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  • Title: [Role of subtotal/total colectomy in emergency treatment of occlusive cancer of the left colon].
    Author: Arnaud JP, Tuech JJ, Duplessis R, Pessaux P.
    Journal: Ann Chir; 1999; 53(10):1019-22. PubMed ID: 10670151.
    Abstract:
    PURPOSE: The aim of this study was to evaluate the results of management of acutely obstructed carcinoma of the left colon by emergency subtotal/total colectomy (STC) with immediate anastomosis without diversion. METHODS: STC was performed in 60 consecutive patients (mean age 72 years). Inclusion criteria were reasonable operative risk, resectable acutely obstructed carcinoma, massively-distended colon of dubious viability, signs of impending cecal perforation. RESULTS: Postoperative mortality was 6.6% (n = 4): 3 patients over 85 years of age died postoperatively as a result of cardiopulmonary complications; an 83 year-old female died as a result of an anastomotic dehiscence. Morbidity was 10% (n = 6) including one fistula which recovered without surgery. There were 5 synchronous colon cancers. Six months after surgery, the mean daily stool frequency was 2 after STC, and 3 after TC. CONCLUSION: Emergency STC achieves one stage relief of bowel obstruction and tumor resection by encompassing a massively distended and fecal-loaded colon with ischemic lesions, ensures restoration of gut continuity via a "safe" anastomosis and removes a possible synchronous carcinoma.
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