Surgical treatment of complicated colorectal cancer. Emergency hospital experience

During the period from 2017 to 2021, 256 people were urgently operated on for complicated colorectal cancer in the Central City Clinical Hospital of Veliky Novgorod. Among the complications of colorectal cancer, acute intestinal obstruction was observed in 166 patients (64.8%), diastatic perforation of the large bowel was noted in 23 (9%), perifocal tumor inflammation — in 20 (7.8%), tumor perforation — in 36 (14%) and in 11 (4.3%) cases, bleeding from the tumor was detected. There were 111 men (43.4%), 145 women (56.7%). The age of the patients varied from 24 to 93 years and averaged 50.9±3.8 years. By localization, tumor of the cecum was noted in 20 (7.8%) patients, the right flank of the colon — in 64 (25%), the left flank of the colon — in 36 (14%), the sigmoid colon — in 97 (37.9%) and the rectum — in 39 (15.2%) patients. Operations with tumor removal were performed in 218 patients (85.2%), including 11 patients with laparoscopy. In 38 patients (14.8%), surgical interventions were symptomatic and limited to the removal of colostomy. Among 256 patients operated for complicated colorectal cancer, 42 patients died, postoperative mortality was 16.4% and was significantly lower than the figures published in the literature.

1. Davydov M.I., Aksel’ E.M. Zabolevayemost' zlokachestvennymi novoobrazovaniyami naseleniya Rossii i stran SNG v 2009 godu [Incidence of malignant tumors in Russia and CIS countries in 2009]. Vestnik RONC im. N.N. Blokhina RAMN — Bulletin of N.N. Blokhin Russian Cancer Research Center at RAMS, 2010, no. 21(2), pp. 52–86.

2. Zlokachestvennyye obrazovaniya v Rossii v 2012 godu (zabolevayemost' i smertnost') [Malignant tumors in Russiain 2012 (incidence and mortality)]. Eds. Kaprin A.D., Starinskiy V.V., Petrova G.V. Moscow: Р.А. Herzen Moscow Scientific and Research Oncological Institute–branch of the National Medical Research Radiological Centre, Ministry of Healthof Russia, 2016. 250 p. (In Russ.)

3. Barsukov Yu.A., Tkachev S.I., Kuz’michev D.V., et al. Kompleksnoye lecheniye bol'nykh operabel'nym rakom pryamoy kishki distal'noy lokalizatsii [Multimodality treatment in patients with operable distal rectal cancer]. Onkologicheskaya koloproktologiya — Colorectal Oncology, 2012, vol. 3, pp. 28–37. doi: https://doi.org/10.17650/2220-3478-2012-0-3-28-37

4. Teixeira F., Akaishi E.H.,Ushinohama A.Z., et al. Can we respect the principles of oncologic resection in an emergency surgery to treat colon cancer? World J. Emergency Surg., 2015, vol. 10(5), pp. 1186–91. Available at: http://www.wjes.org/content/10/1/5 (accessed: 13.04.2022). doi: https://doi.org/10.1186/1749-7922-10-5

5. Achkasov E.E., Pugaev A.V., Alekperov S.F., et al. Klassifikatsiya obturatsionnoy tolstokishechnoy neprokho-dimosti opukholevogo geneza [Classification of obstructive colonic obstruction of tumor genesis]. Koloproktologiya — Coloproctology, 2009, no. 3, pp. 17–23.

6. Klinicheskaya operativnaya koloproktologiya: Rukovodstvo dlya vrachey [Clinical operative coloproctology: A guide for doctors]. Ed. Fedorov V.D., Vorobyov G.I., Rivkin V.L. Moscow, GNTS proktologii Publ., 1994. 432 p.

7. Klinicheskiye rekomendatsii. Koloproktologiya [Clinical recommendations. Coloproctology]. Ed. Shelygin Yu.A. 2nd ed. Moscow, GEOTAR-Media Publ., 2017. 560 p. (In Russ.)

8. Klinicheskiye rekomendatsii. Rak obodochnoy kishki i rektosigmoidnogo otdela [Clinical recommendations. Cancer of the colon and rectosigmoid department]. ICD10:C18/C19, 2018. Available at: http://oncology.ru/association/clinicalguidelines/2018/rak_obodochnoy_kishki_pr2018.pdf. (In Russ.)

9. Sazhin V.P., Gostkin P.A., Soboleva V.I, Siatkin D.A., Sazhin I.V., Bublikov I.D. Kompleksnoye lecheniye oslozhnennogo kolorektal'nogo raka [Complex approach to the complicated forms of colorectal cancer]. Khirurgiya. Zhurnal im. N.I. Pirogova — Pirogov Russian Journal of Surgery, 2010, vol. 7, pp. 15–19.

10. NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines ®) Colon Cancer Version 3.2021. Available at: https://www.lissod.com.ua/doctor/files/colon-cancer-of-largebowel.pdf

11. Aliyev S.A. Puti uluchsheniya rezul'tatov khirurgicheskogo lecheniya neprokhodimosti obodochnoy kishki opukholevogo geneza [Ways to improve the results of surgical treatment of colon obstruction of tumor genesis]. Vestnik Khirurgii Imeni I.I. Grekova — Bulletin of Surgery named after I.I. Grekov, 1998, vol. 157(6), pp. 34–39.

12. Kalinin E.V. Khirurgicheskoye lecheniye bol'nykh s oslozhnennym kolorektal'nym rakom [Surgical treatment in patients with colorectal cancer]. Onkologiya. Zhurnal im. P.A. Gertsena — P.A. Herzen Journal of Oncology, 2016, vol. 5(4), pp. 30–34. doi: https://doi.org/10.17116/onkolog20165430-34

13. Matviychuk B.O. Acute obturation ileus of large bowel of tumor origin: surgical tactics. Klin. Surgery, 1997 vol. 11–12, pp. 88–90. ( in Ukrainian)