Retrospective analysis of acute left colon obstructions due to colorectal cancers

Abstract

Objectives: In cases showing acute left colon obstruction due to colorectal tumors, it was aimed to evaluate the results of emergency resection primary anastomosis and compare these results with those of Hartmann Procedure.
Material and Method: 84 patients who were operated due to colorectal cancer-induced acute left colon obstruction who were admitted to the Ankara Numune Training and Research Hospital Emergency Surgery Service between August 2005 and March 2011 were included in the study and analyzed retrospectively. All of the patients were evaluated in the emergency room and operated in the emergency operating room. In the treatment of patients, Hartmann colostomy and resection primer anastomosis surgical procedures were used. It was operated without bowel cleansing, and after an intraoperative resection, either primary anastomosis or threshing colostomy was performed after manual decompression.
Results: The number of patients in need of postoperative intensive care was 25, the number of patients with ventilator need was 16, and the number of patients with stoma revision was 3 in the group with stoma. Cardiopulmonary morbidity number was 10, reoperation was 9 and mortality was 13. In the anastomosis group, there were 13 patients with need for intensive care, 4 patients with ventilator needs and 2 patients with anastomosis leakage. The number of patients re-operated was 2. The mortality number was found to be 5. The postoperative intensive care requirement, ventilator requirement, reoperation and mortality values were p<0.05 and statistically significant between the two groups.
Conclusion: Patients who will be operated on for acute left colon obstruction due to colorectal cancer; We recommend performing resection-primary anastomosis by performing intraoperative manual decompression based on the surgeon’s experience in patients with a good general condition and low comorbidity and ASA score.

Keywords

• Left colon obstruction,Hartmann procedure,anastomosis

Kolorektal kanserlere bağlı gelişen akut sol kolon obstrüksiyonlarının retrospektif analizi

Abstract

Amaç: Kolorektal tümörlere bağlı akut sol kolon tıkanıklığı bulguları gösteren olgularda acil koşullarda uygulanan rezeksiyon primer anastomoz sonuçlarının değerlendirilmesi ve bu sonuçların Hartmann Prosedür uygulanan hastaların sonuçlarıyla karşılaştırılması amaçlanmıştır.
Gereç ve Yöntem: Ağustos 2005-Mart 2011 tarihleri arasında Ankara Numune Eğitim ve Araştırma Hastanesi Acil Cerrahi Servisi’ne yatış yapılan kolorektal kansere bağlı akut sol kolon obstrüksiyonu nedeniyle ameliyat edilen 84 hasta çalışmaya alındı ve retrospektif olarak incelendi. Hastaların tümü acil serviste değerlendirilip acil ameliyathanede opere edilmiştir. Hastaların tedavisinde Hartmann kolostomi ve rezeksiyon primer anastomoz cerrahi prosürleri kullanıldı. Barsak temizliği yapılmadan operasyona alındı ve intraoperatif rezeksiyon sonrası tüm hastalara manuel dekompresyon yapıldıktan sonra ya rezeksiyon primer anastomoz ya da Hartmann Prosedür yapıldı.
Bulgular: Stoma açılan grupta postoperatif yoğun bakım ihtiyacı olan hasta sayısı 25, ventilatör ihtiyacı olanların sayısı 16, stoma revizyonu yapılan hasta sayısı 3 idi. Kardiyopulmoner morbidite sayısı 10, reoperasyon 9, mortalite sayısı 13 olarak saptandı. Anastomoz yapılan grupta ise postoperatif yoğun bakım ihtiyacı olan hasta sayısı 13, ventilatör ihtiyacı olanların sayısı 4’tü ve anastomoz yapılanların 2’sinde anastomoz kaçağı olduğu görüldü. Yeniden operasyona giren hasta sayısı 2 idi, mortalite sayısı 5 olarak saptandı. Her iki grup arasında postoperatif yoğun bakım ihtiyacı, ventilatör ihtiyacı, reoperasyon ve mortalite açısından p değerleri <0,05 olup anlamlı idi.
Sonuç: Kolorektal kansere bağlı akut sol kolon obstrüksiyonu nedeniyle ameliyat edilecek hastalarda; genel durumu iyi, komorbiditesi ve ASA skoru düşük olan hastalara cerrahın tecrübesine dayanarak intraoperatif manuel dekompresyonla rezeksiyon-primer anastomoz yapılmasını önermekteyiz.

Keywords

• Sol kolon obstrüksiyonu,Hartmann prosedür,anastomoz

References

1. 1. Midgley R, Kerr D. Colorectal cancer. Lancet 1999; 353: 391-9.
2. 2. Singh KK, Barry MK, Ralston P, et al. Audit of colorectal cancer surgery by non-specialist surgeons. Br J Surg 1997; 84: 343–7.
3. 3. Serpell JW, McDermott FT, Katrivessis H, et al. Obstructing carcinomas of the colon. Br J Surg 1989; 76: 65–9.
4. 4. Tsugawa K, Koyanagi N, Hashizume M, et al. Therapeutic strategy of emergency surgery for colon cancer in 71 patients over 70 years of age in Japan. Hepatogastroenterol 2002; 49: 393-8.
5. 5. Deans GT, Krukowski ZH, Irwin ST. Malignant obstruction of the left colon. Br J Surg 1994; 81: 1270-6.
6. 6. Phillips RK, Hittinger R, Fry JS, Fielding LP. Malignant large bowel obstruction. Br J Surg 1985; 72; 296-302.
7. 7. Lee YM, Law WL, Chu KW, Poon RT. Emergencysurgery for obstructing colorectal cancers: a comparison between right-sided and left-sided lesions. J Am Coll Surg 2001; 192: 719-25.
8. 8. Wang HS, Lin JK, Mou CY, et al. Long-term prognosis of patients with obstructing carcinoma of the right colon. Am J Surg 2004; 187: 497-500.

9. 9. Bostancı H, Yüksel O, Dikmen K, Şahin T, Dikmen A, Şare M. Acil Sol Kolon Patolojilerinde Hartmann Prosedürünün Yeri: Klinik Deneylerimiz. Kolon Rektum Hast Derg 2007; 17: 191-5.
10. 10. Meyer F, Marusch F, Koch A, et al. Emergencyoperation in carcinomas of the left colon: value ofHartmann’s procedure. Tech Coloproctol 2004; 8: 226-29.
11. 11. Lau PW, Lo CY, Law WL. The role of one-stagesurgery in acute left-sided colonic obstruction. AmJ Surg 1995; 169: 406-9.
12. 12. Zorcolo L, Covotta L, Carlomagno N, Bartolo DCC. Safety of primary anastomosis in emergency colo-rectal surgery. Colorectal Dis 2003; 5: 262-9.
13. 13. Poon JT, Chan B, Law WL. Evaluation of P-POSSUM in surgery for obstructing colorectal cancer and correlation of the predicted mortality with different surgical options. Dis Colon Rectum 2005: 48: 493-8.
14. 14. Lim JF, Tang CL, Seow-Choen F, Heah SM. Prospective, randomized trial comparing intraoperative colonic irrigation with manuel decompression only for obstructed leftsided colorectal cancer. Dis Colon Rectum 2005; 48: 205-9.
15. 15. Villar JM, Martinez AP, Villegas MT, et al. Surgical options for malignant left-sided colonic obstruction. Surg Today 2005; 35: 275-81.
16. 16. Park UC, Chung SS, Kim KR, et al. Single-stage procedure with intraoperative colonoscopy and colonic irrigation in patients with obstructing left-sided colonic cancer. Int J Colorectal Dis 2004; 19: 487-92.
17. 17. Forloni B, Reduzzi R, Paludetti A, Colpani L, Cavallari G, Frosali D. Intraoperative colonic lavage in emergency surgical treatment of left-sided colonic obstruction. Dis Colon Rectum 1998; 41: 23-7.
18. 18. Patriti A, Contine A, Carbone E, Gulla N, DoniniA. One-stage resection without colonic lavage in emergency surgery of the left colon. Colorectal Dis 2005; 7: 332-8.
19. 19. Hsu TC. Comparison of one-stage resection andanastomosis of acute complete obstruction of left and right colon. Am J Surg 2005; 189: 384-7.
20. 20. Naraynsingh V, Rampaul R, Maharaj D, KuruvillaT, Ramcharan K, Pouchet B. Prospective study of primary anastomosis without colonic lavage for patients with an obstructed left colon. Br J Surg 1999; 86: 1341-3.
21. 21. Gatsoulis N, Roukounakis N, Kafetzis I, et al. Surgical management of large bowel obstruction due to colonic canser. Tech Coloproctol 2004; 8: 82-4.
22. 22. Papapolychroniadis C, Kaimakis D, Giannoulis K, et al. large bowel obstruction in women with pelvic malignancies. What is the primary? Tech Coloproctol 2004; 8: 108-11.
23. 23. Minopoulos GI, lyratzopoulos n, Efremidou HI, et al. Emergency operations for carcinoma of the colon. Tech Coloproctol 2004; 8: 235-7.
24. 24. Coco C, Verbo A, Manno A, et al. Impact of emergency surgery in the outcome of rectal and left colon carcinoma. World J Surg 2005; 29: 1458-64.
25. 25. Poon rTP, law Wl, Chu KW, et al. Emergency resection and primary anastomosis for left-sided obs- tructing colorectal carcinoma in the elderly. Br J Surg 1998; 85: 1539-42.
26. 26. Runkel NS, Hinz U, Lehnert T, et al. Improved outcome after emergency surgery for cancer of the large intestine. Br J Surg 1998; 85: 1260-5.