Risk

stratification is at the base of patient selection. The Association of Coloproctology of Great Britain and Ireland (ACPGBI) study of large bowel obstruction caused by colorectal cancer identified four important predictors of outcome – age, ASA grade, operative urgency, and Dukes’ stage [5]. Similar results were shown by other studies [14, 20]. Recent large studies demonstrated that mortality rate after PRA of obstructive right colon cancer is higher than mortality after PRA for OLCC [5, 14, 21], whereas one study did not show any difference [22]. This findings could be explained by the fact that almost all patients with right-sided Seliciclib supplier obstruction are treated by one stage resection and anastomosis, whereas patients with OLCC are carefully

selected according to risk. Keeping in mind these considerations the HP could be appropriate for patients deemed to be at high risk. Moreover the same considerations could explain the results of a questionnaire survey of American Gastrointestinal Surgeons in 2001 who responded that 67% would perform HP and 26% a simple colostomy in the high-risk patient [23]. Otherwise we should assume a lack of adherence to the literature evidence in the clinical practice or difficulty in changing from Vadimezan surgical AZD5582 datasheet tradition. The experience and subspecialty of surgeon seems to be a primary factor in the choice of anastomosis or end colostomy. It has been shown that primary anastomosis is more likely to be performed by colorectal consultants rather than general surgeons, and by consultants rather than unsupervised trainees [20]. The

ACPGBI study has shown that the mortality rate following surgery was similar between ACPGBI and non-ACPGBI members [5]. This result can be challenged as the study was done on a voluntary basis. The Large Bowel Cancer Project showed that registrars had a higher mortality rate than consultants after primary resection for obstruction in the late 1970 s, and this result has remained unchanged 20 years later in the Zorcolo study [1, 20]. Other studies have also shown that unsupervised trainees had significantly greater morbidity, mortality and anastomotic dehiscence rates [10, 24]. Recommendation:HP ADAMTS5 offers no overall survival benefit compared to segmental colonic resection with primary anastomosis in OLCC (Grade of recommendation 2C+); HP should be considered in patients with high surgical risk (Grade of recommendation 2C) Primary resection and anastomosis (PRA): total or subtotal colectomy (TC) vs. segmental colectomy (SC) There is only one RCT, write out SCOTIA study group (Subtotal Colectomy versus on Table Irrigation and Anastomosis) in 1995, that compared the TC (47 patients) vs. SC (44 patients) and ICI. There were no differences in mortality, overall morbidity and rates of single complications (superficial and deep surgical site infections, anastomotic leakage).