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KMID : 1188520190150020106
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Korean Journal of Clinical Oncology
2019 Volume.15 No. 2 p.106 ~ p.111
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Safety of subtotal or total colectomy with primary anastomosis compared to Hartmann procedure for left-sided colon cancer obstruction or perforation
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Kim Eun-Do
Lee Jin-Kwon
Cho Jin-Kyu
Kim Jae-Myung
Park Ji-Ho
Kim Ju-Yeon
Jeong Sang-Ho
Ju Young-Tae
Jeong Chi-Young
Jung Eun-Jung
Lee Young-Joon
Hong Soon-Chan
Kwag Seung-Jin
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Abstract
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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.
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KEYWORD
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Subtotal colectomy, Anastomosis, Colonic neoplasms, Hartmann procedure
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