PRIMARNI KOLOREKTALNI KARCINOM U NAŠOJ KLINIČKOJ PRAKSI U PETOGODIŠNJEM PERIODU. (Serbian)
In: Timocki Medicinski Glasnik, Jg. 42 (2017-07-01), Heft 3, S. 139-146
academicJournal
Zugriff:
INTRODUCTION: Colorectal cancer (CRC) is the most common malignancy of the digestive tract. Annually in the world about 1.2 million people are affected from CRC, accounting for 9.8% of all patients with malignant diseases. In Serbia, annually are affected about 4,000 people (near 800 patients are from Vojvodina), slightly more than half is colon cancer and slightly less than half is rectal cancer. OBJECTIVE: To show the distribution of CRC by gender, age, the anatomical segments of the colon and TNM stage; to show the used surgical techniques and to determine the rate of early postoperative mortality and average number of days of hospitalization. PATIENTS AND METHODS: In a retrospective analytical study were included the patients who had elective or emergency surgery for primary CRC at the surgical ward of General Hospital Kikinda from January 1st 2012 to December 31st 2016. For statistical analysis we used χ2-test. RESULTS: Operation was performed in 196 patients, 114 men and 82 women (χ2 = 5.22; p<0.05), mean age 67.45 ± 10.41 years (32-91). 40 (20.41%) patients were under the age of 60 years, and 156 (79.59%) were over the age of 60 years (χ2 = 68.65; p <0.001). CRC had the highest distribution in population of 60-79 years (131 vs 65, χ2 = 22.22; p <0.001). Average number of days of hospitalization per patient was 18.75 ± 11.05 (2-89). 153 (78.06%) patients were elective operated while 43 (21.94%) patients were emergency operated (χ2 = 61.74; p<0.001). CRC was localized in the rectum and sigmoid colon in 132 (67.35%) patients, while in 64 (32,65%) patients it was in the remaining segments of the colon (χ2 = 23.59; p <0.001). It was done 37 (18.88%) of the right and 30 (15.31%) of the left hemicolectomy, 18 (9.18%) of the subtotal and 4 (2.04%) of the total colectomy, 15 (7.65%) of the high-anterior and 45 (22.96%) of the low-anterior resection of the rectum, 21 (10.71%) Miles's procedure, 18 (9.18%) Hartmann's procedure, 7 (3.57%) "loop" colostomy and 1 (0.51%) the terminal ileostomy.CRC was in the early stage (T1,T2) in 54 (27.55%) patients, and in an advanced stage (T3,T4) in 142 (72.45%) patients (χ2 = 39.26; p <0.001).Adenocarcinoma was diagnosed in 172 (87.76%) patients, mucinous adenocarcinoma in 21 (10.71%) patients, neuroendocrine tumor (carcinoid) in 2 (1.02%) patients and the signet ring cell carcinoma in 1 (0.51%) patient.110 (56,12%) patients had metastases in the lymph nodes, while 86 (43,88%) patients didn't have metastases (χ2 = 2.94; p> 0.05). On average, 13.42 ± 3.4 (6-24) of the lymph nodes in adipose tissue of colon or rectum were found and histopathologically examined. Macroscopically visible metastasis of remote organs were found in 42 (21.43%) patients at the time of operation, while in 154 (78.57%) patients were not found (χ2 = 64.0; p <0.001). The rate of early postoperative mortality was 9.15% (14/153) for elective operated patients and 37.21% (16/43) for emergency operated patients (χ2 = 20.4; p <0.001). The overall rate of early postoperative mortality was 15.31% (30/196). CONCLUSION: CRC occurs more in males for 1.4 times than in females. CRC is most common in the population of 60-79 years, although about 20% of patients are younger than 60 years. Although the most commonly used treatment of CRC is elective surgery, about 1/5 of patients undergo emergency surgery. The most common localization of CRC is in the rectum (40%) and sigmoid colon (25%). The proved operational techniques are using in surgical treatement of CRC that include resection of the tumor with the creation of intestinal anastomoses and/or stoma, while in the case of inoperability of the tumor is necessary to create the derivation stoma.Surgical treatment of CRC requires a relatively long hospitalization (average 2-3 weeks). CRCs are usually operated in the stage T3, with metastasis to the lymph nodes in more than 50% of the cases.Dukes C stage is the most frequent in this study. About 20% of patients have remote metastases at the time of surgery. Surgery of CRCs has a high rate of early postoperative mortality (about 15%), and it was significantly higher in patients emergency operated. [ABSTRACT FROM AUTHOR]
UVOD: Kolorektalni karcinom (KRK) je najčešći maligni tumor digestivnog trakta. Od KRK godišnje u svetu oboli oko 1,2 miliona ljudi, što čini 9,8% svih obolelih od malignih bolesti. U Srbiji godišnje oboli oko 4000 osoba (od toga u Vojvodini oko 800), i to nešto više od polovine čini karcinom kolona, a nešto manje od polovine karcinom rektuma. CILJ: Prikazati distribuciju KRK prema polu, godinama starosti, anatomskim segmentima, TNM stadijumu, primenjene operativne tehnike, odrediti stopu ranog postoperativnog mortaliteta i prosečan broj dana hospitalizacije. PACIJENTI I METODE: Retrospektivna analitička studija. Uključeni su pacijenti koji su elektivno ili urgentno operisani zbog primarnog KRK na Odeljenju hirurgije Opšte bolnice u Kikindi, u periodu od 01.01.2012.-31.12.2016. godine. Za statističku analizu podataka korišćen je χ2-test. REZULTATI: Operisano je 196 pacijenata, 114 muškaraca i 82 žene (χ2=5,22; p<0,05), prosečne starosti 67,45±10,41 godina (32-91). Mlađih od 60 godina je bilo 40 (20,41%), a 156 (79,59%) starijih od 60 godina (χ2=68,65; p<0,001). KRK je najveću distribuciju imao u starosnoj grupi 60-79 godina (131 vs 65, χ2=22,22; p<0,001). Prosečan broj dana hospitalizacije po pacijentu iznosio je 18,75±11,05 (2-89). 153 (78,06%) pacijenata je operisano elektivno, a 43 (21,94%) urgentno (χ2=61,74; p<0,001). Kod 132 (67,35%) pacijenata KRK je bio lokalizovan u rektumu i sigmoidnom kolonu, a kod 64 (32,65%) pacijenata u preostalim segmentima debelog creva (χ2=23,59; p<0,001). Urađeno je 37 (18,88%) desnih i 30 (15,31%) levih hemikolektomija, 18 (9,18%) subtotalnih i 4 (2,04%) totalnih kolektomija, 15 (7,65%) prednje-visokih i 45 (22,96%) prednje-niskih resekcija rektuma, 21 (10,71%) Miles-ovih procedura, 18 (9,18%) Hartmann-ovih procedura, 7 (3,57%) prizidnih “loop” kolostomija i 1 (0,51%) terminalna ileostomija. Kod 54 (27,55%) pacijenata je KRK bio u ranom (T1 i T2) stadijumu, a kod 142 (72,45%) u uznapredovalom (T3 i T4) stadijumu (χ2=39,26; p<0,001). Kod 172 (87,76%) pacijenata je dijagnostikovan adenokarcinom, kod 21 (10,71%) mucinozni adenokarcinom, kod 2 (1,02%) neuroendokrini tumor (carcinoid) i kod 1 (0,51%) karcinom ćelija pečatnog prstena. Metastaze u limfnim nodusima je imalo 110 (56,12%), a nije imalo 86 (43,88%) pacijenata (χ2=2,94; p>0,05). U perikoličnom masnom tkivu prosečno je pronađeno i histopatološki pregledano 13,42±3,4 (6-24) limfnih čvorova. Makroskopski vidljive metastaze u trenutku operacije je imalo 42 (21,43%), a nije imalo 154 (78,57%) pacijenata (χ2=64,0; p<0,001). Stopa ranog postoperativnog mortaliteta za elektivno operisane pacijente je iznosila 9,15% (14/153) i 37,21% (16/43) za urgentno operisane pacijente (χ2=20,4; p<0,001). Ukupna stopa ranog postoperativnog mortaliteta iznosila je 15,31% (30/196). ZAKLJUČAK: KRK se 1,4 puta češće javlja kod muškaraca. Najzastupljeniji je u populaciji od 60-79 godina, mada je oko 20% obolelih mlađe od 60 godina. Iako se u lečenju KRK najčešće primenjuje elektivna hirurgija, oko 1/5 pacijenata se operiše urgentnom hirurgijom. Najčešća lokalizacija KRK je u rektumu (40%) i sigmoidnom kolonu (25%). U hirurškom lečenju se koriste dokazane operativne tehnike koje podrazumevaju resekciju tumora uz kreiranje crevnih anastomoza i/ili stoma, a u slučaju inoperabilnosti tumora neophodno je izvesti derivacione stome. Hirurško lečenje KRK zahteva relativno dugu hospitalizaciju (prosečno 2-3 nedelje). KRK se najčešće operiše u T3 stadijumu, sa prisutnim metastazama u limfnim čvorovima u više od 50% slučajeva. Po ovom istraživanju Dukes C stadijum je bio najviše zastupljen. Oko 20% pacijenata u trenutku operacije ima udaljene metastaze. Hirurgiju KRK prati visoka stopa ranog postoperativnog mortaliteta (oko 15%), i ona je statistički značajno veća kod pacijenata operisanih urgentnom hirurgijom. [ABSTRACT FROM AUTHOR]
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Titel: |
PRIMARNI KOLOREKTALNI KARCINOM U NAŠOJ KLINIČKOJ PRAKSI U PETOGODIŠNJEM PERIODU. (Serbian)
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Autor/in / Beteiligte Person: | Davidović, Vladimir ; Miladinov, Bojan ; Davidović, Branislava |
Zeitschrift: | Timocki Medicinski Glasnik, Jg. 42 (2017-07-01), Heft 3, S. 139-146 |
Veröffentlichung: | 2017 |
Medientyp: | academicJournal |
ISSN: | 0350-2899 (print) |
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