Study of long intestinal tube for decompression of obstructive left colon cancer

BACKGROUND/AIMS: Recently, several reports have recommended primary resecti on, rather than a staged operation, for obstructive left colon cancer. Howe ver pre-operative decompression is important for reducing complications and improving the curability of primary resection. Among the many preoperative decompression strategies reported, we selected the long intestinal tube an d evaluated the effectiveness of this convenient strategy. METHODOLOGY: A long intestinal tube was inserted pre-operatively for decomp ression in 27 of 29 patients undergoing resection for obstructive left colo n cancer (1991-1995). We retrospectively studied the clinical features (res ponders vs. non-responders) of the 27 patients. We also compared these 27 w ith 26 other pre-1990 patients, who did not receive pre-operative decompres sion, in term of post-operative morbidity. RESULTS: Twelve of the 27 patients were responders; success rate 44.4%. The re were no blood profile differences between responders and non-responders, but the time from bowel movement cessation to intestinal tube insertion wa s 3 days or less in all responders but 4 days or more in non-responders (p< 0.001). There was no significant difference in the rate of post-operative m orbidity between those with and without pre-operative decompression. CONCLUSIONS: Decompression is likely to be successful, allowing elective pr imary resection, when initiated within 3 days of bowel movement cessation. However, more than 4 days post-onset, other decompression methods or emerge ncy surgery is necessary.