Orhan ÜREYEN, Hüseyin FENERCİOĞLU, Demet ALAY, ENVER İLHAN

KOLOREKTAL KANSER OBSTRÜKSİYONUNUN ACİL CERRAHİSİNDE MORTALİTE İLE İLİŞKİLİ FAKTÖRLER

Giriş: Bu çalışmamızda acil cerrahi tedavi uygulanan kolerektal kanserli olguların mortalite ile ilişkili olabilecek faktörlerini incelemeyi amaçladık. Gereç ve Yöntem: Çalışmamıza acil servise başvurup klinik muayene, laboratuar ve radyolojik tanı yöntemlerinden biri ya da daha fazlasında kolorektal tümör obstrüksiyonu nedeniyle opere edilen olgular dahil edildi. Olguların verileri retrospektif olarak değerlendirildi. Mortalite görülenler (Grup I) ve mortalite görülmeyenler (Grup II) olarak 2 gruba ayrıldı. Bulgular: Çalışmamıza grup I de 7(%22), grup II de 25(%78) olgu dahil edildi. Grup I yaş ortalaması 68.57±11.80, grup II yaş ortalaması 71±9.69 idi. Olguların acile başvurudan ameliyata alınana kadar geçen süre açısından irdelendiğinde gruplar arası farklılık gözlendi(p:0,006). Grup I’ deki 7 olgunun 6(%86)’sı, grup II’nin ise 6(%24)’sı ilk altı saatte ameliyata alınmıştı. Ortalama albumin değeri grup I’de 2.2±0,3, grup II’de 3.2±0,7 idi ve aralarında anlamlı farklılık gözlendi (p:0,001) Sonuç: Çalışmamızda hastaneye başvurudan sonraki ilk altı saatte operasyona alınmasının ve düşük albumin değerinin mortalite görülmesinde ilişkisi bulundu.

MORTALITY-RELATED FACTORS IN EMERGENCY SURGERY OF COLORECTAL CANCER OBSTRUCTION

Introduction:We aimed to investigate the factors that may be associated with mortality in patients with colorectal cancer who underwent emergency surgery. Material and Method:The patients operated in our clinic were included in the study due to colorectal tumor related obstruction in one or more of the clinical examination, laboratory and radiological diagnostic methods. The data of the cases were evaluated retrospectively. Patients were divided into two groups; mortality(Group I) and those without mortality(Group II) Results: Group I 7(22%)cases and group II 25(78%) cases included this study.The mean age of the group I was 68.57 ±11.80 and the mean age of the group II was 71 ±9.69.When the cases were examined in terms of the time elapsed from the time of admission to emergency room to surgery,difference were observed between the groups(p:0.006).6(86%) of 7 patients in group I and 6(24%) of group II were operated in first six hours. Mean albumin value was 2.2±0.3 in group I and 3.2±0.7 in group II, and a significant difference was observed between them (p: 0.001). Conclusion: In this study, there was a correlation between mortality and surgery in the first six hours after admission to hospital and low albumin value.

PDF

___

Tebala GD, Natili A, Gallucci A, Brachini G, Khan A Q, Tebala D, et al. Emergency treatment of complicated colorectal cancer. Cancer Management and Research 2018;10: 827–38.
Baer C, Menon R, Bastawrous S, Bastawrous A. Emergency presentations of colorectal cancer. Surgical Clinics 2017;97(3): 529-45.
Faucheron JL, Paquette B, Trilling B, Heyd B, Koch S, Mantion G. Emergency surgery for obstructing colonic cancer: a comparison between right-sided and left-sided lesions. Eur J Trauma Emerg Surg 2018;44(1):71-7.
Boeding JRE, Ramphal W, Crolla RMPH, Boonman-de Winter LJM, Gobardhan PD, Schreinemakers JMJ. Ileus caused by obstructing colorectal cancer-impact on long-term survival. Int J Colorectal Dis 2018;33(10): 1393-400.
Yang Z, Wang L, Kang L, Xiang J, Peng J, Cui J et al. Clinicopathologic characteristics and outcomes of patients with obstructive colorectal cancer. J Gastrointest Surg 2011; 15(7): 1213-22.
Gainant A. Emergency management of acute colonic cancer obstruction. Journal of Visceral Surgery 2012; 149(1): e3- e10.
Kilic M. Factors affecting postoperative morbidity and mortality in obstructing colorectal cancer. Journal of Clinical and Analytical Medicine 2014; 7(112): 226-30.
Aslar AK, Ozdemir S, Mahmoudi H, Kuzu MA. Analysis of 230 cases of emergent surgery for obstructing colon cancer– lessons learned. J Gastrointest Surg: Off J Soc Surg Aliment Tract 2011; 15(1): 110–9.
Pisano M, Zorcolo L, Merli C, Cimbanassi S, Poiasina E, Ceresoli, M et al. WSES guidelines on colon and rectal cancer emergencies: obstruction and perforation. World Journal of Emergency Surgery 2018; 13(1): 36.
Hsu CW, Wang JH, Kung YH, Chang MC.What is the predictor of surgical mortality in adult colorectal perforation? The clinical characteristics and results of a multivariate logistic regression analysis. Surg Today 2017; 47(6): 683-9.
Bass G, Fleming C, Conneely J, Martin Z, Mealy K. Emergency first presentation of colorectal cancer predicts significantly poorer outcomes: a review of 356 consecutive Irishpatients. Dis Colon Rectum 2009; 52(4): 678–84.
Alvarez JA, Baldonedo RF, Bear IG, Truán N, Pire G, Alvarez P. Presentation, treatment, and multivariate analysis of risk factors for obstructive and perforative colorectal carcinoma. Am J Surg 2005; 190(3): 376–82.
Collard MK, Moszkowicz D, Clause-Verdreau AC, Beauchet A, Cudennec T, Vychnevskaia K et al. Postoperative morbidity and mortality for malignant colon obstruction: The American College of Surgeon calculator reliability. J Surg Res 2018; 226: 112-21.
Kısaoglu A, Özogul B, Aköz A, Atamanalp SS, Öztürk G,Yıldırgan MI. Obstrüktif kolorektal kanserli hastalarda cerrahi tedavi sonuçları. Dicle Tip Dergisi 2013;40(3): 401-05.
Mc Cullough JA, Engledow AH. Treatment options in obstructed left-sided colonic cancer.Clin Oncol (R Coll Radiol) 2010; 22(9): 764-70.
Zorcolo L, Covotta L, Carlomagno N, Bartolo DC. Toward lowering morbidity, mortality, and stoma formation in emergency colorectal surgery: the role of specialization. Dis Colon Rectum 2003; 46(11): 1461–7.
Abe T, Shirabe K, Harimoto N, Gion T, Nagaie T,Kajiyama K. Prediction of 30-day mortality after emergency surgery for colorectal perforation. European Surgery 2017; 49(2): 89-94.