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Journal of Gastrointestinal Surgery

, Volume 14, Issue 2, pp 295–302 | Cite as

Surgery for Obstructed Colorectal Malignancy in an Asian Population: Predictors of Morbidity and Comparison Between Left- and Right-Sided Cancers

Original Article

Abstract

Introduction

Surgical treatment of obstructed colorectal cancers has been associated with significant perioperative morbidity and mortality. This study was performed to review the spectrum of surgery and early outcome of patients with acutely obstructed colorectal cancers. The secondary aims were to compare right- and left-sided obstruction and to identify factors predicting morbidity and mortality in these patients.

Methods

A retrospective review of all patients who underwent operative intervention for acute obstruction from colorectal malignancy from February 2003 to April 2008 was performed. Patients were identified from the hospital’s operating records based on postoperative diagnosis codes of colorectal malignancy. The diagnosis of acute obstruction was confirmed through clinical assessment, radiological investigations, and surgical findings. All the complications were graded according to the classification proposed by Clavien and group.

Results

Out of a total of 1,268 patients who underwent surgery for colorectal malignancy, 134 (10.6%) patients with a median age of 71 years (range, 34–97 years) were operated for acute obstruction. Left-sided malignancy accounted for 79.9% of the obstruction, with sigmoid colon being the most common site in 54 (40.3%) patients. A significant proportion (77.6%) of our patients had associated perioperative morbidity, and the mortality rate was 11.9%. Worse complications (grades of complications III to V) were more frequent in patients who had a higher American Society of Anesthesiologists score (3–4), are ≥60 years old, and had preoperative renal impairment. Stoma was created more frequently in left-sided pathology.

Conclusion

In an Asian population, surgery in patients with acute colorectal malignant obstruction is associated with significant morbidity and mortality rates. Though left-sided malignant obstruction occurs more frequently and is associated with a higher incidence of stoma creation, primary resection and anastomosis is a safe option in selected patients.

Keywords

Intestinal obstruction Colorectal cancers Surgery Treatment outcome 

References

  1. 1.
    Phillips RK, Hittinger R, Fry JS, Fielding LP. Malignant large bowel obstruction. Br J Surg 1985;72:296–302.CrossRefPubMedGoogle Scholar
  2. 2.
    Stower MJ, Hardcastle JD. The results of 1115 patients with colorectal cancer treated over an 8-year period in a single hospital. Eur J Surg Oncol 1985;11:119–123.PubMedGoogle Scholar
  3. 3.
    Carraro PG, Segala M, Cesana BM, Tiberio G. Obstructing colonic cancer: failure and survival patterns over a ten-year follow-up after one-stage curative surgery. Dis Colon Rectum 2001;44(2):243–250.CrossRefPubMedGoogle Scholar
  4. 4.
    Umpleby H, Williamson R. Survival in acute obstructing colorectal carcinoma. Dis Colon Rectum 1984;27:299–304.CrossRefPubMedGoogle Scholar
  5. 5.
    Irvin T, Greaney M. The treatment of colonic carcinoma presenting with intestinal obstruction. Br J Surg 1977;64:741–744.CrossRefPubMedGoogle Scholar
  6. 6.
    Deans GT, Krukowski ZH, Irwin ST. Malignant obstruction of the left colon. Br J Surg. 1994;81(9):1270–1276.CrossRefPubMedGoogle Scholar
  7. 7.
    Lee YM, Law WL, Chu KW, Poon RT. Emergency surgery for obstructing colorectal cancers: a comparison between right-sided and left-sided lesions. J Am Coll Surg 2001;192(6):719–725.CrossRefPubMedGoogle Scholar
  8. 8.
    Hsu TC. One-stage resection and anastomosis for acute obstruction of the left colon. Dis Colon Rectum 1998;41:28–32.CrossRefPubMedGoogle Scholar
  9. 9.
    Lau PW, Lo CY, Law WL. The role of one-stage surgery in acute left-sided colonic obstruction. Am J Surg 1995;169:406–409.CrossRefPubMedGoogle Scholar
  10. 10.
    Watt AM, Faragher IG, Griffin TT, Rieger NA, Maddern GJ. Self-expanding metallic stents for relieving malignant colorectal obstruction: a systematic review. Ann Surg. 2007;246(1):24–30.CrossRefPubMedGoogle Scholar
  11. 11.
    Martinez-Santos C, Lobato RF, Fradejas JM, Pinto I, Ortega-Deballón P, Moreno-Azcoita M. Self-expandable stent before elective surgery vs. emergency surgery for the treatment of malignant colorectal obstructions: comparison of primary anastomosis and morbidity rates. Dis Colon Rectum 2002;45(3):401–406.CrossRefPubMedGoogle Scholar
  12. 12.
    Wu X, Chen VW, Martin J, Roffers S, Groves FD, Correa CN, Hamilton-Byrd E, Jemal A. Subsite-specific colorectal cancer incidence rates and stage distributions among Asians and Pacific Islanders in the United States, 1995 to 1999. Cancer Epidemiol Biomarkers Prev 2004;13(7):1215–1222.PubMedGoogle Scholar
  13. 13.
    Koo JH, Kin S, Wong C, Jalaludin B, Kneebone A, Connor SJ, Leong RW. Clinical and pathologic outcomes of colorectal cancer in a multi-ethnic population. Clin Gastroenterol Hepatol 2008;6(9):1016–1021.CrossRefPubMedGoogle Scholar
  14. 14.
    Fielding LP, Stewart-Brown S, Blesovsky L. Large bowel obstruction caused by cancer: a prospective study. Br Med J 1979;2:515–517.CrossRefPubMedGoogle Scholar
  15. 15.
    Astler VB, Coller FA. The prognostic significance of direct extension of carcinoma of the colon and rectum. Ann Surg 1954;139(6):846–852.CrossRefPubMedGoogle Scholar
  16. 16.
    Clavien PA, Sanabria JR, Mentha G, Borst F, Buhler L, Roche B, Cywes R, Tibshirani R, Rohner A, Strasberg SM. Recent results of elective open cholecystectomy in a North American and a European center. Comparison of complications and risk factors. Ann Surg 1992;216(6):618–626.CrossRefPubMedGoogle Scholar
  17. 17.
    Clavien PA, Camargo CA Jr, Croxford R, Langer B, Levy GA, Greig PD. Definition and classification of negative outcomes in solid organ transplantation. Application in liver transplantation. Ann Surg 1994;220(2):109–120.CrossRefPubMedGoogle Scholar
  18. 18.
    Dindo D, Demartines N, Clavien PA. Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 2004;240(2):205–213.CrossRefPubMedGoogle Scholar
  19. 19.
    Rosenberg IL, Graham NG, De Dombal FT, Goligher JC. Preparation of the intestine in patients undergoing major large-bowel surgery, mainly for neoplasms of the colon and rectum. Br J Surg 1971;58(4):266–269.CrossRefPubMedGoogle Scholar
  20. 20.
    Hsu TC. Comparison of one-stage resection and anastomosis of acute complete obstruction of left and right colon. Am J Surg 2005;189(4):384–387.CrossRefPubMedGoogle Scholar
  21. 21.
    Longo WE, Virgo KS, Johnson FE, Oprian CA, Vernava AM, Wade TP, Phelan MA, Henderson WG, Daley J, Khuri SF. Risk factors for morbidity and mortality after colectomy for colon cancer. Dis Colon Rectum 2000;43(1):83–91.CrossRefPubMedGoogle Scholar
  22. 22.
    Tentes AA, Mirelis CG, Kakoliris S, Korakianitis OS, Bougioukas IG, Tsalkidou EG, Xanthoulis AI, Bekiaridou KA, Dimoulas AI. Results of surgery for colorectal carcinoma with obstruction. Langenbecks Arch Surg 2009;394(1):49–53.CrossRefPubMedGoogle Scholar
  23. 23.
    Alvarez JA, Baldonedo RF, Bear IG, Truán N, Pire G, Alvarez P. Presentation, treatment, and multivariate analysis of risk factors for obstructive and perforative colorectal carcinoma. Am J Surg 2005;190(3):376–382.CrossRefPubMedGoogle Scholar
  24. 24.
    Cuffy M, Abir F, Audisio RA, Longo WE. Colorectal cancer presenting as surgical emergencies. Surg Oncol 2004;13(2–3):149–157.PubMedGoogle Scholar
  25. 25.
    Xiong L, Chintapalli KN, Dodd GD 3rd, Chopra S, Pastrano JA, Hill C, Leyendecker JR, Abbott RM, Grayson D, Feig J. Frequency and CT patterns of bowel wall thickening proximal to cancer of the colon. AJR Am J Roentgenol 2004;182(4):905–909.PubMedGoogle Scholar
  26. 26.
    Fitchett CW, Hoffman GC. Obstructing malignant lesions of the colon. Surg Clin North Am 1986;66(4):807–820.PubMedGoogle Scholar
  27. 27.
    Gatsoulis N, Roukounakis N, Kafetzis I, Mavrakis G. Surgical management of large bowel obstruction due to colonic cancer. Tech Coloproctol 2004;8(Suppl 1):s82–s84.CrossRefPubMedGoogle Scholar
  28. 28.
    Wang HS, Lin JK, Mou CY, Lin TC, Chen WS, Jiang JK, Yang SH. Long-term prognosis of patients with obstructing carcinoma of the right colon. Am J Surg 2004;187(4):497–500.CrossRefPubMedGoogle Scholar
  29. 29.
    Arnaud JP, Bergamaschi R. Emergency subtotal/total colectomy with anastomosis for acutely obstructed carcinoma of the left colon. Dis Colon Rectum 1994;37(7):685–688.CrossRefPubMedGoogle Scholar
  30. 30.
    Arenas RB, Fichera A, Mhoon D, Michelassi F. Incidence and therapeutic implications of synchronous colonic pathology in colorectal adenocarcinoma. Surgery 1997;122(4):706–709.CrossRefPubMedGoogle Scholar
  31. 31.
    Takeuchi H, Toda T, Nagasaki S, Kawano T, Minamisono Y, Maehara Y, Sugimachi K. Synchronous multiple colorectal adenocarcinomas. J Surg Oncol 1997;64(4):304–307.CrossRefPubMedGoogle Scholar
  32. 32.
    Nyam DC, Leong AF, Ho YH, Seow-Choen F. Comparison between segmental left and extended right colectomies for obstructing left-sided colonic carcinomas. Dis Colon Rectum 1996;39(9):1000–1003.CrossRefPubMedGoogle Scholar
  33. 33.
    Halevy A, Ponczek M, Orda R. Emergency subtotal colectomy for obstructing carcinoma of the left colon. J Surg Oncol 1987;35(4):256–258.CrossRefPubMedGoogle Scholar
  34. 34.
    Halevy A, Levi J, Orda R. Emergency subtotal colectomy. A new trend for treatment of obstructing carcinoma of the left colon. Ann Surg 1989;210(2):220–223.CrossRefPubMedGoogle Scholar
  35. 35.
    Irvin TT, Greaney MG. The treatment of colonic cancer presenting with intestinal obstruction. Br J Surg 1977;64(10):741–744.CrossRefPubMedGoogle Scholar
  36. 36.
    Hennekinne-Mucci S, Tuech JJ, Bréhant O, Lermite E, Bergamaschi R, Pessaux P, Arnaud JP. Emergency subtotal/total colectomy in the management of obstructed left colon carcinoma. Int J Colorectal Dis 2006;21(6):538–541.CrossRefPubMedGoogle Scholar
  37. 37.
    Leong QM, Koh DC, Ho CK. Emergency Hartmann’s procedure: morbidity, mortality and reversal rates among Asians. Tech Coloproctol 2008;12(1):21–25.CrossRefPubMedGoogle Scholar
  38. 38.
    David GG, Al-Sarira AA, Willmott S, Cade D, Corless DJ, Slavin JP. Use of Hartmann’s procedure in England. Colorectal Dis 2009;11(3):308–312.CrossRefPubMedGoogle Scholar

Copyright information

© The Society for Surgery of the Alimentary Tract 2009

Authors and Affiliations

  1. 1.Department of General SurgeryTan Tock Seng HospitalSingaporeSingapore

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