Tactica chirurgicală diferenеiată оn cancerul colorectal complicat

Gurghiş Radu; Ursu Alexandr; Şcerbatiuc-Condur Corina; Gagauz Ion; Gafton Victor; Rojnoveanu Gheorghe

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GURGHIŞ, Radu, URSU, Alexandr, ŞCERBATIUC-CONDUR, Corina, GAGAUZ, Ion, GAFTON, Victor, ROJNOVEANU, Gheorghe. Tactica chirurgicală diferenеiată оn cancerul colorectal complicat. In: Chirurgia (București, Romania), 2018, nr. S1(113), pp. 62-63. ISSN 1221-9118.

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Chirurgia (București, Romania)

Numărul S1(113) / 2018 / ISSN 1221-9118

Tactica chirurgicală diferenеiată оn cancerul colorectal complicat

Differentiated surgical approach in complicated colorectal cancer

Pag. 62-63

Gurghiş Radu, Ursu Alexandr, Şcerbatiuc-Condur Corina, Gagauz Ion, Gafton Victor, Rojnoveanu Gheorghe

Universitatea de Stat de Medicină şi Farmacie „Nicolae Testemiţanu“

Disponibil în IBN: 12 decembrie 2021

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Introducere: Cancerul colorectal complicat (CCRC), operat în urgenåã, prezintã încã rate înalte de morbiditate æi mortalitate.
Modalitatea de finalizare a intervenåiei rãmâne o provocare,anastomoza primarã sau derivaåia externãconstituind problema de bazã.
Scop: Analiza rezultatelor tratamentului chirurgical în urgenåeal cancerului colorectal complicat.
Materiale æi metode: Studiu retrospectivpe 98 de pacienåi cu CCRC, operaåi de urgenåãîn IMU (Chiæinãu), în perioada 2015-2017,
cu localizare pe dreapta – 25(25.5%), transvers – 9(9.18%), stânga – 64(64.94%), (p<0.01). S-au efectuat anastomoze primare –
68(69.38%), derivaåii externe – 30(30.61%). Raportul B:F=1.1:1, vârsta medie – 63.96±1.34 ani.
Rezultate: Cu ocluzie intestinalã acutã(OIA) æi peritonitã au fost22(22.44%), dintre care 9(9.18%) cu perforaåie, operaåi în primele
8h; cu OIA–25(25.5%), operaåi la 8-24h; cu sindrom subocluziv– 43(43%), hemoragie– 8(8.2%), operaåi la 2-5 zile. S-au efectuat
hemicolectomii: drepte– 34(34.6%), inclusiv – 7(7.1%) extinse, finalizate cu anastomozã primarã– 28(82.4%) æi ileostomie–
6(17.6%); stângi– 48(48.97%), finalizate cu anastomozã primarã– 40(83.3%), transversostomie–3(7.5%), STEC–5(12.5%) æi în
16(16.3%)– operaåia Hartmann. Dehiscenåe s-au înregistrat în 3(4.4%) cazuri, hemicolectomie dreaptã – 1(2.94%), hemicolectomie
stângã – 2(4.16%), rezolvate prin relaparotomie æi derivaåie intestinalã externã, cu deces într-un caz. Mortalitatea a constituit
19.38%(n=19), dintre care 8(11.8%) cu anastomoze primare æi 11(36.7%) cu derivaåii externe.
Concluzii: Tactica chirurgicalã diferenåiatãîn cancerul colorectal complicat este determinatã de localizarea tumorii æi manifestarile
clinice la spitalizare. Majoritatea pacienåilor au prezentat la spitalizare ocluzie intestinalã acutã(p<0.001), fapt ce explicã numãrul
mare a derivaåiilor intestinale externe, în care s-a înregistrat ratã mai înaltãa complicaåiilor æi mortalitãåii.

Introduction: Complicated colorectal cancer (CCRC) operated in emergency settings still have high rates of morbidity and mortality.
Surgical options still represent a challenge, primary anastomosis or colostomy being the main issue.
Aim: Analysis of emergency surgical treatment results in complicated colorectal cancer.
Materials and Methods: Retrospective study of 98 patients with CCRC operated in emergency settings within Institute of Emergency
Medicine (Chiæinãu), between 2015-2017, right-sided – 25(25.5%), transvers – 9(9.18%), left-sided – 64(64.94%), (p<0.01). Primary
anastomosis – 68(69.38%), colostomy – 30(30.61%). RatioM:F=1.1:1, mean age – 63.96±1.34 years.
Results: 22(22.44%) patients had intestinal obstruction (IO) and peritonitis, 9(9.18%) of them with perforation, operated within 8h;
withIO – 25(25.5%), operated within 8-24h; with partial obstruction – 43(43%), bleeding – 8(8.2%), operated within 2-5 days. Were
performed hemicolonectomies: right-sided – 34(34.6%), including – 7(7.1%) extended, finalizedwithprimary anastomosis – 28(82.4%)
and ileostomy – 6(17.6%); left-sided – 48(48.97%), finalizedwithprimary anastomosis – 40(83.3%), transversostomy – 3(7.5%), STEC
– 5(12.5%) and in 16(16.3%) –Hartmann procedure. There were anastomotic leakage in 3(4.4%) case, right hemicolonectomy –
1(2.94%), left hemicolonectomy – 2(4.16%), which were fixed by relaparotomy and external derivation, one patient died. Mortality rate
was 19.38%(n=19), from which 8(11.8%) with primary anastomosis and 11(36.7%) with external derivations.
Conclusion: Differentiated surgical approach in complicated colorectal cancer is influenced by the tumor`s site and clinical features upon
admission.Most of the patients showed signs of intestinal obstruction at admission (p<0.001), which explains the high rate of external
derivations with higher morbidity and mortality rate.

Cuvinte-cheie
cancer colorectal complicat, tratament chirurgical de urgenåã, tacticã diferenåiatã,

complicated colorectal cancer, emergency surgical treatment, differentiated approach

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