Surgical management of obstructing colonic cancer in Sakol Nakhon Hospital

Abstract

Background: Primary anastomosis after resection is considered safe for obstructing right-sided colon cancer. Different approaches have been used in left-sided colonic obstructing cancer. Recently primary resection with anastomosis in left-sided lesion has been shown to have good results. Objective: To compare the operative results of patients who had emergency operations for right-sided and leff-sided obstructing colonic cancers. Patients and Method: Retrospective analytic study was performed in 81 patients who underwent operation for obstructing colorectal cancers in Sakol Nakhon Hospital from October 1997-September 2003. The operative results were compraed between right-sided and left-sided lesions. Results: There were 23 cases of right-sided and 58 cases of left-sided obstructing colonic cancer. Primary resection was performed in 68 patients (83.9%) and primary anastomosis was performed in 61 patients (75.3%).Among 39 primary anastomosis in left-sided lesion, subtotal colectomy was performed in 27 patients (69.2%) and segmental resection was performed in 12 patients (30.8%).The overall mortality rate was 8.6% and that of the patients with primary resection and anastomosis was 6.6%.The anastomotic leakage rate for those with primary anastomosis was 8.2%. There was no difference in the leakage rate between right-sided and lef-sided lesions(p=1.000).The type of anastomosis ,ileocolic or colocolic,did not affect the incidence of leakage(p=1.000). The type of operation, subtotal colectomy or segmental resection for left-sided lesion had no difference in leakage rate (p=1.000).And primary anastomosis in left-sided and right-sided lesion had no difference in mortality rate(p=0.615). Conclusion: For a single stage operation with primary resection and anastomosis for obstructing colonic cancer the leakage rate and the mortality rate were not different between left-sided and right-sided lesions.