Acute bowel obstruction - the main complication of colorectal cancer. Therapeutical options.
OBJECTIVE
to choose the proper therapeutical approach in obstructing colorectal cancer.


METHODS
77 (29.2%) obstructing colorectal cancers, 88.15% aged between 61 and 80 years, selected from 260 patients admitted in the last 10 years were analyzed. We noticed associated cardiovascular (42 cases=55.2%) and/or respiratory (18 cases=23.6%) disease in 89,55% of cases. The distribution of the obstructing lesions throughout the colon and rectum was: 39 cases on the left colon, 18 cases on the right colon, and 20 cases on the rectum, with the following pTNM staging: stage II 10%, stage III 67% and stage IV 23%. The infiltrative character of the primary tumor (61 cases) and the extension to the adjacent structures (24 cases) were the main causes of the acute bowel obstruction. The diagnosis was established on the clinical aspects and plain X-ray findings. The delay between the onset of the acute obstruction and the admission was 3 days on average, and we noticed severe biological disorders pertaining to the acute bowel obstruction in more than 75% of cases. 76 patients (99.6%) were operated on. We performed primary resection in 8 cases and staged-procedures (cecostomy or ileotransversostomy followed by resection and anastomosis after 3 weeks on average) in 33 cases. In 35 cases we performed one of the so called "exigency procedures" (colostomy, internal diversion or Hartman colectomy).


RESULTS
55 (72.36%) patients had a fair evolution. We registered 21 deaths, with a general mortality rate of 27.6%, and a mortality rate of 25% for primary resection, 9.09% for staged surgery and 47.05% for the so called exigency procedures.


CONCLUSIONS
Acute bowel obstruction is the most common complication of the colorectal cancer, charged by multiple major risk factors. An adequate colon decompression and the treatment of the biological disorders are the main therapeutical objectives. Surgery of the obstructing colorectal cancer is always a palliative one. Staged surgery is the safest therapeutical option for colorectal cancers with acute bowel obstruction.
Nemes
Răducu
R
2nd Surgical Clinic, University of Medicine, Bd. Maresal Antonescu no. 60, Craiova, Romania. nemes@umfcv.ro
Vasile
Ion
I
Curca
Traian
T
Paraliov
Toma
T
Pasalega
Marin
M
Mesina
Cristian
C
Dinca
Nadia
N
Valcea
Dan
D
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015179:Colorectal Neoplasms / Q000150:complications* / Q000473:pathology / Q000601:surgery*; D005260:Female; D006801:Humans; D007415:Intestinal Obstruction / Q000209:etiology* / Q000473:pathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D012189:Retrospective Studies; D016896:Treatment Outcome