Primary resection with antegrade colonic irrigation and peritoneal lavage versus subtotal colectomy in the management of obstructed left colon cancer

Between 1980 and 1996 122 patients with acutely obstructed resectable carcinomas of the colon and rectum were treated in our hospital. Ninety-four has undergone one stage operation of immediate resection and primary anastomosis without proximal colostomy. Intraoperative colonic irrigation was performed in 34 patients, subtotal/total colectomy in 30 patients, right hemicolectomy in 30 patients. There were 2.3 and 1 operative deaths, respectively. The average hospital stay for the survivors was 19.8 days in the primary resection and anastomosis group, and 41.0 days in staged operation group. Concerning the possibility of multiple lesions the authors recommend subtotal/total colectomy except for tumours localized in the sigma where they apply total colectomy only when the proximal part of the colon is necrotized or filled with solid stool.