Evaluation of current therapeutic approach to obstructive and perforated colorectal cancers

BACKGROUND: Late diagnosis continues to be a significant problem in the treatment of colorectal cancer (CRC). Most cases require emergency surgical intervention due to acute intestinal obstruction or perforation. This retrospective study was formed from an assessment of the clinical presentation, treatment, early results, and survival of patients with CRC undergoing emergency surgery for acute obstruction or perforation.
METHODS: Between 2012 and 2017, 612 patients underwent surgery for CRC. In all, 179 patients who required emergency treatment were retrospectively evaluated according to age, gender, significant comorbidities, physiological status, surgical indications, tumor location, tumor stage, perioperative blood transfusion rate, type of surgery, and the length of the operation and hospitalization.
RESULTS: In total, 152 (85%) patients had a complete obstruction and 27 (15%) patients had a perforation. A major postoperative complication was identified nearly in half of the patients. The overall mortality rate was 12% (22 patients). Mortality was seen in 12% (18 patients) cases received surgery due to obstruction and in 15% (four patients) cases received surgery due to perforation. Perioperative blood transfusion and a high Acute Physiology and Chronic Health Evaluation II score were independent factors that predicted a major complication. Advanced age and perioperative blood transfusion were statistically independent prognostic factors for mortality.
CONCLUSION: Consisted with the findings of studies in the literature, the results of this study also revealed a high perioperative morbidity and mortality rate in patients with CRC who required urgent surgery. Our findings suggest that early detection and treatment of CRC with screening programs can be life-saving.

Obstrükte ve perforasyonlu kolorektal kanser hastalarýna güncel tedavi yaklaþýmýnýn deðerlendirilmesi

AMAÇ: Kolorektal kanserin (KRK) tedavisinde tanýda gecikme önemli bir sorun olmaya devam etmektedir. Birçok olgu akut baðýrsak obstrüksiyonu ya da perforasyonundan ötürü acil cerrahi müdehaleyi gerektirir. Bu geriye dönük çalýþma akut obstrüksiyon ya da peforasyon için acil cerrahi müdehaleye maruz kalan KRK'li hastalarýn saðkalýmý, erken ameliyat sonrasý sonuçlarý, tedavileri ve klinik durumlarýný deðerlendirmeyi amaçlamýþtýr.
GEREÇ VE YÖNTEM: 2012–2017 yýllarý arasýnda toplam 612 hasta KRK nedeniyle ameliyat edildi. Bu hastalar içinde acil müdehale gerektiren 179 hasta yaþ, cinsiyet, komorbidite, fizyolojik durum, cerrahi endikasyon, tümör lokalizasyonu, tümör evresi, perioperatif kan transfüzyon oraný, cerrahi müdehale þekli ve hastanede kalma ve ameliyat geriye dönük olarak deðerlendirildi.
BULGULAR: Toplamda 152 (%85) hastada tam obstrüksiyon, 27 hastada (%15) perforasyon vardý. Majör ameliyat sonrasý komplikasyon hastalarýn neredeyse yarýsýnda gözlendi. Genel mortalite oraný %12 (22 hasta) idi. Obstrüksiyon nedeniyle ameliyat edilen hastalarýn %12'sinde (18 hasta), perforasyon nedeniyle ameliyat edilen hastalarýn ise %15'inde (4 hasta) mortalite geliþti. Peroperatuvar kan transfüzyonu ve yüksek ASA skoru majör komplikasyonu öngören baðýmsýz prognostik faktörler olarak tespit edilirken, ileri yaþ ve peroperatuvar kan transfüzyonu mortaliteyi öngören baðýmsýz risk faktörü olarak bulundu.
TARTIÞMA: Baþka çalýþmalarda da görüldüðü üzere, bizim yazýmýzda da acil cerrahi giriþim gerektiren KRK hastalarýnda yüksek oranda peroperatuvar morbidite ve mortaliteye rastladýk. Tarama programlarý yardýmýyla erken taný ve tedavi bu hastalýkta yaþam kurtarýcý rol oynamaktadýr.