Staged surgery after colonic decompression may be safer for the treatment of obstructive left-sided colorectal cancer in a non-specialized hospital

Abstract

Background/aims: The management for the obstructive left sided colorectal cancer is still controversial.

Methodology: A retrospective study was performed on 249 consecutive patients who underwent surgical intervention for left sided colorectal cancer in our hospital. Among 36 patients who had colonic obstruction, 25 patients received tumor resection while the rest of the patients received palliative stoma creation. Clinical characteristics and outcome following tumor resection was compared between patients with and without colonic obstruction.

Results: Prior to tumor resection, all patients received colonic decompression. Flowingly, 20 patients received staged surgeries and five patients underwent one stage surgery, with three of the latter requiring reoperation due to anastomotic leakage. The five-year overall survival rate for patients following tumor resection was 75.5 % and 69.1 % for those with and without colonic obstruction respectively. Log-rank test showed no significant difference in overall survival between the two groups (p = 0.91).

Conclusions: Onestage surgery for patients with obstructive colorectal cancer in our hospital was associated with frequent anastomotic leakage. Colonic obstruction itself may not be a poor prognostic factor when decompression preceded surgical resection.