total colectomy in older patients with acute malignant obstruction of the left–sided colons

Objective: The older population is one of the fastest growing segments of Serbian society. The aging population is also present in developed countries. Demographics the oldest region in the world is Europe. Serbia by the number colorectal cancer suffering among the countries with high risk of disease. In 2006. the number of new cases was around 4 000. Methods: In study retrospective review of 81 patients with malignant obstruction of the left-sided colon, where it underwent a total colectomy. Symptoms and signs of acute obstruction of the left-sided colon are complemented with radiological examination in all patients. The compulsory part of the preoperative examination digitorectal exam how to assess the function of the sphincter apparatus in terms of continence, and to view the rectum and the exclusion of the tumor. In poorly functioning sphincter apparatus was performed Hartmann's procedure, in order to avoid postoperative incontinence. Results: The primary anastomosis rate of 81% in the elderly and 83% of younger patients. In younger group 31 patients underwent a total colectomy with anastomosis and 6 total colectomy with end ileostomy. In older group there were 36 total colectomy with anastomosis and 8 with total colectomy with end ileostomy. Anastomotic leak occurred in 4 patients of elderly group and 2 patients in the younger group. Mortality (30 d) in the older group was 3 patients who had ASA IV, and younger group 2 patients (1 patient ASA III, 1 patients ASA IV). Of the 3 patients died from the older group, 2 patients were end ileostomy. Conclusions: Emergency resection and primary anastomosis for left-sided colon carcinoma can be performed with favorable outcome in the elderly. Years of age are not a decisive prognostic factor in colorectal surgery. The surgeon has a duty of careful selection of patients for resection with anastomosis for malignant obstruction of the left-sided colon, with adequate preoperative preparation and postoperative monitoring.