Comparison of Clinical Differences between Colonic Obstruction and Non-obstruction Groups in Colon Surgery

ABSTRACT

PURPOSE: The purpose for this study is to compare the clinical differences of the two groups (ie. colonic obstruction and non-obstruction) in colonic surgery. METHODS: A retrospective clinical analysis was done in 149 patients with colorectal disease who had been surgically treated from January 1995 to December 1997 at our institution. RESULTS: 1) The peak age of incidence was in the 7th. and 8th. decades (53.3%)in the obstruction group and 6th. and 7th. decades (54.3%) in the non-obstruction group, the sex ratio of male to female was higher in the obstruction group (2.001) than in the non-obstruction group (1.041). 2) The most common cause of colonic obstruction was malignant disease in both groups (75.4% in the obstruction group and 78.3% in the non-obstruction group). 3) The most frequent symptom and sign of the two groups were abdominal pain (36.8% and 2.6% respectively). 4) The most common location was cecum (24.6%) followed by sigmoid colon (22.8%) and rectum (15.8%) in the obstruction group, and rectum (40.2%) followed by ascending colon (15.2%), cecum (13.0%), and transverse colon (13.1 %) in the non obstruction group. 5) The right hemicolectomy was the most common procedure in the obstruction group (29.8%) while abdominoperineal resection was most frequently performed in the non-obstruction group (23.9 %). The surgical resection rate was 77.4% and 100% in obstruction group and non-obstruction group, respectively. 6) In the case of colon cancer, the stage of cancer (according to Modified Astler-Coller classification) was much higher in the obstruction group. An average 6.5 metastatic lymph nodes were found from 18.5 dissected lymph nodes in the obstruction group whereas 2.7 out of 13.9 lymph nodes in the non-obstruction group. 7) The postoperative complication rate of obstruction group were 21.4% whereas that of non-obstruction group were 15.0% respectively. The postoperative mortality rate was 14% in the obstruction group and 3.3% in the non-obstruction group. The complication rate and postoperative mortality of the obstruction group was higher than those of the non-obstruction group, especially in the malignant disesae group. CONCLUSIONS: The results of our study indicate that the obstruction group has a different clinical course from the non- obstruction group and associated higher postoperative complication and mortality rate.