Evaluation of primary restorative colectomy in malignant left-sided colonic obstruction with intra‌operative colonic decompression followed by post‌operative adjuvant chemotherapy

There has been a trend towards one stage resection and anastomosis in obstructed left colonic cancer even in the elderly with on-table colonic lavage. The aim of this work was to evaluate the outcome in twenty two patients with obstructed left colonic cancer at or distal to splenic flexure managed by primary restorative colectomy using intra-operative colonic decompression. It was done on 22 patients at Emergency Hospital, Mansoura University from Augest 1994 to December 1996. Intra-operative colonic decompression was done on a thirty-six Fr multiperforated Nelaton tube before division of mesentery followed by radical left hemicolectomy. Anastemotic leakage occurred in one patient who died (mortality rate 4.5%). Mean time of colonic decompression was 21±3.4 minutes. Wound infection occurred in (13.6%), chest infection in (4.5%) and paralytic ileus in (4.5%). Post-operative adjuvant chemotherapy consisting of 6 courses of 5- fluorouracil (5-FU) and leucovorin (LV) was given. Primary resection and anastomosis of left colonic cancer can be achieved by colonic decompression before division of the mesentery avoiding spillage of colonic contents, improving blood supply and the tone of the colon ensuring safe and rapid anastomosis with low morbidity and mortality. The 5-year DFS and OS rates for the, whole of our group, were 42.9% and 52.4% respectively. They were related to the Dukes stage, as for Dukes' B the DFS and OS rates at 5-years were 66.7% and 83.3% respectively, while for Dukes' C patients, they were 45.5% and 54.6% respectively. For Dukes' D patients, the 2-year OS was 20% with non of the patients was alive at 5-years.