method All patients operated on for OLCC were reviewed. Clinical, surgical, histological, morbidity and long‐term results were noted. Results From 2000–11, 83 patients (48 men) with a mean age of 70.3 ± 15.1 years underwent surgery for OLCC. Eleven (13.3%) had a subtotal colectomy owing to a laceration of the caecal wall. Eleven had a HP for tumour perforation (n = 6) or as palliation in a severely ill patient (n = 5). The remaining 61 (73.5%) patients had an IC, with the intention of performing an elective resection shortly after recovery. Postoperative complications occurred in six (9.8%) and there were two (3.3%) deaths. Fifty‐nine operation survivors had a colonoscopy shortly afterwards which showed a synchronous cancer in two (3.4%). Twelve of the 59 patients had synchronous metastases. The subsequent elective resection including the colostomy site could be performed in 45 (74%) patients during the same admission at a median interval of 11 (7–17) days. The overall median length of hospital stay was 20 days and the 30‐day mortality was 3/61 (5%). Conclusion IC followed by surgical resection is a technically simple strategy, allowing initial abdominal exploration with a short period of having a colostomy, and permitting elective surgery with a low morbidity and full oncological lymphadenectomy.