RU2470599C1 - Method of two-stage treatment of complicated colon cancer - Google Patents

Method of two-stage treatment of complicated colon cancer Download PDF

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RU2470599C1
RU2470599C1 RU2011148403/14A RU2011148403A RU2470599C1 RU 2470599 C1 RU2470599 C1 RU 2470599C1 RU 2011148403/14 A RU2011148403/14 A RU 2011148403/14A RU 2011148403 A RU2011148403 A RU 2011148403A RU 2470599 C1 RU2470599 C1 RU 2470599C1
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method
colon cancer
tumor
stage
performed
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RU2011148403/14A
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Russian (ru)
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Петр Андреевич Ярцев
Андрей Андреевич Гуляев
Владислав Дмитриевич Левитский
Татьяна Павловна Пинчук
Бакур Темурович Цулеискири
Андрей Владимирович Оранский
Наталья Сергеевна Савельева
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Государственное учреждение здравоохранения Научно-исследовательский институт скорой помощи имени Н.В. Склифосовского Департамента здравоохранения г. Москвы
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Abstract

FIELD: medicine.
SUBSTANCE: invention relates to medicine and can be applied for two-stage treatment of complicated colon cancer. Colonoscopy with recanalisation of tumour canal by means of successive stricture bougienage to maximally possible lumen is performed. Metal string-guide is installed, along which after removal of endoscope probe for decompression is introduced for 2-3-day period. After 2-3 days second stage - radical operation by laparoscopic method is performed.
EFFECT: method makes it possible to reduce operation trauma, reduce risk of complications and lethality.
3 cl, 2 ex

Description

The invention relates to medicine, namely to surgery.

In the structure of oncological morbidity, according to the World Health Organization, colon cancer ranks third in the world after lung and breast cancer. Moreover, in 60-80% of patients with a newly established diagnosis, stage III or IV disease is detected [1, 2]. Late diagnosis of colon cancer is caused by a long asymptomatic course of the disease and the absence of pathognomonic signs at an early stage of the disease. 50-89% of these patients enter hospitals with various complications of colorectal cancer, such as acute intestinal obstruction, intestinal bleeding, perforation of the intestine and peritonitis [3, 4, 5].

Due to the high likelihood of developing postoperative purulent-septic complications during surgical interventions on the background of intestinal obstruction, most surgeons avoid the formation of primary intestinal anastomosis [6]. According to the literature, from 65% to 100% of emergency operations on the colon end with the formation of a colostomy [7]. The need for reconstructive surgery requiring re-hospitalization, and the presence of complications associated with the colostomy itself (bleeding, paracolostomy hernias), as well as the psychological discomfort of patients and the need to learn how to properly care for the stoma, all make us look for ways to form a primary anastomosis [8, 9] .

Currently, it is possible to carry out two-stage treatment for acute colonic obstruction: at the first stage, retrograde decompression of the colon is performed using various methods, and at the second, a radical surgical operation. The effectiveness of endoscopic decompression of the colon with tumor intestinal obstruction is from 20 to 76% [10].

The following methods are proposed:

- Butler S.Yu. [11] suggests the implementation of endoscopic electrosurgical instrumental recanalization of a stenotic tumor of the colon with its left-sided localization, followed by an open radical operation with the formation of a primary anastomosis. The main disadvantage of this method is the danger of instrumental perforation of the colon wall during the recanalization of the tumor channel with the development of intestinal bleeding (the frequency of such complications reaches 7%, postoperative mortality - 10%).

- Shelekhov A.V. [prototype - 12] for decompression of the colon suggests either recanalization using the same method using monopolar diathermocoagulation or stents, or laparoscopic colostomy. In the second stage, a radical surgical operation is performed after 2-3 months. The disadvantage of the technique in addition to the above disadvantages is the late execution of a radical operation, which can lead to the spread of the oncological process.

Thus, the current two-stage treatment methods have certain disadvantages, which determines the need for their optimization and improvement.

The problem solved by the present invention is to determine the optimal method for performing two-stage treatment of acute colonic obstruction using a safe endoscopic method of retrograde decompression of the colon and a modern laparoscopic method of radical surgical treatment.

Achievable technical result is the optimization of treatment of acute colonic obstruction, achieved by:

- conservative resolution of acute colonic obstruction at the first stage of treatment using the endoscopic method avoids emergency surgery, which makes it possible to prepare the patient for surgery and, therefore, reduce the number of intra- and postoperative complications and mortality;

- resolved intestinal obstruction (lack of dilatation of the intestine) determines the possibility of performing a radical surgery using the laparoscopic method, which minimizes surgical trauma, reduces the time of inpatient treatment and the number of postoperative complications associated with the failure of anastomoses, and also reduces mortality in this group of patients.

The proposed method is as follows.

The implementation of this technique is possible in patients with acute colonic obstruction. At the first stage, for the purpose of determining the level of intestinal obstruction, as well as for endoscopic resolution of the phenomena of acute intestinal obstruction, patients undergo colonoscopy with the recanalization of the tumor channel by successively boughening the stricture with instruments and endoscopes of small diameter to the maximum possible clearance, avoiding gross destruction of the tumor tissue, which is dangerous in terms of development bleeding and perforation. After successful dilatation of the tumor, the endoscope is proximal to the stricture. Then, through the channel of the device, a metal conductor string is installed, through which, after removing the device, a probe for decompression is inserted for a period of 2-3 days. If the tumor is rigid and its lumen cannot be dilated in a safe way, the conductor string is passed through the tumor channel under X-ray control. After that, a probe for decompression with a diameter of 5 to 10 mm is installed along the string in the same way. The position of the probe in the colon is also controlled radiologically by introducing a water-soluble contrast agent through its lumen. The probe is started to empty the colon, restore its blood supply and peristalsis. After 2-3 days in an emergency-delayed order, a radical operation is performed by the laparoscopic method, including the removal of the tumor with the formation of a primary intestinal anastomosis. The volume of surgery depends on the location of the tumor and the presence of metastases.

Differences between our methodology and those proposed by other authors:

1. The recanalization of the tumor channel is performed by the endoscopic method under ocular or radiological control without using the coagulation method, which minimizes the risk of damage to the intestine with the development of perforation or bleeding.

2. Surgery is performed in an emergency-delayed order for 2-3 days from the moment of resolution of acute colonic obstruction, which helps to prevent the further spread of the oncological process.

3. Performing decompression of the colon allows you to perform a surgical operation using the laparoscopic method, which leads to a more favorable course of the postoperative period and a reduction in the number of complications and deaths.

Clinical example No. 1.

Patient S. 72 years. Clinical diagnosis: Stenosing rectosigmoid tumor. T3NxMx. Obstructive colonic obstruction. He entered the institute with a clinical and instrumental picture of acute intestinal obstruction. Rg of the abdominal cavity: colonic obstruction. Under intravenous anesthesia, a sigmoidoscopy, tumor stricture stricture, colon intubation were performed. During the study, tumor stenosis of the distal sigmoid colon and rectosigmoid junction zone up to 10 cm in length was decompensated. Roughening and intubation of the rectum and sigmoid colon with the installation of a probe proximal to the tumor level were performed. With x-ray control: low obstructive colonic obstruction with pronounced positive dynamics. After 3 days from the moment of endoscopic resolution of acute colonic obstruction, an operation was performed: laparoscopic anterior resection of the rectum with the formation of a sigmorectal anastomosis in a hardware way. The postoperative period is smooth. In satisfactory condition, the patient was discharged from the hospital.

Clinical example No. 2.

Patient N., 59 years old. Clinical diagnosis: Cancer of the sigmoid colon. T3NxMx. Obstructive colonic obstruction. He entered the institute with a clinical and instrumental picture of acute colonic obstruction. Under intravenous anesthesia, a sigmoidoscopy, tumor stricture stricture, colon intubation were performed. The study revealed extended to 6 cm decompensated tumor stenosis of the distal sigmoid colon. When x-ray control study: low obstructive colonic obstruction with pronounced positive dynamics. After 2 days from the moment of retrograde intubation of the colon, a laparoscopic resection of the sigmoid colon was performed with the formation of rectosigmanastomosis with an end-to-end circular apparatus. The postoperative period was uneventful. In satisfactory condition, the patient was discharged from the hospital.

Bibliography

1. Uryadov S.V. Diagnostic and therapeutic endoscopy in surgical diseases of the colon: abstract. dis. ... Dr. honey. Sciences / Uryadov S.V. - M., 2011 .-- 35 p.

2. Davydov M.I. Statistics of malignant tumors in Russia and the CIS countries in 2007 / Davydov M.I., Axel E.M. // Bulletin of the Russian Research Center. N.N. Blokhina. - 2009. - Volume 20, No. 3 (Appendix 1), pp. 36-41.

3. The modern tactics of surgical treatment of patients with cancer of the left flank of the colon complicated by obstruction / Belyaev AM, Zakharenko AA, Sementsov DA, Surov DA, Babkov OV, Kondratsov S.A . // Oncology. - 2011. - Volume 12, p. 610-619.

4. An algorithm for the treatment of complicated forms of colon cancer / Shelekhov AV, Minakin NI, Rasulov RI, Dvornichenko VV, Belonogov AV // Bulletin of the VSSC SB RAMS, 2005 .-- Volume 1 (39), pp. 110-115.

5. Briskin BS, Obstructive obstruction in cancer of the colon / Briskin BS, Smakov GM, Borodin AS // Surgery. - 1999. - No. 5. p. 37-40.

6. Buyanov V.M. The current state of the issues of diagnosis, tactics and methods of surgical treatment of large bowel obstruction / Buyanov V.M., Maskin S.S. // Annals of surgery. - 1999. - No. 2. - S. 23-31.

7. Possibilities of endoscopy in the diagnosis and treatment of colonic obstruction of tumor origin / Kuzmin-Krutetskiy MI, Belyaev AM, Degterev DB, Dvoretsky S.Yu. // RZHGGK. - 2008. - Volume 3, p. 73-76.

8. Tactics of treatment of patients with acute colonic obstruction of tumor origin using endoscopic methods of recanalization / Belyaev AM, Zakharenko AA, Dvoretsky S.Yu., Surov DA, Babkov OV, Kondratsov S. BUT. // Oncology. - 2011. - Volume 12, p.620-630.

9. Yamtsky N.A., Tumors of the colon / Yamtsky N.A., Sedov V.M., Vasiliev S.V. // Medpress-inform. - M., 2004, 372 p.

10. Treatment of tumor colonic obstruction // Hanevich MD, Zyazin AA, Shasholin MA, Luzin VV // Bulletin of Surgery. I.I. Grekova, 2005. - No. 1. - S.85-89.

11. Butler Sergei Yuryevich. Endoscopic recanalization in colorectal cancer complicated by obstruction: dissertation ... candidate of medical sciences: 14.00.27 / Dvoretsky Sergey Yuryevich (place of defense: GOUDPO "St. Petersburg Medical Academy of Postgraduate Education"). - St. Petersburg. 2008 .-- 117 p .: ill.

12. Shelekhov Alexey Vladimirovich. Endosurgical technologies in the combined treatment of complicated forms of colorectal cancer: the dissertation ... Doctors of medical sciences: 14.00.14 / Shelekhov Aleksey Vladimirovich (place of protection of the State Educational Institution of Higher Education "Irkutsk State Institute for the Improvement of Physicians of the Federal Health Agency"). - Irkutsk-Tomsk. 2009 .-- 234 p.

Claims (3)

1. A method of two-stage treatment of complicated colon cancer, including performing decompression at the first stage and a radical operation using the laparoscopic method at the second stage, characterized in that decompression is performed as follows: colonoscopy is performed with recanalization of the tumor channel by sequentially stricturing the stricture to the maximum possible clearance, after which the endoscope is proximal to the stricture, and a metal conductor string is installed, through which after removing the endoscope A decompression probe is put in place for a period of 2-3 days; after 2-3 days, the second stage is performed - a radical operation using the laparoscopic method.
2. A method of treating colon cancer obstructed by acute colon obstruction of a colon cancer according to claim 1, characterized in that if the tumor is rigid, the conductor string is conducted through the tumor channel under radiological control.
3. A method for the treatment of colonic obstruction of colon cancer complicated by acute colon cancer according to claim 1, characterized in that the radical operation involves the removal of a tumor with the formation of a primary intestinal anastomosis.
RU2011148403/14A 2011-11-29 2011-11-29 Method of two-stage treatment of complicated colon cancer RU2470599C1 (en)

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Citations (2)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
RU2143228C1 (en) * 1996-10-24 1999-12-27 Московский областной научно-исследовательский клинический институт Method of treatment of postoperative structures of ureter in patients with transplanted kidney
US20090281560A1 (en) * 2008-05-06 2009-11-12 Wexner Steven D Method for anastomosis surgery using zip-ties

Patent Citations (2)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
RU2143228C1 (en) * 1996-10-24 1999-12-27 Московский областной научно-исследовательский клинический институт Method of treatment of postoperative structures of ureter in patients with transplanted kidney
US20090281560A1 (en) * 2008-05-06 2009-11-12 Wexner Steven D Method for anastomosis surgery using zip-ties

Non-Patent Citations (2)

* Cited by examiner, † Cited by third party
Title
LORUSSO C. et al. Subtotal colectomy in the treatment of neoplastic left colon obstruction. Ann Ital Chir. 2005 Nov-Dec; 76(6):569-72 (Abstract). *
ДВОРЕЦКИЙ С.Ю. Эндоскопическая реканализация при колоректальном раке, осложненном непроходимостью. Автореферат дисс. канд. мед. наук. - СПб., 2008, с.19. *

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