ABDULLAH KISAOĞLU, Bünyamin ÖZOĞUL, AYHAN AKÖZ, SABRİ SELÇUK ATAMANALP, Gürkan ÖZTÜRK, Mehmet İlhan YILDIRGAN

Obstrüktif kolorektal kanserli hastalarda cerrahi tedavi sonuçları

Amaç: Kolorektal kanserlere bağlı obstrüksiyonlar kolonik acillerin yaklaşık %85inden sorumludur. Bu çalışmanın amacı, kansere bağlı gelişen akut kolorektal obstrüksiyonlarda uygulanacak cerrahi girişimin sonuçlarını incelemektir. Yöntemler: Bu çalışmada Ocak 2000-Aralık 2010 tarihleri arasında kliniğimize akut kolon obstrüksiyonu ile başvuran ve kolon tümörü tanısı ile opere edilen 86 olgu retrospektif olarak değerlendirildi. Yaş, cins, başvuru anındaki semptomlar, ek hastalığının olup olmaması, uygulanan cerrahi yöntemler, komplikasyon ve mortalite oranları tespit edildi. Bulgular: Olguların 50si erkek, 36sı kadındı. Ortalama yaş 63,6 yıl idi. Olguların 20sinde tanıda acil kolonoskopik değerlendirme yapıldı ve tıkayıcı lezyon gözlendi. Olguların 18ine sağ hemikolektomi, 34üne sigmoid rezeksiyon, 10una sol hemikolektomi, 2sine abdomino-perineal rezeksiyon, 4üne subtotal kolektomi, 2sine transvers kolektomi yapıldı. Primer anastomoz 34 olguya yapıldı. Toplam 12 olguda mortalite görüldü. Sonuç: Obstrüktif sol kolon kanserlerinde seçilmiş vakalarda rezeksiyon ve primer anastomoz genellikle mümkündür. 70 üzeri yaş, komorbiditenin varlığı, albümin de- ğerinin 3 g/dlnin altında olması, ASA skorunun 3 ve üzeri olması, 500 mlden fazla kan kaybı ve ameliyatta kan verilmesi postoperatif yüksek mortalite ile ilişkili bulundu.

The outcome of surgical treatment in patients with obstructive colorectal cancer

Objectives: Colorectal cancer obstructions are responsible for about 85% of colonic emergencies. The aim of this study was to investigate the results of urgent surgical intervention that applied in acute colonic obstructions related to cancer. Methods: In this study, 86 cases presenting with acute colonic obstruction who were operated with the diagnosis of colonic tumor between January 2010 and December 2010 were assessed retrospectively. Age, gender, symptoms on presentation, presence of concomitant disease, surgical methods applied, complication and mortality rates were recorded. Results: Fifty of the cases were male, 36 were female. The mean age was 63.6 years. Twenty cases had undergone emergency colonoscopic examination at diagnosis and an obstructive lesion had been observed. The surgical operations performed were right hemicolectomy in 18, sigmoid resection in 34, left hemicolectomy in 10, abdomino-perineal resection in 2, subtotal colectomy in 4, transverse colectomy in two. Primary anastomosis was performed in thirty-four cases. Mortality was observed in 12 cases. Conclusions: In selected cases of left colon cancers with obstruction, resection and primary anastomosis is generally possible. Those over 70, presence of co-morbidities, albumin level under 3 g/dl, ASA score 3 and higher, blood loss of more than 500 ml, and preoperative blood transfusion were related to the high postoperative morbidity

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1. Coco C, Verbo A, Manno A, et al. Impact of emergency surgery in the outcome of rectal and left colon carcinoma. World J Surg 2005;29:1458-1464.
2. Zorcolo L, Covotta L, Carlomagno N, Bartolo DC. Safety of primary anastomosis in emergency colo-rectal surgery. Colorectal Dis 2003;5:262-269.
3. Alvarez JA, Baldonedo RF, Bear IG, et al. Presentation, treatment, and multivariate analysis of risk factors for obstructive and perforative colorectal carcinoma. Am J Surg 2005;190:376-382.
4. Villar JM, Martinez AP, Villegas MT et al. Surgical options for malignant left-sided colonic obstruction. Surg Today 2005;35:275-281.
5. Jiang JK, Lan YT, Lin TC, et al. Primary vs. delayed resection for obstructive left-sided colorectal cancer: impact of surgery on patient outcome. Dis Colon Rectum 2008;51:306- 311.
6. Lee YM, Law WL, Chu KW, Poon RT. Emergency surgery for obstructing colorectal cancers: a comparison between right-sided and leftsided lesions. J Am Coll Surg 2001;192:719-725.
7. Smothers L, Hynan L, Fleming J, et al. Emergency surgery for colon carcinoma. Dis Colon Rectum 2003;46:24-30.
8. Cuffy M, Abir F, Audisio RA, Longo WE. Colorectal cancer presenting as surgical emergencies. Surg Oncol 2004;13:149-157.
9. Phillips RK, Hittinger R, Fry JS, Fielding LP. Malignant Large bowel obstruction. Br J Surg 1985;72:296-302.
10. Irvin TT, Greaney MG. The treatment of colonic cancer presenting with intestinal obstruction. Br J Surg 1977;64:741- 744.
11. Serpell JW, McDermott FT, Katrivessis H, Hughes ES. Obstructing carcinomas of the colon. Br J Surg 1989;76:965- 969.
12. Valerio D, Jones PF. Immediate resection in the treatment of large bowel emergencies. Br J Surg 1978;65:712-716.
13. Hsu TC. One-stage resection and anastomosis for acute obstruction of the left colon. Dis Colon Rectum 1998;41:28- 32.
14. Ören D, Öztürk G. Kolorektal Kanserlerde Güncel Acil Tedavi. Türkiye Klinikleri J Gen Surg-Special Topics 2009;2:127-133.
15. Hsu TC. Comparison of one-stage resection and anastomosis of acute complete obstruction of left and right colon. Am J Surg 2005;189:384-387.
16. Bokey EL, Chapuis PH, Fung C, et al. Postoperative morbidity and mortality following resection of the colon and rectum for cancer. Dis Colon Rectum 1995;38:480-486.
17. Keymling M. Colorectal Stenting. Endoscopy 2003;35:234- 238.
18. Iversen LH, Bülow S, Christensen IJ, et al. Danish Colorectal Cancer Group. Postoperative medical complications are the main cause of early death after emergency surgery for colonic cancer. Br J Surg 2008;95:1012-1019.
19. Seah DW, Ibrahim S, Tay KH. Hartmann procedure: is it still relevant today? ANZ J Surg 2005;75:436-440.
20. Deen KI, Madoff RD, Goldberg SM, Rothenberger DA. Surgical management of left colon obstruction: the University of Minnesota experience. J Am Coll Surg 1998; 187:573-576.
21. Sayek İ. Kolorektal karsinomlar. Sayek İ, ed. Temel Cerrahi. Güneş kitabevi, Ankara 1996;1173-1177.
22. Onuk E, Tekin E. Kolon ve rektum kanserleri. Engin A, ed. Genel Cerrahi. Atlas kitapçılık, Ankara 2000;574-580.
23. Çayır K, Bilici M, Tekin SB, ve ark. Evre II-III kolon kanserli hastalarda adjuvan tedavinin yan etki profilinin değerlendirilmesi. Dicle Tıp Dergisi 2010;37:145-150.