대한대장항문학회

Differential surgical procedures have been described on the treatment of patients with<br>obstructing carcinoma of the left colon and rectum, and these vary from classical three<br>stage approach to primary resection and anastomosis using intraoperative colonic<br>irrigation or subtotal colectomy. Staged colonic prcedures are associated with significant<br>morbidity and mortality eventhough its initial easy performance, and many patients, unfit<br>for further surgery, are left with a permanent colostomy.<br>We have already reported the initial results of intraoperative antegrade colonic<br>irrigation for one-stage operation in obstructing left colorectal cancers. In this<br>investigation, we evaluated the results of prospective trials of primary resection and<br>anastomosis using intraoperative colon irrigation and subtotal colectomy in obstructing<br>left colon and rectal carcinomas.<br>During recent five years, 19 cases of obstructing left colon and rectal carcinomas<br>which could not received regular colon preparation due to marked abdominal distension<br>were enrolled to this study.<br>There were 12 men and 7 women, and mean age was 61. 14 of the 19 patients which<br>tumors located below mid-descending colon were subjected to primary resection and<br>anastomosis using intraoperative antegrade colonic irrigation, 4 patients which tumors<br>located above the mid-descending colon were treated with subtotal colectomy,<br>and<br>remaining one patient which tumor located upper rectum was performed subtotal<br>coloectomy because of underlying colonic ischemia. There was no mortality and<br>significant postoperative complications such as anastomotic lealrage, pelvic abscess or<br>intraabdominal sepsis which seemed to be related with anastomotic<br>dehiscence.<br>Therefore, primary resection and anastomosis using intraoperative colonic irrigation or<br>subtotal colectomy depending on tumor locations in cases of obstructing left colon and<br>rectal carcinomas might be useful methods to obtain safe one-stage restorative colorectal<br>resections.<br>