Authors
Lukianiuk P.P.1, Surov D.A.1, Soloviev I.A.1, Demko A.E.2, Sizonenko N.A.1, Bezmozgin B.G.2,Balura O.V.1, Babkov O.V.2
1 FGBVOU VO «Military Medical Academy S. M. Kirova» MO RF, Department of Naval Surgery, Saint-Petersburg
2 Saint-Petersburg I.I. Dzhanelidze research institute of emergency medicine, Saint-Petersburg
Abstract
The study included 68 patients with locally advanced colon tumors and histologically verified necrosis. The control group of the study (n = 43) consisted of patients who were treated using traditional tactics and operational approaches. The main group (n = 25) included patients whose probability of tumor necrosis was predicted on the basis of the previously developed algorithm. The basis of operative surgery in patients of the main group was based on the principles of embryologically justified surgery, compliance with which ensured the effective use of visceral rotations in the planes of the embryonic layers, as well as the use of an extrafascial approach to achieve tumor-negative resection boundaries. Surgical intervention time in patients of the main group decreased to 222.96±68.98 minutes, while in the control group it was 321.51±69.72 minutes. A similar trend identified in the evaluation of the average volume of intraoperative blood loss, which in the main group decreased to 525,92±163,63 ml, in control group this indicator amounted to 962,79±127,63 ml. Postoperative complications in patients of the main group decreased by 1.5 times (from 39.53 % to 28 %), and postoperative mortality has decreased in 2,5 times (from 20.93% to 8%). Tumor-negative boundaries of resection in the main group were achieved in 96% of patients (n = 24), while in the control group this figure was 60.46% (n = 26). The average number of remote regional lymph nodes in the study group was 25.04±1112 in the localization of tumors in the colon and 23.3±8.74 in the rectum, while in the control group, these indicators were 12.35±6.17 and 12.21±6.58, respectively. Preoperative planning of combined surgical intervention, as well as the application of the principles of embryologically based operative surgery allows not only to improve the immediate results, but also to increase the oncological radicalism of surgical interventions.
Keywords: colon, locally advanced tumor, preoperative planning of surgery, embryologically based surgery, immediate results.
References
1. Gebhardt C, Meyer W, Ruckriegel S, Meier U. Multivisceral resection of advanced colorectal carcinoma. Langenbecks Arch Surg. 1999;384(2):194–199. doi: 10.1007/s004230050191.
2. McGory ML, Shekelle PG, Ko CY. Development of quality indicators for patients undergoing colorectal cancer surgery. J Natl Cancer Inst. 2006;98(22):1623–1633. doi: 10.1093/jnci/djj438.
3. Lopez MJ. Multivisceral resections for colorectal cancer. J Surg Oncol. 2001; 76(1): 1–5. doi: 10.1002/1096-9098(200101)76:1<1::aid-jso1000>3.0.co;2-q.
4. Govindarajan A, Coburn NG, Kiss A, et al. Population-based assessment of the surgical management of locally advanced colorectal cancer. J Natl Cancer Inst. 2006 Oct 18;98(20):1474–1481. doi: 10.1093/jnci/djj396.
5. Shevchenko YL, Stojko YM, Levchuk AL. Sochetanie oslozhnennykh form raka tolstoi kishki: klinika, diagnostika, khirurgicheskaya taktika. Vestnik eksperimental’noi i klinicheskoi khirurgii. 2011;4(4):641–646. (In Russ).
6. Kim J. Pelvic exenteration: surgical approaches. J Korean Soc Coloproctol. 2012; 28(6):286–293. doi: 10.3393/jksc.2012.28.6.286.
7. Mañas MJ, Espín E, López-Cano M, et al. Multivisceral resection for locally advanced rectal cancer: prognostic factors influencing outcome. Scand J Surg. 2015; 104(3):154–160. doi: 10.1177/1457496914552341.
8. Rosander E, Nordenvall C, Sjövall A, et al. Management and and outcome after multivisceral resections in patients with locally advanced primary colon cancer. Dis Colon Rectum. 2018;61(4):454–460. doi: 10.1097/DCR.0000000000001046.
