Treatment of Obstructive Colorectal Cancer

ABSTRACT

The occurrence of the colonic obstruction secondary to colorectal carcinoma (CRC) has been reported in 7~30% of the CRC patients. It is generally believed that obstructive CRC is associated with a poor prognosis with respect to operative mortality and five-year survival. A series of 1064 cases of the CRC treated surgically at Asan Medical Center from June 1989 to December 1996 has been analyzed to compare clinicopathological findings between obstructive and non-obstructive CRC and to evaluate surgical treatment options in obstructive CRC. Complete obstruction was present in 49 cases (4.6%). There were no differences between obstructive and non-obstructive CRC in tumor location, size, Dukes' stage, and differentiation. In forty-nine obstructive CRC cases, primary resections were performed in 29 cases after peri-operative bowel decompression. In this group, right colon cancer was more prevalent than staged operation group (45% vs. 5%, P<0.05) and hospital stay was significantly short (16 days vs. 38 days, P<0.05). Postoperative complication rate was higher in staged operation group (65% vs. 28%, P=0.01). It may be due to stoma related wound complication. In obstructive left colon cancer, there was a significant difference in complication rate between primary resection and staged operation (P<0.05). Overall 5-year survival rate were 66% and 53% in non-obstructive and obstructive group, respectively. Survival rate according to the Dukes' B and C stages did not show statistical differences, either. Conclusively, primary resection is preferred to the obstructive CRC when supportive care, preoperative bowel decompression, and intraoperative colonic irrigation were performed adequately.