Parametri radikalnosti kod laparoskopske i otvorene hirurgije karcinoma kolona i rektuma

  • Igor Krdžić University Clinical Hospital Center Zvezdara, Surgery Clinic “Nikola Spasić”, Department of Colorectal Surgery
  • Marko Kenić University Clinical Hospital Center Zvezdara, Surgery Clinic “Nikola Spasić”, *Department of Colorectal Surgery
  • Milena Šćepanović University Clinical Hospital Center Zvezdara, Surgery Clinic “Nikola Spasić”, Department of Colorectal Surgery
  • Ivan Soldatović University of Belgrade, Faculty of Medicine, Institute for Statistics and Informatics
  • Jelena Ilić Živojinović University of Belgrade, Faculty of Medicine, Institute of Hygiene and Medical Ecology
  • Dragan Radovanović University Clinical Hospital Center “Dr Dragiša Mišović-Dedinje”, Surgery Clinic
DOI: https://doi.org/10.2298/VSP180607127K
Ključne reči: kolon, neoplazme;, laparoskopija;, laparotomija;, neoplazme, rektum;, hirurgija, operativna, procedure;, lečenje, ishod

Sažetak


Uvod/Cilj. Resekcija kod karcinoma kolona i rektuma smatra se radikalnom kada su proksimalna, distalna i radi­jalna linija resekcije bez prisustva tumorskih ćelija. Koncept totalne mezorektalne ekscizije podrazumeva kompletno uklanjanje tumora unutar fascijalnog omotača zajedno sa limfnim čvorovima, limfaticima i krvnim sudovima duž kojih tumor može da se širi. Cilj rada bio je da se utvrdi da li se laparoskopskim pristupom obezbeđuju svi parametri onkološke radikalnosti kao i u otvorenoj hirurgiji karcinoma kolona i rektuma. Metode. Studijom su bila obuhvaćena 122 bolesnika sa karcinomom kolona i rektuma svrstana u dve jednake grupe ˗ bolesnici operisani laparoskopskim i oni operisani otvorenim pristupom. U hirurgiji kolona analizirali smo proksimalnu i distalnu resekcionu liniju i broj uklon­jenih limfnih žlezda, a u hirurgiji rektuma proksimalnu, dis­talnu i cirkumferentnu resekcionu liniju kao i broj uklo­nje­nih limfnih žlezda. Rezultati. Obe grupe su bile jednake u odnosu na životno doba, pol, rezultat klasifikacije Ame­ričkog društva anesteziologa, lokalizaciju, veličinu tumora i vrstu operativnog zahvata. Prema lokalizaciji tumora, naj­češće izvedena operacija bila je prednja resekcija rektuma (60,7% u odnosu na 59%). Nije bilo slučajeva sa pozitivnom distalnom linijom resekcije. Prosečno rastojanje tumora od proksimalne linije resekcije na fiksiranom preparatu bilo je 100 mm u odnosu na 120 mm, sa statistički značajnom razlikom (p < 0,001). Udaljenost od distalne linije resekcije bila je bez razlike, 40 mm u obe grupe (p = 0,143). Nađana je pozitivna cirkumferentna resekciona linija kod dva bolesnika u laparoskopskoj grupi (7,7%), a kod tri bolesnika u grupi operisanih otvorenom metodom (8,8%). Prosečan broj uklonjenih limfnih čvorova iznosio je 15 u laparo­skop­skoj grupi i 16 u grupi operisanoj otvorenim pristupom. Du­žina boravka u bolnici kod bolesnika operisanih laparoskop­skim pristupom bila je kraća, što je bilo visoko statistički značajno. U pogledu postoperativnih komplikacija, nije ut­vrđena značajna razlika između grupa. Ukupni postope­rativni morbiditet iznosio je 18% prema 21,3%. Zaključak. Laparoskopskim pristupom je moguće obezbediti sve parametre onkološke radikalnosti jednako kao i u otvorenoj hirurgiji karcinoma kolona i rektuma.

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2021/05/06
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Vol. 77 Br. 5 (2020): Vojnosanit Pregl
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Originalni članak