Emergency surgery for obstructing colorectal cancers: A comparison betweenright-sided and left-sided lesions

BACKGROUND: Fifteen to twenty percent of patients with primary colorectal c ancers present with intestinal obstruction. Traditionally, different approa ches have been used in the management of right-sided and left-sided colonic obstruction. Recently, single-stage resection with primary anastomosis in left colonic obstruction has been shown to have good results. The objective of this study was to compare the operative results of patients who had eme rgency operations for right-sided and left-sided obstructions from primary colorectal cancers. STUDY DESIGN: This is a retrospective study including 243 patients who unde rwent emergency operations for obstructing colorectal cancers from 1989 to 1997. Primary resection of the tumor-bearing segment followed by primary an astomosis was attempted when the conditions were feasible. The operative re sults of patients with right-sided tumors were compared with those of patie nts with left-sided tumors. RESULTS: One hundred seven patients had obstruction at or proximal to the s plenic flexure (right-sided lesions), and 136 had lesions distal to the spl enic flexure (left-sided lesions). The primary resection rate was 91.8%. Of the 223 patients with primary resection, primary anastomosis was possible in 197 patients. Among the 101 primary anastomoses in patients with left-si ded obstruction, segmental resection with on-table lavage was performed in 75 patients and subtotal colectomy was performed in 26. The overall operati ve mortality rate was 9.4%, although that of the patients with primary rese ction and anastomosis was 8.1%. The anastomotic leakage rate for those with primary resection and anastomosis was 6.1%. There were no differences in t he mortality or leakage rates between patients with right-sided and left-si ded lesions (mortality: 7.3% versus 8.9%, p = 0.79; leakage: 5.2% versus 6. 9%, p = 0.77). Colocolonic anastomosis did not show a significant differenc e in leakage rate when compared with ileocolonic anastomosis (6.1% versus 6 .0%, p = 1.0). CONCLUSIONS: This study showed that primary resection and anastomosis for l eft-sided malignant obstruction, either by segmental resection with on-tabl e lavage or subtotal colectomy, was not more hazardous than primary anastom osis for right-sided obstruction. The single-stage procedure should be the objective for the treatment of patients with obstructing colorectal cancers , except when patients are hemodynamically unstable during surgery or when the condition of the bowel is not optimal for primary anastomosis. (J Am Co ll Surg 2001;192:719-725. (C) 2001 by the American College of Surgeons).