Obstructing Colorectal Carcinoma: Outcome and Risk Factors for Morbidity and Mortality

Abstract

Background/Aims: Emergency surgery for colorectal cancer is widely thought to be associated with high morbidity and mortality. The aim of this study was to assess the operative results of patients who had emergency operations for obstructing colorectal cancer. Clinical factors that might influence the outcome were also evaluated. Patients and Methods: This is a retrospective study including 83 patients who underwent emergency operations for completely obstructing colorectal cancers from 1991 to 2002. Demographic, clinical, and pathological variables were examined. Their influence on major morbidity and mortality was assessed using univariate and multivariate analyses. Results: The overall and major morbidity rate was 67.5 and 32.5%, respectively. Mortality was 10.8%. Univariate analysis showed that high ASA class and perioperative blood transfusion were significantly associated with major complication, whereas older age and high APACHE II were linked to mortality. Independent risk factors for major morbidity were perioperative blood transfusion and high ASA class. The only independent predictor of postoperative death was high APACHE II score. Conclusions: Emergency surgery for obstructing colorectal carcinoma carries a negative impact on outcome. Patients with risk factors should undergo safe and least risky procedures. Moreover, their presence might help in selecting patients for intensive treatment after surgery.

Results of surgery for colorectal carcinoma with obstruction

“…It is believed in a few studies that the incidence of tumor distribution obstructing the colon is not significantly different between left and right sides [7,8]. However, in most studies, it is documented that the left colon is the most frequent site of obstruction, and this has been confirmed in the present study [4,6,9,10]. Although the splenic flexure has been reported to be the most vulnerable site for obstruction because of its acute angle [6], only two out of six patients with left colic flexure tumors have had obstruction at this site.…”

“…Many studies state that obstructing colorectal carcinomas are either locally advanced or they are associated with distant metastases [6,10,11]. Others have documented that this is not true and even T 1 carcinomas may be the cause of obstruction [12].…”

Effect of Preoperative Colonic Drainage for Obstructing Colorectal Cancer

“…Currently, postoperative adjuvant chemotherapy is indicated in the NCCI guidelines (Version 3.2013 Colon Cancer) for the Many studies have noted that OCRC is either locally advanced or associated with distant metastases. 8,9,12,13 In this study, however, distribution of TNM stage and rate of residual tumor after decompression surgery were similar between the 2 groups, indicating no association between OCRC and distant metastasis in patients undergoing colectomy for primary colorectal cancer. There is a possible association between OCRC and aging.…”

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.…”