Safety of subtotal or total colectomy with primary anastomosis compared to Hartmann procedure for left-sided colon cancer obstruction or perforation

Approximately one-third of patients with colon cancer present to an emergency room because of obstruction or perforation. They have high postoperative mortality and poor survival [1]. Acute obstruction of the colon is an early symptom in 7%–29% of colorectal cancer patients. It often leads to emergency surgery. Acute symptoms are more common in advanced disease and elderly patients. Tumor-related left-sided colon obstruction is particularly difficult for surgery due to the risk of perforation in the enlarged colon near the tumor. Emergency surgery due to malignant obstruction of the left-sided colon is associated with frequent complications and poor survival [2]. Colon perforation is a life-threatening condition. If severe peritonitis occurs after colon perforation, emergency surgery is needed [3]. In the past, Hartmann procedure (HP) was recommended because it could prevent intra-abdominal sepsis associated with anastomotic dehiscence. However, subtotal or total colectomy with Original Article Korean Journal of Clinical Oncology 2019;15:106-111 https://doi.org/10.14216/kjco.19019 pISSN 1738-8082 ∙ eISSN 2288-4084