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Palliative large bowel resections. Impact of the laparoscopic approach

Veselin Marinov, Kiril Draganov, Nikolay Katev, Anastazia Petreska, Dimitar Rusenov, Radoslav Gajdarski

Abstract

INTRODUCTION: Nowadays colorectal cancer (CRC) incidence rate increases in the Western world. The lack of effective screening programs results in diagnosis of advanced cases in our country. Combination of hematogenic, peritoneal or systemic CRC dissemination with present or potential complications from local disease is not an exception. The decision for palliative resection is not easy and is a matter of balance be­tween potential risks of operative intervention and advances due to local tumour resection. Positive aspects of the laparoscopic approach are important in planning of these interventions. The aim of this study is to as­sess the indications for laparoscopic palliative large bowel resections in the literature available and to share our own experience.

PATIENTS AND METHODS: During a two-year period, in the HPB and General Surgery Clinic, Acibadem City Clinic, Tokuda Hospital of Sofia, six laparoscopic palliative colon resections were performed. In the all cases, multiple liver metastases were diagnosed without possibility of liver resection. The early periopera­tive results were analyzed.

RESULTS: Four left colon resections were performed with primary anastomosis due to high-level large bow­el obstruction and two right colectomies were done for primary tumour bleeding. Three patients were over 77 years old and presented with comorbidity. Average hospital stay was 5,6 days. No perioperative compli­cations were observed.

CONCLUSION: Minimal surgical trauma, short recovery period and well-defined indications are important features in the process of planning of palliative large bowel resections in patients with disseminated CRC. The objective is to reduce risks of complications connected with primary tumour and to assure a good pa­tient`s quality of life. Scr Sci Med 2017; 49(3): 27-30


Keywords

laparoscopic surgery, colorectal cancer, large bowel, palliative resection, tumour bleeding

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References

Brenner H, Kloor M, Pox CP. Colorectal cancer. Lancet. 2014;383(9927):1490-1502. doi: 10.1016/ S0140-6736(13)61649-9.

Adam R, de Gramont A, Figueras J, Kokudo N, Kunstlinger F, Loyer E, et al.; of the EGOSLIM (Expert Group on OncoSurgery management of Liver Metastases) group. Managing synchronous liver metastases from colorectal cancer: a multidisciplinary international consensus. Cancer Treat Rev. 2015;41(9):729-41. doi: 10.1016/j.ctrv.2015.06.006.

Søreide K. Emergency management of acute obstructed left-sided colon cancer: loops, stents or tubes? Endoscopy. 2013;45(4):247-8. doi: 10.1055/s-0032-1326404.

Maeda Y, Shinohara T, Katayama T, Minagawa N, Sunahara M, Nagatsu A, et al. A laparoscopic approach is associated with a decreased incidence of SSI in patients undergoing palliative surgery for malignant bowel obstruction. Int J Surg. 2017;42:90-4. doi: 10.1016/j.ijsu.2017.04.052.

Tei M, Wakasugi M, Akamatsu H. Short-term outcomes of single-port surgery for palliative resection of the primary tumor in patients with incurable stage IV colon cancer. Asian J Endosc Surg. 2016;9(4):258-64. doi: 10.1111/ases.12289.

Biondi A, Vacante M, Ambrosino I, Cristaldi E, Pietrapertosa G, Basile F. Role of surgery for colorectal cancer in the elderly. World J Gastrointest Surg. 2016;8(9):606-13. doi: 10.4240/wjgs.v8.i9.606.

Zhou MW, Gu XD, Xiang JB, Chen ZY. Clinical safety and outcomes of laparoscopic surgery versus open surgery for palliative resection of primary tumors in patients with stage IV colorectal cancer: a meta-analysis. Surg Endosc. 2016;30(5):1902-10. doi: 10.1007/s00464-015-4409-1.

Patel S, Chang GJ. Primary tumor resection in metastatic colorectal cancer: Please pass the salt. JAMA Oncol. 2015;1(9):1213-4. doi: 10.1001/ jamaoncol.2015.2757.

Chang GJ. Primary tumor resection in stage IV colorectal cancer: the debate continues. Dis Colon Rectum. 2011;54(8):919-20. doi: 10.1097/ DCR.0b013e31821ccf05.

Mik M, Dziki L, Galbfach P, Trzcinski R, Sygut A, Dziki A. Resection of the primary tumour or other palliative procedures in incurable stage IV colorectal cancer patients? Colorectal Dis. 2010;12(7 Online):e61-7. doi: 10.1111/j.1463-1318.2009.01860.x.

Cellini C, Hunt SR, Fleshman JW, Birnbaum EH, Bierhals AJ, Mutch MG. Stage IV rectal cancer with liver metastases: is there a benefit to resection of the primary tumor? World J Surg. 2010;34(5):1102- 8. doi: 10.1007/s00268-010-0483-7.

Akagi T, Inomata M, Etoh T, Yasuda K, Shiraishi N, Kitano S. Laparoscopic versus conventional palliative resection for incurable, symptomatic stage IV colorectal cancer: impact on short-term results. Surg Laparosc Endosc Percutan Tech. 2011;21(3):184-7. doi: 10.1097/ SLE.0b013e31821db75e.




DOI: http://dx.doi.org/10.14748/ssm.v49i3.4049

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About The Authors

Veselin Marinov
Tokuda Hospital, Sofia, Bulgaria

Department of Miniinvasive and Laparoscopic Surgery, HPB and General Surgery Clinic, Acibadem City Clinic

Kiril Draganov
Tokuda Hospital, Sofia, Bulgaria

Department of Miniinvasive and Laparoscopic Surgery, HPB and General Surgery Clinic, Acibadem City Clinic

Nikolay Katev
Tokuda Hospital, Sofia, Bulgaria

Department of Miniinvasive and Laparoscopic Surgery, HPB and General Surgery Clinic, Acibadem City Clinic

Anastazia Petreska
Tokuda Hospital, Sofia, Bulgaria

Department of Miniinvasive and Laparoscopic Surgery, HPB and General Surgery Clinic, Acibadem City Clinic

Dimitar Rusenov
Tokuda Hospital, Sofia, Bulgaria

Department of Miniinvasive and Laparoscopic Surgery, HPB and General Surgery Clinic, Acibadem City Clinic

Radoslav Gajdarski
Tokuda Hospital, Sofia, Bulgaria

Department of Miniinvasive and Laparoscopic Surgery, HPB and General Surgery Clinic, Acibadem City Clinic

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