Odnos između kratkotrajne preoperativne radioterapije i vrednosti albumina u serumu i postoperativnih komplikacija u hirurgiji karcinoma rektuma
Sažetak
Uvod/Cilj. Identifikacija faktora rizika mogla bi biti važna za poboljšanje ranog postoperativnog ishoda kod bolesnika operisanih zbog karcinoma rektuma. Cilj ove studije bio je da se odredi odnos između kratkotrajne preoperativne radioterapije (RT), vrednosti albumina u serumu i nastanka postoperativnih komplikacija kod bolesnika podvrgnutih prednjoj resekciji rektuma zbog rektalnog karcinoma bez kreiranja protektivne stome. Metode. Ova retrospektivna studija obuhvatila je bolesnike sa histološki potvrđenim adenokarcinomom rektuma i kliničkim stadijumom T2-T4, operisanih u periodu 2007–2012. godine. Kod svih bolesnika učinjena je prednja resekcija rektuma otvorenim hirurškim pristupom bez kreiranja protektivne stome. Kod svakog bolesnika određena je preoperativna vrednost albumina u serumu. Lokalizacija tumora zabeležena je intraoperativno kao udaljenost donje ivice tumora od analne ivice. Dimenziju tumora merio je i zabeležio patolog koji je pregledao resecirane uzorke. Jedan broj bolesnika primio je kratkotrajnu preoperativnu RT, dok drugi nisu. Bolesnici su bili podeljeni u dve grupe (grupa 1 sa kratkotrajnom preoperativnom RT i grupa 2 bez kratkotrajne preoperativne RT). Postoperativne komplikacije: klinički evidentna dehiscencija anastomoze, infekcija hirurške rane, difuzni peritonitis i pneumonija, upoređivane su između grupa u odnosu na vrednost serumskog albumina merenog preoperativno, godine starosti bolesnika, dimenzije i lokalizaciju tumora. Rezultati. Studija je obuhvatila 107 bolesnika (51 u grupi 1 i 56 u grupi 2). Nije bilo značajne razlike između grupa u godinama starosti (p = 0,95), polu (p = 0,12) bolesnika, i udaljenosti tumora od analne granice (p = 0,53). Dimenzija rektalnog karcinoma bila je značajno veća u grupi 1 nego u grupi 2 (51,37 ± 12,04 mm vs 45,57 ± 9,81 mm, p = 0.007). Vrednost preoperativno merenog albumina u serumu bila je značajno niža u grupi 1 nego u grupi 2 (34,80 ± 2,85 g/L vs 37,55 ± 2,74 g/L, p < 0,001). Nađena je statistički značajna korelacija između dimenzije tumora i vrednosti serumskog albumina (p = 0,042). Ukupno, postoperativne komplikacije zabeležene su kod 13 (25,5%) bolesnika u grupi 1 i kod 10 (17,8%) u grupi 2, bez statistički značajne razlike između grupa (p = 0,18). Statistički značajno niži nivo serumskog albumina nađen je kod bolesnika sa postoperativnim komplikacijama i kod onih koji su umrli. Uočena je statistički značajna razlika u pojavi dehiscencije anastomoze između grupa (p = 0,039). Muški pol i niža vrednost serumskog albumina bili su statistički značajni prediktori pojave dehiscencije anastomoze (p = 0,05 odnosno p = 0,002), dok kratkotrajna preoperativna RT nije imala statistički značajnog uticaja na njenu pojavu. Zaključak. Ustanovljena je povezanost nižih vrednosti serumskog albumina, ali ne i kratkotrajne preoperativne RT, sa nastankom ranih postoperativnih komplikacija nakon resekcije rektuma zbog rektalnog karcinoma bez kreiranja protektivne stome.
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