Emergency Management of Malignant Acute Left-Sided Colonic Obstruction

Abstract

The searches showed one Cochrane systematic review, two further systematic reviews, one meta-analysis, two decision METHODS A literature search was undertaken using PubMed and the Cochrane Library regarding the options in emergency management of left-sided colonic obstruction focusing on outcomes such as mortality, morbidity, long-term prognosis and cost effectiveness. DISCUSSION Colonic stenting is the best option either for palliation or as a bridge to surgery. It reduces morbidity and mortality rate and the need for colostomy formation. Stenting is likely to be cost effective, but data are variable depending on the individual healthcare system. Nevertheless, surgical management remains relevant as colonic stenting has a small rate of failure, and it is not always available. There are various surgical options. One-stage primary resection and anastomosis is the preferred choice for low-risk patients. Intra-operative colonic irrigation has no proven benefit. Subtotal colectomy is useful in cases of proximal bowel damage or synchronous tumours. Hartmann's procedure should be reserved for high-risk patients. Simple colostomy has no role other than for use in very ill patients who are not fit for any other procedure.

Is Total-subtotal Colectomy and Primary Anastomosis Good Treatment Alternatives in Malignant Obstructive Lesions of the Left Colon?

“…[5] Emergent surgery in colorectal cancers has been reported to be associated with high mortality and morbidity rates. [6,7] Several surgical procedures have been described for the treatment of obstructive lesions of the left colon; however, there is no consensus on a particular method to be used for the surgical management of acute obstructions due to malignancies. [8,9] The classical three-step surgical approach including initial transverse loop colostomy followed by left colectomy performed after improvement in the patient's general status and closure by colostomy after two or three weeks has started to be replaced with the more aggressive single-step emergent surgery as subtotal colectomy and primary anastomosis.…”

“…It has been shown that intraoperative colonic lavage prolongs operative duration and does not lower the incidence of anastomosis leak. [7] Intraluminal fecal loading and the difference between the proximal and distal colon diameters renders difficulty in terms of anastomosis technique in patients treated by resection and primary anastomosis. [26,27] An increased incidence of anastomosis leak, which is the most significant disadvantage, has currently been reported within 1-7% in several studies, and the mortality rate has been reported to be 2-9%.…”

“…[27,28] The longer operation time, postoperative diarrhea and incontinence in elderly patients are the disadvantages of the procedure. [7,27] In most of the patients, the diarrhea resolves spontaneously or with medical treatment in a few months. [26,27] Reported complication rates associated with this technique in several series are from 2-8% for anastomosis leakage, 10-21% for morbidity, and 0-10% for mortality, which are all lower than with multi-step procedure alternatives.…”

Total-Subtotal Colectomy And Anastomosis In Obstructive Malignant Lesions Of Left Colon

“…2,4 Kolon malign obstrüksiyonlar›n›n büyük ço¤unlu¤u (%65-90) sol kolon kaynakl› tümörlere ba¤l›d›r. 3,5,6 Serimizde bu oran %86 olup literatür ile benzerdir.…”

Colorectal stenting in cancer patients

“…В таких слу-чаях систематический анализ эффективности исполь-зования колоректальных стентов позволяет предполо-жить, что они являются относительно безопасным и действенным симптоматическим средством [16,17]. Однако для применения противопоказаний для уста-новки стента необходимо выполнение компьютерной томографии брюшной полости [18][19][20] для выявления возможных перфораций ТК, некроза опухоли, пара-колитического абсцесса [21,22].…”