Surgical treatment of colorectal cancer complicated with acute intestinal obstruction

Background. The main reason for urgent complications of colon cancer is an acute intestinal obstruction (AIO). This is complex pathological condition in 90 % of cases caused by colorectal cancer (CRC).
Objective – to evaluate radicality of the performed operations in complicated colorectal cancer in general surgical hospitals. Dependence of the severity of intestinal obstruction by tumor localization, its morphological characteristics, determine dependence of the type of the surgical operation performed on the severity of intestinal obstruction.
Materials and methods. We have studied the data on 667 patients with colorectal cancer complicated by acute intestinal obstruction. These patients were treated in the period from 2001 to 2013 in general surgical hospital in the territory of Smolensk and Smolensk region. For the processing of the obtained results we have used software Statistica 6.1. Differences were considered statistically at p ≤ 0.05.
Results. All the patients were divided into 3 groups by the expression of intestinal obstruction. Group 1 (n = 279) consisted of patients with the presence of decompensated intestinal obstruction (DIO), group 2 (n = 313) consisted of patients with subcompensated intestinal obstruction (SIO), group 3 (n = 75) included patients with compensated intestinal obstruction (CIO). In case of tumor localization in right halfof the colon we most commonly observed clinical picture of acute development of decompensated intestinal obstruction (p = 0.041). Subcompensated intestinal obstruction prevailed in case of tumor localization in left half of the colon and rectal localization. In general surgical hospitals it is not always possible to speak about radicality of surgical treatment, as in a large number of cases (62.5 %) the number of examined lymph nodes was less than 4. When DIO patients are admitted in the clinic, the percentage of singlestage operations is equal to 7.5 % (n = 21). In case of DIO and SIO there was a high percentage of multi-stage operations with removal
of the tumor at the 2nd stage (33.0 and 25.2 %, respectively). DIO most often was noted in case of circular tumor growth (93.5 % of cases). To a lesser extent the severity of acute intestinal obstruction was influenced by such factors as extent of the tumor along the intestinal wall and its histological type.
Conclusion. In the general surgical hospitals final decision on the choice of surgical approach depends on the general condition of patients, surgeon’s experience and hospital where the surgery is performed. It is advisable to carry out surgical interventions in the given contingent of patients in the specialized departments.

colorectal cancer, decompensated intestinal obstruction, subcompensated intestinal obstruction, compensated intestinal obstruction, single-stage and multi-stage surgery

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