Emergency treatment strategy analysis of acute intestinal obstruction induced by left colorectal cancer / 中国基层医药

Objective To evaluate the emergency treatment strategy of acute intestinal obstruction induced by left colorectal cancer.Methods 50 patients with acute intestinal obstruction caused by left colorectal cancer were selected as the research subjects .The clinical data were retrospectively analyzed .Results Of 50 patients,6 cases of postoperative incision infection occurred in phase I excision anastomosis surgery ,no anastomotic fistula.21 cases received ileus tube decompression and phase I excision anastomosis of incision ,there were no postoperative complica-tions.50 patients recovered after surgery , no patients died in the follow-up.Conclusion For acute intestinal obstruction caused by left half colon cancer ,the method ofⅠ resection and heal surgery is the most safe ,and can be used as the preferred way to make a diagnosis and treatment ,but for patients can't tolerance emergency surgery,need the help of colonoscopy,through anal insertion catheter colon decompression and lavage and clean the dirt .

Comparative Study of Postoperative Complications in Patients With and Without an Obstruction Who Had Left-Sided Colorectal Cancer and Underwent a Single-Stage Operation After Mechanical Bowel Preparation

PURPOSE: The purpose of this study is to compare postoperative complications for single-stage surgery after mechanical bowel preparation in patients who experienced obstruction and those who did not. METHODS: From 2000 to 2011, 1,224 patients underwent a single-stage operation for left colorectal cancer after bowel preparation. Nonobstruction (NOB) and obstruction (OB) colorectal cancer patients were 1,053 (86.0%) and 171 (14.0%), respectively. Postoperative morbidity and mortality were compared between groups. RESULTS: The OB group had poor preoperative conditions (age, white blood cell, hemoglobin, albumin level, and advanced tumor stage) compared with the NOB group (P < 0.05). Mean on-table lavage time for the OB group was 17.5 minutes (range, 14-60 minutes). Mean operation time for the OB group was statistically longer than that of the NOB group (OB: 210 minutes; range, 120-480 minutes vs. NOB: 180 minutes; range, 60-420 minutes; P < 0.001). Overall morbidity was similar between groups (NOB: 19.7% vs. OB: 23.4%, P = 0.259). Major morbidity was more common in the OB group than in the NOB group, but the difference was without significance (OB: 11.7% vs. NOB: 7.6%, P = 0.070). Postoperative death occurred in 16 patients (1.3%), and death in the OB group (n = 7) was significantly higher than it was in the NOB group (n = 9) (4.1% vs. 0.9%, P = 0.001). Twelve patients had surgical complications, which were the leading cause of postoperative death: postoperative bleeding in five patients and leakage in seven patients. CONCLUSION: Postoperative morbidity for a single-stage operation for obstructive left colorectal cancer is comparable to that for NOB, regardless of poor conditions of the patient.

The Characteristics and Prognosis of Patients with Obstructing Carcinoma of the Left Colon and Rectum: A Case-Control Study

PURPOSE: Many reports have described significantly lower survival rates for patients with obstructing colorectal cancer than for patients with non-obstructing colorectal cancer. The aim of this retrospective study was to assess the long-term prognosis of patients with obstructing carcinomas of the left colon and rectum and to identify the clinical and pathologic characteristics that affect the prognosis. METHODS: From June 1996 to October 2003, 46 patients with obstructing left colon and rectal cancer underwent curative surgery (case group), and from the patients with non- obstructing left colon and rectal cancer who had curative surgery, 48 patients with clinicopathologic characteristics similar to those of the case group were selected and matched as a control group. A comparative analysis of demographic, clinical, and pathologic characteristics, the recurrence rate, and the long-term survival rate between these two groups was done. RESULTS: Emergency operations were done more frequently for obstructing cancer than for non-obstructing cancer (P=0.0001), and more patients with obstructing cancer presented to non-specialists (P=0.0001). The overall recurrence rate was significantly higher in obstructing cancer patients than in non-obstructing cancer patients. Further, the 5-year overall and the disease-free survival rates were significantly lower in obstructing cancer patients when examining either overall patient outcome or stage-III patients outcome. CONCLUSIONS: The long-term prognosis of patients with obstructing carcinomas of the left colon and rectum is poor. We suggest that the poor general condition of patients with obstructing cancer, the increased number of emergency operations involving those patients, and more patients with obstructing cancer presenting to non-specialists may contribute to poor long-term prognosis for obstructing cancer patients.