Comparison of One Stage Operation with Staged Operation in Malignant Obstruction of the Left Colon and Rectum

ABSTRACT

BACKGROUND: The optimal management of malignant obstruction of the left colon and rectum is controversial. METHODS: A retrospective study was performed of 33 patients who underwent one-stage operation(n=11), staged operation(n=20), and palliative colostomy(n=2) at Kwangju Christian Hospital between January 1992 and December 1996. RESULTS: Eleven patients underwent one-stage operations(7 cases with anterior resection, 3 cases with left hemicolectomy, 1 case with Miles' operation). In this group, postoperative morbidity was 36.3% including 1 wound infection(9.0%), 1 anastomotic leakage (9.0%), 1 postoperative intestinal obstruction and 1 pulmonary complication, but there was no postoperative death. The average of hospital stay in this group was 18.1 days and the first day of normal diet was 6.0 days. Twenty patients underwent staged operations including 12 cases of Hartmann's procedure. In this group, postoperative morbidity was 35.0% including 3 wound infections(15.0%), 2 pulmonary complications(10.0%), 1 parastomal hernia and 1 fistula. There were two postoperative deaths as a result of sepsis. The average of hospital stay in this group was 34.9 days and the first day of normal diet was 6.8 days. CONCLUSION: We believe that one-stage operation was of value in management of malignant obstruction of the left colon and rectum in selected patients.