Palliative Treatment if Patients with Colorectal Cancer Complicated by Intestinal Obstruction

V.L. Denisenko, Yu.M. Gain

Abstract


Actuality. Colorectal cancer is one of the most widespread forms of malignant tumors in the majority of economically developed countries of the world. The most frequent complication of this kind of cancer is the intestinal obstruction with tumor localization in the left half of the large bowel. Postsurgical lethality in this group of patients is rather high and comes to 10–36 % of the number of the patients operated.
To present time standard approaches to choice of methods of surgical intervention and of termination of operations are not elaborated. This fact requires further scientific research and scrutiny of the possibility of realization of new problem solving tendencies.
Aim of the Investigation. To improve the results of complex treatment of obstructing colorectal cancer complicated with intestinal obstruction using Fast-Track Recovery technologies.
Material and Methods. In medicine of the time, namely, in surgery of colorectal cancer complicated with intestinal obstruction, the trend of complex treatment based on the concept of Fast-Track Recovery, or Fast-Track Surgery, is coming into force. One of the tendencies of real using of the concept of rapid (enchanced) recovery for the treatment of obturative tumoral large-intestine obstruction is the method of recanalization of the area of tumor stenosis with the following stenting of the zone of narrowing and laser recanalization.
Results and Discussion. The Fast-Track Recovery Strategy method aimed in symptomatic treatment of colorectal cancer complicated with intestinal obstruction has been applied in 8 patients in the IPD of Second Vitebsk Regional Clinical Hospital and in the abdominal department of Vitebsk Regional Clinical Dispensary. Self-expanding silicone covered nitinol stent 22 mm in diameter and 140 mm in length frame expanding the bowel lumen in the tumor stenosis zone was placed in the constriction zone in four patients suffering from complicated colorectal cancer.
In all observations, after the operation of recanalization of stenosis zone the passage of the digestive tract was restored. The post-operative period was uneventful.
We applied high-intensity impulsive laser radiation with wave length 1.06 mcm and power 20–25 W in four patients to carry out the recanalization of obstructing colorectal cancer complicated by colonic obstruction. In 4–6 days the patients were discharged from the in-patient department in the condition of clinicometabolic compensation. Tumor recanalization was the final symptomatic operation in view of the gravity of the background pathology with cardiac decompensation.
Conclusion. The application of endoscopic placing of self-expanding metallic colorectal stent enables surgeons to perform early antegrade decompression of the digestive tract with rapid restoration of its motor and evacuating function and early clinical and metabolic compensation (avoiding laparotomy and intestinal fistula formation) in obstructing colorectal cancer complicated with intestinal obstruction.


Keywords


stenting; colorectal cancer; intestinal obstruction

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DOI: https://doi.org/10.22141/1997-2938.1.24.2014.82874

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