Implementation of Multistage Approach for Colorectal Cancer With Bowel Obstruction in Surgeon Units of Moscow

Abstract

AIM: to work out and to implement multistage colorectal cancer treatment as a standard of surgical care in Moscow PATIENTS AND METHODS: Five-hundred seventy-two patients were included in the study reviewed: 247 of them were hospitalized in 2011-2013 (I group); 325-in 2014-2017 (II group). Forty-six patients underwent conservative treatment; 302-urgent bowel resection; 141-proximal stoma formation; 83-endoscopic stent insertion. One-hundred ten patients of the II group underwent elective bowel resection after 0,5-6 months and further chemoradiotherapy. The 3-year cumulative survival was assessed with Kaplan-Meier method. MultiStage treatment was implemented as a standard of surgical care in Moscow for colorectal cancer complicated by obstruction. Postoperative mortality and morbidity rate were estimated in 2014-2018 in Moscow. RESULTS. Complications occurred in 46,69 % (I group) and 21 % (II group) (p<0.05). Postoperative mortality was significantly higher in I group compared with II group: 26,11 % vs 10,33 % p<0.05). The survival rate was higher in II group than in I group (0,82 vs 0,69, p<0.05). The result was a decrease in postoperative mortality in Moscow from 22.4 % to 10.0 %. CONCLUSION: the efficacy of the new standard of medical care of colorectal cancer complicated by bowel obstruction is confirmed. A «bridge» strategy may be a valid alternative in these patients, because of significantly lower postoperative mortality and morbidity rate.