Korean J Clin Oncol.  2019 Dec;15(2):106-111. 10.14216/kjco.19019.

Safety of subtotal or total colectomy with primary anastomosis compared to Hartmann procedure for left-sided colon cancer obstruction or perforation

• Kim ED
• Lee JK
• Cho JK
• Kim JM
• Park JH
• Kim JY
• Jeong SH
• Ju YT
• Jeong CY
• Jung EJ
• Lee YJ
• Hong SC
• Kwag SJ

• KMID: 2470674
• DOI: http://doi.org/10.14216/kjco.19019

Abstract

PURPOSE
Whether subtotal or total colectomy with primary anastomosis (PA) is safer than Hartmann procedure (HP) for left-sided colon cancer obstruction or perforation remains controversial. The purpose of this study was to compare postoperative morbidity, mortality, and defecation frequency between PA and HP for left-sided colon cancer obstruction or perforation.
METHODS
This retrospective study enrolled 54 patients from January 2014 to February 2018 who underwent emergency surgery due to left-sided colon cancer obstruction or perforation.
RESULTS
PA was carried out in 20 patients while HP was performed for 34 patients. Thirty-day mortality did not show significant difference between the two groups (15.0% vs. 14.7%, P=1.000). No anastomotic leakage occurred in PA group while three (8.8%) cases of stump leakage occurred in HP group. Stoma repair was performed for 13 cases (44.8%) and stoma reformation was performed for one case in HP group (7.7%). Stoma related complications occurred in five cases (17.24%). For patients after stoma repair, defecation frequency at 3 months after operation was 2.91±2.88 times per day in PA group and 2.86±2.63 times per day in HP group. At 1 year after operation, defecation frequency was changed to 1.40±1.12 times per day in PA group and 1.17±0.39 times per day in HP group.
CONCLUSION
Primary ileosigmoid or ileorectal anastomosis for left-sided colon cancer obstruction or perforation is safe, and shows similar outcome of defecation frequency compared to HP.

Keyword

Subtotal colectomy; Anastomosis; Colonic neoplasms; Hartmann procedure

MeSH Terms

Anastomotic Leak
Colectomy*
Colon*
Colonic Neoplasms*
Defecation
Emergencies
Humans
Mortality
Retrospective Studies