Tactics for the Treatment of Obstructive Colorectal Cancer in a Regional Proctological Hospital

The dissertation is devoted to the development and justification of the tactics for surgical treatment of patients with obstructive colorectal cancer in the conditions of a regional proctological hospital. The study analyzes clinical observations, examines the influence of social and demographic factors on the timeliness of diagnosis of colon cancer complicated by intestinal obstruction, assesses the severity of patients' condition, and develops diagnostic and treatment algorithms. Special attention is given to two-stage surgical interventions, their indications, and outcomes.

Treatment of Colon Cancer Complicated by Intestinal Obstruction. (Literature Review).

Characteristic of Clinical Observations 27 and Research Methods.

2.1. Characteristic of Clinical Observations 27

2.2. Examination Methods for Patients. 34

Analysis of the Causes of Development of Acute Intestinal 39 Obstruction and Assessment of the Severity of Patients' Condition.

3.1. Influence of Social and Demographic Factors 39 on the Timeliness of Diagnosis of Colon Cancer Complicated by Intestinal Obstruction.

3.2. Assessment of the Severity of Patients' Condition. 49

Choice of Treatment Tactics and Results of Treatment of Colon 57 Cancer Complicated by Intestinal Obstruction.

4.1. Choice of Treatment Tactics for Colon Cancer Complicated 57 by Intestinal Obstruction.

4.1.1. Character of Palliative Surgical Interventions in Patients with Colon Cancer Complicated by Colonic Obstruction. 58

4.1.2. Character of Surgical Interventions with Removal of the Primary Tumor in Patients with Colon Cancer Complicated by Colonic Obstruction. 59

4.2. Early and Late Results of Treatment of Colon Cancer Complicated by Intestinal Obstruction 74

CONCLUSION.

79

CONCLUSIONS.

92

PRACTICAL RECOMMENDATIONS.

93

REFERENCES.

94

Introduction.

Treatment of patients with colon cancer remains one of the most complex issues of modern surgery. Despite the development of proctology as an independent discipline, advances in refining medical techniques and the introduction of new methods of intensive therapy, mortality from these neoplasms has no tendency to decrease. In recent times, there has been a steady increase in the number of patients with newly diagnosed colon tumors.

According to Vorob'ev G.I. (2003), in 2000 the increase in morbidity of sigmoid colon cancer per 100,000 population amounted to 2.57% per year. At the same time, the proportion of advanced forms of tumors of this localization constitutes 81-90% of all observations (Pugaev A.V., Achkasov E.E., 2005). Prolonged asymptomatic course of the disease, untimely referral of patients to specialists, as well as low oncological alertness of primary healthcare physicians lead to unsatisfactory results - up to 73% of patients are admitted to clinics with complicated forms of cancer, the most common of which is intestinal obstruction (Yaitsky N.A., 2004; Nemes R, 2004; Giglio D, 2004).

Despite the large number of studies devoted to the treatment of colon cancer complicated by intestinal obstruction, the early and late results cannot satisfy surgeons. According to various authors, postoperative mortality reaches 27-60%, and in the overwhelming majority of patients the operation ends with the formation of a colostomy.

Analysis of the literature shows the absence of a unified treatment tactic for these patients, which is not least related to their severe general condition caused by the extent of the tumor process. At the same time, in the available literature there are practically no works devoted to the objective assessment of the severity of patients with colorectal cancer complicated by intestinal obstruction. Socio-demographic features of regions and their influence on timely diagnosis and treatment of colon cancer are not considered.

In our view, the development of a diagnostic and treatment algorithm for this category of patients, based not only on the extent of the tumor process but also on an objective assessment of somatic status, will allow reducing both the frequency of postoperative complications and mortality. Studying the influence of socio-demographic factors on the frequency of development of acute intestinal obstruction in colorectal cancer will make it possible to develop preventive measures aimed at improving early diagnosis of this disease.

The aim of this study is to improve the results of surgical treatment of patients with acute intestinal obstruction in the conditions of a regional proctological department.

In accordance with the set goal, the following tasks were determined:

1. To study the dependence of the frequency of detection of acute intestinal obstruction in colon cancer on the social and demographic features of the population of the Bryansk region.

2. To identify the most frequent causes of late diagnosis of colon cancer complicated by acute colonic obstruction, to assess the dependence of the obstruction stage on the localization of the tumor and the duration of the disease.

3. To develop an algorithm for the diagnosis of colon cancer complicated by colonic obstruction and assessment of the severity of patients' condition in the conditions of emergency care.

4. To develop a tactic for surgical treatment of patients with acute colonic obstruction depending on the localization of the tumor and the severity of patients' condition.

5. To assess the frequency of development of intra- and postoperative complications depending on the nature of the surgical intervention and the stage of colonic obstruction.

6. To assess the early and late results of the performed operations.

7. To develop indications and contraindications for various types of surgical treatment of patients with acute colonic obstruction in the conditions of a regional proctological department.

Scientific novelty of the research:

For the first time on a large number of clinical observations, the influence of social and demographic features of a specific region on the timeliness of diagnosis of colorectal cancer complicated by intestinal obstruction was studied. A tactic for surgical treatment of colon cancer complicated by intestinal obstruction, based on an objective assessment of the severity of patients' condition, was justified. Indications for two-stage surgical interventions in complicated colorectal cancer were developed.

Practical significance of the research results:

The results of the conducted study showed that the application of the developed diagnostic and treatment algorithm for patients with colon cancer complicated by intestinal obstruction allows not only reducing the frequency of postoperative complications and mortality, but also makes it possible in some cases to exclude the need for repeated hospitalization for medical and social rehabilitation of patients.

Main provisions to be defended:

Two-stage surgical interventions in colon cancer complicated by intestinal obstruction allow reducing the frequency of postoperative complications and mortality.

Performing two-stage surgical interventions in colon cancer complicated by intestinal obstruction makes it possible to exclude the need for repeated hospitalization for the rehabilitation of patients.

Dissertation defense:

The dissertation was demonstrated at a joint scientific conference of the Department of Proctology of the Russian Medical Academy of Postgraduate Education and the State Scientific Center of Proctology in Moscow on February 6, 2007.

Dissertation materials were reported at the Plenum of the Board of the Association of Proctologists of Russia in 2004 (Ryazan), scientific-practical conferences of the SSC of Proctology in 2005 and 2006, the Central European Congress of Proctology (Graz) in 2006.

Based on the dissertation materials, 3 scientific works were published.

I express sincere gratitude to my scientific supervisor, Director of the SSC of Proctology, Academician of RAMS, Professor G.I. Vorob'ev, for providing the opportunity to carry out this work and for valuable consultative assistance in the process of conducting the research.