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Large Bowel Obstruction: Predictive Factors for Postoperative Mortality

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Diseases of the Colon & Rectum

PURPOSE

The aims of this study were to assess the prognostic value for mortality of several factors in patients with colonic obstruction and to study the differences between proximal and distal obstruction.

METHODS

Two-hundred and thirty-four consecutive patients who underwent emergency surgery for colonic obstruction were studied. Patients with an obstructive lesion distal to the splenic flexure were assessed as having a distal colonic obstruction. Resection and primary anastomosis was the operation of choice in selected patients. Alternative procedures were Hartmann’s procedure in high-risk patients, subtotal colectomy in cases of associated proximal colonic damage, and colostomy or intestinal bypass in the presence of irresectable lesions. Obstruction was considered proximal when the tumor was situated at the splenic flexure or proximally and a right or extended right colectomy was performed. A range of factors were investigated to estimate the probability of death: gender, age, American Society of Anesthesiologists score, nature of obstruction (benign vs. malign), location of the lesion (proximal vs. distal), associated proximal colonic damage and/or peritonitis, preoperative transfusion, preoperative renal failure, and laboratory data (hematocrit ≤30 percent, hemoglobin ≤10 g/dl, and leukocyte count >15,000/mm3). Univariate and multivariate forward steptwise logistic regression analysis was used to study the prognostic value of each significant variable in terms of mortality.

RESULTS

One or more complications were detected in 109 patients (46.5 percent). Death occurred in 44 patients (18.8 percent). No differences were observed between proximal and distal obstruction. Age (>70 years), American Society of Anesthesiologists III–IV score, preoperative renal failure, and the presence of proximal colon damage with or without peritonitis were significantly associated with postoperative mortality in the univariate analysis. Only American Society of Anesthesiologists score, presence of proximal colon damage, and preoperative renal failure were significant predictors of outcome in multivariate logistic regression.

CONCLUSION

Large bowel obstruction still has a high of mortality rate. An accurate preoperative evaluation of severity factors might allow stratification of patients in terms of their mortality risk and help in the decision-making process for treatment. Such an evaluation would also enable better comparison between studies performed by different authors. Principles and stratification similar to those of distal lesions should be considered in patients with proximal colonic obstruction.

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REFERENCES

  1. GL Irvin JS Horsley JA Caruana (1984) ArticleTitleThe morbidity and mortality of emergent operations for colorectal disease Ann Surg 199 598–603 Occurrence Handle6609686

    PubMed  Google Scholar 

  2. RK Phillips R Hittinger JS Fry LP Fielding (1985) ArticleTitleMalignant large bowel obstruction Br J Surg 72 296–302 Occurrence Handle1:STN:280:BiqC2srnvVE%3D Occurrence Handle3986481

    CAS  PubMed  Google Scholar 

  3. KJ Buechter C Boustany R Caillouette I Cohn SuffixJr (1988) ArticleTitleSurgical management of acutely obstructed colon. A review of 127 cases Am J Surg 156 163–8 Occurrence Handle1:STN:280:BieA3sfovFc%3D Occurrence Handle3048132

    CAS  PubMed  Google Scholar 

  4. WH Isbister J Prasad (1997) ArticleTitleEmergency large bowel surgery: a 15-year audit Int J Colorect Dis 12 285–90 Occurrence Handle10.1007/s003840050107 Occurrence Handle1:STN:280:DyaK1c%2FmsFCjtw%3D%3D

    Article  CAS  Google Scholar 

  5. S Biondo MT Perea J Martí Ragué D Parés E Jaurrieta (2001) ArticleTitleOne-stage procedure in non-elective surgery for diverticular disease complications Colorectal Dis 3 42–5 Occurrence Handle10.1046/j.1463-1318.2001.00193.x Occurrence Handle1:STN:280:DC%2BD3s3msV2quw%3D%3D Occurrence Handle12791020

    Article  CAS  PubMed  Google Scholar 

  6. YM Lee WL Law KW Chu RT Poon (2001) ArticleTitleEmergency surgery for obstructing colorectal cancers: a comparison between right-sided and left-sided lesions J Am Coll Surg 192 719–25 Occurrence Handle10.1016/S1072-7515(01)00833-X Occurrence Handle1:STN:280:DC%2BD3Mzjtlyisw%3D%3D Occurrence Handle11400965

    Article  CAS  PubMed  Google Scholar 

  7. TT Irvin MG Greaney (1977) ArticleTitleThe treatment of colonic cancer presenting with intestinal obstruction Br J Surg 64 741–4 Occurrence Handle1:STN:280:CSeD2c%2FpvFQ%3D Occurrence Handle922296

    CAS  PubMed  Google Scholar 

  8. GT Deans ZH Krukowski ST Irwin (1994) ArticleTitleMalignant obstruction of the left colon Br J Surg 81 1270–6 Occurrence Handle1:STN:280:ByqD2c7hvVQ%3D Occurrence Handle7953385

    CAS  PubMed  Google Scholar 

  9. V Naraynsingh R Rampaul A Maharaj T Kuruvilla K Ramcharan B Pouchet (1999) ArticleTitleProspective study of primary anastomosis without colonic lavage for patients with an obstructed left colon Br J Surg 86 1341–3 Occurrence Handle10.1046/j.1365-2168.1999.01230.x Occurrence Handle1:STN:280:DC%2BD3c%2FgvF2kug%3D%3D Occurrence Handle10540146

    Article  CAS  PubMed  Google Scholar 

  10. L Zorcolo L Covotta N Carlomagno DC Bartolo (2003) ArticleTitleSafety of primary anastomosis in emergency colo-rectal surgery Colorectal Dis 5 262–9 Occurrence Handle10.1046/j.1463-1318.2003.00432.x Occurrence Handle1:STN:280:DC%2BD3s3ls1KjtA%3D%3D Occurrence Handle12780890

    Article  CAS  PubMed  Google Scholar 

  11. J-P Arnaud R Bergamaschi (1994) ArticleTitleEmergency subtotal/total colectomy with anastomosis for acutely obstructed carcinoma of the left colon Dis Colon Rectum 37 685–8 Occurrence Handle1:STN:280:ByuB1MfktFw%3D Occurrence Handle8026235

    CAS  PubMed  Google Scholar 

  12. DR Timmermans AW Gooszen RH Geelkerken RA Tollenaar HG Gooszen (1997) ArticleTitleAnalysis of the variety in surgeon’s decision strategies for the management of the left colonic emergencies Med Care 35 701–13 Occurrence Handle10.1097/00005650-199707000-00004 Occurrence Handle1:STN:280:ByiA28zhslY%3D Occurrence Handle9219497

    Article  CAS  PubMed  Google Scholar 

  13. CA Akle (1998) ArticleTitleEndoprostheses for colonic strictures Br J Surg 85 310–4 Occurrence Handle10.1046/j.1365-2168.1998.00713.x Occurrence Handle1:STN:280:DyaK1c7ptVakug%3D%3D Occurrence Handle9529481

    Article  CAS  PubMed  Google Scholar 

  14. E Tejero R Fernández-Lobato A Mainar et al. (1997) ArticleTitleInitial results of a new procedure for treatment of malignant obstruction of the left colon Dis Colon Rectum 40 432–6 Occurrence Handle1:STN:280:ByiB28%2FlslU%3D Occurrence Handle9106691

    CAS  PubMed  Google Scholar 

  15. S Biondo E Jaurrieta R Jorba et al. (1997) ArticleTitleIntraoperative colonic lavage and primary anastomosis in peritonitis and obstruction Br J Surg 84 222–5 Occurrence Handle10.1046/j.1365-2168.1997.02497.x Occurrence Handle1:STN:280:ByiB3cvptlA%3D Occurrence Handle9052441

    Article  CAS  PubMed  Google Scholar 

  16. JR McGregor PJ O’Dwyer (1993) ArticleTitleThe surgical management of obstruction and perforation of the left colon Surg Gynecol Obstet 177 203–8 Occurrence Handle1:STN:280:ByyA2c3lvFM%3D Occurrence Handle8342105

    CAS  PubMed  Google Scholar 

  17. HC Umpleby RC Williamson (1984) ArticleTitleSurvival in acute obstructing colorectal carcinoma Dis Colon Rectum 27 299–304 Occurrence Handle1:STN:280:BiuC1c7pvFM%3D Occurrence Handle6714046

    CAS  PubMed  Google Scholar 

  18. JC Goligher (1984) Surgery of the anus, rectum and colon EditionNumber5th ed Balliere Tindall London

    Google Scholar 

  19. TE Madiba SR Thomson (2002) ArticleTitleThe management of cecal volvulus Dis Colon Rectum 45 264–7 Occurrence Handle10.1007/s10350-004-6158-4 Occurrence Handle1:STN:280:DC%2BD387hslSltw%3D%3D Occurrence Handle11852342

    Article  CAS  PubMed  Google Scholar 

  20. RK Phillips (2001) Colorectal surgery EditionNumber2nd ed WB Saunders Company London 53–87

    Google Scholar 

  21. TC Hsu (1998) ArticleTitleOne-stage resection and anastomosis for acute obstruction of the left colon Dis Colon Rectum 41 28–32

    Google Scholar 

  22. D Perez-Díaz F Turégano-Fuentes M Calvo-Serrano et al. (1999) ArticleTitleEmergency subtotal colectomy as treatment of choice in obstructing carcinomas of the left colon Colorectal Dis 1 15–8 Occurrence Handle10.1046/j.1463-1318.1999.00003.x

    Article  Google Scholar 

  23. F Glenn CK McSherry (1971) ArticleTitleObstruction and perforation in colorectal cancer Ann Surg 173 983–92 Occurrence Handle1:STN:280:CS6B3cvovFM%3D Occurrence Handle4102925

    CAS  PubMed  Google Scholar 

  24. PG Setti Carraro M Segala C Orlotti G Tiberio (1998) ArticleTitleOutcome of large-bowel perforation in patients with colorectal cancer Dis Colon Rectum 41 1421–6

    Google Scholar 

  25. DL Paul I Pinto LR Fernandez LC Montes (1999) ArticleTitlePalliative treatment of malignant colorectal strictures with metallic stents Cardiovasc Intervent Radiol 22 29–36 Occurrence Handle10.1007/s002709900325 Occurrence Handle9929542

    Article  PubMed  Google Scholar 

  26. R Fernandez Lobato I Pinto L Paul et al. (1999) ArticleTitleSelf-expanding prostheses as a palliative method in treating advanced colorectal cancer Int Surg 84 159–62 Occurrence Handle1:STN:280:DyaK1MzjsVOktg%3D%3D Occurrence Handle10408289

    CAS  PubMed  Google Scholar 

  27. R Bhardwaj MC Parker (2003) ArticleTitlePalliative therapy of colorectal carcinoma: stent or surgery? Colorectal Dis 5 518–21 Occurrence Handle10.1046/j.1463-1318.2003.00519.x Occurrence Handle1:STN:280:DC%2BD3szovVemtg%3D%3D Occurrence Handle12925093

    Article  CAS  PubMed  Google Scholar 

  28. WL Law KW Chu JW Ho HM Tung SY Law KM Chu (2000) ArticleTitleSelf-expanding metallic stent in the treatment of colonic obstruction caused by advanced malignancies Dis Colon Rectum 43 1522–7 Occurrence Handle1:STN:280:DC%2BD3M%2Fkt1Gjug%3D%3D Occurrence Handle11089586

    CAS  PubMed  Google Scholar 

  29. TL Raftery N Samson (1980) ArticleTitleCarcinoma of the colon: a clinical correlationship between presenting symptoms and survival Am Surg 4 600–6

    Google Scholar 

  30. S Biondo E Ramos M Deiros et al. (2000) ArticleTitlePrognostic factors for mortality in left colonic peritonitis: a new scoring system J Am Coll Surg 191 635–42 Occurrence Handle10.1016/S1072-7515(00)00758-4 Occurrence Handle1:STN:280:DC%2BD3M%2FosFemsg%3D%3D Occurrence Handle11129812

    Article  CAS  PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Surgery, Hospital Universitario de Bellvitge, University of Barcelona, Barcelona, Spain

    Sebastiano Biondo M.D., David Parés M.D., Ricardo Frago M.D., Joan Martí-Ragué M.D., Esther Kreisler M.D., Javier De Oca M.D. & Eduardo Jaurrieta M.D.

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  1. Sebastiano Biondo M.D.
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  2. David Parés M.D.
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  3. Ricardo Frago M.D.
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  4. Joan Martí-Ragué M.D.
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  5. Esther Kreisler M.D.
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  6. Javier De Oca M.D.
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  7. Eduardo Jaurrieta M.D.
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Correspondence to Sebastiano Biondo M.D..

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Biondo, S., Parés, D., Frago, R. et al. Large Bowel Obstruction: Predictive Factors for Postoperative Mortality. Dis Colon Rectum 47, 1889–1897 (2004). https://doi.org/10.1007/s10350-004-0688-7

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  • DOI: https://doi.org/10.1007/s10350-004-0688-7

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