Hongming Li, Jin Wan. Guandong Provincial Hospital of TCM
Background: The management of malignant colorectal obstruction remains controversial. A 2-stage approach such as the Hartmann procedure with colostomy, or primary resection and anastomosis with protective ileostomy is the traditional approach for the acute open surgery. The purpose of this study was to investigate the clinical advantages of damage control surgery to treat colorectal cancer (CRC) patients with acute colorectal obstruction.
Methods: From April 2010 to September 2017, 110 consecutive patients with colorectal carcinoma with acute colonic obstruction underwent self-expandable metallic stent (SEMS) placement followed by one-stage laparoscopic resection according to the principle of damage control surgery. The data obtained from a prospectively established database were analyzed retrospectively.
Results: The mean interval between stenting and surgery was 9.6 day (range, 5-14day). All procedures were successful without any serious intraoperative complications. 1.8% (2 cases) of patients were converted to open surgery due to the local extension of cancer with infiltrations of surrounding structures (urinary bladder in 1 cases, and iliac vessels in the other). One resection (0.9%) was performed by open surgery due to the high ASA score. The mean operation time was 135.3 min (range, 100-150), and the mean blood loss was 61.3 ml (range, 50-180). The mean Bowel function recovery time was 2.7day (range, 2-4day). One terminal stomy and one ileostomy (in a total colectomy) were performed. In the other 108 cases, we performed one-stage bowel anastomosis at the same time as resection, employing a temporary ileostomy only in 3 cases(2.8%).No postoperative complications were observed.
CONCLUSIONS: The findings indicate that damage control surgery to treat colorectal malignant obstruction is a feasible and safe.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 87647
Program Number: S070
Presentation Session: Acute Care Session
Presentation Type: Podium