Rektum kanserlerinde cerrahi yaklaşımımız

Abstract

VII- ÖZET S.B. Ankara Hastanesi II. Genel Cerrahi Kliniği'nde Kasım-1990 - Eylül-1995 tarihleri arasında rektum kanseri tanısıyla ameliyat edilen 32 hasta, dosya taramasıyla gözden geçirilmiştir. Hastalar preoperatif olarak kolonoskopi, abdomino-pelvik USG ve serum CEA düzeyi ile değerlendirilmişlerdir. Ayrıca 6 vakada (% 15.69) abdomino- pelvik CT, 5 vakada (% 12.5) endorektal USG ilave edilmiştir. Uygun cerrahinin seçimi için primer tümörün lokalizasyonu, ilk tanı anında hastaların tespit edilebilir metastazlarının olması, izole metastazlı hastalarda agresif cerrahi tedaviden sonra önemli yaşamsal faydalar sağlanabileceği ve hastalığın evresi göz önünde bulundurulmuştur. Hastaların yaş ortalaması 55.4 idi ve % 25'i 40 yaşın altındaydı. Kadın/Erkek oranı 3/5 olarak bulundu. Vakaların 7'si (% 21.8) akut karın bulgularıyla acil olarak, 25'i (% 78.2) elektif olarak öpere edilmiştir. Akut karın tablosuyla ameliyata alınan vakaların % 57. Tinde intestinal obstrüksiyon, % 42.9'unda ise tümör perforasyonu mevcuttu. Acil olarak ameliyata alman bu vakaların % 57.1'inde organ metastazı saptanmış ve % 71.4'ü de inoperabl, nonrezektabl bulunarak palyatif kolostomi yapılmıştır. Astler-Coller sınıflamasına göre tüm vakaların % 3.1' i Bİ5 % 25'i B2, % 25'i Cı, % 18.7'si C2 ve % 28.1 'i D evresindeydi. Operatif mortalite % 9.3 olup, tamamı akut karın tanısıyla acil olarak öpere edilmiştir. Yara enfeksiyonu en önemli postoperatif komplikasyondur ve oranı % 25'dir. Takip süresi ortalama 18 aydır (3-60 ay). Hastaların % 53.1 'ine postoperatif kemoterapi, % 43.7'sine postoperatif kemoterapi + radyoterapi yapılmıştır. Küratif cerrahi uygulanan vakalarımızda lokal ve uzak rekürens oranı % 30.4'dür. 72

VIII- SUMMARY 32 patients with rectum cancer operated in 2nd General Surgery Clinic of Ankara Hospital between November 1990-September 1995 were retrospectively reviewed. The patients were evaluated by the help of preoperative colonoscopic, abdominopelvic ultrasonographic examinations and serum CEA levels. In addition to these procedures, in 6 patients (15.6 %) abdominopelvic CT, in 5 patients (12.5 %) endorectal USG was performed. The decision for the applicable surgical procedure was based upon the localization of the primary tumor, presence of the metastasis when patients were first admitted, in patients with isolated metastasis agressive surgical treatment may enable better prognosis and the stage of the tumor. The mean age of the patients was 55.4 and 25 % of the patients were under 40 years-old. The ratio of F to M was 3/5. 7 patients (21.8 %) were operated by the signs and symptoms of acute surgical abdomen where as 25 (78.2 %) underwent operation electively. In the patients who underwent emergency operations, 57.1 % was found to be in intestinal obstruction and 42.9 % was tumor perforation. Also 57.1 % of the patients had distant metastasis and 71.4 % was evaluated as `inoperable`, `non-resectable` and palliative colostomy was performed to these patients. According to Astler-Coller classification 3.1 % of all cases were Bi stage, 25 % were B2, 25 % were Ci, 18.7 % were C2, 28.1 % were D stage. Operative mortality was 9.3 % and all the cases were operated in emergency conditions. The major complication in the postoperative period was wound infection. Mean follow-up period was 18 months (Range 3-60 months). 53.1 % of patients had postoperative chemotherapy, 43.7 % had chemotherapy + radiotherapy. After the curative surgical procedure local and distant recurrence was found to be 30.4 %. 73