Two-Stage Operations in Patients with Acute Right-sided Colonic Obstruction: A 15-year Single Institution Experience

Abstract BACKGROUND: Longer procedure times and bigger wounds can result in more mortality and complications in patients with acute RSCO with one stage surgery. OBJECTIVES:To review two-stage operations for acute right-sided colonic obstruction (RSCO) in a single institution. METHODS: The study reviewed the patients who underwent emergency surgery for acute RSCO in a tertiary center from 2004-2018. First-stage operations other than diverting loop ileostomy, incomplete obstructions that could be treated medically, or pathologies other than adenocarcinomas were excluded. Perioperative data such as operations, operative times, lengths of stay, harvested lymph nodes, and any complications were included. We assessed overall survival (OS) and disease-free survival (DFS) for the oncologic outcomes. RESULTS: Sixty-nine patients were included. Seven patients had surgical complications related to ileostomy. Three of them died within 30 days of first admission. Thirty-one patients received a second-stage 4 operation by right hemicolectomy. None had anastomosis leakage or 30-day mortality. Only 9.7% of patients had fewer than 12 harvested lymph nodes. One-year OS was 34% vs. 89% between the two groups (P < 0.001). For 26 patients underwent curative resection of tumor, their 3-year DFS was 61.5%. CONCLUSIONS: A two-stage operation is associated with low mortality and morbidity rates in an emergency setting. The subsequent right hemicolectomy can harvest more lymph nodes than emergency resection. Long-term survival benefits can be expected.