Mustafa KUŞAK, Mustafa GÜN, Serdar ŞENOL
Journal of Medicine and Palliative Care - 2026;7(3):580-584
Aims: The present study aims to evaluate the perioperative safety, postoperative bowel function, and oncological outcomes of stoma-free subtotal colectomy (STC) and total colectomy (TC) with primary anastomosis in patients with obstructed left-sided colon cancer, with particular focus on long-term bowel adaptation and antidiarrheal medication requirement. Methods: This retrospective single-center cohort study included consecutive patients who underwent STC or TC with primary anastomosis for obstructed left-sided colon cancer between June 2016 and August 2024. Patients who required end ileostomy or diverting loop ileostomy were excluded. Demographic, operative, pathological, and postoperative data were reviewed. Results: TC was performed in 41 patients (68.3%) and STC in 19 patients (31.7%). Minor complications occurred in 16 patients (26.7%), major complications in 8 (13.3%), and perioperative mortality in 5 (8.3%). No anastomotic leakage was observed. Follow-up beyond 12 months was available in 51 patients (85.0%). Median daily bowel movements decreased from 7 (range 3-12) at 3 months to 2 (range 2-3) at 12 months. Long-term antidiarrheal medication was required in 14 patients (23.3%) and was significantly more frequent after TC than after STC (31.7% vs. 5.3%, p < 0.05). In stage II-III disease, the combined 3-year overall survival and disease-free survival rates were 82.4% and 80.2%, respectively. Conclusion: In selected patients with obstructed left-sided colon cancer, stoma-free STC and TC with primary anastomosis appear to be feasible and safe options with acceptable perioperative morbidity, progressive functional adaptation, and satisfactory oncological outcomes. STC may offer an advantage over TC in terms of lower long-term antidiarrheal requirement.
