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(067). Low rectal cancer management: Surgical a department experience
AB33
Colorectal Cancer / Arab Journal of Gastroenterology 10 (2009) AB27–AB35
(066) The management of colic cancer: Surgical a department experience Am. Souadka, B. Zakri, H.O. El Malki, R. Mohsine, L. Ifrine, A. Belkouchi Surgical Department A, Ibn Sina Hospital, Rabat, Morocco
Introduction: Colic cancer represents a real public health problem not only in western countries, but also in arabic ones, with its high incidence, high potential of hepatic metastasis and mortality. Methods: We present a large retrospective study of 193 cases of colic cancers treated at the ‘‘surgical department A’’ at Ibn Sina hospital during 12 years, from 1995 to 2006. Results: The mean age of our patients was 54 years (17–84) with a sex ratio of 1.3 man/women. The mean time between first symptoms and the medical consult was about 9 months and the principals clinical signs were: abdominal pain in 74.1% of the cases, transit disorders in 58% of cases and bleeding in 46.6% of cases. Only 29% of the patients had an abdominal mass at the initial clinical examination. We performed total colonoscopy in all cases that showed exactly the site of the cancer: 46% in left colon, 39% in right colon, 10% in the rectosigmoid junction and 5% in transverse colon. One patient had double localization at the moment of the diagnosis: rectal and colic cancer. Patients (26%) were metastatic at the moment of the diagnosis. The adenocarcinoma was the predominant histological type with 95% of cases. The 5% left were: malignant lymphoma and neuroendocrine carcinoma. The operability rate was 95% and rescalability rate was 85%. We performed curative resections at 124 patients versus 32 palliative ones. 6 synchronous hepatic metastases resections were performed. Post-operative mortality rate was 2.2% and post-operative morbidity was 14.8%. The mean following time was 23 months: 19 patients developed a local reccurrences and 9 patients developed metastases. The survival rate all stages mixed was 89% at the first year, 79% years at 3 years and 60% at 5 years for followed patients. Discussion: Our serie showed the special young age of the Moroccan population with colic cancer and the late diagnosis stage of this cancer. The management of colic cancer needs a multidisciplinary and a well establish coordination associated to an early screening to be able to propose a curative surgical treatment at the early stages to improve a long-term prognosis of this disease. doi:10.1016/j.ajg.2009.07.192
(067) Low rectal experience
cancer
management:
Surgical
a
department
Am. Souadka, B. Zakri, O.H. El Malki, R. Mohsine, L. Ifrine, A. Belkouchi Surgical Department A, Ibn Sina Hospital, Rabat, Morocco
The management or low rectal malignancy has undergone a hilarious evolution, not only by the developpement of surgical techniques but also by the adjunction of adjuvant radiochemotherapy. The aim of this study: to report the results of our retrospective study concerning the surgical management of low rectal cancer in our department . Methods: During 16 years (from 1990 to 2006), we managed, in our department, 324 patients with low rectal cancer. Fifty four percent of them were men with an average old of 50 years old. 12% were nonoperable and 8% non-resecable. Most of the cases (59%) underwent
an abdomino-perineal resection (APR) although in the 41% left, 88% of them had an anterior (AR) resection and 11% local resetion (LR). Results: Mortality rate was 1.4%. Operative morbidity was represented by: 11 cases of postoperative peritonitis, 14 cases of acute intestinal obstruction, 7 cases of pelvic abscess, 32 cases of urinary complications, 15 cases of sexual complications, 16 cases of perineal complications and 15 cases of stomial complications. Recurrence rate reached 10.2% (9% with APR, 13.5% with AR and 9% with LR). Conclusion: The management of low rectal cancer is still difficult and heavy because the high risk or local recurrences and fonctionnel sequel. This cannot be envisaged without a multidisciplinary approach. doi:10.1016/j.ajg.2009.07.193
(068) Colonic cancer obstruction: Experience of emergency surgical department about 110 cases B. Zakri, A. Souadka, M. El Absi, M. El Ouanani, M. Eccharab, F.H. El Alami, M. Amraoui, A. Errougani, R. Chkoff Emergency Department of Surgery, Ibn Sina Hospital, Rabat, Morocco
Introduction: Management of obstructed colonic carcinomas remains a surgical challenge specially in elderly patients. The aim of our study is to assess mortality and morbidity rates of procedures performed in emergency for this pathology Methods: We reviewed the records of 110 cases of cancer in colic occlusion treated in surgical emergency department of the Avicenne hospital. They were divided into 60 men and 50 women. The average age is 53 years old. Patients (42%) had a past history of constipation. Ninety-three percent of the cases consulted at the complete occlusion state after a mean evolution time of 8 days. Results: The tumor was at the left colon in 76% of cases mostly at the recto-sigmoid junction and sigmoid colon only. In 24% of cases the tumor was at the right colon. The surgical management was represented by: 34 discharge stomas, 68 total tumor ablation, 6 internal derivation and 2 explorative laparotomies. The overall mortality is 20.75%. The internal bypass is the most blamed in the deaths of patients in our series. The disease is 23.5% dominated by infectious complications, especially anastomotic fistula. For right colic occlusions: right colectomy with immediate ileocolic anastomosis is done whenever possible. For Left colic occlusions: a discharge stomas is the best approach. Conclusion: Our study confirms that obstructed colonic cancer has a bad prognosis because of the elderly age and health state of the patients. Whereas stents are unfortunately not available at our institution, the discharge stoma remain a good, easy and quick alternative for those tired patient. doi:10.1016/j.ajg.2009.07.194
(069) Surgery of liver metastases of colorectal cancer experience in surgical clinic ‘‘a’’ S. Lahmidani, O. Malki, R. Mohcine, L. Ifrine, A. Belkouchi CHU Avicenne, Rabat, Morocco
Introduction: Advances in surgery and chemotherapy have improved the care of patients with liver metastases of colorectal origin.
Colorectal Cancer / Arab Journal of Gastroenterology 10 (2009) AB27–AB35
(066) The management of colic cancer: Surgical a department experience Am. Souadka, B. Zakri, H.O. El Malki, R. Mohsine, L. Ifrine, A. Belkouchi Surgical Department A, Ibn Sina Hospital, Rabat, Morocco
Introduction: Colic cancer represents a real public health problem not only in western countries, but also in arabic ones, with its high incidence, high potential of hepatic metastasis and mortality. Methods: We present a large retrospective study of 193 cases of colic cancers treated at the ‘‘surgical department A’’ at Ibn Sina hospital during 12 years, from 1995 to 2006. Results: The mean age of our patients was 54 years (17–84) with a sex ratio of 1.3 man/women. The mean time between first symptoms and the medical consult was about 9 months and the principals clinical signs were: abdominal pain in 74.1% of the cases, transit disorders in 58% of cases and bleeding in 46.6% of cases. Only 29% of the patients had an abdominal mass at the initial clinical examination. We performed total colonoscopy in all cases that showed exactly the site of the cancer: 46% in left colon, 39% in right colon, 10% in the rectosigmoid junction and 5% in transverse colon. One patient had double localization at the moment of the diagnosis: rectal and colic cancer. Patients (26%) were metastatic at the moment of the diagnosis. The adenocarcinoma was the predominant histological type with 95% of cases. The 5% left were: malignant lymphoma and neuroendocrine carcinoma. The operability rate was 95% and rescalability rate was 85%. We performed curative resections at 124 patients versus 32 palliative ones. 6 synchronous hepatic metastases resections were performed. Post-operative mortality rate was 2.2% and post-operative morbidity was 14.8%. The mean following time was 23 months: 19 patients developed a local reccurrences and 9 patients developed metastases. The survival rate all stages mixed was 89% at the first year, 79% years at 3 years and 60% at 5 years for followed patients. Discussion: Our serie showed the special young age of the Moroccan population with colic cancer and the late diagnosis stage of this cancer. The management of colic cancer needs a multidisciplinary and a well establish coordination associated to an early screening to be able to propose a curative surgical treatment at the early stages to improve a long-term prognosis of this disease. doi:10.1016/j.ajg.2009.07.192
(067) Low rectal experience
cancer
management:
Surgical
a
department
Am. Souadka, B. Zakri, O.H. El Malki, R. Mohsine, L. Ifrine, A. Belkouchi Surgical Department A, Ibn Sina Hospital, Rabat, Morocco
The management or low rectal malignancy has undergone a hilarious evolution, not only by the developpement of surgical techniques but also by the adjunction of adjuvant radiochemotherapy. The aim of this study: to report the results of our retrospective study concerning the surgical management of low rectal cancer in our department . Methods: During 16 years (from 1990 to 2006), we managed, in our department, 324 patients with low rectal cancer. Fifty four percent of them were men with an average old of 50 years old. 12% were nonoperable and 8% non-resecable. Most of the cases (59%) underwent
an abdomino-perineal resection (APR) although in the 41% left, 88% of them had an anterior (AR) resection and 11% local resetion (LR). Results: Mortality rate was 1.4%. Operative morbidity was represented by: 11 cases of postoperative peritonitis, 14 cases of acute intestinal obstruction, 7 cases of pelvic abscess, 32 cases of urinary complications, 15 cases of sexual complications, 16 cases of perineal complications and 15 cases of stomial complications. Recurrence rate reached 10.2% (9% with APR, 13.5% with AR and 9% with LR). Conclusion: The management of low rectal cancer is still difficult and heavy because the high risk or local recurrences and fonctionnel sequel. This cannot be envisaged without a multidisciplinary approach. doi:10.1016/j.ajg.2009.07.193
(068) Colonic cancer obstruction: Experience of emergency surgical department about 110 cases B. Zakri, A. Souadka, M. El Absi, M. El Ouanani, M. Eccharab, F.H. El Alami, M. Amraoui, A. Errougani, R. Chkoff Emergency Department of Surgery, Ibn Sina Hospital, Rabat, Morocco
Introduction: Management of obstructed colonic carcinomas remains a surgical challenge specially in elderly patients. The aim of our study is to assess mortality and morbidity rates of procedures performed in emergency for this pathology Methods: We reviewed the records of 110 cases of cancer in colic occlusion treated in surgical emergency department of the Avicenne hospital. They were divided into 60 men and 50 women. The average age is 53 years old. Patients (42%) had a past history of constipation. Ninety-three percent of the cases consulted at the complete occlusion state after a mean evolution time of 8 days. Results: The tumor was at the left colon in 76% of cases mostly at the recto-sigmoid junction and sigmoid colon only. In 24% of cases the tumor was at the right colon. The surgical management was represented by: 34 discharge stomas, 68 total tumor ablation, 6 internal derivation and 2 explorative laparotomies. The overall mortality is 20.75%. The internal bypass is the most blamed in the deaths of patients in our series. The disease is 23.5% dominated by infectious complications, especially anastomotic fistula. For right colic occlusions: right colectomy with immediate ileocolic anastomosis is done whenever possible. For Left colic occlusions: a discharge stomas is the best approach. Conclusion: Our study confirms that obstructed colonic cancer has a bad prognosis because of the elderly age and health state of the patients. Whereas stents are unfortunately not available at our institution, the discharge stoma remain a good, easy and quick alternative for those tired patient. doi:10.1016/j.ajg.2009.07.194
(069) Surgery of liver metastases of colorectal cancer experience in surgical clinic ‘‘a’’ S. Lahmidani, O. Malki, R. Mohcine, L. Ifrine, A. Belkouchi CHU Avicenne, Rabat, Morocco
Introduction: Advances in surgery and chemotherapy have improved the care of patients with liver metastases of colorectal origin.