EMERGENCY RESECTION AND PRIMARY ANASTOMOSIS FOR LEFT-SIDED OBSTRUCTING COLORECTAL-CARCINOMA IN THE ELDERLY

Background Emergency colorectal surgery in the elderly has been associ ated with a high mortality rate. Although the current trend for the ma nagement of obstructing left-sided colorectal carcinoma favours primar y resection and anastomosis, the safety and benefits of this approach in the elderly have not been studied. Methods Some 57 elderly (aged mo re than 70 years) and 59 younger patients underwent emergency resectio n of an acutely obstructing left-sided colorectal carcinoma. Postopera tive results in the two groups were compared. Results The primary rese ction rate was 95 per cent in the elderly and 89 per cent in younger p atients (P = 0.70), with a primary anastomosis rate of 84 per cent and 78 per cent respectively (P = 0.64). Elderly patients had a significa ntly higher incidence of premorbid risk factors and postoperative card iorespiratory complications but no increase in surgical complications. Anastomotic leaks occurred in 6 per cent of the elderly and 4 per cen t of younger patients (P = 0.65), and the hospital mortality rate was 9 and 5 per cent respectively (P = 0.48). Conclusion Emergency resecti on and primary anastomosis for left-sided obstructing colorectal carci noma can be performed with favourable outcome in the elderly and shoul d be the treatment of choice in most elderly patients.