Time frames and volume of surgical intervention of reconstructive restorative stage after Hartmann’s procedure

Cover Page

Abstract


Aim. To improve immediate and remote results of reconstructive restorative procedures in patients with complicated colorectal cancer.

Methods. The study is based on clinical experience of treatment of 107 patients who had reconstructive restorative procedures performed in specialized oncology institution after previous Hartmann’s procedure performed in urgent surgical department for complicated colorectal cancer. Reconstructive restorative procedures were performed at different time after the primary operation. To assess functional state of anal sphincter all patients were adminestered sphincteromentry during the preoperative period. Morphological analysis of all tissues removed during the surgery was performed. To evaluate morphological changes of distal end of the stump at different time a histological analysis was performed.

Results. According to the results of sphincterometry dynamic reduction of tonic contraction and maximum pressure of anal sphincter is observed. The more the period between Hartmann’s operation and reconstructive restorative surgery, the less pronounced muscle tone of anal sphincter. Histological studies of intestinal wall during the first 3 months after Hartmann’s surgery revealed intact quantity and size of intestinal crypts, non-significant inflammatory infiltration of mucous and submucous layers, during the period of 4 to 6 months - initial signs of diversion colitis, during the period of 7 to 12 months - atrophic changes in mucous membrane (reduction of crypts quantity, their shortening, decreased thickness of mucus), after 1 year - signs of atrophy of its submucous layer.

Conclusion. Reconstructive surgery in patients with previous Hartmann’s surgery for complicated colorectal cancer should be performed in specialized departments with all modern methods of surgical, radiation and medical treatment of colon cancer available; based on functional and morphological studies the optimal time frame for reconstructive surgery is 1 to 3 months after the initial surgery.


I G Gataullin

Author for correspondence.
marat-khalikov@inbox.ru
Kazan state medical academy

M M Khalikov

marat-khalikov@inbox.ru
Republican clinical oncology dispensary

E V Kozlova

marat-khalikov@inbox.ru
Republican clinical oncology dispensary

Z A Afanas’eva

marat-khalikov@inbox.ru
Kazan state medical academy

V P Potanin

marat-khalikov@inbox.ru
Republican clinical oncology dispensary

  • Bryusov P.G., Malakhov Yu.P. Evolution of approaches to the surgical treatment of patients with the colon cancer, complicated by the obturation intestinal obstruction. Rossiyskiy onkologicheskiy zhurnal. 2004; (5): 4–7. (In Russ.)
  • Volenko A.V., Rudin E.P., Andreev Yu.V. Causes of postoperative complications of restoration of intestinal continuity after Hartmann’s surgery. Ambulatornaya khirurgiya. 2011; (3–4): 12–13. (In Russ.)
  • Gataullin I.G. Tactics of surgical treatment of patients with colorectal cancer complicated with obturation intestinal obstruction. Problemy koloproktologii. 2000; (17): 285. (In Russ.)
  • Gataullin I.G., Aglullin I.R., Khasanov R.Sh. Actual organizational issues of treatment of metastatic and locally advanced rectal cancer. Remedium Privolzh’e. 2011; (1): 39. (In Russ.)
  • Davydov M.I., Aksel’ E.M. Morbidity of malignant tumors of the population of Russia and CIS countries. Vestnik RONTs imeni N.N. Blokhina RAMN. 2008; 29 (2): 53. (In Russ.)
  • Zhashuev A.Zh., Miziev I.A., Mishchenko S.F. Vybor taktiki hirurgicheskogo lechenija bol’nyh kolorektal’nym rakom s uchjotom ocenki tjazhesti obshhego sostojanija po sisteme APACHE II. (The choice of surgical treatment of patients with colorectal cancer in accordance with severity assessment according to APACHE II.) Materials of the first meeting of the surgeons of YuFO. Rostov. 2006; 111–112. (In Russ.)
  • Zlokachestvennye novoobrazovaniya v Rossii v 2012 godu (zabolevaemost’ i smertnost’). (Malignant tumors in Russia in 2011 (morbidity and mortality).) Ed. by A.D. Kaprin, G.V. Petrova, V.V. Starinskiy. Moscow: MNIOI imeni P.A. Gertsena. 2014; 4 p. (In Russ.)
  • Pravosudov I.V. Multidisciplinary approach in the treatemtn of patients with rectal cancer. Zlokachestvennye opukholi. 2014; 3 (10): 64–67. (In Russ.)
  • Timerbulatov V.M., Afanas’ev S.N., Gaynutdinov F.M. et al. Surgical rehabilitation of patients with stoma. Koloproktologiya. 2004; 1 (7): 3–6. (In Russ.)
  • Khavina E.M., Osmolovskiy S.V., Gorokh O.V. et al. Surgical treatment of right colon cancer complicated with obturation intestinal obstruction. Vestnik khirurgii. 2000; (4): 37–39. (In Russ.)
  • Fedorov V.D., Vorob’ev G.I., Rivkin V.L. Klinicheskaya operativnaya koloproktologiya. (Clinical operative coloproctology.) Moscow: Medpraktika, 1994; 432 p. (In Russ.)
  • Khanevich M.D., Manikhas G.M., Luzin V.V. et al. Kolorektal’nyy rak. Vybor khirurgicheskoy taktiki pri tolstokishechnoy neprokhodimosti. (Colorectal cancer. Choice of surgical treatment of colonic obstruction.) SPb.: Agraf+. 2008; 136 р. (In Russ.)
  • Yaitskiy N.A., Sedov V.M., Vasil’ev S.V. Opukholi tolstoy kishki. (Tumors of colon.) Moscow: Medpress-inform. 2004; 376 p. (In Russ.)
  • Marling A., Holm T., Johansson H. et al. The Stockholm treatment on preoperative radiotherapy in rectal carcinoma: long-term follow-up of a population — based study. Canсer. 2001; 92: 896–902.
  • Monson J.R.T., Weiser M.R., Buie W.D., Chang G.J. Practice parameters for the management of rectal cancer. Dis. Colon. Rectum. 2013; 56: 535–550. http://dx.doi.org/10.1097/DCR.0b013e31828cb66c
  • Pravosudov I.V. No more standart abdominoperineal excision. Colorectal Dis. 2014; 16 (6): 484–485. http://dx.doi.org/10.1111/codi.12633

Views

Abstract - 33

PDF (Russian) - 25


© 2017 Gataullin I.G., Khalikov M.M., Kozlova E.V., Afanas’eva Z.A., Potanin V.P.

Creative Commons License

This work is licensed
under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.