Safety and efficacy of total colectomy with D3 lymph node dissection at colorectal cancer, developed at inflammatory bowel diseases (case control study)

Abstract

Aim of investigation. To compare results of radical surgery in IBD-associated colorectal cancer (IBD-CRC) and sporadic colorectal cancer (spCRC) patients. Material and methods. The main group included retrospective cases of IBD-CRC with total colectomy and D3 lymph node (LN) dissection. The control group included matched cases of spCRC in 1:3 ratio according to localization and stage. Results. Overall 6 IBD-CRC and 18 spCRC patients were matched. IBD-CRC patients had longer operation time (313±37 vs 240±16 min, p=0.05), while there was no significant difference in mean volume of blood loss and postoperative stay duration (383±145 and 186±29 ml, p=0.24; 15.7±3.2 and 14.1±0.9 days, p=0.5 respectively). IBD-CRC patients spent longer time in ICU than spCRC (2.3±0.6 and 1.17±0.2 days, p=0.02) and had later bowel peristalsis restoration (2.0±0.4 and 1.3±0.1 days, p=0.02), however, time to first gas and stool discharge via stoma didn’t differ (2.5±1.4 and 2.1±0.6 days, p=0.5; 4.2±3.4 and 2.4±0.7 days, p=0.3). Tumor grade, histological type and adenoma rate didn’t differ between groups. Average number of involved LN in IBDCRC and spCRC was 39±16 and 30±5 (p=0.6). The rate of metastatic LN was 33.3% in both groups. The mean follow-up time was 27.3±5.3 months. Distant metastases were detected in 33.3% and 16.7% of IBD-CRC and spCRC cases respectively (p=0.4), without local recurrence in both groups. Conclusion. Tumor and LN characteristics in spCRC and IBD-CRC were similar, therefore radical surgery with extended LN dissection is recommended for IBDCRC patients.

Keywords

• неспецифические воспалительные заболевания кишечника
• язвенный колит
• болезнь крона
• колоректальный рак
• расширенная лимфодиссекция