I.E. Khatkov, Y.A. Barsukov, V.A. Aliev, D.V. Kuzmichev, A.O. Atroshchenko, R.I.Tamrazov, P.S. Tyutyunnik.
Background: the cytoreductive surgery in the volume of the primary tumor removal, even in patients with synchronous multiple metastases in the liver and/or other organs, allows to increase two-year survival by 3.9 times up to 18.2% in comparison with symptomatic operations – 4.7% (colostomy or bypass). Adjuvant chemotherapy after cytoreductive surgery may improve the results of a two-year survival after combined treatment up to 52.7 %. The laparoscopic precision technique may minimize the surgical trauma for patients with synchronous metastatic colorectal cancer. It could helps to optimize treatment strategy (to estimate the spreading of tumor during diagnostic laparoscopy, to determine the treatment strategy) and to expand the indications for cytoreductive operations, especially in patients burdened with co morbidity. The aim of the study is to determine the role of cytoreductive laparoscopic surgery in combined treatment for patients with colorectal carcinoma with synchronous distant metastases.
to determine the role of cytoreductive laparoscopic surgery in combined treatment for patients with with distant .
Materials and methods: since December of 2010 at the department of proctology of N.N.Blokhin’s Cancer Research Center 20 patients underwent laparoscopic primary tumor removal. Fifteen patients had T3 tumors and 5-T4. Metastases in one organ (M1a) were diagnosed in 13patients, two or more organs (M1b)-7patients. Pathological examination revealed regional lymph nodes metastases in 10 patients: N1–8; N2–in 2 patients.
Results. The volume of laparoscopic operations was: right hemicolectomy-3, left hemicolectomy-2, sigmoid colectomy-6, rectal resection-2. Six patients underwent only colostomy and 1–bypass surgery. One patient had simultaneous atypical liver resection. Primary anastomosis was performed in 13(65%) patients: stapled anastomosis "end to end"-10; hand-assisted anastomosis "side to side”-3. Diagnostic laparoscopy revealed peritoneal carcinomatosis in 3 patients. One of them had conversion and open bypass surgery, 2petients laparoscopic colostomy was performed. Totally laparoscopic access was performed in 17(85%) patients, video-assisted – in 3(15%). Only one patient had anastomotic leakage after stapled anastomosis for low anterior resection. One patient had suppuration of minilaparotomy wound. All complications were treated without re operation. The average hospital stay in the clinic was 10.3 days.
Conclusions: introduction of laparoscopic surgery in combined treatment scheme metastatic colon cancer can expand the indications for cytoreductive surgery, especially in patients with comorbidity, and to optimize treatment strategy, to clarify the tumor dissemination and to determine the treatment strategy.
клинический случай в отделении невоспалительной патологии кишечника
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