The role of conservative therapy in the treatment of complicated colorectal cancer

Objective: to evaluate the possibilities of conservative treatment of patients with complications of colorectal cancer.

Materials and methods. The study included the results of treatment of 105 patients with complications of colorectal cancer treated on the basis of the District Clinical Hospital of Surgut for the period 2012—2017. Of these, 86 (81.9 %) patients with acute obstructive intestinal obstruction, 11 (10.5 %) patients with bleeding from colon tumors, and 8 (7.6 %) patients with purulent-septic complications of colon cancer.

Results. The complex of conservative measures, including colon stenting, provides restoration of the passage through the digestive tract in 79.1 % of patients, which allows preparing the patient to perform surgery, thereby reducing the risk of complications. Twenty-eight (27.6 %) patients were operated on an emergency basis: due to the lack of effect from conservative therapy for acute intestinal obstruction — 18 (17.1 %) patients, due to peritonitis — 8 (7.6 %), due to recurrent colonic bleeding — 3 (2.9 %) patients. The death rate was 13.8 % (n = 4). In the delayed order after successful conservative therapy, 70 (66.7 %) patients underwent surgical treatment in the surgical and oncology departments. Postoperative mortality was 1.4 % (n = 1).

Conclusion. The complex of conservative measures, which allows avoiding emergency surgical intervention at the urgent stage of treatment, is the basis for carrying out a full-fledged surgical intervention in a delayed procedure in a specialized hospital, observing the principles of oncological radicalism.

1. Leong K., Hartley J., Karandikar S. Association of Coloproctology of Great Britain & Ireland (ACPGBI): Guidelines for the Management of Cancer of the Colon, Rectum and Anus (2017) - Follow Up, Lifestyle and Survivorship. Colorectal Dis 2017;19(suppl 1):67-70. PMID: 28632315. https://doi.org/10.1111/codi.13706.

2. Malignant tumors in Russia in 2016. Ed. By A.D. Kaprin, V.V. Starinskiy, G.V. Petrovskiy. Moscow, 2018. (In Russ.).

3. Achkasov E.E., Pugaev A.V., Alekperov S.F. et al. Classification of tumor-associated large bowel obstruction. Koloproktologiya = Coloproctology 2009;(3):17-23. (In Russ.).

4. Darvin V.V., Lysak M.M., Vasilyev V.V. Comprehensive rehabilitation of patients with tumor-associated colonic obstruction. Vestnik SurGU = Bulletin of Surgut State University. Medicine 2009;1(2):76-80. (In Russ.).

5. Darvin V.V., Lysak M.M., Ilkanich A.Ya. et al. Surgical treatment of tumor-associated intestinal obstruction: evaluation of outcomes and ways of optimization. Proceedings of the International Congress of the Association of Russian Coloproc-tologists and the first ESCP/ECCO regional master class (abstracts). Moscow, 16.04-18.04.2015. P. 99. (In Russ.).

6. Sheyanov S.D., Kharitonova E.A. Acute intestinal obstruction and intraabdominal hypertension (literature review). Vestnik SPbGU = Bulletin of Saint Petersburg University. Medicine 2009;11(4):150-60. (In Russ.).

7. Kalinin E.V. Surgical treatment for patients with complicated colorectal cancer. Onkologiya. Zhurnal im. P.A. Gertsena = P.A. Herzen Journal of Oncology 2016;5(4):30-4. (In Russ.).

8. Narezkin D.V., Shchaeva S.N. Providing medical care to patients with complicated colorectal cancer in a general surgical hospital. Koloproktologiya = Coloproctology 2011;4:38-40. (In Russ.).

9. Shchaeva S.N. Outcomes of radical surgery in patients with complicated colorectal cancer. Kubanskiy nauchniy meditsinskiy vestnik = Kuban Research Medical Bulletin 2014;6(148):103-6. (In Russ.).

10. Shulutko A.M., Moiseev A.Yu., Zubtsov V.Yu. et al. Colon tumors in emergency surgery. Moskovskiy khirurgicheskiy zhurnal = Moscow Surgical Journal 2012;3:5-8. (In Russ.).

11. Aliev SA., Aliev E.S. Improving the technique of intraoperative colon decompression in patients with tumor-associated colonic obstruction. Procceedings of the 2nd Congress of Coloproctologists of CIS countries and 3rd Congress of Coloproc-tologists of Ukraine with the participation coloproctologists from Central and Eastern Europe. Odessa, 2011. Pp. 66-67. (In Russ.).

12. Khataryan A.G., Glumov E.E, Miziev I.A. Results of the use of self-expanding stents in patients with colorectal cancer complicated by acute intestinal obstruction. Koloproktologiya = Coloproc-tology 2014;3(annex):83. (In Russ.).

13. Avakimyan V.A., Karipidi G.K., Avakimyan S.V. et al. Surgical tactics in urgent complications of colon cancer. Kubanskiy nauchniy meditsinskiy vestnik = Kuban Research Medical Bulletin 2018;25(6): 9-13. (In Russ.).

14. Cirocchi R., Farinella E., Trastulli S. et al. Safety and efficacy of endoscopic colonic stenting as a bridge to surgery in the management of intestinal obstruction due to left colon and rectal cancer: a systematic review and meta-analysis. Surg Oncol 2012;22:14-21. PMID: 23183301. https://doi.org/10.1016/j.suronc.2012.10.003.

15. Darvin V.V., Ilkanich A.Ya., Onishchenko S.V. et al. Diagnostic and treatment algorithm for acute colonic obstruction. Proceedings of the visiting plenum meeting of the task group “Emergency Surgery” and research and practical conference dedicated to the 65 th anniversary of the Research Surgical Society and the 20th anniversary of the Association of Surgeons in the Caucasian Mineral Waters. Pyatigorsk, 6.10- 7.10.2011. Pp. 143-44. (In Russ.).

16. Melnikov P.V., Achkasov E.E., Alekperov S.F. et al. Choosing an optimal treatment strategy for tumor-associated colonic obstruction. Chirur-giya = Surgery 2013;10:84-7. (In Russ.).

17. Gainant A. Emergency management of acute colonic cancer obstruction. J Visc Surg 2012;149:e3-10. PMID: 22189474. https://doi.org/10.1016/j.jviscsurg.2011.11.003.

18. Frago R., Ramirez E., Millan M. et al. Current management of acute malignant large bowel obstruction: a systematic review. Am J Surg 2014;207(1):127-38. PMID: 24124659. https://doi.org/10.1016/j.amj-surg.2013.07.027.

19. Shelygin Yu.A., Bagnenko S.F., Davydov M.I. et al. Acute tumor-associated intestinal obstruction: clinical guidelines. 2014. Available at: http://obshchestvo-khirurgov.rf. (In Russ.).

20. Shchaeva S.N. Surgical treatment of colorectal cancer complicated by acute intestinal obstruction. Onkol-ogicheskaya koloproktologiya = Colorectal Oncology 2016;6:8-16. (In Russ.).

21. Vaziri K., Choxi S.C., Orkin B.A. Accuracy of colonoscopic localization. Surg Endosc 2010;24:2502-5. PMID: 20333403. https://doi.org/10.1007/s00464-010-0993-2.

22. Shchaeva S.N. Efficacy of surgical treatment in patients with urgent complications of colorectal cancer. Annaly khirurgii = Annals of Surgery 2016;21(4):240-7. (In Russ.).

23. Shchaeva S.N. Emergency resections in patients with complicated right- and left-sided colon cancer: long-term outcomes. Onko-logicheskaya koloproktologiya = Colorectal Oncology 2018;8(2):46-54. (In Russ.).