Surgical treatment of complicated colorectal cancer: a retrospective study

Background. The following section provides a contextual overview. A substantial number of recommendations and data concerning the treatment of complicated colorec-tal cancer have been identified as being controversial. Purpose – of the present study is to conduct a retrospective analysis. A thorough inves-tigation into the immediate consequences of surgical intervention for complex cases of colon cancer has been conducted. Materials and Methods. A two-centre case-control study was conducted, with 274 pa-tients of both sexes participating. The mean age of the patients was 70.2 years (± 2.6 years). Results. The study demonstrated that 70.1% of cases exhibited acute intestinal obstruc-tion, 26.3% were characterised by perforated cancer, while the remaining instances pre-sented with bleeding (0.7%) or a combination of perforation and obstruction (2.9%). These cases were categorised into four distinct groups based on the presence of these complications. The demographic characteristics, American Society of Anaesthesiologists classification, and types of comorbidities did not differ between all patients evaluated (p > 0.05). The tumourʼs location in the colon did not differ significantly between the patient groups (p = 0.2714): most often, the tumours were located in the left colon (56.6%). Fifty-six patients (20.4%) underwent emergency surgery within two hours of admission, and 204 patients (74.5%) were operated on urgently within six hours of ad-mission to the emergency surgery department. A further 14 patients (5.1%) underwent delayed surgical procedures following the stabilisation of their condition. A total of 137 colon resections were performed, of which 48.2% were primary anastomoses and 51.8% were ileostomies or colostomies. The «no touch» technique was used in 11 (4%) of the 274 patients, and the «damage control surgery» approach was used in 13 (4.7%) patients to treat septic shock. The overall mortality rate was 10.2%, with the highest mortality rate observed in patients with combined obstructive and perforating colon cancer (37.5%, p < 0.05). The most prevalent cause of mortality within 30 days was the progression of multiple organ failure against the background of generalised peritonitis and abdominal sepsis. The mean duration of hospitalisation was found to be 17 days. Conclusions. In the presence of a tumour on the right, in contrast to the left-sided local-isation, a single-stage surgical intervention is possible, namely right-sided hemicolec-tomy with ileotransverse anastomosis, if the general condition of the patient and the ca-pabilities of the local hospital allow this intervention. In cases where tumours are local-ised to the left side of the patient, the optimal surgical intervention in our conditions is an obstructive resection of the colon. Surgeries that are performed for the management of colon cancer, and which do not involve the removal of the tumour, are frequently as-sociated with high postoperative mortality. Such surgeries include anastomosis and stoma placement and are typically performed on patients with the most severe and ad-vanced categories of the disease.