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Assessment of Colonic Anastomosis after Surgical Management of Obstructed Left Colonic Cancer Performing Primary Repair with or without Proximal Diversion

Saber Foda, Mohamed Alsharabasy, Osama Gharieb and Fady Fayek

Background: Up to 20% of patients with colorectal cancer present with obstruction. The goal of this study was to compare the short-term outcomes of patients with obstructing colon cancer who underwent resection and primary anastomosis with or without proximal diversion.

Objective: This study was carried out in Surgery Department of Zagazig University Hospitals from February 2000 to February 2018 to compare the on-table irrigation and primary anastomosis versus proximal diversion with loop proximal diversion.

Patients and methods: This study comprised 2525 patients who were divided into 2 groups: Group A included 2322 patients who have undergone on table lavage and primary anastomosis. Group B included 203 patients who have undergone primary anastomosis with proximal ileostomy. In our study, 1431 patients were males and 1094 patients were females. All patients were well prepared and investigated for selection of patients who can be operated. All patients were operated and discharged from the hospital and followed up in outpatient clinic of Zagazig University Hospitals, Surgery department.

Results: As regard the age, there was a highly significant difference in the age of the two groups (p=0.004) while there was no significance in the sex of the studied groups (p=0.61). As regard the tumor location there was no significance (p=0.298). The intraoperative time was increased in case of on table irrigation with a significant difference (p=0.001). There was also a significant difference in the postoperative hospital stay (p=0.001). There was no significance regarding the postoperative complications of the studied groups expect stoma complications in case of diversion (p=0.001).

Conclusion: On table colonic lavage and primary anastomosis is favored in surgical management of acute obstructed left sided colon cancer in low risk patients while in high risk older patients primary anastomosis with a covering stoma is preferred for fear of leakage and a covering loop ileostomy is preferred than loop colostomy.