Are there any changes in the surgical management of stenosing rectal cancer?

Česká verzia

Authors: A. Pelikán ^1,2; L. Tulinský ¹ ; M. Peteja ¹ ; M. Lerch ¹
Authors place of work: Chirurgická klinika LF OU a FN Ostrava ¹; Ústav zdravotnických věd, Fakulta humanitních studií UTB ve Zlíně ²
Published in the journal: Gastroent Hepatol 2017; 71(1): 62-68
Category: Gastrointestinal Oncology: Original Article
doi: https://doi.org/10.14735/amgh2016csgh.info16

Summary

Background:
In the last few decades, there have been many advances in the management of patients with rectal carcinoma. However, surgical treatment options for patients with stenosing carcinomas are still very limited and the prognosis is poor.

Methods:
A retrospective clinical study was used to evaluate the surgical treatments of patients with this tumor’s type at the University Hospital Ostrava. The outcomes of patients with stenosis rectal carcinomas were analyzed for two study period (2003–2004 and 2013–2014).

Results:
Within the first study period (2003–2004), stenosing rectal carcinoma was diagnosed in 63 patients (24 patients had clinical signs of bowel obstruction). Surgery in patients with bowel obstruction was done within 72 hours after hospital admission in majority of cases (17 patients – 70.8%) and palliative surgery (stoma) was done in 14 patients (58.3%). There were 39 patients without signs of bowel obstruction. In these patients, primary radical surgical resection was done in 30 patients (76.9%) and only 2 patients (5.1%) were indicated for neoadjuvant treatment. Within the second study period (2013–2014), 44 patients with stenosing carcinoma were treated (18 patients had signs of bowel obstruction). Among the patients with bowel obstruction, surgery was done within 72 hours after hospital admission in 13 patients (72.2%). Palliative surgery was done in 10 patients (55.6%). There were 26 patients with stenosing carcinoma without signs of bowel obstruction, among whom primary radical surgical resection was done in 10 patients (38.2%) and primary neoadjuvant treatment was indicated in 13 patients (50.0%).

Discussion:
Management of patients with stenosing rectal carcinoma without clinical signs of bowel obstruction should be based on careful staging, a multidisciplinary approach, and treatment. In patients with signs of bowel obstruction, it is advisable to proceed on an individual basis depending on the practice in each surgical department.

Conclusions:
Within 10 years, there have been no significant changes in the surgical treatment of patients with bowel obstruction resulting from stenosing rectal carcinoma; the number of patients, spectrum of the operations performed, and postoperative morbidity and mortality rates have not changed.

Key words:
rectal cancer – bowel obstruction – multidisciplinary approach – surgery

The authors declare they have no potential conflicts of interest concerning drugs, products, or services used in the study.

The Editorial Board declares that the manuscript met the ICMJE „uniform requirements“ for biomedical papers.

Submitted:
20. 12. 2015

Accepted:
17. 5. 2016

Zdroje

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