Emergency resection and primary anastomosis for left-sided obstructing colorectal carcinoma in the elderly

Abstract

Background: Emergency colorectal surgery in the elderly has been associated with a high mortality rate. Although the current trend for the management of obstructing left-sided colorectal carcinoma favours primary resection and anastomosis, the safety and benefits of this approach in the elderly have not been studied. Methods: Some 57 elderly (aged more than 70 years) and 59 younger patients underwent emergency resection of an acutely obstructing left-sided colorectal carcinoma. Postoperative results in the two groups were compared. Results: The primary resection rate was 95 per cent in the elderly and 89 per cent in younger patients (P = 0·70), with a primary anastomosis rate of 84 per cent and 78 per cent respectively (P = 0·64). Elderly patients had a significantly higher incidence of premorbid risk factors and postoperative cardiorespiratory complications but no increase in surgical complications. Anastomotic leaks occurred in 6 per cent of the elderly and 4 per cent of younger patients (P = 0·65), and the hospital mortality rate was 9 and 5 per cent respectively (P = 0·48). Conclusion: Emergency resection and primary anastomosis for left-sided obstructing colorectal carcinoma can be performed with favourable outcome in the elderly and should be the treatment of choice in most elderly patients.