Between January 1980 and December 1989, 179 consecutive patients (99 males, 80 females, mean age at presentation 70.3 years, range 34 to 93 years) with large bowel obstruction due to cancer not complicated by perforation were admitted to one Unit. Within 24 hours from admission and after intensive resuscitation, 172 patients underwent laparotomy and staging under general anaesthesia. One hundred sixty one (90%) patients received one stage definitive treatment of the obstruction: thirty patients had definitive diverting procedure (colostomy of internal bypass) while primary resection and immediate anastomosis was performed in 131 (73.2%). Five more (2.8%) patients received primary resection and colostomy and six (3.4%) had a colostomy as the first step of a staged procedure. Curative resection rate was 0.64 (n = 115). Anastomotic leaks occurred in 18 (13.7%) out of 131 anastomoses. In 3 of these patients a colostomy was raised, while 15 were conservatively treated. Four (3.1%) patients died of septicaemia following the leak. The overall mortality rate was 13.4%: 13 of 136 (9.6%) patients died after primary resecton, and 11 of 43 (25.6%) after diverting procedures without resection (p <0.05). Most patients died of cadiopulmonary complications. In this series definitive one stage treatment of malignant colonic obstruction could be carried on in 90% of the cases. One stage treatment of left sided obstructing tumours was complicated by a high leak rate, but low mortality. One stage definitive treatment of these lesions may avoid cumulative mortality due to staged resection and offer better long term results.
|Translated title of the contribution||Definitive one-stage treatment of malignant large bowel obstruction|
|Number of pages||7|
|Publication status||Published - 1994|
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