ALGORITHM OF SURGICAL CARE IN COMPLICATED COLORECTAL CANCER

Abstract

AIM: to standardize surgical care for the malignant colonic obstruction. PATIENTS AND METHODS: the retrospective cohort study included 797 patients with complicated colorectal cancer. Malignant colonic obstruction was diagnosed in 572 patients: 247 of them were treated in 2011-2013 (I group); 325 - in 2014-2017 (II). Urgent bowel resection was performed more often in I group (one-stage treatment), fecal diversion or stent- in II (two-stage treatment). Seventy-seven patients with tumor bleeding were included as well: 62 of them were treated conservatively or underwent endoscopic coagulation or arterial embolization (III group); 15 patients - underwent urgent bowel resection (IV). All of 148 patients with bowel perforation were underwent urgent surgery: resection was performed in 115 patients (V), suturing the perforation site-in 15 (VI), extraperitoneal drainage of the abscess - in18 (VII). Elective bowel resection was performed in 241 patients (186 - from I-II group, 40 - from III, 15 - from VI-VII) after 0.1-6 months. The comparative analysis of the early and late results of one- and two-stage treatment was carried out with assessment of the 3-year cumulative survival. RESULTS: postoperative mortality was significantly lower in elective resection groups compared with urgent resection groups: 3.6% vs 29.2% (II vs I); 5.0% vs 20.0% (III vs IV); 0.0% vs 35,7% (VI-VII vs V). The survival rate was higher in elective resection groups than in urgent ones: 0.809 vs 0.680 (II vs I), 0.8882vs 0.3571 (III vs IV), 0.8615 vs 0.4257 (VI-VII vs V). CONCLUSION: multi-stage approach for complicated colorectal cancer is more effective than one-stage.