P-0264 - Treatment tactics of colorectal cancer complicated by bowel obstruction

Date 28 June 2014
Event World GI 2014
Session Poster Session
Topics Supportive Care
Colon Cancer
Rectal Cancer
Surgery and/or Radiotherapy of Cancer
Presenter Hrachya Manukyan
Citation Annals of Oncology (2014) 25 (suppl_2): ii14-ii104. 10.1093/annonc/mdu165
Authors H. Manukyan, A. Mirijanyan, K. Grigoryan
  • Yerevan State Medical University, Yerevan/AM

Abstract

Introduction

During last decades there has been an unprecedented increase in the incidence of colorectal cancer in developing countries. Bowel obstruction as one of the common complications occurs in up to 28% of patients with colorectal cancer. In general, patients with malignant bowel obstruction suffer greater surgical morbidity and mortality than those who present for elective resection of non-obstructing colonic tumors. Current surgery is undergoing revolutionary changes due to newer approaches to pain control, the introduction of techniques that reduce the perioperative stress response, and the use of minimally invasive techniques. Recent development in this sphere is the introduction of fast-track surgery. It includes non-invasive techniques, optimal pain control, and aggressive postoperative rehabilitation, including early peroral nutrition and ambulation. The aim of this study was to evaluate the postoperative outcome after fast-track surgery and to determine the optimal management of bowel obstruction in patients with colorectal cancer.

Methods

The single centre study was done to determine the optimal treatment tactics for patients with malignant bowel obstruction. A retrospective study was developed from 154 patients with acute bowel obstruction undergoing colonic resection with conventional care at the “Heratsi” University Hospital between January 2004 and December 2009. Median patient age was 63 years (range: 49-73). Our prospective study includes 67 patients with acute bowel obstruction, who underwent fast-track multimodal rehabilitation between January 2010 and December 2013. The median age in this group is comparable with the first group (65 years). The disease site varied with the pathology. Overall, the sigmoid colon was the commonest in both groups. All patients included in study underwent major emergency operations. The patients were confirmed to have a malignant tumor after postoperative pathologic examination.

Results

Short-term postoperative data and medium-term recurrence and survival were compared and analyzed. In all patients resection and anastomosis was generally performed for right-sided lesions, whereas Hartmann's operation was the commonest procedure for more distally situated neoplastic lesions. A loop diverting colostomy was used most commonly in patients with peritonitis. As showed our previous studies, the complication rates and mortality were equal when single-stage and multi-stage procedures were compared, so in our clinic we tried to prefer single-stage surgeries. Median hospital stay was 11.5 days (range 9-14 days) in group 1 and 2 days (range 4-6 days) in group 2. Postoperative complications rate was significantly equal in two groups. However the cardiopulmonary complications were lower in the second group of patients. There were 5 anastomotic leaks in the first group and 2 in the second, which is comparable. Eleven patients died post-operatively (25 days), an overall postoperative mortality rate in group 1 is 5.2% and in group 2 is 4.5%.

Conclusion

Fast-track surgery has many advantages, especially with regard to postoperative comfort and the rapid regain of normal physical activities in comparison with conventional care. In malignant bowel obstruction surgery, the fast-track multimodal rehabilitation accelerated convalescence, lowered the number of cardiopulmonary complications, and reduced the duration of hospital stay. Therefore, evaluation of fast-track concepts is warranted in other types of elective abdominal surgery.