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Article: Emergency surgery for obstructing colorectal cancers: A comparison between right-sided and left-sided lesions

TitleEmergency surgery for obstructing colorectal cancers: A comparison between right-sided and left-sided lesions
Authors
Issue Date2001
PublisherElsevier Inc. The Journal's web site is located at http://www.elsevier.com/locate/jamcollsurg
Citation
Journal Of The American College Of Surgeons, 2001, v. 192 n. 6, p. 719-725 How to Cite?
AbstractBACKGROUND: Fifteen to twenty percent of patients with primary colorectal cancers present with intestinal obstruction. Traditionally, different approaches 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 emergency operations for right-sided and left-sided obstructions from primary colorectal cancers. STUDY DESIGN: This is a retrospective study including 243 patients who underwent emergency operations for obstructing colorectal cancers from 1989 to 1997. Primary resection of the tumor-bearing segment followed by primary anastomosis was attempted when the conditions were feasible. The operative results of patients with right-sided tumors were compared with those of patients with left-sided tumors. RESULTS: One hundred seven patients had obstruction at or proximal to the splenic flexure (right-sided lesions), and 136 had lesions distal to the splenic 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-sided obstruction, segmental resection with on-table lavage was performed in 75 patients and subtotal colectomy was performed in 26. The overall operative mortality rate was 9.4%, although that of the patients with primary resection and anastomosis was 8.1%. The anastomotic leakage rate for those with primary resection and anastomosis was 6.1%. There were no differences in the mortality or leakage rates between patients with right-sided and left-sided 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 difference 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 left-sided malignant obstruction, either by segmental resection with on-table lavage or subtotal colectomy, was not more hazardous than primary anastomosis 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. © 2001 by the American College of Surgeons.
Persistent Identifierhttp://hdl.handle.net/10722/84506
ISSN
2015 Impact Factor: 4.257
2015 SCImago Journal Rankings: 2.604
ISI Accession Number ID
References

 

DC FieldValueLanguage
dc.contributor.authorLee, YMen_HK
dc.contributor.authorLaw, WLen_HK
dc.contributor.authorChu, KWen_HK
dc.contributor.authorPoon, RTPen_HK
dc.date.accessioned2010-09-06T08:53:45Z-
dc.date.available2010-09-06T08:53:45Z-
dc.date.issued2001en_HK
dc.identifier.citationJournal Of The American College Of Surgeons, 2001, v. 192 n. 6, p. 719-725en_HK
dc.identifier.issn1072-7515en_HK
dc.identifier.urihttp://hdl.handle.net/10722/84506-
dc.description.abstractBACKGROUND: Fifteen to twenty percent of patients with primary colorectal cancers present with intestinal obstruction. Traditionally, different approaches 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 emergency operations for right-sided and left-sided obstructions from primary colorectal cancers. STUDY DESIGN: This is a retrospective study including 243 patients who underwent emergency operations for obstructing colorectal cancers from 1989 to 1997. Primary resection of the tumor-bearing segment followed by primary anastomosis was attempted when the conditions were feasible. The operative results of patients with right-sided tumors were compared with those of patients with left-sided tumors. RESULTS: One hundred seven patients had obstruction at or proximal to the splenic flexure (right-sided lesions), and 136 had lesions distal to the splenic 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-sided obstruction, segmental resection with on-table lavage was performed in 75 patients and subtotal colectomy was performed in 26. The overall operative mortality rate was 9.4%, although that of the patients with primary resection and anastomosis was 8.1%. The anastomotic leakage rate for those with primary resection and anastomosis was 6.1%. There were no differences in the mortality or leakage rates between patients with right-sided and left-sided 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 difference 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 left-sided malignant obstruction, either by segmental resection with on-table lavage or subtotal colectomy, was not more hazardous than primary anastomosis 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. © 2001 by the American College of Surgeons.en_HK
dc.languageengen_HK
dc.publisherElsevier Inc. The Journal's web site is located at http://www.elsevier.com/locate/jamcollsurgen_HK
dc.relation.ispartofJournal of the American College of Surgeonsen_HK
dc.rightsJournal of American College of Surgeons. Copyright © Elsevier Inc.en_HK
dc.titleEmergency surgery for obstructing colorectal cancers: A comparison between right-sided and left-sided lesionsen_HK
dc.typeArticleen_HK
dc.identifier.openurlhttp://library.hku.hk:4550/resserv?sid=HKU:IR&issn=1072-7515&volume=192&spage=719&epage=725&date=2001&atitle=Emergency+surgery+for+obstructing+colorectal+cancers:+a+comparison+between+right-sided+and+left-sided+lesionsen_HK
dc.identifier.emailLaw, WL: lawwl@hkucc.hku.hken_HK
dc.identifier.emailPoon, RTP: poontp@hkucc.hku.hken_HK
dc.identifier.authorityLaw, WL=rp00436en_HK
dc.identifier.authorityPoon, RTP=rp00446en_HK
dc.description.naturelink_to_subscribed_fulltext-
dc.identifier.doi10.1016/S1072-7515(01)00833-Xen_HK
dc.identifier.pmid11400965-
dc.identifier.scopuseid_2-s2.0-0034994143en_HK
dc.identifier.hkuros62888en_HK
dc.relation.referenceshttp://www.scopus.com/mlt/select.url?eid=2-s2.0-0034994143&selection=ref&src=s&origin=recordpageen_HK
dc.identifier.volume192en_HK
dc.identifier.issue6en_HK
dc.identifier.spage719en_HK
dc.identifier.epage725en_HK
dc.identifier.isiWOS:000169043500008-
dc.publisher.placeUnited Statesen_HK
dc.identifier.scopusauthoridLee, YM=8521465600en_HK
dc.identifier.scopusauthoridLaw, WL=7103147867en_HK
dc.identifier.scopusauthoridChu, KW=7402453653en_HK
dc.identifier.scopusauthoridPoon, RTP=7103097223en_HK

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