Analysis of treatment outcomes in patients with colorectal cancer in 2015 and 2022

Abstract

BACKGROUND: The surgical management of colorectal cancer remains an urgent problem. In the surgical treatment of patients with colorectal cancer, reducing the incidence of anastomotic leakage, the length of hospital stay and improving the prognosis of the disease are of great importance.

AIM: To compare the results of treatment of patients with colorectal cancer before and after the introduction into clinical practice of optimisation methods adopted in the clinics of the Department of Hospital Surgery named after V.A. Oppel.

MATERIALS AND METHODS: The analysis of treatment outcomes in 101 patients who underwent surgery for colorectal cancer in the Clinic of Hospital Surgery named after. V.A. Oppel, North-Western State Medical University named after I.I. Mechnikov in 2015 and 2022. All the patients were divided into 2 groups: in 2022 the study included 57 patients, who made up group A; in 2015, the clinic treated 44 patients, who were included in group B. The largest number of patients in both groups had stage II of the disease: in group A — 31 patients (54%), in group B — 19 patients (43%).

RESULTS: The average length of hospital stay was 12.16 days in 2022, in 2015 — 15.95 days in the patients with uncomplicated postoperative period; with the development of postoperative complications, the hospital stay reached 31 days. The share of laparoscopic surgery in 2015 was 47.7%. In 2022 it was 74.1%. In 2022, 8 patients were diagnosed with complications in the early postoperative period (complication rate — 14.0%). In 2015, complications were identified in 10 people (complication rate was 22.7%). Thus, the tactics we used in the surgical phase of the complex treatment of colorectal cancer patients made it possible to reduce the incidence of early postoperative complications (anastomotic leakage). In group B, 6 (85.7%) patients who developed this complication required repeated surgery. In group A, only 4 (50%) patients required repeated surgical treatment, two of them required minimally invasive interventions.

CONCLUSIONS: The results of the following study show that optimisation of the perioperative management of patients, prevention of postoperative complications, individualisation of the treatment approach can reduce the length of hospital stay.

Keywords

colorectal cancer / anastomotic leak / surgical treatment of colorectal cancer

References

[1] Alekseev MV, Shelygin YuA, Rybakov EG. Methods of anastomotic leakage prevention. A systematic review. Koloproktologia. 2015;(4(54)):46–56. EDN: UQCVBJ

[2] Алексеев М.В., Шелыгин Ю.А., Рыбаков Е.Г. Методы профилактики несостоятельности колоректального анастомоза (обзор литературы) // Колопроктология. 2015. № 4(54). С. 46–56. EDN: UQCVBJ

[3] Shelygin IuA, Achkasov SI, Sushkov OI, Zapol’ski AG. Is single laparoscopic access safe in surgery of the colon? Endoscopic Surgery. 2014;20(3):3–5. EDN: SXMRAJ

[4] Шелыгин Ю.А., Ачкасов С.И., Сушков О.И., Запольский А.Г. Безопасен ли единый лапароскопический доступ в хирургии ободочной кишки? // Эндоскопическая хирургия. 2014. Т. 20, № 3. С. 3–5. EDN: SXMRAJ

[5] Glushkov NI, Gorshenin TL. Video assisted operations in the treatment of complicated forms of colon cancer in elderly and senile patients. Herald of North-Western State Medical University named after I.I. Mechnikov. 2014;6(4):7–11. EDN: TYFZBF doi: 10.17816/mechnikov2014647-11

[6] Глушков Н.И., Горшенин Т.Л. Видеоассистированные операции в лечении осложненных форм рака ободочной кишки у больных пожилого и старческого возраста // Вестник Северо-Западного государственного медицинского университета им. И.И. Мечникова. 2014. Т. 6, № 4. С. 7–11. EDN: TYFZBF doi: 10.17816/mechnikov2014647-11

[7] Erokhina EA, Topuzov EG, Topuzov EE, et al. Diagnostic criterions of postoperative intra-abdominal complications of colorectal cancer. Bulletin of the Russian Military Medical Academy. 2016;(3):36–39. EDN: YJMFKJ

[8] Ерохина Е.А., Топузов Э.Г., Топузов Э.Э., и др. Диагностические критерии послеоперационных внутрибрюшных осложнений колоректального рака // Вестник Российской Военно-медицинской академии. 2016. № 3(55). С. 36–39. EDN: YJMFKJ

[9] Zaridze DG, Kaprin AD, Stilidi IS. Dynamics of morbidity and mortality from malignant tumors in Russia. Problems in Oncology. 2018;64(5):578–591. (In Russ.) EDN: YMKCAX

[10] Заридзе Д.Г., Каприн А.Д., Стилиди И.С. Динамика заболеваемости злокачественными новообразованиями и смертности от них в России // Вопросы онкологии. 2018. Т. 64, № 5. С. 578–591. EDN: YMKCAX

[11] Navmatulja AYu, Solov’ev IA, Litvinov OA, et al. The differentiated way of forming preventive stomas in surgery of the rectal cancer. Bulletin of Pirogov National Medical and Surgical Center. 2016;11(2):54–57. EDN: UGDFHJ

[12] Навматуля А.Ю., Соловьев И.А., Литвинов О.А., и др. Дифференцированный подход к формированию превентивных стом в хирургии рака прямой кишки // Вестник Национального медико-хирургического центра им. Н.И. Пирогова. 2016. Т. 11, № 2. С. 54–57. EDN: UGDFHJ

[13] Kislitsyna ON, Topuzov RE, Petryashev AV, et al. The score system of assessing the risk of anastomosis leakage in colorectal operations. Ural Medical Journal. 2016;(8):137–144. EDN: WZJTPJ

[14] Кислицына О.Н., Топузов Р.Э., Петряшев А.В., и др. Балльная система оценки риска несостоятельности анастомоза при колоректальных операциях // Уральский медицинский журнал. 2016. № 8(141). С. 137–144. EDN: WZJTPJ

[15] Kislitsyna ON. Optimization of diagnostics and treatment of complications after colon surgery [dissertation]. Saint Petersburg; 2019. 145 p. (In Russ.). EDN: APLLNY

[16] Кислицына О.Н. Оптимизация диагностики и лечения осложнений после операций на толстой кишке: дис. … канд. мед. наук. Санкт-Петербург, 2019. 145 с. EDN: APLLNY

[17] Merabishvili VM. Oncological statistics (traditional methods, new information technologies). Guidelines for physicians. Part I. 2nd ed. Saint Petersburg: KOSTA; 2015. 223 p. (In Russ.)

[18] Мерабишвили В.М. Онкологическая статистика (традиционные методы, новые информационные технологии). Руководство для врачей. Часть 1. 2-е изд., доп. Санкт-Петербург: КОСТА, 2015. 223 с.

[19] Karachun AM, Petrov AS, Samsonov DV, Petrova EA. The place of laparoscopic surgery for colon and rectal cancer. Practical Oncology. 2012;13(4):261–268. (In Russ.) EDN: PUHUOX

[20] Карачун А.М., Петров А.С., Самсонов Д.В., Петрова Е.А. Место лапароскопических операций при раке ободочной и прямой кишок // Практическая онкология. 2012. Т. 13, № 4. С. 261–268. EDN: PUHUOX

[21] Petryashev AV. Preventive stomas in the treatment of colorectal cancer [dissertation]. Saint Petersburg; 2020. 142 p. (In Russ.) EDN: KNNZUS

[22] Петряшев А.В. Превентивные стомы в лечении колоректального рака: дис. … канд. мед. наук. Санкт-Петербург, 2020. 142 с. EDN: KNNZUS

[23] Topuzov RE. Optimization of indications for the use of laparoscopic technologies at the surgical stage of colorectal cancer treatment [dissertation]. Saint Petersburg; 2015. 109 p. (In Russ.)

[24] Топузов Р.Э. Оптимизация показаний к применению лапароскопических технологий на хирургическом этапе лечения колоректального рака: дис. … канд. мед. наук. Санкт-Петербург, 2015. 109 с.

[25] Januskevics SV, Januskevics VY. Protection of an anastomosis in rectal cancer surgery. Surgery news. 2017;25(4):412–420. EDN: ZCRXGV doi: 10.18484/2305-0047.2017.4.412

[26] Янушкевич С.В., Янушкевич В.Ю. Протекция анастомозов в хирургии рака прямой кишки // Новости хирургии. 2017. Т. 25, № 4. С. 412–420. EDN: ZCRXGV doi: 10.18484/2305-0047.2017.4.412

[27] Tortorelli AP, Alfieri S, Sanchez AM, et al. Anastomotic leakage after anterior resection for rectal cancer with mesorectal excision: incidence, risk factors, and management. Am Surg. 2015;81(1):41–47.

[28] Tortorelli A.P., Alfieri S., Sanchez A.M., et al. Anastomotic leakage after anterior resection for rectal cancer with mesorectal excision: incidence, risk factors, and management // Am Surg. 2015. Vol. 81, N 1. P. 41–47.

[29] Sopik V, Phelan C, Cybulski C, Narod SA. BRCA1 and BRCA2 mutations and the risk for colorectal cancer. Clin Genet. 2015;87(5):411–418. doi: 10.1111/cge.12497

[30] Sopik V., Phelan C., Cybulski C., Narod S.A. BRCA1 and BRCA2 mutations and the risk for colorectal cancer // Clin Genet. 2015. Vol. 87, N 5. P. 411–418. doi: 10.1111/cge.12497

[31] Thanikachalam K, Khan G. Colorectal cancer and nutrition. Nutrients. 2019;11(1):164. doi: 10.3390/nu11010164

[32] Thanikachalam K., Khan G. Colorectal cancer and nutrition // Nutrients. 2019. Vol. 11, N 1. P. 164. doi: 10.3390/nu11010164

[33] Weitz J, Koch M, Debus J, et al. Colorectal cancer. Lancet. 2005;365(9454):153–165. doi: 10.1016/S0140-6736(05)17706-X

[34] Weitz J., Koch M., Debus J., et al. Colorectal cancer // Lancet. 2005. Vol. 365, N 9454. P. 153–165. doi: 10.1016/S0140-6736(05)17706-X

[35] Nasseri Y, Langenfeld SJ. Imaging for colorectal cancer. Surg Clin North Am. 2017;97(3):503–513. doi: 10.1016/j.suc.2017.01.002

[36] Nasseri Y., Langenfeld S.J. Imaging for colorectal cancer // Surg Clin North Am. 2017. Vol. 97, N 3. P. 503–513. doi: 10.1016/j.suc.2017.01.002

[37] van Vugt JL, Reisinger KW, Derikx JP, et al. Improving the outcomes in oncological colorectal surgery. World J Gastroenterol. 2014;20(35):12445–12457. doi: 10.3748/wjg.v20.i35.12445

[38] van Vugt J.L., Reisinger K.W., Derikx J.P., et al. Improving the outcomes in oncological colorectal surgery // World J Gastroenterol. 2014. Vol. 20, N 35. P. 12445–12457. doi: 10.3748/wjg.v20.i35.12445

[39] Fleshman J, Sargent DJ, Green E, et al. Laparoscopic colectomy for cancer is not inferior to open surgery based on 5-year data from the COST Study Group trial. Ann Surg. 2007;246(4):655–662. doi: 10.1097/SLA.0b013e318155a762

[40] Fleshman J., Sargent D.J., Green E., et al. Laparoscopic colectomy for cancer is not inferior to open surgery based on 5-year data from the COST Study Group trial // Ann Surg. 2007. Vol. 246, N 4. P. 655–662. doi: 10.1097/SLA.0b013e318155a762

[41] Trastulli S, Cirocchi R, Listorti C, et al. Laparoscopic vs open resection for rectal cancer: a meta-analysis of randomized clinical trials. Colorectal Dis. 2012;14(6):e277–e296. doi: 10.1111/j.1463-1318.2012.02985.x

[42] Trastulli S., Cirocchi R., Listorti C., et al. Laparoscopic vs open resection for rectal cancer: a meta-analysis of randomized clinical trials // Colorectal Dis. 2012. Vol. 14, N 6. P. e277–e296. doi: 10.1111/j.1463-1318.2012.02985.x

[43] Reischl S, Wilhelm DF, Neumann PA, et al. Peri- and postoperative nutrition in colorectal cancer patients. Ther Umsch. 2018;75(10):642–648. (In German). doi: 10.1024/0040-5930/a001052

[44] Reischl S., Wilhelm D.F., Neumann P.A., et al. Peri– and postoperative nutrition in colorectal cancer patients // Ther Umsch. 2018. Vol. 75, N 10. P. 642–648. (In German). doi: 10.1024/0040-5930/a001052

[45] Kijima S, Sasaki T, Nagata K, et al. Preoperative evaluation of colorectal cancer using CT colonography, MRI, and PET/CT. World J Gastroenterol. 2014;20(45):16964–16975. doi: 10.3748/wjg.v20.i45.16964

[46] Kijima S., Sasaki T., Nagata K., et al. Preoperative evaluation of colorectal cancer using CT colonography, MRI, and PET/CT // World J Gastroenterol. 2014. Vol. 20, N 45. P. 16964–16975. doi: 10.3748/wjg.v20.i45.16964

[47] Rahbari NN, Weitz J, Hohenberger W, et al. Definition and grading of anastomotic leakage following anterior resection of the rectum: a proposal by the International Study Group of Rectal Cancer. Surgery. 2010;147(3):339–351. doi: 10.1016/j.surg.2009.10.012

[48] Rahbari N.N., Weitz J., Hohenberger W., et al. Definition and grading of anastomotic leakage following anterior resection of the rectum: a proposal by the International Study Group of Rectal Cancer // Surgery. 2010. Vol. 147, N 3. P. 339–351. doi: 10.1016/j.surg.2009.10.012

RIGHTS & PERMISSIONS

Eco-Vector