Role of early reconstructive operative interferences in IV stage colon cancer after the liquidation of acute intestinal obstruction
Purpose: to study the role of early reconstructive operations in IV stage colon cancer complicated by intestinal obstruction. Мaterials and methods. We operated on 82 patients with IV stage colon cancer complicated by the acute intestinal obstruction (AIO) during the period from 2005 to 2012 years. All the patients went through the main focus tumorectomy by Mikulicz despite of the long-term metastases. The patients were divided into two groups: the first group numbered 41 patient that don't went through the reconstructive operations in the future; the second group consisted of 41 patients that in 35-45 days after the surgery went through the intestinal continuity reconstruction, including 36 patients with extraperitoneal reconstruction, in spite of palliative character of primary operation. After the discharge from the hospital the patients got a specific treatment in the oncodispensaries. In 3, 6 and 9 months the patients were questioned with the help of EORTC QLQ-C30 quality of life questionnaire and compared the received results. Results and discussion. In three months after the surgery treatment their life as “good” and “satisfactory” assesses 18 patients from the first group; it was 43,9 %. In the second group the results numbered 39 (94,1 %) of patients. After the 6-month period in the first group the number of patients with “unsatisfactory” quality of life assessment was 28 (68,3 %); and in the second one only 3 (7,3 %) of patients. Despite of the number of patients with “good” and “satisfactory” quality of life decreased insignificantly in the both groups, in the second group the rates were significantly better. After the 9-month period 3 (7,3 %) of the patients assessed their quality of life as “good” in the second group; in the first one there were no patients at all. As “satisfactory” in the first group numbered 9 (22 %) against 26 (63,8 %) in the second group and “unsatisfactory” 32 (78 %) in the first one there were 12 (29,3 %). Despite of the early stoma closing that doesn't influence the tumor process, in the second group nevertheless the long life survival increased on 2,2 ± 1,4 of months in comparison with the first group. Conclusions. Thus we achieved statistically reliable facts of improvement of life quality in patients with early recovering of intestinal continuity as during the early periods after 1 month as well as during the later ones, videlicet 6, 9 months and later. Also it should be underlined that the reconstructive surgeries have sense in improvement of patients' quality of life and rehabilitation; and also even not very significant (2,2 ± 1,4 month) increase of patients' survival. From the morphological point of view the confirmed levelling procedure of inflammatory events in the intestine wall during four weeks allowed implementing in the early terms of 35-45 days of postoperative period large intestine stoma closing.