Obstructing carcinoma of the left colon managed by subtotal colectomy

Obstructing carcinomas of the left colon are traditionally managed with a staged resection, as immediate colonic anastomosis is associated with a high risk of anastomotic dehiscence. We have prospectively performed total or subtotal colectomy in 18 consecutive patients presenting with obstruction at or distal to the splenic flexure. The operative mortality was 11%, which compared favourably with the results of other methods of surgical management. The procedure is safe and no cases of anastomotic dehiscence occurred. Subtotal colectomy achieves in a single procedure relief of the obstruction, tumour resection and restoration of gut continuity whilst allowing resection of synchronous lesions and eliminating the risk of metachronous tumour. Frequent liquid stool was not a significant sequel of a subtotal colectomy in this series.     

Emergency subtotal colectomy. A new trend for treatment of obstructing carcinoma of the left colon.

During a 5-year period, 22 patients with obstructing carcinoma of the left colon were operated on in our department. All patients underwent emergency subtotal colectomy with primary ileocolonic or ileorectal anastomosis. The quality of life for patients undergoing subtotal colectomy is excellent. All patients enjoy an almost normal diet and those with an ileorectal anastomosis stabilize on two to three bowel movements per day. During a followup period of 65 months, four patients died from spread of their primary disease while two other patients died of unrelated causes. Sixteen patients are alive and free of disease. We consider subtotal colectomy the procedure of choice for patients with obstructing carcinoma of the left colon.     

Role of subtotal/total colectomy in emergency treatment of occlusive cancer of the left colon

PURPOSE: The aim of this study was to evaluate the results of management of acutely obstructed carcinoma of the left colon by emergency subtotal/total colectomy (STC) with immediate anastomosis without diversion. METHODS: STC was performed in 60 consecutive patients (mean age 72 years). Inclusion criteria were reasonable operative risk, resectable acutely obstructed carcinoma, massively-distended colon of dubious viability, signs of impending cecal perforation. RESULTS: Postoperative mortality was 6.6% (n = 4): 3 patients over 85 years of age died postoperatively as a result of cardiopulmonary complications; an 83 year-old female died as a result of an anastomotic dehiscence. Morbidity was 10% (n = 6) including one fistula which recovered without surgery. There were 5 synchronous colon cancers. Six months after surgery, the mean daily stool frequency was 2 after STC, and 3 after TC. CONCLUSION: Emergency STC achieves one stage relief of bowel obstruction and tumor resection by encompassing a massively distended and fecal-loaded colon with ischemic lesions, ensures restoration of gut continuity via a "safe" anastomosis and removes a possible synchronous carcinoma.     

Fate of the retained rectum after subtotal colectomy for inflammatory disease of the colon.

Of forty-nine consecutive patients who underwent subtotal colectomy for inflammatory disease of the colon, 73.5 per cent required subsequent combined abdominoperineal resection of the retained rectum and only two patients had successful ileoproctostomy. For the patient whose rectum is substantially diseased along with the rest of the colon, one-stage total proctocolectomy is the preferred operation.     

Role of emergency subtotal colectomy in neoplastic obstructions of the left colon]

From 1984 to 1990, 60 patients underwent emergent surgery for a neoplastic obstruction of the left colon. We performed 19 colostomies without initial exeresis and 41 immediate tumoral resections. In the latter group, five subtotal colectomies (S.T.C.) were performed, including four with immediate mechanical anastomosis. Two patients had synchronous cancers and three had pre-perforating cecal lesions. Three patients had an associated general peritonitis. Three of the patients treated with STC died. These were these patients with general peritonitis, two of whom also had hepatic metastases. The data found in the literature on neoplastic obstructions of the left colon treated with STC with immediate anastomosis (227 cases are published) show an overall mortality rate of 8.4% with 24% morbidity, a complication of the anastomosis occurring in 4.5% of all cases.     

Role of subtotal colectomy in the treatment of incapacitating constipation

Nine patients from a community surgical practice have been presented who underwent subtotal colectomy with ileal lower sigmoid anastomosis for the treatment of chronic incapacitating idiopathic constipation. Emphasis was placed on carefully selecting patients for this procedure. The results in this small series have been promising. Long-term follow-up is necessary to determine whether the patients will continue to do well. A review of the literature regarding the surgical treatment of constipation has indicated that subtotal colectomy is the most successful form of treatment in select patients. More studies are needed, specifically in the area of radiopaque markers and anorectal manometry, to determine whether or to what extent these procedures can help select patients who might benefit from this procedure.     

Laparoscopic subtotal colectomy with transrectal extraction of the colon and ileorectal anastomosis

Background  

Despite the growing acceptance of laparoscopic colon surgery, an abdominal incision is needed to remove the specimen and perform an anastomosis.     

A case of ulcerative colitis relapsing at the defunctionalized colon after subtotal colectomy

A 25-year-old female with left sided ulcerative colitis underwent subtotal colectomy, and colo-anal anastomosis with diverting ileostomy by combined abdomino-sacral approach on February 14, 1985. Immediately after the operation, bleeding from the anus occurred, and one month after the operation, endoscopic examination revealed the relapse of the ulcerative colitis in the remaining colon. It was recognized, that relapse had occurred postoperatively at the nonfunctioning colon, which had been free from the disease so long as eight years since the onset of the disease. Then the relapsed colon was removed, and ileoanal anastomosis with diverting ileostomy was performed, again by combined abdomino-sacral approach. The sacral approach offered an excellent operative field and ensured the anastomosis between the small intestine and the anus.     

腹腔镜结肠次全切除术治疗结肠结核2例

目的探讨应用腹腔镜、纤维结肠镜术中判断结肠的病变范围，腹腔镜完成结肠次全切除术的可行性。方法全麻，仰卧位，脐部上方、下方、左下腹、右下腹分别置入10 mm trocar，右上腹置入5 mm trocar。右半结肠切除时腹腔镜置放于下腹部，左半结肠切除时腔镜置于右下腹部。术中经右结肠断端置人纤维结肠镜配合定位。自回盲部始游离结肠至乙状结肠。扩大左下腹部切口至4cm，腹腔外回肠、乙状结肠吻合。结果2例结肠结核腹腔镜下可以明确观察到结肠、小肠壁的增厚、变硬等改变，术中纤维结肠镜可见结肠黏膜的假性息肉及溃疡等病理改变已波及到降结肠及部分乙状结肠。手术时间分别170、190min。术中出血分别150、200ml。2例术后病理证实为肠结核。切除结肠及回肠术后近期无并发症发生。术后近期大便每天5～6次，术后5、6个月随访大便每天1～2次。体重分别增加2．5、4kg。结论腹腔镜术中配合纤维结肠镜可以准确判断结肠的病变范围，腹腔镜下结肠次全切除术安全可行。     

Subtotal colectomy for obstructing carcinoma of the left colon

This retrospective review of seven patients with completely obstructing cancers of the left half of the colon, in addition to other reports in the literature, suggests that subtotal colectomy with primary ileal

1 Clinical data on seven patients who underwent subtotal colectomy for obstructing carcinoma of the left colon: 1975–1982.

Patient	Age (yr) and Sex	Tumor Location	Hospital Stay	Comments
1	68, F	Decending	10 days	A and W 40 mo postop1
2	71, F	Sigmoid	22 days	A and W 18 mo postop
3	73, F	Sigmoid	…	A and W 5 yr postop
4	66, F	Decending	8 mo	Dead from complications
5	72, M	Sigmoid	11 days	Incidental cecal cancer; A and W 3 mo postop
6	66, M	Sigmoid	28 days	Alive with metastasis 16 mo postop
7	78, M	Left transvers	34 days	Many other polyps; A and W 9 mo postop

1

A and W = alive and well.

proctostomy may be the treatment of choice for those lesions that are technically resectable and located high enough to permit an intraperitoneal ileal proctostomy. The morbidity and mortality is less than that seen with the staged approach and the length of hospitalization is shorter. By eliminating a second or third hospitalization and a temporary colostomy, palliation is better in those patients who ultimately die from recurrent cancer. Furthermore, those patients resected for cure may have increased rates of long-term survival.     

Subtotal colectomy with primary anastomosis without diversion in the treatment of obstructing carcinoma of the left colon

A small series of patients with obstruction from an adenocarcinoma of the left colon is presented. The recommended treatment in selected cases is subtotal colectomy with primary anastomosis without diversion. The morbidity and mortality in this small series was minimal compared with those reported in a much larger series of similar cases treated by bowel decompression with or without concomitant resection of the lesion. Further follow-up of this series is needed. However, this procedure should be considered seriously in selected patients with obstructing carcinoma of the left colon.