Radical surgical approach to radiation injury of the small bowel

During a period of 12 years, 52 patients without tumor recurrence were treated for chronic radiation injury to the small bowel. Eighteen patients also had concomitant large bowel injuries. Forty-seven patients were treated surgically, 42 of whom presented with obstruction, necrosis, or perforation of the bowel and had emergency operations. Thirty-eight patients underwent wide resection of the injured bowel, and six had bypass procedures. Anastomotic leakage occurred in 6 percent of the patients. The operative morbidity rate was 34 percent, and the mortality rate, 9 percent. Based on this experience, when surgery for small intestinal radiation injury is mandatory, the procedure should be a generous small bowel resection whenever possible, and probably should be performed only by experienced surgeons.     

Large bowel perforation: morbidity and mortality

Perforations of large bowel are rare but severe complications, mainly of colorectal cancer and colonic diverticulitis. The choice of the surgical procedure is still debated. We retrospectively studied peritonitis caused by large bowel perforation to assess predictors of mortality and safety of primary resection and anastomosis. We investigated 59 patients with large bowel perforation treated surgically as emergency cases: 18 patients underwent primary resection and anastomosis, 36 had primary resection of the diseased part of bowel without anastomosis, and 5 patients had non-resective procedures. The severity of peritonitis was assessed using Hinchey's classification and the Mannheim peritonitis index (MPI). Overall mortality was 16.9%. MPI score was significantly lower for survivors vs. non-survivors, and for patients with resection and anastomosis vs. those who underwent resection without anastomosis (p<0.001). The mortality rate was 11.1% for primary resection with anastomosis, and 22.2% for primary resection without anastomosis. No patient with MPI less than 25 died, while 10 (38.5%) of the patients with MPI of 26–36 died. In conclusion, a radical aggressive approach is recommended for most patients with large bowel perforation. Mortality and morbidity are closely related to the extent of intraperitoneal infection and the incidence of postoperative complications is higher in patients with perforation due to non-malignant causes. Received: 20 September 2002 / Accepted: 30 October 2002     

Emergency one-stage surgery for obstructing left-sided colorectal carcinomas

A one-stage operation for obstructing left-sided colorectal carcinoma remains controversial. This study was performed to compare our surgical management of patients with left-sided colorectal cancer (at or distal to splenic flexure) obstruction presenting to the Kaohsiung Medical University Hospital from January 1995 to December 2000. Ninety-six patients underwent immediate operation within 24 hours of admission. Of these, 73 patients (76%) who underwent immediate tumor resection and anastomosis in one stage after appropriate resuscitation were enrolled into our study. In one-stage operation subtotal coloectomy with ileocolic or ileorectal anastomosis (group 1) was performed in 46 patients (63%), and intraoperative bowel preparation followed by immediate resection (group 2) was undertaken in 27 patients (37%). In comparing the two groups, there was no significant difference in the postoperative mortality (8.7% in group 1 vs. 7.4% in group 2) or cumulative 5-year survival rate (36.7% in group 1 vs. 35.7% in group 2) (all p > 0.05). However, mean operation time (178 +/- 12 min in group 1 vs. 238 +/- 12 min in group 2) and postoperative wound infection rate were significantly lower (10.9% in group 1 vs. 29.6% in group 2). The incidence of postoperative diarrhea was more prominent in the group 1 than group 2 (32.6% in group 1 vs. 11.1% in group 2) (all p < 0.05). The results of our current study showed that primary resection and anastomosis by subtotal colectomy is an acceptable means for the treatment of patients with obstructing left-sided colorectal carcinomas when the patient's condition is feasible.     

Modification of end-loop ileostomy for the treatment of ischemic or radiation enteritis

AIM： To evaluate a new technique of temporary ileal anastomotic stoma, following small bowel resection, in patients where the anastomosis is anticipated to have borderline margins with dubious viability. METHODS： Five patients underwent enterectomy and partially anastomosed end-loop ileostomy at the University Hospital of Larissa between 2000 and 2006. Enterectomy was performed because of conditions such as mesenteric vascular occlusive disease, radiation entritis and small bowel injury. RESULTS： Postoperatively, none of the patients developed any stoma-related or anastomotic complications. There were no major complications. All patients were discharged between the 8th and 15th day after the procedure, and the stoma was closed 3 wk to 4 wk later. CONCLUSION： We believe that our proposed modification of end-loop ileostomy is a simple, quick and safe technique with minimal stoma-related morbidity, and with simple and safe reversion. This technique can be considered as a useful option in the treatment of ischemic or radiation-induced enteritis, and in the management of severe intestinal trauma.     

Complications requiring reoperation following pancreatectomy

Summary Conclusions In this series, the overall reoperative rate following pancreatic surgery is 9%. Complications following pancreatectomy that require reoperation fall into four categories: hemorrhage, infectous, delayed gastric emptying, and anastomotic leak. A delay in the management of these types of complications can be fatal. Background Despite the improvement in the morbidity and mortality rates associated with pancreatic resection, complications still arise that require surgical intervention. This study reviews the pancreatic surgical experience at a major medical center to determine the overall reoperative complication rate. Study Design From 1985 to 1995, 107 patients underwent pancreatic resection. There were 50 pancreaticoduodenectomies, 20 total pancreatectomies, and 37 distal pancreatectomies for 102 periampullary or pancreatic cancers and five for chronic pancreatitis. The operative mortality rate was 6.5% and the morbidity rate was 43%. Ten patients (9%) developed complications that required reoperation. Results Re-exploration was performed in five patients for hemorrhage. Four patients had bleeding intra-abdominally and one had a suture line bleed. One patient developed a wound infection and fascial necrosis which necessitated reoperation. Three patients were explored for sepsis and one was found to have a pancreatic leak. One patient had persistent gastric outlet obstruction and he required conversion of the gastrojejunostomy to a Roux-en-y anastomosis. The mortality rate for re-exploration was 3/10 (30%).     

Surgical aspects of radiation enteritis of the small bowel

Injury to the small bowel is one of the tragic complications of radiotherapy. We performed a retrospective analysis of patients operated upon for stenosis, perforation, fistulization, and chronic blood loss of the small bowel after radiotherapy for multiple malignant diseases. In the period 1970 to 1982 in the Department of General Surgery of the St. Radboud University Hospital, Nijmegen, and the Department of Surgical Oncology of the State University, Groningen, 27 patients were treated surgically. Twenty patients presented with obstruction. In 17 patients a side-to-side ileotransversostomy was performed; in three the injured bowel was resected. Of the five patients with fistulization, three underwent a bypass procedure; in two cases the affected bowel was resected. In one patient with perforation, a resection was performed, as in a patient with chronic blood loss. Two of the 20 patients (10 per cent) in whom the diseased bowel was bypassed died postoperatively. Of the seven patients whose affected bowel was resected four (57 per cent) died of intra-abdominal sepsis. Management of the patient with chronic radiation enteritis is discussed. We conclude, on the basis of our experience, that in patients with obstruction and fistulization, a bypass procedure of the affected bowel is a safe method of treatment. In case of resection, the anastomosis should be performed during a second operation.     

Surgical treatment of left colon malignant emergencies. A new tool for operative risk evaluation

BACKGROUND/AIMS: The surgical treatment of left colon and rectal cancer emergencies is still controversial. In our opinion the choice is to be based on the general health status of each patient. METHODOLOGY: We retrospectively analyzed our series of 57 patients who underwent immediate resection and anastomosis. RESULTS: Factors significantly related to short-term results were chronic renal failure, heart disease, low albumin serum levels and colonic perforation. The presence of a diverting colostomy did not result in being a protective factor toward anastomotic dehiscence. We constructed a Colorectal Tumors Emergencies Score made of the identified four factors in which the score of each factor is the approximated odds ratio (chronic renal failure 7 points, low albumin serum levels 6 points, heart disease 5 points, colon perforation 4 points). Each patient was classified as Low Risk (CTES < 4), Moderate Risk (CTES 4-12) and High Risk (CTES > 12), mortality and morbidity being 4.3% and 21.7%, 24.0% and 60.0%, 88.9% and 88.9%, respectively. CONCLUSIONS: High-risk patients may undergo a staged procedure. Moderate risk patient may be treated by immediate resection of the tumor, without anastomosis. Immediate resection and anastomosis may be reserved to low-risk patients.     

Surgical management of intestinal radiation injury

The management of 14 cases of radiation injury to the intestinal tract over a 4-year period is evaluated. The longest latent interval between radiation treatment and symptoms was 30 years. Eight patients were treated surgically; six were treated conservatively by laser therapy or application of formalin to the affected mucosa. The indications for surgery were rectovaginal fistula (four), rectal stricture (one), radiation proctitis (eight), and small bowel obstruction (one). Seven patients underwent large bowel resection. These consisted of four anastomoses with coloanal J-reservoirs, two low anterior resections, and one coloanal anastomosis without reservoir. There was no perioperative mortality. Morbidity occurred in one of the eight surgical cases. Radical resection of the radiation-damaged rectum has been shown to be a safe and reliable treatment for rectovaginal fistulas, rectal strictures, and proctitis unresponsive to medical measures. Coloanal J-reservoir is the procedure of choice to avoid urgency and frequency symptoms associated with coloanal sleeve anastomosis. Laser therapy for hemorrhagic proctitis can achieve an important place in the management of this problem without recourse to surgery.     

Management of obstructed left colon carcinoma

BACKGROUND/AIMS: The treatment of acutely obstructed carcinoma of the left colon still represents a matter of controversy. The aim of this retrospective study is to review the results of three surgical procedures used in our department of Visceral Surgery (subtotal colectomy, segmental resection following intraoperative irrigation, and Hartman's procedure) and to determine if there were advantages of one technique over the other. METHODOLOGY: Ninety-three patients with acute left colonic obstruction were treated by subtotal/total colectomy (n=38), segmental resection following intraoperative irrigation (n=39), and Hartman's procedure (n=16). We assessed immediate postoperative results (mortality and morbidity rates, reoperation rate and hospital stay. RESULTS: The overall mortality and morbidity rates were respectively 13% (n=12) and 30.1% (n=28). The mortality rate was 13% (n=5) in the subtotal colectomy group, 7.7% (n=3) in the intraoperative colonic irrigation and 25% (n=4) in the Hartman's procedure group. The morbidity rates were similar after subtotal or segmental resection (7.9% vs. 10.2%), bowel movements were more frequent after subtotal colectomy (range 1-5 day) than segmental colectomy (range: 1-2 per day). CONCLUSIONS: Segmental resection following intraoperative irrigation is the preferred treatment for left sided malignant colonic obstruction. Subtotal colectomy is recommended for patients with ischemic lesions and serosal tears on the cecum, and when there is a synchronous neoplasm in the proximal colon.     

Acute mesenteric ischaemia, a highly lethal disease with a devastating outcome

BACKGROUND: Acute mesenteric ischaemia remains a serious condition requiring emergency, surgical management. The mortality rate still remains high, due to the unspecific and delayed diagnosis and ranges from 59% to 100%. Purpose of our study is to present our experience in the management of the disease. PATIENTS AND METHODS: This is a retrospective study of 61 patients treated surgically for acute mesenteric ischaemia, between 1988 and 2004. All patients underwent a laparotomy. 75% of the patients were operated within the first 24 hours and the rest within 48 hours. RESULTS: Superior mesenteric artery embolism occurred in 36 (59%), thrombosis in 21 (34%) and superior mesenteric vein thrombosis in 4 (7%) cases. In 49 (80%) cases, embolectomy or thrombectomy of the superior mesenteric artery with resection of the necrotic segment of the bowel was performed. Twelve cases (20%) were considered inoperable because of massive bowel necrosis. According to our study mortality and morbidity rate amounts to 75% and 80% respectively. No significant difference in the mortality rate between patients with embolism (75%) and thrombosis (76%) was found. However a significant increase of mortality rate was observed when the surgical intervention became afterwards the first 24-hour period. (72% versus 87%). Patients who underwent embolectomy or thrombectomy with bowel resection presented an improved survival rate compared with patients that underwent only bowel resection. (p = 0.019) CONCLUSIONS: Acute mesenteric ischaemia has the characteristics of a highly lethal condition and only early recognition and appropriate treatment can reduce the potential for a devastating outcome. The reduction of time interval from the beginning of symptoms up to the treatment remains the main critical important factor.     

Detection of mechanisms of immediate failure by transesophageal echocardiography in quadrangular resection mitral valve repair technique for severe mitral regurgitation

Residual mitral regurgitation (MR) after repair is a risk factor for late reoperation. The use of intraoperative transesophageal echocardiography (IOTEE) decreases the incidence of immediate repair failure. This study identifies the mechanisms of immediate failure by IOTEE in the quadrangular resection technique, a well-standardized mitral valve repair procedure to guide further repair procedures. Two hundred five consecutive patients underwent quadrangular resection due to prolapse or flail posterior leaflet. Twenty-four patients (11%) had immediate failure. Immediate reinstitution of cardiopulmonary bypass ("second pump run") was needed in 21 patients (10%) for further repair. The identified mechanisms of failure were residual cleft provoking interscallop malcoaptation into the posterior leaflet in 8 patients, residual prolapse of the anterior or posterior leaflets in 1 and 4 patients, respectively, residual annular dilation in 3, left ventricular outflow obstruction in 2, suture dehiscence in 2, and other mechanisms in another 2 patients. In 20 patients (95%), IOTEE guided further repair with resolution of the residual MR, whereas 1 patient underwent valve replacement due to pharmacologically untreatable left ventricular outflow obstruction. In conclusion, even if this type of valve repair technique is well standardized, the incidence of immediate failure is not negligible. IOTEE identified the mechanisms of the immediate failure and guided further repair procedures, thus reducing the incidence of valve replacement (0.5%) without increasing perioperative mortality and morbility.     

High incidence of colic anastomotic leakage complicating upper abdominal en bloc evisceration for cancer: a 47-patient series

BACKGROUND/AIMS: The purpose of this study was to analyze the early outcome of en bloc extended resection for upper abdominal locally advanced cancer. METHODOLOGY: A retrospective medical chart review was performed in 47 consecutive patients who underwent an upper abdominal en bloc resection for cancer involving multiple organs or structures at Paoli-Calmettes Institute and Conception Hospital from October 1988 through April 1997. A third of patients underwent a resection of 4 sus mesocolic organs or more. RESULTS: The postoperative morbidity and mortality rate were respectively, 57% and 19%. Despite a high number of theoretically risky procedures including pancreatic resection and pancreatojejunostomy, total gastrectomy and esophagojejunostomy, total hepatectomy and liver transplantation, the higher percentage of complication was found with colic anastomosis. Five of the 30 patients (17%) who underwent a colic anastomosis developed a colic anastomotic leakage, 4 patients were reoperated and 2 patients died. CONCLUSIONS: Because of this unacceptably high rate of complications, we propose to systematically perform a protective stoma when an upper abdominal evisceration includes a colic anastomosis.     

Carcinoma of the pancreas with portal vein involvement--our experience with a modified technique of resection

BACKGROUND/AIMS: Up to 40% of the patients with pancreatic carcinoma are not fit for curative resection due to the locally advanced nature of the disease in the form of vascular involvement. In recent years a more aggressive approach of vascular resection with pancreaticoduodenectomy (PD) has resulted in the increase in resectability rate and survival in this group of patients. The most important determinant of survival in these patients is negative resection margins. The aim of the present study is to present our experience of vascular resection using a modified technique, in patients with pancreatic cancer. METHODOLOGY: This is a retrospective study of 48 patients who underwent portal vein/superior mesenteric vein (PV/SMV) resection along with PD using the modified technique of resection, during 1982-2004. The principle modification is the initial extensive retroperitoneal dissection for the assessment of the extent of tumor involvement of the superior mesenteric vessels and division of retroperitoneal margin before the division of the pancreas. All patients also underwent extended lymphadenectomy. RESULTS: The subtotal PD was done in 26 and total PD in 22 patients, with resection of the PV/SMV in all of them. The end-to-end anastomosis was possible after adequate mobilization of the PV and SMV in 40 patients. In 4 patients reconstruction was able to be done with the use of a graft. The portal vein occlusion time was 8-15 minutes. Histopathological examination showed negative margins in all the resected specimens. Postoperative complications occurred in 16.66% with reoperation rate of 8.33%, and mortality of 6.25%. After a mean follow-up of 110 months, mean survival was 40 months with the range of 18-250 months. The five-year and 10-year survival was 18% and 10% respectively. The venous patency rate was 100% at three years. CONCLUSIONS: In conclusion, PD with en bloc resection of the PV/SMV confluence can safely be done with morbidity and mortality similar to that of standard PD. The survival advantage is directly related to the attainment of negative resection margins. The modified technique is a useful way of doing vascular resection with the least amount of bowel congestion and securing negative resection margins.     

An Algorithm for the Management of Sigmoid Colon Volvulus and the Safety of Primary Resection: Experience with 827 Cases

Purpose This study was designed to review the outcomes of emergent treatment of sigmoid colon volvulus. Methods The records of 827 patients were reviewed retrospectively. Results The mean age was 57.9 years (range, 10 weeks to 98 years), and 688 patients (83.2 percent) were male. Nonoperative reduction was applied in 575 patients (barium enema in 13, rigid sigmoidoscopy in 351, and flexible sigmoidoscopy in 211, with rectal tube placement in all patients). The results were as follows: success of 78.1 percent, mortality of 0.9 percent, complication of 3 percent, and early recurrence of 3.3 percent. Surgical treatment was performed on 393 patients (detorsion in 46, mesosigmoidopexy in 56, exteriorization in 4, resection with Hartmann’s procedure in 146, resection with Mikulicz procedure in 14, resection with primary anastomosis in 51, tube cecostomy and colonic cleansing with resection in 75, and laparotomy in 1). The results were as follows: mortality of 15.8 percent, complication of 37.2 percent, early recurrence of 0.8 percent, and late recurrence of 6.7 percent. Conclusions Nonoperative reduction is the initial treatment of sigmoid colon volvulus, and flexible sigmoidoscopy with rectal tube placement can be used successfully. Patients in whom bowel gangrene or peritonitis is present or nonoperative treatment is unsuccessful need emergency surgery. In surgical treatment, resection and primary anastomosis is the first choice, and it can be performed with acceptable mortality and morbidity rates if the patient is stable and a tension-free anastomosis is possible. Nondefinitive procedures have high recurrence rates; thus, definitive surgical techniques must be preferred.     

Surgical recurrence in Crohn’s disease: a comparison between different types of bowel resections

Purpose

To compare recurrence frequency and location between different types of bowel resections in Crohn’s disease patients.

Methods

This was a retrospective study of consecutive patients undergoing bowel resection for Crohn’s disease between 2006 and 2016. Type of primary operation was recorded and grouped as ileocolic resection, small bowel resection, segmental colon resection with colocolic anastomosis or colorectal anastomosis, colectomy with ileorectal anastomosis, or end stoma operation. Binary logistic regression was used to compare surgical recurrence frequency between groups. We also investigated how Crohn’s disease location at reoperations was related to the primary bowel resection type.

Results

Altogether, 218 patients with a median follow-up of 4.7 years were included in our study. Reoperation was performed in 42 (19.3%) patients. The risk of reoperation using the ileocolic resection group as reference was the following: small bowel resection (odds ratio (OR) 2.95, 95% confidence interval (CI) 1.01–8.66; P?=?0.049), segmental colon resection with colocolic or colorectal anastomosis (OR 6.20, 95% CI 2.04–18.87; P?=?0.001), colectomy with ileorectal anastomosis (OR 26.57, 95% CI 2.59–273.01; P?=?0.006), and end stoma operation (OR 4.62, 95% CI 1.90–11.26; P?=?0.001). In case of surgical recurrence, the reoperation type and location correlated with the primary bowel resection type.

Conclusions

Reoperation frequency in Crohn’s disease is lower after ileocolic resection than after other types of bowel resections. Surgical recurrence in Crohn’s disease tends to maintain the disease location of the primary operation. One third of Crohn’s patients undergoing an end stoma operation will still need new bowel resections due to recurrence.

     

Coronary artery revascularization using both ITAs as free conduits in patients with three-vessel disease--the lambda graft

BACKGROUND: There is little information on using internal thoracic arteries (ITA) as free conduits in coronary artery bypass grafting. This study examines the results using both ITAs as free grafts in a lambda configuration implanting the common trunk into the ascending aorta. METHODS: Over a 6-year period, 317 patients underwent coronary artery revascularization with both ITAs as free grafts in a lambda configuration. RESULTS: An average of 4.9 distal anastomoses per patient was performed. There were 4 deaths (three early and one late). The mean NYHA class improved from preoperatively 2.8 to 1.1 at the last check. All 16 patients with suspected recurrent angina or a pathologic exercise test were restudied by angiography. Segmental graft stenosis or occlusion was found in 13 (in only one at aortic anastomosis). Five patients underwent late PTCA, and two underwent coronary reoperation. The six-year actuarial survival was 98% (90 % CL+/- 2 %), intervention-free survival 96 % (90 % CL +/- 2 %). CONCLUSION: Revascularization using both ITAs as free grafts in a lambda configuration gives good early and mid-term results for up to 6 years. The aortic ITA anastomosis can be considered safe.     

Coronary bypass grafting without cardiopulmonary bypass--technical considerations, clinical results, and follow-up

BACKGROUND: Coronary bypass surgery can be performed less invasively by avoiding cardiopulmonary bypass (CPB). We present our early 'off pump' coronary bypass surgery experience in combination with a minithoracotomy or sternotomy. METHODS: Between 11/1996 and 12/1997 312 patients were included in a prospective study, 223 (Group A) underwent an antero-lateral minithoracotomy (MIDCAB) and 89 (Group B) had a full sternotomy (OPCAB). ITA harvesting and anastomosis was performed under direct vision in all cases. Different devices for local mechanical immobilization were used to perform the anastomosis. RESULTS: In 212 patients of group A revascularization was by a single ITA graft and in 11 patients by a double graft using the radial artery as a T graft. Conversion to sternotomy and cardiopulmonary bypass was necessary in 12 (5.3%) patients. Intraoperative myocardial infarction was observed in 5 patients (2.2%). Early-postoperative reoperation due to graft failure was necessary in 5 patients (2.2%). Mortality was 0.4% (one patient). The early postoperative graft patency rate was 97.1% as confirmed by angiography. In group B, 25 patients had single graft and 64 patients multiple graft revascularization. Intraoperative conversion to CPB was necessary in 10 patients (11.2%). Intraoperative myocardial infarction occurred in 1 patient (1.1%), postoperative low output syndrome in 2 patients (2.2%). Early postoperative reoperation due to graft failure was necessary in 1 patient (1.1%). Mortality was 1.1%. Angiographic control of 48 patients after 6 months confirmed a patency rate of 92.6%. CONCLUSION: Coronary bypass surgery without using cardiopulmonary bypass is safe to achieve good early and mid-term results. MIDCAB is a minimally invasive technique. Experienced surgeons should be ready to compete with PTCA techniques.     

Toward Lowering Morbidity,Mortality, and Stoma Formation in Emergency Colorectal Surgery: The Role of Specialization

INTRODUCTION: Surgical management of left-sided large bowel emergencies has been evolving toward single-staged procedures. Selection for single or staged resection remains the most controversial issue. METHODS: The results from a series of 336 emergency colorectal procedures performed between January 1990 and December 2000 for cancer and diverticular disease by two different surgical units in one hospital are reported: one with a specific interest in colorectal surgery, and one specialized in upper gastrointestinal surgery. RESULTS: A primary anastomosis was performed in 142 (64.3 percent) patients by colorectal surgeons and in 42 (36.5 percent) by noncolorectal surgeons (P < 0.0001). The overall morbidity and mortality rates were lower for colon and rectal surgeons (14.5 vs. 24.3 percent and 10.4 vs. 17.4 percent, respectively). Trainees were more likely to perform anastomoses when assisted by colorectal consultants (72.1 percent of cases) than when a noncolorectal consultant was present (47.5 percent of cases; P < 0.05). The 30-day mortality for patients with primary anastomosis was 6 percent, and anastomotic dehiscence occurred in nine (4.9 percent) patients. The mortality for patients undergoing staged resections (21.1 percent) was significantly higher than those who had primary resections performed (P < 0.001). CONCLUSIONS: Primary anastomosis for left-sided colorectal diseases can be performed with low morbidity and mortality in selected patients. Specialization increased anastomotic rates and reduced morbidity. This study suggests that colon and rectal surgeons should manage colorectal emergencies, and trainees should not be left unsupervised.     

Emergency surgery for patients with colorectal cancer over 90 years of age

BACKGROUND/AIMS: Colorectal cancer has an extremely poor prognosis in the elderly with high rates of emergency presentation and perioperative mortality. This report examines our experience and results in the emergency treatment of patients older than 90 years with colorectal cancer. METHODOLOGY: From 1995 to 2000, 486 patients with colorectal cancer were operated on in an emergency surgery situation at the Department of Emergency Surgery of Sant'Orsola-Malpighi University Hospital. A retrospective analysis of 20 patients aged 90 or older was carried out. RESULTS: Thirteen patients underwent resection of the primary growth and anastomosis and 7 subjects with carcinomatosis had palliative intervention by creating a stoma only or bypass anastomosis without resection. We registered two deaths caused by respiratory insufficiency and 2 postoperative complications successfully treated with medical therapy. CONCLUSIONS: Emergency surgery for colorectal cancer in patients over 90 years of age can be performed safely without restrictions related to the age.     

Outcomes of emergency surgical treatment in malignant bowel obstructions

BACKGROUND/AIMS: Malignant bowel obstructions are still a challenging problem for surgeons and carry high morbidity and mortality risk. The aim of this study was to review the presentation and outcomes of malignant bowel obstructions and to identify the risk factors related with poor prognosis. METHODOLOGY: One hundred and twenty-five patients underwent emergency surgical treatment for malignant obstructions between January 1997 and January 2002. Data included age, sex, past medical history, presenting symptoms; physical findings on admission, American Society of Anesthesiologists (ASA) class, operative details, postoperative complications, length of hospitalization and hospital mortality were reviewed retrospectively. RESULTS: Seventy-three (58%) of the patients have poor performance status on admission. Potentially curative resection was performed in 74 (60%) patients. Surgical treatment was palliative in 43 (34%) patients. Extended bowel resections were utilized in 20 (16%) patients. Our hospital mortality rate was 21%, and postoperative morbidity rate was 31%. Coexisting cardiopulmonary diseases, presence of generalized perforation, poor general condition and extended bowel resections appeared to be related with unfavorable outcomes. CONCLUSIONS: Emergency surgical treatment for malignant obstruction may be curative in selected patients with good performance status.