SÜLEYMAN KARGIN, MURAT ÇAKIR, Tevfik KÜÇÜKKARTALLAR, Ahmet TEKİN, Ebubekir GÜNDEŞ, Mehmet Sinan İYİSOY

Rektum kanserinde neoadjuvan tedavi alan hastalarda total mezorektal eksizyon sonrası koruyucu ileostomi gerekliliği

Amaç: Rektum kanseri için neoadjuvan kemoradyoterapi kullanımı hızla gelişmektedir. Neoadjuvan tedavilerdeki tüm gelişmelere karşın kemoradyoterapi alan hastalarda cerrahi sonrası komplikasyonlar ise hala tartışmalıdır. Çalışmamızın amacı rektum kanserinde neoadjuvan tedavi sonrası küratif cerrahi uygulanan hastalarda koruyucu ileostomi gerekliliğinin araştırılmasıdır. Gereç ve yöntemler: Kliniğimizde, neoadjuvan tedavi sonrası low anterior rezeksiyon ve total mezorektal eksizyon uygulanan rektum kanserli 19 hastanın verileri retrospektif olarak değerlendirildi. Ameliyat süresi, peroperatif ve postoperatif komplikasyonları, morbidite, mortalite ve hastade kalış süreleri ileostomi durumuna göre kıyaslandı. İstatistiksel analizde ki kare ve Mann Whitney U testleri kullanıldı. Bulgular: İleostomi açılan grupta anastomoz kaçağı 2 hastada görülürken açılmayan grupta 1 hastada anastomoz kaçağı gözlendi. Gruplar arasında postoperatif morbidite açısından anlamlı fark gözlenmedi. Komplikasyon ve hastanede kalış süreleri benzerdi. İleostomi açılmayan grupta ameliyat süresi daha kısaydı. Sonuç: Rektum kanserinde neoadjuvan tedavi sonrası küratif rezeksiyon yapılan hastalarda koruyucu ileostominin komplikasyonları ve morbiditeyi artırmadığını düşünmekteyiz. Ancak bu konunun daha geniş serilerde irdelenmesi gerekmektedir

Requirements of protective ileostomy after mesorectal excision in patients with rectal cancer who treated by adjuvant therapy

Objectives: The use of neoadjuvant chemoradiation for rectal cancer is developing rapidly. Despite all the advances in neoadjuvant therapy, complications after surgery is still controversial in patients who receiving chemoradiation. The aim of our study is to investi- gate the necessity of protective ileostomy after neoadjuvant therapy in rectal cancer patients who undergoing curative surgery. Mate- rial and methods: Data of 19 rectal cancer patients who were treaded with low anterior resection and total mesorectal excision after neoadjuvant therapy were evaluated retrospectively. Surgical operation time, intraoperative and postoperative complications, mor- bidity, mortality and length of stay in hospital were compared according to ileostomy state. Chi-square and Mann-Whitney U tests were used as statistical analysis. Results: Anastomotic leakage was seen two patients in ileostomy group while in other group leakage was seen one patient. No significant differences between the groups about postoperative morbidity was observed. Complications and length of hospital stay were similar. Surgery time was shorter in without ileostomy group. Conclusion: We believe that protective ileostomy after neoadjuvant therapy in rectal cancer patients who underwent curative resection, not increasing complications and morbidity. However, this issue needs to be evaluated in larger series

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