Système gastro-intestinal et digestif

Abstrait

Subtotal Colectomy is a Safe and Effective Single Stage Surgery for Acute Left Colonic Malignant Obstruction with Acceptable Functional

Senthil Kumar Ganapathi, Harish Kakkilaya, Sathiyamoorthy Rudramurthy, Rajapandian Subbiah, Aravinth Subramanium, Praveenraj Palanivelu, Palanivelu Chinnusamy

Purpose: Primary resection and anastomosis for malignant acute obstruction of left colon offers a single stage surgical option without a stoma. Our aim was to determine the outcome of subtotal colectomy in acutely obstructed left colonic cancer.

Methods: A retrospective review of all patients who underwent subtotal colectomy for acutely obstructed left colon cancer over a 10 years period was performed. All procedures were performed by specialist colorectal surgeons. The primary objective is to analyse the anastomotic leak rate and the functional outcome measured in terms of frequency of bowel movements.

Results: A total of 72 patients underwent sub-total colectomy among which one patient had primary peritoneal carcinomatosis causing obstruction of the sigmoid colon. Male predominance was noted (61.1%). The tumours predominantly involved the distal transverse colon (23/71) and proximal sigmoid colon (22/71), followed by descending colon (16/71) and splenic flexure (11/71). All the patients had locally advanced T3 and T4 tumours leading to colonic obstruction. Eight patients had synchronous adenomatous polyps among which 3 of them had high grade dysplasia. Seven patients had synchronous non-obstructing malignant colonic lesions. The average postoperative stay in hospital was 6.5 days. Only one patient had an anastomotic leak (1.4%). The average frequency of bowel movements per day was 2.83 at 6 months after surgery. There was no mortality during the six month follow up.

Conclusion: Sub-total colectomy is a safe, effective and well tolerated single stage procedure with acceptable functional outcome with added benefits of removing synchronous polyps and cancers.