To the Editor. —We read with interest the article by Walsh et al1 concerning the quality of life after total abdominal colectomy (TAC). Although their patients ranged in age from 30 to 87 years (mean age, 61 years) and only 6.5% of the patients in the series underwent emergency TAC, we would like to emphasize that their results and conclusions are also applicable in the management of older patients with acute malignant obstruction of the left colon, which has become an increasingly recognized indication for TAC.
During a 4½-year period at the Royal Gwent Hospital, Newport, Gwent, United Kingdom, 63% of patients undergoing immediate resection for acute left-sided malignant colonic obstruction underwent radical subtotal or total colectomy.2 These patients ranged in age from 50 to 88 years (mean age, 73 years) and were compared with a group of patients undergoing more conventional management. Mortality was 3% in patients