Results of surgical treatment in patients with stenotic colorectal carcinoma complicated by tumor perforation, diastatic colonic rupture, and abdominal sepsis

Abstract

The paper provides a comparative analysis of the results of surgical treatment in 46 patients aged 24 to 85 years with stenotic colorectal carcinoma (CRC) complicated by colonic obstruction and perforation and peritonitis. All the patients had decompensated obstruction, the clinical picture of which manifested with colonic perforation both in the area of tumor involvement in 33 (71.7%) patients and above the site of obstruction in 13 (28.3%). The clinical and laboratory criteria for systemic inflammatory response syndrome and abdominal sepsis were found in 37 (80.4%) of the 46 patients. The author attempted to provide evidence whether the intestinal form of abdominal sepsis should be identified in patients with CRC complicated by colonic obstruction and perforation on the basis of whether the patients had symptoms of systemic inflammatory response syndrome. The choice of a surgical method was differentially determined by to the site of the tumor, the specific features of malignant growth, the type of colonic perforation, the extent of peritonitis, and the patients' medical condition and age. Forty-four of the 46 patients were operated on. Radical surgery was performed in 34 patients (38.2% death) and palliative surgery was made in 10 (80% death). Postoperative mortality was 47.7%. Two unoperated patients died. Overall mortality was 50%. The mortality rates for perforated colonic tumors and diastatic perforations were 41.9 and 61.5%, respectively. Comparative analysis of the results of surgical treatment for concomitant complications of CRC showed the efficiency of primary radical operations irrespective of cancer localization, type of perforation, and patient age. The obstructed modes of radical operations are considered to be the method of choice for the surgical treatment of left colonic involvement. In the past 10 years, the applied surgical tactic allowed the author to make postoperative and overall mortality rates stable in the above group patients at levels of 47.2-47.7 and 50%, respectively.