Transverse colostomy in the management of cancer of the colon

Summary

The indications, time factors, results and complications of the transverse colostomy when used at some time in the course of management of 45 patients with cancer of the large bowel are reviewed. The transverse colostomy is safe and effective for decompression, but when it was needed to alleviate acute obstruction only approximately half of the patients subsequently completed the three staged procedures. An average of 94 days was required for completion of the staged operations.

Significant complications are associated with closure of the transverse colostomy. The survival rate in 45 patients with cancer of the colon who had transverse colostomies was extremely poor—8.8 per cent survived five years. Colostomy closure was not achieved in 42 per cent of the patients.

It is suggested that when possible, reconsideration be given to Mikulicz resection for management of obstructing lesions of the proximal colon. When a transverse colostomy has been established to alleviate obstruction closure at the time of resection would be desirable, in view of the poor prognosis for these patients and in order to decrease hospitalization and the need for a further major surgical procedure, with its attendant risks and expense.