[Urgent management of obstructing colo-rectal cancer: authors' experience].

Annali italiani di chirurgia

PubMedID: 15283385

Giglio D, Di Muria A, Marano A, Cione G, Arciero G, Rossi R, Aveta M, Formisano V. [Urgent management of obstructing colo-rectal cancer: authors' experience]. Ann Ital Chir. 2004;75(1):35-9; discussion 39.
PURPOSE
The aim of this retrospective study is to compare the different surgical approaches in obstructing colo-rectal cancer in terms of mortality, morbidity and quality of life.

MATERIALS AND METHODS
We observed 379 patients with colorectal cancer, 354 of which underwent surgical treatment, 189 M (53.4%) and 165 F (46.6%), with a median age of 72.6 years. Complicated tumors were 150 (42.4%), with 126 obstructions (84%). For 95 obstructing left-sided colorectal cancers we performed: 9 defunctioning colostomies; 62 two-stages operations: 55 Hartmann's procedures, 5 primary anastomosis with colostomy; 2 primary anastomosis with on table wash-out and ileostomy; 24 single-stage operations: 17 primary anastomosis with on table wash-out and 7 colectomy.

RESULTS
The overall operative mortality rate was 8.7% (11/126). The overall leak rate was 8% (5/62), 12.9% (4/31) in left colon and 3.2% (1/31) in right colon, all treated conservatively. The wound infection rate was 23.8% (30/126).

DISCUSSION AND CONCLUSIONS
Obstructing colo-rectal cancer is associated with a high operative mortality and a worse prognosis. Defunctioning colostomy can be regarded as a valid option only in extreme circumstances. Hartmann's operation has indicated in case of metastatic disease, unsure anastomosis, simultaneous colonic perforation. The gold-standard is primary anastomosis, as colonic resection with on table wash-out or subtotal/total colectomy, in case of largely distended colon or synchronous lesions.