Surgical Treatment and Prophylactic Bowel Stoma for Acute Obstruction of Left Colorectal Carcinoma
Abstract: Objective: To investigate the selection of surgical treatment for left colorectal carcinoma with acute obstruction and feasibility of prophylactic bowel stoma. Methods: The data of 278 left colon carcinoma patients with acute obstruction (LCCPAO) treated surgically during 15 years were analyzed retrospectively. Results: In this study, there were 59 cases of LCCPAO underwent resection without intestinal anastomosis, and 219 cases of one-stage underwent one-stage resection with intestinal anastomosis. Among the latter cases, 66 underwent one-stage underwent one-stage resection with enteral anastomosis plus prophylactic colostomy. The procedures were left colectomy in 24 cases, sigmoid colectomy in 20 cases, subtotal colectomy in 1 case, Dixon’s operation in 13 cases, and intersphincteric resection (ISR) in 8 cases. In addition, 5 cases were treated with expandable metal stent for relieving intestinal obstruction before operation and followed by one-stage resection and anastomosis. The anastomotic leakage rate in patients with one-stage resection and intestinal anastomosis was 6.4% (14/219 cases), and no significant difference was found between the patients with (5.6%, 3/54 cases) or without (6.1%, 10/165) intraoperative irrigation (P > 0.05), and no anastomostic leakage was found in the cases with one-stage anastomosis plus prophylactic bowel stoma. Conclusion: The principle of surgical treatment is to resolve intestinal obstruction, resect tumor with radical and one-stage intestinal anastomosis, and prophylactic bowel stoma is added, if necessary. But in case of the old patients with poor general condition, the proximal colon stoma and Hartmann’s operation is indicated for relief of intestinal obstruction.
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