Get access

Curative surgery for obstruction from primary left colorectal carcinoma: Primary or staged resection?

  • Review
  • Intervention




In 8 to 29% of patients with colorectal carcinoma, obstruction is the main symptom at diagnosis, and 85% of patients undergoing emergency colorectal surgery have obstruction from colorectal carcinoma. The prognosis of patients who undergo emergency surgery for obstruction is often poor. So far, two types of surgical approach have been used for this condition: primary resection (primary anastomosis or Hartmann's procedure) with simultaneous treatment of carcinoma and obstruction, or staged resection (treatment of the obstruction prior to resection).
However, neither strategy has been found to have any advantages over the other.


To ascertain whether primary resection in patients with obstruction from left colorectal carcinoma has advantages over staged resection in terms of morbidity and mortality.

Search methods

Electronic database searches of Cochrane Controlled Trials Register, Medline, Cancerlit, Embase. Hand searching of the most important journals in the fields of oncology and surgery from 2003 and onward until the time of writing.

Selection criteria

Randomised Clinical Trials (RCT) and Controlled Clinical Trials (CCT), in which a group of patients who undergo primary resection for intestinal obstruction from left primary colorectal carcinoma is compared with a group of patients who undergo staged resection for the same condition. Since only one study of this type was available, we considered all other studies, except for case-controls, on the basis of the best possible available evidence.
Studies were considered without language restrictions.

Data collection and analysis

Two reviewers (GLDS, CG) examined all the citations and abstracts derived from the electronic search strategy. Reports of potentially relevant trials were retrieved in full. Both reviewers independently applied the selection criteria to trials reports. Reviewers were not blind to the names of institutions, journals or authors of trials. A third opinion (SP, ML) was obtained to resolve disagreements.

Main results

We identified 2043 citations: Medline 1205, Embase 635, Cancerlit 203. One study for potential inclusion was identified, but was then excluded (Kronborg 1995).

Authors' conclusions

The limited number of identified trials together with their methodological weaknesses do not allow a reliable assessment of the role of either therapeutic strategy in the treatment of patients with bowel obstruction from colorectal carcinoma. It would appear advisable to conduct high quality large scale RCT to establish which treatment is more effective. However, it is doubtful whether they could be carried out in a timely and satisfactory way in this particular surgical context.








Cochrane Controlled Trials Register、Medline、Cancerlit、Embaseの電子データベース検索を行い、腫瘍学および手術の分野における主要雑誌のほとんどを2003年から現時点までハンドサーチした。






2043件の引用を同定した。Medline1205件、Embase635件、Cancerlit203件。採択可能と思われる試験1件を同定したが、その後、除外した(Kronborg 1995年)。




監  訳: 2007.7.18

実施組織: 厚生労働省委託事業によりMindsが実施した。

ご注意 : この日本語訳は、臨床医、疫学研究者などによる翻訳のチェックを受けて公開していますが、訳語の間違いなどお気づきの点がございましたら、Minds事務局までご連絡ください。Mindsでは最新版の日本語訳を掲載するよう努めておりますが、編集作業に伴うタイム・ラグが生じている場合もあります。ご利用に際しては、最新版(英語版)の内容をご確認ください。

Plain language summary

Curative surgery for obstruction from primary left colorectal carcinoma: Primary or staged resection?

No strong evidence about whether removal of bowel obstruction and cancer should be done in one step or as a staged procedure, when people have cancer in the left colon. Colorectal (bowel) cancer is common. It can obstruct the bowel, causing severe dilation of the intestine and the stomach, pain and vomiting. Surgery is used to try to remove the obstruction, as well as the cancer. When the cancer is in the right colon, the obstruction and cancer are usually removed simultaneously. If the cancer is in the left colon or in the rectum, however, it may be better for the patient to have the obstruction and the cancer removed in separate surgical procedures.
This review found no evidence in comparative trials indicating which of these techniques is preferable for people with cancer in the left colon. More research is therefore needed.