Surgical Treatment in Stenosing Rectal Cancer

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Surgical Treatment in Stenosing Rectal Cancer

V. Deaconescu, L. Simion, M. Alecu, S. Ionescu, B. Mastalier, N.D. Straja
Original article, no. 6, 2014
Introduction: Rectal cancer represents an important healthissue, which involves multidisciplinary treatment, posing amajor surgical challenge, both in terms of diagnosis andtreatment.Material and Method: Between 2009-2013, we analysed 83patients with stenosing rectal cancer operated on at theClinic of General Surgery II of Colentina Clinical Hospitaland at the Clinic of General Surgery I of “Prof. Dr. Al.Trestioreanu” Oncology Institute, in Bucharest. Genderdistribution was: 51 males and 32 females. Average age was65 years old. The most frequently encountered symptomswere colicky abdominal pain and rectorrhagia. 25 patientspresented intestinal occlusion phenomena at admission, theother 58 cases being in subocclusive stage.Results: In occlusive stages: 17 patients presented withresectable tumour, while 8 patients had locally advanced neoplasticforms (“frozen pelvis”), left iliac colostomy with tumour biopsy being the chosen approach. In subocclusive stages: 5cases had unresectable tumours for which left iliac anus withtumour biopsy was performed; 53 cases presented withresectable tumour, for which the Hartmann procedure (12patients) and left iliac colostomy with tumour biopsy (41patients) were performed. Depending on the histopathologicalresult, patients were submitted to radio- and chemotherapy.Tumour resection was possible in 70 cases (84.33%), only 34 ofthese (40.96%) being with radical intent.Conclusions: Treatment for stenosing rectal cancer is multimodal,represented by surgical approach, radio- andchemotherapy. The rationality behind surgery as a firsttherapeutic gesture in the given study group was represented bythe need to treat occlusive type complications, patientsbenefitting subsequently from radio- and chemotherapy. Theopportunity of a second surgical intervention, with theobjective to remove the tumour, was established based on thetherapeutic response to radio- and chemotherapy.