Surgical treatment of acute malignant large bowel obstruction.

OBJECTIVE: To evaluate the morbidity and mortality in all patients operated on urgently for acute large bowel obstruction caused by carcinoma of the colon or rectum during a 10 year period. DESIGN: Retrospective study. SETTING: Aalborg Hospital, Denmark. SUBJECTS: 156 consecutive patients operated on for obstructing primary colorectal cancers. MAIN OUTCOME MEASURES: Operations done, morbidity and mortality. RESULTS: 95 patients (61%) had advanced disease (Dukes' stage C or "D") and their median age was 73 years (range 38-93). 97 had the obstructing lesion resected with a 30 day mortality of 5%. 43 patients underwent primary resection and 4 died (9%), and 54 underwent staged resection with one death (2%). Complications were common, particularly after staged resections, median hospital stay being 19 days after primary, compared with 30 days after staged resection. 59 patients (38%) had palliative operations with 29 deaths (49%); in 39 the tumor was completely unresectable. CONCLUSION: Patients with obstructing primary colorectal cancers are a high risk group who are characterised by advanced disease and old age. Only prospective trials comparing different operations can assess whether it is possible to achieve a reduction in mortality.