SINGLE-STAGE TREATMENT FOR MALIGNANT LEFT-SIDED COLONIC OBSTRUCTION -A PROSPECTIVE RANDOMIZED CLINICAL-TRIAL COMPARING SUBTOTAL COLECTOMY WITH SEGMENTAL RESECTION FOLLOWING INTRAOPERATIVE IRRIGATION

This multicentre study is the first prospective randomized trial to co mpare subtotal colectomy with segmental resection and primary anastomo sis following intraoperative irrigation for the management of malignan t left-sided colonic obstruction, Of the 91 eligible patients recruite d by 12 centres, 47 were randomized to subtotal colectomy and 44 to on -table irrigation and segmental colectomy. Hospital mortality and comp lication rates did not differ significantly, but 4 months after operat ion increased bowel frequency (three or more bowel movements per day) was significantly more common in the subtotal colectomy group (14 of 3 5 versus four of 35, chi(2) = 6.06, 1 d.f., P = 0.01). More patients i n the subtotal colectomy group reported that they had consulted their general practitioner with bowel problems than did those in the segment al resection group (15 of 37 versus three of 35, chi(2) = 8.17, 1 d.f. , P = 0.004). Segmental resection following intraoperative irrigation is the preferred option except when there is caecal perforation or if synchronous neoplasms are present in the colon, when subtotal colectom y is more appropriate.