Palliative large bowel resections. Impact of the laparoscopic approach

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.

Challenges in surgical treatment of locally recurent colorectal carcinoma

“…The application of intraoperative radiotherapy in addition to a preoperative such further increases the levels of survival (14). Locally recurrent CRC as a rule is locally advanced and needs very careful assessment before planning a therapeutic strategy (15).…”