Are there any changes in the surgical management of stenosing rectal cancer?

Česká verze

Authors: A. Pelikán ^1,2; L. Tulinský ¹ ; M. Peteja ¹ ; M. Lerch ¹
Authors place of work: Chirurgická klinika LF OU a FN Ostrava ¹; Ústav zdravotnických věd, Fakulta humanitních studií UTB ve Zlíně ²
Published in the journal: Gastroent Hepatol 2017; 71(1): 62-68
Category: Gastrointestinální onkologie: původní práce
doi: https://doi.org/10.14735/amgh2016csgh.info16

Summary

Background:
In the last few decades, there have been many advances in the management of patients with rectal carcinoma. However, surgical treatment options for patients with stenosing carcinomas are still very limited and the prognosis is poor.

Methods:
A retrospective clinical study was used to evaluate the surgical treatments of patients with this tumor’s type at the University Hospital Ostrava. The outcomes of patients with stenosis rectal carcinomas were analyzed for two study period (2003–2004 and 2013–2014).

Results:
Within the first study period (2003–2004), stenosing rectal carcinoma was diagnosed in 63 patients (24 patients had clinical signs of bowel obstruction). Surgery in patients with bowel obstruction was done within 72 hours after hospital admission in majority of cases (17 patients – 70.8%) and palliative surgery (stoma) was done in 14 patients (58.3%). There were 39 patients without signs of bowel obstruction. In these patients, primary radical surgical resection was done in 30 patients (76.9%) and only 2 patients (5.1%) were indicated for neoadjuvant treatment. Within the second study period (2013–2014), 44 patients with stenosing carcinoma were treated (18 patients had signs of bowel obstruction). Among the patients with bowel obstruction, surgery was done within 72 hours after hospital admission in 13 patients (72.2%). Palliative surgery was done in 10 patients (55.6%). There were 26 patients with stenosing carcinoma without signs of bowel obstruction, among whom primary radical surgical resection was done in 10 patients (38.2%) and primary neoadjuvant treatment was indicated in 13 patients (50.0%).

Discussion:
Management of patients with stenosing rectal carcinoma without clinical signs of bowel obstruction should be based on careful staging, a multidisciplinary approach, and treatment. In patients with signs of bowel obstruction, it is advisable to proceed on an individual basis depending on the practice in each surgical department.

Conclusions:
Within 10 years, there have been no significant changes in the surgical treatment of patients with bowel obstruction resulting from stenosing rectal carcinoma; the number of patients, spectrum of the operations performed, and postoperative morbidity and mortality rates have not changed.

Key words:
rectal cancer – bowel obstruction – multidisciplinary approach – surgery

The authors declare they have no potential conflicts of interest concerning drugs, products, or services used in the study.

The Editorial Board declares that the manuscript met the ICMJE „uniform requirements“ for biomedical papers.

Submitted:
20. 12. 2015

Accepted:
17. 5. 2016

Zdroje

1. Ferlay J, Steliarova-Fourcher E, Lortet-Tieulent J et al. Cancer incidence and mortality patterns in Europe: estimates for 40 countries in 2012. Eur J Cancer 2013; 49(6): 1374– 1403. doi: 10.1016/ j.ejca.2012.12.027.

2. Hoch J, Dytrych P, Prausová J. Nádory konečníku. In: Krška Z, Hoskoved D, Petruželka L et al. Chirurgická onkologie. Praha: Grada 2014: 553– 564.

3. Becker HD, Jehle E, Kratt T et al. Karcinom rekta. In: Becker HD, Hohenberger W, Junginger T et al. Chirurgická onkologie. Praha: Grada 2005: 515– 539.

4. Berardi R, Maccaroni E, Onofri A et al. Locally advanced rectal cancer: the importance of a mutlidisciplinary approach. World J Gastroenterol 2014; 20(46): 17279– 17287. doi: 10.3748/ wjg.v20.i46.17279.

5. Herzog T, Belyaev O, Chromik AM et al. TME quality in rectal cancer surgery. Eur J Med Res 2010; 15(7): 292– 296.

6. Ihnát P, Martínek L, Ihnát Rudinská L et al. Cirkumferenčný resekčný okraj v modernej liečbe karcinómu rekta. Rozhl Chir 2013; 92(6): 297– 303.

7. Nagtegaal ID, Quirke P. What is the role for the circumferential margin in the modern treatment of rectal cancer? J Clin Oncol 2008; 26(2): 303– 312. doi: 10.1200/ JCO.2007.12.7027.

8. Peng J, Ding Y, Tu S et al. Prognostic nomograms for predicting survival and distant metastases in locally advancer rectal cancers. PLoS One 2014; 9(8): e106344. doi: 10.1371/ journal.pone.0106344.

9. Trakamsanga A, Ithimakin S, Weiser MR. Treatment of locally advanced rectal cancer: controversies and questions. World J Gastroenterol 2012; 18(39): 5521– 5532. doi: 10.3748/ wjg.v18.i39.5521.

10. Martínek L, Zonča P, Ihnát P. Je celkové přežití objektivním kritériem kvality chirurgické léčby kolorektálního karcinomu? Rozhl Chir 2013; 92(12): 690– 693.

11. Hoch J. Chirurgická léčba kolorektálního karcinomu. Rozhl Chir 2012; 91(1): 48– 52.

12. Fung-Kee-Fung SD. Therapeutic approaches in the management of locally advanced rectal cancer. J Gastrointest Oncol 2014; 5(5): 353– 361. doi: 10.3978/ j.issn.2078-6891.2014.067.

13. Martínek L, Jahoda P, Guňka I et al. Predikce komplikací a volba operační techniky. Miniinvaziv Chir 2010; 14(1): 13– 15.

14. Ghaza AH, El-Shazly WG, Bess SS et al. Colonic endolumental stenting devices and elective surgery versus emergency subtotal/ total colectomy in the management of malignant obstructed left colon carcinoma. J Gastrointest Surg 2013; 17(6): 1123– 1129. doi: 10.1007/ s11605-013-2152-2.

15. van Hooft JE, van Halsema EE, Vanbiervliet G et al. Self-expandable metal stents for obstructing colonic and extracolonic cancer: European Society of Gastrointestinal Endoscopy (ESGE) Clinical Guideline. Gastrointest Endosc 2014; 80(5): 747– 761. doi: 10.1016/ j.gie.2014.09.018.

16. Bertelsen CA, Bols B, Ingeholm P et al. Cant he quality of colonic surgery be improved by standardization of surgical technique with complete mesocolic excision? Colorectal Dis 2011; 13(10): 1123– 1129. doi: 10.1111/ j.1463-1318.2010.02474.x.

17. West NP, Hohengerger W, Weber K. Complete mesocolic exciton with central vascular ligation produces an oncologically superior specimen compared with standard surgery for carcinoma of the colon. J Clin Oncol 2010; 28(2): 272– 278. doi: 10.1200/ JCO.2009.24.1448.

18. Ihnát P, Delongová P, Dvořáčková J et al. Zvýšení kvality histopatologického hodnocení preparátů kolorektálního karcinomu prostřednictvím zavedení standardního protokolu. Rozhl Chir 2013; 92(12): 703– 707.

19. Ihnát P, Delongová P, Horáček J et al. Impact of standard protocol implementation on the quality of colorectal cancer pathology reporting. World J Surg 2015; 39(1): 259– 265. doi: 10.1007/ s00268-014-2796-4.

20. Smith N, Brown G. Preoperative staging of rectal cancer. Acta oncologica 2008; 47(1): 20– 31.

21. Lindebjerg J, Osler M, Bisgaard C. Colorectal cancers detected through screening are associated with lower stages and improved survival. Dan Med J 2014; 61(1): A4758.

22. Guňková P, Guňka I, Martínek L et al. Vliv dehiscence anastomózy na onkologické výsledky u resekčních výkonů pro karcinom rekta. Rozhl Chir 2013; 92(5): 244– 249.

23. Ihnát P, Ihnát Rudinská L, Zonča P. Radiofrequency energy in surgery: state of the art. Surg Today 2014; 44(6): 985– 991. doi: 10.1007/ s00595-013-0630-5.

24. How P, Stelzner S, Branagan G et al. Comparative quality of life in patients following abdominoperineal excision and low anterior resection for low rectal cancer. Dis Colon Rectum 2012; 55(4): 400– 406. doi: 10.1097/ DCR.0b013e3182444fd1.

25. Ihnát P, Martínek L, Mitták M et al. Quality of life after laparoscopic and open resection of colorectal cancer. Dig Surg 2014; 31(3): 161– 168. doi: 10.1159/ 000363415.

26. Dimitriou N, Michail O. Moris D et al. Low rectal cancer: sphinter preserving techniques-selection of patients, techniques and outcomes. World J Gastrointest Oncol 2015; 7(7): 55– 70. doi: 10.4251/ wjgo.v7.i7.55.

27. Mabardy A, Miller P, Goldstein R et al.Stenting for obstructing colon cancer: fewer complications and colostomies. JSLS 2015; 19(1): e2014.00254. doi: 10.4293/ JSLS.2014.00254.

28. Cirocchi R, Farinella E, Trastulli S et al. Safety and efficacy of endoscopic colonic stenting as a bridge to surgery in the management of intestinal obstruction due to left colon and rectal cancer: a systematic review and mate-analysis. Surg Oncology 2013; 22(1): 14– 21. doi: 10.1016/ j.suronc.2012.10.003.

29. Tsoulfas G, Pramateftakis MG. Management of rectal cancer and liver metastatic disease: which comes first? Ing J Surg Oncol 2012; 2012: 196908. doi: 10.1155/ 2012/ 196908.

30. Ihnát P, Vávra P, Zonča P. Treatment strategies for colorectal carcinoma with synchronous liver metastases: which way to go? World J Gastroenterol 2015; 21(22): 7014– 7021. doi: 10.3748/ wjg.v21.i22. 7014.

31. Verhoef C, van der Pool AE, Nuyttens JJet al. The „liver-first“ approach for patients with locally advanced rectal cancer and synchronous liver metastases. Dis Colon Rectum 2009; 52(1): 23– 30. doi: 10.1007/ DCR.0b013e318197939a.