Malignant obstruction of the large bowel: One-stage subtotal colectomy

Thirty-eight patients with obstructing carcinoma of the left colon were treated by subtotal colectomy and ileocolic or ileorectal anastomosis. There were 21 males and 17 females aged 51-83 years (mean age 71 years). The mean symptomatic period was 90 h. All patients had abdominal pains and constipation. 47% vomited, and 6% bled rectally. Abdominal distention was pronounced in 70%. There was an abdominal mass in 11% and a rectal lesion in 6%. The site of the tumor was rectum 3%, and colon in the remainder. The tumors, adenocarcinomas, were well or moderately differentiated in 94%. Twenty-three percent had liver metastases. Postoperative complications included wound infections (8%) and intra-abdominal infections (24%). Fourteen percent had anastomotic complications requiring surgery. Seven patients died (18%), in 3 cases mortality was connected to anastomotic complications. Mean follow-up on 25 patients was 4.6 years (1-12 years). Bowel movements averaged 3.5 daily at 3 months and 1.5 at 1 year. Ten died of extension of their disease and 5 of unrelated causes. Survival was 39% at 5 years and 25% at 10 years. Subtotal colectomy relieves obstruction, resects the tumor, restores continuity and eliminates the risk of additional tumors. Morbidity and mortality rates are acceptable in this high-risk group. In very low rectal tumors, there is still a place for a Hartmann's operation or possibly laser or other decompression procedures.