Survival in acute obstructing colorectal carcinoma

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Abstract
Acute intestinal obstruction was the presenting feature in 124 (19%) of 646 patients with colorectal carcinoma seen over a 6 yr period. Of tumors, 42% were incurable at presentation. Obstruction was complicated by perforation in 22 patients (18%). Only 15% of tumors occurred in the rectum. Although the postoperative mortality rate was higher in patients with coincidental perforation than in those without (52 vs. 26%: P = 0.03), 5 yr survival rates were the same: 18% overall, rising to 29-34% after curative resection. Five year survival rates were best for right colon tumors and worst for rectal tumors (36 vs. 5%: P = 0.01). The overall hospital mortality rates for colostomy and delayed resection, resection with colostomy, and resection with anastomosis were equivalent (18-22%), but following curative resection the hospital mortality rate was higher for resection with colostomy than with other treatments (29 vs. 15), since 2 patients died following early colosure of colostomy. Five year survival was better following resection with anastomosis (48%) than staged procedures (18%: P = 0.01), since 2 patients died following late closure of colostomy.