Long Term Results after One Stage Surgery for Obstructed Left Colonic Cancer

Introduction: Emergency surgery for obstructed left-sided colorectal cancer remains a clinical challenge. WhileHartmann’s procedure is traditionally favored, it is associated with significant morbidity, a high permanent stomarate, and a burdensome second operation. One-stage resection with primary anastomosis has emerged as analternative, but safety concerns, particularly regarding anastomotic leakage, persist.Aim of work: To compare the short- and long-term outcomes of one-stage resection with primary anastomosisversus Hartmann’s procedure in patients undergoing emergency surgery for obstructed left colonic cancer.Patients and methods: This retrospective cohort study included 192 patients treated between 2012 and 2021at the National Cancer Institute, Cairo University. Patients were divided into two groups: one-stage surgery (n=96)and Hartmann’s procedure (n=96). Baseline characteristics, perioperative outcomes, complication rates, andpredictors of anastomotic leak were analyzed. Multivariate logistic regression identified independent risk factorsfor leakage.Results: Anastomotic leakage occurred in 13.5% of patients in the one-stage group. There was no significantdifference in 30-day mortality between groups (7.3% vs. 9.4%, p=0.61). Hospital stay was significantly shorter inthe one-stage group (10.8 ± 3.5 vs. 12.6 ± 4.3 days, p=0.003). Stoma-related complications occurred in 29.2%of the Hartmann’s group. Only 60.4% underwent stoma reversal, with a 22.4% complication rate. Low serumalbumin, prolonged operative time, and absence of a protective stoma were independent predictors of leakage.Conclusion: One-stage resection with primary anastomosis is a safe and effective option for selected patientswith obstructed left colonic cancer, offering comparable mortality and reduced long-term morbidity compared toHartmann’s procedure.