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[Surgical management of acute, malignant obstruction of the left colon with colostomy].
Acta Med Port. 1991 Sep-Oct; 4(5):257-62.AM

Abstract

One-stage subtotal colectomy of an acutely obstructed left colon would improve quality of life while shortening the length of hospitalization. Prohibitive mortality rates, however, are ascribed to such an approach. Analyzing the Senior Author's experience we compared the one-stage approach versus the multi-stage resections concerning operative mortality and morbidity rates and the duration of hospitalization. Forty-nine of 291 (17%) large bowel cancers presented acute left-sided obstruction requiring emergency surgery. Colostomy alone was performed in 18 (37%), multi-stage colectomy in 20 (41%, Group A) and one-stage subtotal colectomy in 11 (22%, Group B, all of them after 1979), the years under scrutiny being from 1973 through Sept. 1990. Both groups were comparable in age and sex distribution, TNM staging and ASA classification. Operative mortality and morbidity rates were 10% and 30% in Group A, 9% and 18% in Group B, respectively. The average length of hospitalization was 21.25 days (14-30) in Group A, 9.18 days (7-14) in Group B. Whenever an experienced surgical team is available and in the absence of contra-indications (local factors precluding a swift dissection, hemodynamic instability, gangrenous bowel) a one-stage subtotal colectomy, taking advantage of a better healing ileo-sigmoid or ileo-rectal anastomosis, carries acceptable mortality and morbidity rates while enhancing the quality of life and shortening the length of hospitalization. It should be considered the choice procedure, provided selection requirements and technical demands are met. An evaluation of the Senior Author's team experience (1973-90) in the management of acutely obstructing left colon cancer (49/291 or 17%) provides information on multi-stage resections and one-stage subtotal colectomy (Group A and B) as regards operative mortality (10% in Group A, 9% in Group B) as well as length of hospitalization (21 days in Group A, 9 days in Group B).(

ABSTRACT

TRUNCATED AT 250 WORDS)

Authors+Show Affiliations

Facuklade de Medicina de Lisboa, Hospital Universitário de Santa Maria.No affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

English Abstract
Journal Article

Language

por

PubMed ID

1785365

Citation

de Almeida, A M., et al. "[Surgical Management of Acute, Malignant Obstruction of the Left Colon With Colostomy]." Acta Medica Portuguesa, vol. 4, no. 5, 1991, pp. 257-62.
de Almeida AM, Gracias CW, dos Santos NM, et al. [Surgical management of acute, malignant obstruction of the left colon with colostomy]. Acta Med Port. 1991;4(5):257-62.
de Almeida, A. M., Gracias, C. W., dos Santos, N. M., & Aldeia, F. J. (1991). [Surgical management of acute, malignant obstruction of the left colon with colostomy]. Acta Medica Portuguesa, 4(5), 257-62.
de Almeida AM, et al. [Surgical Management of Acute, Malignant Obstruction of the Left Colon With Colostomy]. Acta Med Port. 1991 Sep-Oct;4(5):257-62. PubMed PMID: 1785365.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - [Surgical management of acute, malignant obstruction of the left colon with colostomy]. AU - de Almeida,A M, AU - Gracias,C W, AU - dos Santos,N M, AU - Aldeia,F J, PY - 1991/9/1/pubmed PY - 1991/9/1/medline PY - 1991/9/1/entrez SP - 257 EP - 62 JF - Acta medica portuguesa JO - Acta Med Port VL - 4 IS - 5 N2 - One-stage subtotal colectomy of an acutely obstructed left colon would improve quality of life while shortening the length of hospitalization. Prohibitive mortality rates, however, are ascribed to such an approach. Analyzing the Senior Author's experience we compared the one-stage approach versus the multi-stage resections concerning operative mortality and morbidity rates and the duration of hospitalization. Forty-nine of 291 (17%) large bowel cancers presented acute left-sided obstruction requiring emergency surgery. Colostomy alone was performed in 18 (37%), multi-stage colectomy in 20 (41%, Group A) and one-stage subtotal colectomy in 11 (22%, Group B, all of them after 1979), the years under scrutiny being from 1973 through Sept. 1990. Both groups were comparable in age and sex distribution, TNM staging and ASA classification. Operative mortality and morbidity rates were 10% and 30% in Group A, 9% and 18% in Group B, respectively. The average length of hospitalization was 21.25 days (14-30) in Group A, 9.18 days (7-14) in Group B. Whenever an experienced surgical team is available and in the absence of contra-indications (local factors precluding a swift dissection, hemodynamic instability, gangrenous bowel) a one-stage subtotal colectomy, taking advantage of a better healing ileo-sigmoid or ileo-rectal anastomosis, carries acceptable mortality and morbidity rates while enhancing the quality of life and shortening the length of hospitalization. It should be considered the choice procedure, provided selection requirements and technical demands are met. An evaluation of the Senior Author's team experience (1973-90) in the management of acutely obstructing left colon cancer (49/291 or 17%) provides information on multi-stage resections and one-stage subtotal colectomy (Group A and B) as regards operative mortality (10% in Group A, 9% in Group B) as well as length of hospitalization (21 days in Group A, 9 days in Group B).(ABSTRACT TRUNCATED AT 250 WORDS) SN - 0870-399X UR - https://www.unboundmedicine.com/medline/citation/1785365/[Surgical_management_of_acute_malignant_obstruction_of_the_left_colon_with_colostomy]_ L2 - http://www.actamedicaportuguesa.com/revista/index.php/amp/article/view/3366/2692 DB - PRIME DP - Unbound Medicine ER -