TREATMENT STRATEGY FOR COLORECTAL CANCER COMPLICATED WITH DECOMPENSATED INTESTINAL OBSTRUCTION AND DIASTATIC PERFORATION OF THE COLON

Abstract

Objective: to improve the results of treatment of patients with colorectal cancer complicated by acute bowel obstruction and diastatic rupture.Materials and methods. Retrospective analysis of treatment outcomes of patients with complicated colorectal cancer, treated at the Clinic of Hospital Surgery of theI.I.MechnikovNorth-WestStateMedicalUniversity from 1986 till 2015.Results. Of the 1206 patients with colorectal cancer complicated by intestinal patency violation injury breach of intestinal, decompensated violation intestinal patency (ABO) was detected in 245 (20.3 %) cases. The main principle of treatment of colonic obstruction in cancer was the intention for the simultaneous elimination of obstruction and the radical removal of the tumor. Radical surgery was performed in 152 (62 %) of 245 cases with ABO. In case of right-sided colon tumors generally colon resection with anastomosis formation were performed, in case of left-sided tumors colon resection in the majority ended with the terminal colostomy formation. Palliative operations were performed to 93 (37.9 %) patients. Postoperative complications were detected in 51 (20.8 %) cases. The death rate was 11.8 %. The mortality after radical surgical operations was 6.6 %. Diastatic rupture was diagnosed in 15 (1.2 %) patients. Subtotal colectomy with the formation or anastamosis was performed to 3 patients, operation ended with ileostomy formation – in 9 cases.Conclusion. In case of the left-side cancer of colon, complicated by АВО, a radical surgical operation with colostomy formation is beneficial. In the case of colorectal cancer, complicated by the diastatic rupture the operation of choice is subtotal colectomy.

Keywords

• colorectal cancer
• complications
• acute bowel obstruction
• diastatic rupture
• treatment
• stoma
• subtotal colectomy