Obstructive colorectal carcinoma. Principles and technique in 134 cases.
In order to define the influence of intestinal obstruction on therapy and prognosis of colorectal carcinoma, we analyzed retrospectively the records of 1756 patients with this type of malignancy (1966-1990). The incidence of obstruction was 8% among our patients (n = 134), 3% of which suffered perforation (n = 4). Operative mortality was 30% as compared to 7% after elective surgery. Curative resections could be performed in only 34%, while this was possible in 75% of non-obstructive cancers. 5-year survival dropped from 51% to 23% in cases with obstruction. The choice of operative procedure depends mostly on tumor localization. Tumor obstructions of the right colon benefit from primary resection, while this advantage could not be demonstrated for left-sided lesions. Still, we consider it in any case desirable to remove the malignancy during the initial operation. In recent years, the number of one-stage procedures has increased dramatically, while mortality was reduced.