Brief Article
Copyright ©2012 Baishideng Publishing Group Co., Limited. All rights reserved.
World J Gastroenterol. Jul 7, 2012; 18(25): 3267-3271
Published online Jul 7, 2012. doi: 10.3748/wjg.v18.i25.3267
Two-stage resection for malignant colonic obstructions: The timing of early resection and possible predictive factors
Hsiang-Yu Yang, Chang-Chieh Wu, Shu-Wen Jao, Kuo-Feng Hsu, Chen-Ming Mai, Kevin Cheng-Wen Hsiao
Hsiang-Yu Yang, Chang-Chieh Wu, Shu-Wen Jao, Kuo-Feng Hsu, Chen-Ming Mai, Kevin Cheng-Wen Hsiao, Division of Colon and Rectal Surgery, Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei 114, Taiwan, China
Author contributions: Yang HY and Hsiao KCW designed the research; Yang HY, Wu CC and Jao SW performed the research; Hsu KF and Mai CM contributed analytic tools; Yang HY and Hsiao KCW wrote the paper.
Correspondence to: Kevin Cheng-Wen Hsiao, MD, Division of Colon and Rectal Surgery, Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, No. 325, Sec. 2, Chenggong Rd., Neihu District, Taipei 114, Taiwan, China. dr.hsiao@msa.hinet.net
Telephone: +886-2-87923311 Fax: +886-2-87927376
Received: August 27, 2011
Revised: April 14, 2012
Accepted: May 12, 2012
Published online: July 7, 2012
Abstract

AIM: To study potential predictive factors for early radical resection in two-stage resection for left malignant colonic obstruction.

METHODS: Thirty-eight cases of left-sided obstructive colon cancer undergoing two-stage operations were reviewed between January 1998 and August 2008. Patients were classified into two groups (n = 19 each): early radical resection (interval ≤ 10 d) and late radical resection (interval > 10 d). Baseline demographics, post-diversion outcome, perioperative data, tumor characteristics, outcome and complications were analyzed.

RESULTS: The baseline demographics revealed no differences except for less pre-diversion sepsis in the early group (P < 0.001) and more obstruction days in the late group (P = 0.009). The mean intervals of early and late radical resections were 7.9 ± 1.3 d and 17.8 ± 5.5 d, respectively (P < 0.001). After diversion, the presence of bowel sounds, flatus, removal of the nasogastric tube and the resumption of oral feeding occurred earlier in the early group. The operation time and duration of hospital stay were both significant reduced in the early group. Complication rates did not differ between groups.

CONCLUSION: The earlier recovery of bowel function seems to be predictive of early radical resection. In contrast, pre-diversion sepsis and more obstruction days were predictive of delayed radical resection.

Keywords: Colorectal cancer; Colostomy; Diversion; Obstruction; Two-stage resection