DIFFERENTIATED TACTICS OF TREATMENTOF COLON CANCER COMPLICATED BY PERFORATION,INCLUDING THE RISK OF COLONAND ENTEROCOLIC ANASTOMOSES FAILURE

Abstract

Introduction. In recent decades, the worldwide increase in the incidence of colorectal cancer
(further on CRC) is noted. A serious complication of CRC is perforation of the tumor or rupture of the
intestinal wall proximal to the neoplasm. Prospects for improving the results of treatment of complicated
colorectal cancer require the definition of conditions and the creation of an optimal algorithm for using
surgical techniques of restoring the intestinal passage in combination with a complex pathogenetic
approach, restoring the disturbed homeostasis and functional state of the patient's organs and systems
with subsequent radical surgery. Also an objective evaluation of immediate and long-term results of their
joint application. The objective of the study were to develop and implement a differentiated tactics for
treatment of colon cancer complicated by perforation, taking into account the risk of failure of
anastomoses in situations involving the creation of the intestinal stoma.
Materials and methods. The study was of a clinical nature and based on a study of the results of
the surgical treatment of 124 patients with colon cancer complicated by perforations operated in the
Poltava Clinical Oncology Center (Poltava, Ukraine) between 2007 and 2017, in patints aged between
26 and 80, who were divided into 2 groups: the comparison group and the main group. The comparison
group included 66 patients who were operated from 2007 to 2012, by the conventional tactical schemes
of treatment of colon cancer, complicated by perforation. The main group included 58 patients who were treated between 2013 and 2017. To assess the severity of dysfunction or decompensation of organs
and systems and the risk of intra- and postoperative complications, the scale of severity assessment of
SAPS were used in the comparison group. The effectiveness of the complex of detoxification activities
were confirmed by the study of the leukocyte index of intoxication and peptides of average molecular
weight in dynamics. The clinical efficacy and safety of the developed technology were assessed by the
following criteria: the number of intact anastomoses, the frequency of early postoperative complications,
the lethality due to intra-abdominal complications of anastomosis formation.
Results. When choosing the extent of surgery in perforative tumors, one should be guided by the
severity of the patient's general condition, the prevalence of the tumor process and the form of
peritonitis, and assessment of the risk of development of anastomosis insufficiency. To determine the
degree of risk of one-stage operations in complicated cancer, we developed an index of the risk of
development of anastomosis insufficiency. According to the analysis, the optimal score was 15 ± 2,5. In
patients whose severity is assessed as light on the SAPS scale, and the risk of development of
anastomosis failure when summing up the score does not exceed 15, we consider it adequate to
perform one-stage radical and palliative resections of the colon, in cases of a severe general condition
of the patient at a high risk (more than 15 points). The risk of developing an anastomosis failure, as well
as the detection of peritoneal carcinomatosis, performing of radical and palliative interventions with the
formation of primary-delayed small intestine-colon and colon-colon anashtomoses. Optimal invasion in
multiple diasthatic perforations of inbound bowel were considered a subtotal colectomy with ileosthoma
formation or formation of primary-delayed ileo-sigmo or ileo-rectoanasthomosis. Comparative evaluation
of LEE and PSMM in dynamics showed quick coping of endogene intoxication in main group patients.
Overall early postoperative complications in comparison group constituted 27 (40,9%), main group – 17
(29,3%), while inflammatory-suppurative complications in comparison group constituted 11(16,7%) and
5 (8,6%) in the main group. No patient died in the main group and in the comparison group three
patients died (5%).
Conclusions: The developed methods for anasthomoses failure and surgical treatment of the
perforation complicated colon cancer patients are sufficiently effective and lead to a decrease of
immediate postoperative complications and postoperative lethality and may be widely used in this
category of patients.