대한대장항문학회

Purpose: Although staged operations have been thought a main treatment for obstructive<br>left colon cancer, their disadvantages make one-stage operations popular. We tried to<br>identify technical feasibility and oncologic safety of one-stage operation with<br>intra-operative lavage (IOL) for the treatment of obstructive left colon and rectal cancer.<br>Methods: From June 1996 to May 1999, of 456 colorectal cancer patients, 25 with<br>obstructive left colon or rectal cancer underwent surgery. In 18 of those, we intended to do<br>a one-stage operation with IOL. Male (n=14) were predominant to female (n=4). Mean age<br>was 61.2 (29∼78) years. Lesions were located on the sigmoid colon in 8, rectum in 4,<br>descending in 3, and rectosigmoid junction in 3 cases.<br>Operative technique: Lymphovascular division was initiated at the origin of IMA followed<br>by mobilization of the left colon up to the splenic flexure and distal transverse colon.<br>Thereafter antegrade irrigation of the proximal colon with warm normal saline was done by<br>using a corrugated tube. Anastomoses were made by hand or stapler in end-to-end or<br>side-to-end fashion.<br>Results: Mean operative time was 221 (185∼360) min. No significant post-operative<br>complications occurred except for two wound infections and one pulmonary atelectasis.<br>There was one unexpected conversion to Hartmann's procedure due to intra-operative fecal<br>soilage during the lavage. Within 18 months follow-up period, 4 recurrences occurred with<br>two of them expiring.<br>Conclusions: One-stage operation for the treatment of obstructive left colon cancer with<br>IOL could avoid colostomy or reoperation, and, was technically feasible, safe, and<br>oncologically acceptable.<br>