Risk Factors for Development of Complications Following Surgical Resection in Cases of Obstructed Colorectal Cancer: Case Series Study

Purpose: To describe the incidence of obstructed colorectal cancer (CRC), to report complications in patients managed by resection with primary anastomosis, and to identify the risk factors predisposing to these complications. Methods: Fifty-eight consecutive adult patients presented to our tertiary referral center with obstructed CRC during the period from January 2018 to December 2020. Only patients managed by resection and primary anastomosis were assessed for incidence of complications according to Clavien-Dindo classification. They were grouped into obstructed right colon cancer (ORCC), obstructed left colon cancer (OLCC) according to tumor location. Patients were followed on outpatient basis for at least three months after discharge. Results: During the study period, 221 adult patients underwent colorectal resections for the presence of CRC, colorectal resections for benign disease and non-obstructed CRC were excluded. Obstructed CRC was present in 58 patients (22.9%). Out of these 58 patients, nine-patients refused emergency resection and were managed by diverting stoma. The remaining 49 patients underwent emergency colorectal resections, 7 patients were managed by Hartman's procedure or temporary end colostomy, the remining 42 patients underwent primary anastomosis and were divided to ORCC (13 patients) and OLCC (29 patients). Morbidity and mortality rates were 21.4% and 4.8% respectively. Two thirds of reported complications were major. ORCC did not significantly differ from OLCC as regard mortality, anastomotic leak, burst abdomen, reoperation, and ICU readmission. DM, and BMI > 35 Kg/m(2) were significantly related to the incidence of complications. Anastomotic leak was significantly related to the presence of colonic perforation, closed loop obstruction and cecal dilatation >10 cm. Conclusions: DM and BMI > 35 Kg/m(2) significantly predisposed to complications compared to patient's age. Results of the current study highlight a more significant role of prolonged bowel obstruction sequalae on incidence of anastomotic leak compared to tumor location.