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REVIEW ARTICLE
Year : 2019  |  Volume : 8  |  Issue : 2  |  Page : 35-39

Curative management of malignant left-sided colorectal obstruction


1 Department of General Surgery, Colorectal Unit, The Alfred Hospital, Monash University, Melbourne, Victoria, Australia
2 Division of Cancer Surgery, University of Melbourne, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
3 Department of General Surgery, Colorectal Unit, The Alfred Hospital, Monash University; Division of Cancer Surgery, University of Melbourne, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia

Correspondence Address:
Dr. Wen-Shen Lee
Department of General Surgery, Colorectal Unit, The Alfred Hospital, Monash University, 55 Commercial Road, Melbourne, Victoria 3004
Australia
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/WJCS.WJCS_44_18

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Left-sided malignant colonic obstruction remains a challenging surgical problem despite recent advances. We aim to provide a concise overview of the relevant surgical options for this condition in the curative setting. A literature search of MedLine, PubMed, and Embase was performed to elucidate the latest evidence in the management of malignant left-sided colorectal obstruction, focusing on the risks and benefits of each approach and the appropriate patient selection. Primary resection and anastomosis are the intervention of choice for low-risk patients in the curative setting. Delayed resection with a bridge to surgery should be considered in unwell patients requiring medical optimization. While stenting has gained popularity, the risk of stent perforation carries a poor prognosis and must be carefully considered. Hartmann's procedure should be considered in high-risk elderly patients. Subtotal colectomy is preferred over segmental colectomy when there is extensive proximal colon damage but results in more frequent bowel actions postoperatively.


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