Pelvic Infiltrations Following Amputation Procedures for Rectal Carcinomas

Overview

Introduction:
The authors present anatomical division of the rectum and then give a short overview of the rectal surgery development. Currently, even in departments specialized in colorectal surgery, 25–30% of the rectal carcinoma cases must be managed by abdominoperineal amputations.

Complications of amputation procedures:
The study deals with complications following extirpation of the rectum, like bleeding and its management, inflammatory complications during the healing process or following healing of the perineum. However, pelvic relapses, which in most cases cannot be managed surgically, remain the major therapeutic problem. These cases are indicated for systemic treatment with combinations of cytostatic drugs, eventually for radiotherapy.

Results:
324 patients with rectal carcinomas were operated at the I^st Surgical Clinic of the VFN in Prague. In 230 cases, resection was completed, in 94 cases, the rectum was amputated. In 78 cases, sutures of the pelvic floor was conducted, 64 cases healed per primam within 3 weeks, 11 healed per secundam within 3 months. In 16 cases, tamponade with surgical cover sheets and longettes was applied. 70% of these patients healed within 12 weeks of the surgery. In 3 cases, chronic fistules persisted for over 6 months. In 11 cases, locoregional relapses occurred. In 2 cases, radical excision was conducted, the other underwent systemic chemotherapy.

Conclusion:
Good preoperative care of the intestine, ATB prophylaxis and saving surgical technique were the precautions taken with the aim to prevent inflammatory complications. With respect to management difficulties of local relapses following amputations of the rectum, a requirement for total excisioning of the mesorectum on the first operation is substantial.

Key words:
abdominoperineal amputation – inflammatory infiltrations – locoregional relaps