Colorectal cancer complicated by perforation. Specific features of surgical tactics

Щаева, С. Н.

doi:10.17650/2220-3478-2015-5-4-38-41

Cited by 6 publications

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“…Экстренные хирургические вмешательства для рака толстой кишки связаны с 15-20 % летальностью и 40-50 % послеоперационных осложнений, которых значительно больше, чем в плановой хирургии КРР [15], и 5-летней выживаемостью 10,0-39,6 % [13,[16][17][18].…”

Section: Discussionunclassified

“…Данная ситуация обусловлена поздними стадиями (III-IV) заболевания при перфорации опухоли и таким вариантом хирургического вмешательства, как формирование колостом, дренирование малого таза и брюшной полости, при якобы нерезектабельном опухолевом процессе. По данным ряда авторов, перфорация при КРР наиболее часто встречается у пациентов на 6-й и 7-й декаде жизни и связана с худшим прогнозом [10,18]. При технической возможности опухоль необходимо радикально или паллиативно удалить, несмотря на степень распространенности онкологического процесса, так как симптоматические операции в хирургическом лечении опухолевых абсцессов, развившихся на фоне перфорации опухоли, не решают возникших проблем [24].…”

Section: Discussionunclassified

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Emergency surgeries for complicated colorectal cancer performed in hospitals for general surgery: multivariate analysis of short-term and long-term treatment outcomes

Щаева

2019

Onkol. koloproktol.

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Цель исследования-изучить результаты экстренных хирургических вмешательств по поводу осложненного колоректального рака в общехирургических стационарах, оценив факторы риска и их влияние на непосредственные и отдаленные результаты лечения. Материалы и методы. Исследование основано на анализе результатов лечения 677 больных, перенесших экстренные хирургические вмешательства по поводу осложненного колоректального рака в 3 общехирургических стационарах г. Смоленска за период 13 лет. Послеоперационные осложнения оценивали по классификации Clavien-Dindo. Продолжительность наблюдения больных составила от 0 до 60 мес. Безрецидивную и общую выживаемость анализировали методом Kaplan-Мeier. Для определения влияния потенциальных факторов риска на скорость наступления изучаемого события использовали регрессию Кокса.

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Emergency surgeries for complicated colorectal cancer performed in hospitals for general surgery: multivariate analysis of short-term and long-term treatment outcomes

Щаева

2019

Onkol. koloproktol.

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“…Колоректальный рак (КРР) -одно из самых распространенных онкологических заболеваний [2,4,5,[7][8][9][10][11]19]. Основной проблемой является возникновение у 8-30% пациентов с КРР различных осложнений, в первую очередь, стеноза, проявляющегося острой обтурационной толстокишечной непроходимостью (ООТКН), кровотечения и перфорации.…”

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“…Летальность при этих осложнениях составляет 7,6-55,5% [2][3][4][5]10,11,19]. Несмотря на большое число работ, посвященных диагностике и лечению осложненного КРР, проблема стандартизации хирургической помощи таким больным не теряет своей актуальности [2,4,5,9,17,19]. Одни хирурги при осложненном КРР главной задачей опе-ративного вмешательства считают удаление опухоли [4,6,10].…”

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“…Одни хирурги при осложненном КРР главной задачей опе-ративного вмешательства считают удаление опухоли [4,6,10]. Другие клиницисты экстренную резекцию рассматривают как меру отчаяния и рекомендуют ее избегать [2,3,9,14,16,[20][21][22]24]. В связи с отсутствием единой точки зрения в отношении выбора метода лечения осложненного КРР, предметом данного исследования стала стандартизации хирургической помощи таким больным.…”

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Algorithm of Surgical Care in Complicated Colorectal Cancer

Шабунин

Багателия

2019

Koloproktologiâ

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AIM: to standardize surgical care for the malignant colonic obstruction. PATIENTS AND METHODS: the retrospective cohort study included 797 patients with complicated colorectal cancer. Malignant colonic obstruction was diagnosed in 572 patients: 247 of them were treated in 2011-2013 (I group); 325 - in 2014-2017 (II). Urgent bowel resection was performed more often in I group (one-stage treatment), fecal diversion or stent- in II (two-stage treatment). Seventy-seven patients with tumor bleeding were included as well: 62 of them were treated conservatively or underwent endoscopic coagulation or arterial embolization (III group); 15 patients - underwent urgent bowel resection (IV). All of 148 patients with bowel perforation were underwent urgent surgery: resection was performed in 115 patients (V), suturing the perforation site-in 15 (VI), extraperitoneal drainage of the abscess - in18 (VII). Elective bowel resection was performed in 241 patients (186 - from I-II group, 40 - from III, 15 - from VI-VII) after 0.1-6 months. The comparative analysis of the early and late results of one- and two-stage treatment was carried out with assessment of the 3-year cumulative survival. RESULTS: postoperative mortality was significantly lower in elective resection groups compared with urgent resection groups: 3.6% vs 29.2% (II vs I); 5.0% vs 20.0% (III vs IV); 0.0% vs 35,7% (VI-VII vs V). The survival rate was higher in elective resection groups than in urgent ones: 0.809 vs 0.680 (II vs I), 0.8882vs 0.3571 (III vs IV), 0.8615 vs 0.4257 (VI-VII vs V). CONCLUSION: multi-stage approach for complicated colorectal cancer is more effective than one-stage.

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Comparative analysis of clinical and morphological data of patients of different age groups who underwent emergency surgical interventions for complicated colon cancer

Shchaeva

2023

Onkol. koloproktol.

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The aim of the study was to conduct a comparative analysis of clinical and morphological data of patients of different age groups after emergency resection interventions for complicated colon cancer. Materials and methods. The retrospective cohort study included 227 patients who underwent emergency operations for complicated colon cancer during the period from September 2016 to December 2022. Two groups of patients were selected: group 1 – under 60 years old, group 2–60 years old and older. In the 2nd group, 2 subgroups were selected: patients aged between 60 to 74 years and patients between 75 years and older. The primary point of the study was assessment of postoperative complications according to the Clavien–Dindo classification within 30 days after surgery. The secondary point was study of oncological adequacy of the operation. Results. The study included 128 (56.4 %) women and 99 (43.6 %) men. The median age was 66 years. Forty seven (20.7 %) patients were included in the group of persons younger than 60 years; 180 (79.3 %) patients were included in the group 60 years and older. There were no differences between the groups by gender and tumor localization. Tumor perforation was more often recorded in group 2 (23.3 % and 4.3 %, p = 0.017). High comorbidity was also more often observed in group 2 (46.8 % and 100 %, p = 0.023). In group 2, the physical status mostly corresponded to ASA grade 3 and 4 (p = 0.031). The difference between the groups by T-status was revealed: in group 1, there were more cases of T2-T3 (76.6 % vs. 46.7 %), and in group 2 – of T4 (53.3 % vs. 23.4 %), p = 0.034. Most patients in group 1 had the pN2 status (68.1 %), however, the pN1 status prevailed in the 2nd group (70 %). There were more oncologically inadequate operations in group 2: 54 (30 %) compared with group 1–2 (4.3 %) (p = 0.004). The main factors influencing the radicality of the performed operation were the type of urgent complication – tumor perforation (odds ratio (OR) 1.81, 95 % CI 1.43–3.96, p = 0.002); type of surgery (the Hartmann type surgery) (OR 1.62, 95 % CI 1.22–3.83, p <0.001); age OR 0.76, 95 % CI 0.54–1.33, p = 0.004); comorbidity (OR 0.61, 95 % CI 0.43–1.28, p = 0.02); physical status of patients according to ASA classification grade 3–4 at admission (OR 0.52, 95 % CI 0.30–1.49, p = 0.002); tumor localization (OR 0.43, 95 % CI 0.28–1.15, p = 0.011). Conclusion. Emergency operations for complicated colon cancer are characterized by a high risk of serious postoperative complications, especially in elderly and senile patients. In patients younger than 60 years of age, the malignant tumors are often characterized by more aggressive course with damage to regional lymph nodes (N2 status).

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Colorectal cancer complicated by perforation. Specific features of surgical tactics

Cited by 6 publications

References 4 publications

Emergency surgeries for complicated colorectal cancer performed in hospitals for general surgery: multivariate analysis of short-term and long-term treatment outcomes

Emergency surgeries for complicated colorectal cancer performed in hospitals for general surgery: multivariate analysis of short-term and long-term treatment outcomes

Algorithm of Surgical Care in Complicated Colorectal Cancer

Comparative analysis of clinical and morphological data of patients of different age groups who underwent emergency surgical interventions for complicated colon cancer

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