Ulus Travma Acil Cerrahi Derg. 2022; 28(9): 1248-1257 | DOI: 10.14744/tjtes.2021.67792

Akut obstrüktif sol kolon tümörü nedeniyle Hartman prosedürü uygulanan hastalarda yeni bir prognostik belirteç

Ali Kemal Kayapinar¹, Bulent Calik¹, Hilal Sahin², Korhan Tuncer¹, Koray Bas³, Omer Engin⁴, Gokhan Akbulut^5
1Saðlýk Bilimleri Üniversitesi Ýzmir Tepecik Eðitim ve Araþtýrma Hastanesi, Genel Cerrahi Kliniði, Ýzmir
²Saðlýk Bilimleri Üniversitesi Ýzmir Tepecik Eðitim ve Araþtýrma Hastanesi, Radyoloji Kliniði, Ýzmir
³Saðlýk Bilimleri Üniversitesi Ýzmir Bozyaka Eðitim ve Araþtýrma Hastanesi, Genel Cerrahi Kliniði, Ýzmir
⁴VM Medical Park Pendik Hastanesi, Genel Cerrahi Kliniði, Ýstanbul
⁵Ýzmir Týnaztepe Üniversitesi Týp Fakültesi, Galenos Hastanesi, Genel Cerrahi Anabilim Dalý, Ýzmir

AMAÇ: Akut obstrüktif sol kolorektal kanserlerde (AOSKRK), tümörün proksimalindeki kolon segmentlerinin distansiyonu sonucu kolon duvarýnda hasar meydana gelebilir. Amacýmýz Hartmann prosedürü (HP) uygulanan hastalarda, ameliyat öncesi abdominal bilgisayarlý tomografi (BT) tarama-sýnda dilate kolon çapýnýn lomber vertebra korpus çapýna oraný ile ameliyat sonrasý komplikasyonlar arasýndaki iliþkiyi deðerlendirmektir.
GEREÇ VE YÖNTEM: Tümör grubu, acil þartlarda AOSKRC nedeniyle HP uygulanan 49 hastadan oluþturuldu. Kontrol grubu, gastrointestinal sistem dýþýndaki patolojiler nedeniyle abdominal BT’si olan, batýn ameliyatý öyküsü olmayan, tümör grubu ile yaþ ve cinsiyet bakýmýndan uyumlu 49 kiþiden oluþturuldu. Her iki grupta, her hastanýn aksiyel BT görüntülerinde kolon çapýnýn (KÇ) ilk lomber vertebra korpusunun çapýna (L1-VÇ) oraný ölçüldü. Ameliyat sonrasý komplikasyonlar (Clavien-Dindo sýnýflamasý -major (grade ≥III), minor (grade <III)) ile demografik özellikler, ameliyat öncesi biyokimyasal deðerler, komorbid hastalýklar, tümör patolojik evresi, operasyon süresi ve kolon segmentlerinin KÇ/L1-VÇ oranlarý arasýndaki iliþki deðerlendirildi.
BULGULAR: Tümör grubunda KÇ/L1-VÇ oraný, kontrol grubuna göre anlamlý derecede yüksekti (p<0.001). Tümör grubunda ameliyat öncesi transvers ve inen kolon KÇ/L1-VÇ oranýnda artýþ, majör ameliyat sonrasý komplikasyonlar için prognostik parametre olarak bulundu (sýrasýyla p<0.001, p=0.015). KÇ/L1-VÇ oranlarýnýn cut-off deðerleri sýrasýyla 1.52 ve 1.21 (p=0.013, p=0.042) tespit edildi. Ameliyat öncesi transvers kolon KÇ/L1-VÇ oranýndaki artýþ da kan üre düzeyindeki artýþla iliþkili bulundu (p=0.044). Ameliyat öncesi kan üre düzeyleri ile ameliyat sonrasý komplikasyonlar arasýnda pozitif korelasyon gözlendi (p=0.015).
TARTIÞMA: AOSKRK’de ameliyat öncesi transvers ve inen kolon KÇ/L1-VÇ oranlarý, majör ameliyat sonrasý komplikasyonlar için umut verici prognostik parametrelerdir.

Anahtar Kelimeler: Akut karýn, Hartmann prosedürü, ileus; kolon tümörü; Laplas kanunu; obstrüktif sol kolorektal tümör.

---

A new prognostic marker in patients undergoing Hartmann’s procedure for acute tumoral obstruction of the left colon

Ali Kemal Kayapinar¹, Bulent Calik¹, Hilal Sahin², Korhan Tuncer¹, Koray Bas³, Omer Engin⁴, Gokhan Akbulut^5
1Department of General Surgery, University of Health Sciences Ýzmir Tepecik Training and Research Hospital, Ýzmir-Türkiye
²Department of Radiology, University of Health Sciences Ýzmir Tepecik Training and Research Hospital, Ýzmir-Türkiye
³Department of General Surgery, University of Health Sciences Ýzmir Bozyaka Training and Research Hospital, Ýzmir-Türkiye
⁴Department of General Surgery, VM Medical Park Pendik Hospital, Ýstanbul-Türkiye
⁵Department of General Surgery, Ýzmir Týnaztepe University Faculty of Medicine, Galenos Hospital, Ýzmir-Türkiye

BACKGROUND: In acute obstructive left-sided colorectal cancers (AOLCRC), damage to the colon wall may occur as a result of distension of the colon segments proximal to the tumor. In this study, we aimed to evaluate the relationship between the ratio of dilated colon diameter (CD) to lumbar vertebral corpus diameter on preoperative abdominal computed tomography (CT) scan in patients undergoing Hartmann’s Procedure (HP) and post-operative complications.
METHODS: The tumor group consisted of 49 patients who underwent HP for AOLCRC under emergency conditions. The control group consisted of 49 age-and gender-matched individuals (compatible with tumor group) that had an abdominal CT due to pathologies outside the gastrointestinal tract and without a history of abdominal surgery. In both group, the ratios of the CD to the diameter of the first lumbar vertebra corpus (L1-VD) measured on axial CT images of each patient. These ratios were compared between groups. In the tumor group, the relationship between post-operative complications (Clavien-Dindo classification-major (grade ≥III), minor (grade <III)) and demographic characteristics, pre-operative biochemical values, comorbid diseases, tumor pathological stage, opera-tion time, and colon segments’ CD/L1-VD ratios was evaluated.
RESULTS: The CD/L1-VD ratio in the tumor group was significantly higher than that of the control group (p<0.001). An increase in the pre-operative transverse and descending colon CD/L1-VD ratios in the tumor group were found to be a prognostic parameter for the development of major post-operative complications (p<0.001 and p=0.015, respectively), with the cut-off values as 1.52 and 1.21 (p=0.013 and p=0.042), respectively. The increase in the pre-operative transverse colon CD/L1-VD ratio was also associated with the increase in the blood urea level (p=0.044). A positive correlation was observed between the pre-operative blood urea levels and post-operative complications (p=0.015).
CONCLUSION: Pre-operative transverse and descending colon CD/L1-VD ratios in AOLCRC are promising prognostic parameters for major postoperative complications.

Keywords: Acute abdomen, colon tumor, Hartmann’s procedure; ileus, Laplace’s law; obstructive left-sided colorectal cancer.

---

ATIF KOPYALA