Modern trends in the treatment of patients with colon cancer

Abstract

Introduction. Colon cancer (CC) is one of the most frequent types of malignant tumors, the incidence of which is steadily enlarging globally, despite large-scale screening programs and efforts to increase the oncological awareness of the population. Significant growth in the number of CC patients, increasing professional level of surgeons and emergence of private hospitals had led to widespread practice of treating patients outside of specialized oncological institutions, being long observed in developed countries of Europe and the USA. The aim of the study. To evaluate the results of treatment of CC patients in a multi-profile hospital. Materials and methods. The retrospective study covered 89 patients with СС treated in the 2nd Surgical department of the "St. Panteleimon Hospital" (1st Territorial medical union of Lviv) in 2019-2022. There was a slight predominance of men – 50 (56.2%). Age of patients was in range of 39-81. The largest group consisted of persons aged 55-65 (55.1%). Anemia (normal limits – men<130 g/L, women <120 g/L) was diagnosed in 88.3%. An increased level of carcino-embryonic antigen in the blood (>5 ng/mL) was found in 24.7%. Ultrasonography and computed tomography with contrast enhancement were performed in all patients to visualize the tumor, regional lymph nodes, possible distant metastases (primarily in the liver) and ascites, signs of invasion into adjacent organs and structures (anterior abdominal wall, ureters, uterus etc.). Indication for magnetic resonance imaging was the localization of cancer in the rectum, especially in the middle and lower third, in order to find out the growth into the mesorectal fascia, seminal vesicles and vaginal wall. Transanal ultrasonography was performed to determine contraindications to intersphincteric resection (tumor invasion of the external sphincter, invasion to lymph nodes). In all cases, pathomorphological examination of the biopsy material obtained during colonoscopy revealed adenocarcinomas of various degrees of differentiation: high in 77.6%, moderate – 13.5% and low – in 8.9%. The complex of preoperative studies established the localization of the tumor process: cecum – 4.3%, ascending colon – 2.5%, hepatic flexure – 16.1%, transverse colon – 11.5%, splenic flexure – 12.7%, descending colon – 4.9%, sigmoid – 24.1%, rectosigmoid junction – 15.3% and rectum – 8.6%. Neoadjuvant chemoradiation therapy due to tumor localization in the middle or lower third of the rectum was used in 5.2% of patients; surgery was performed 1 month after its completion. Operations performed were: right-sided hemicolectomy – 25.1%, transverse colon resection – 9.4%, left-sided hemicolectomy – 22.6%, sigmoid colon resection – 14.5%, high anterior rectal resection – 17.8%, low anterior rectal resection – 6.2%, intersphincter rectal resection – 2.3%, Quenu-Miles’ rectal extirpation – 2.1%. Removal of synchronous metastases from the liver was used in 7.4% of observations. Seventynine patients (88.8%) underwent laparotomic operations, 8 (8.9%), laparoscopically – 2 (2.3%), using the Da Vinci robotic surgical system. Results and discussion. In 87.6% of cases of CC, wide anatomical resections (R0) with removal of 4 collectors of regional lymph nodes (D3) and rectal – total mesorectectomy were considered radical. Palliative/cytoreductive interventions were performed in 10.1% of patients. In 2 patients (2.3%), operation had a forced diagnostic nature. Postoperative complications developed in 15 (16.8%) cases: suppuration of the wound – 9 (10.1%), failure of anastomotic sutures – 3 (3.4%), thromboembolism of the pulmonary artery – 3 (3.4%). Relaparotomy due to failure of anastomotic sutures, peritonitis was performed in 2 patients (2.2%). Two patients died: postoperative mortality – 2.2%. In both cases, pulmonary embolism was recognized as the cause of death. A license (Order of the Ministry of Health of Ukraine, January 10, 2023, No. 49) had granted the permission to carry out activities in the specialties of "oncological surgery" and other in the Municipal non-profit enterprise "1st Territorial medical union of Lviv, Multi-profile clinical hospital of intensive care and emergency medical aid". In 89 of operated, it was not possible to determine the survival rate in 3 (3.4%) due to the change of residence and unsuccessful telephone contact. One year after treatment in the 2nd surgical department of "Hospital of St. Panteleimon" of the 1st Territorial medical union of Lviv, 86 (96.6%) operated patients lived, of those 2 years – 81 (91.1%) and 3 – 74 (83.1%). Monitoring measures of patients after discharge from the hospital consisted of periodic determination of the content of carcino-embryonic antigen in the blood, ultrasonography, computed tomography and colonoscopy. Within 3 years, 8 (9.3%) patients developed liver metastases. Conclusions. 1. Colon cancer is a malignant tumor with a stable increase in incidence in the world. 2. Treatment of patients with colon cancer in multi-profile clinical hospitals is possible with appropriate license and provision of diagnosis and treatment in accordance with international and national guidelines. 3. Survival is the main indicator of the quality of complex treatment of oncological patients, particularly with colon cancer.