[Subtotal colectomy for the treatment of obstructive left colon cancer. Follow-up results]

Abstract

Aim: Subtotal colectomy (STC) involves an extended resection of the large bowel over the splenic flexure. In a period of 8 years, a total of 72 subtotal colectomies (STC) were performed for the treatment of large bowel obstructions or symptomatic stenosis caused by cancer of the left colon. A primary ileocolic latero-terminal anastomosis was made in each case. The aim of study was to evaluate the late results of procedure.

Patients and methods: In a non-prospective, non-randomized study of 23 of the total of 72 STC cases, authors investigated the postoperative quality of life, the changes in the intestinal bacterial flora, and signs of a nutritional deficiency or of an accelerated bowel transit.

Methods: 1) H2 excretion test, 2) UDCA-PABA and 3) Schilling test for contaminated small bowel syndrome and bowel transit time, studied by means of a 4) barium meal and 5) radiopaque marker passage, and 6) registration of the number of defecations/day.

Results: The laboratory findings were in the normal range in each case. The daily number of defecations gradually decreased during the 3 months after the operation (mean 1.9/day). The lack of an ileocoecal valve did not result in bacterial overgrowth in the small bowel and the investigations did not reveal contaminated bowel syndrome. The oro-anal transit time was reduced in only four cases. Three months postoperatively, no patient had a deteriorated quality of life.

Conclusions: STC offers 1) one-stage treatment for colonic obstruction in emergency surgery, 2) tumour removal with sufficient oncological radicality, and 3) primary reconstruction of the digestive tract, with a safe ileocolic anastomosis even in emergency cases. The follow-up study of 23 of the patients proved that loss of 60-80% of the colon did not cause any symptomatic disturbance of the digestive functions. The quality of life after surgery was normal, the slightly increased number (mean 1.9) of daily defecations was acceptable, and bacterial colonization of the small bowel did not occur.