Sažetak
Uvod/Cilj. U poslednje dve decenije postignut je značajan napredak u hirurgiji karcinoma rektuma. Preoperativna radioterapija, uvođenje staplera kopči i ponajviše unapređena hirurška tehnika umnogome su doprineli boljim rezultatima lečenja, pre svega smanjivanjem učestalosti ranih hirurških komplikacija i stope lokalnih recidiva. Cilj ovog istraživanja bio je da se uporede operativni i postoperativni rezultati u lečenju karcinoma rektuma između dve grupe hirurga – onih koji se usko bave kolorektalnom hirurgijom i onih koji se ovom problematikom bave sporadično. Metode. Ova retrospektivna studija obuhvatila je 146 bolesnika koji su operisani na Institutu za onkologiju Vojvodine u periodu od 1. 1. 2008. do 31. 12. 2010. godine. Bolesnici su bili podeljeni u dve grupe. U prvoj grupi N1 bio je 101 bolesnik koje su operisali visoko edukovani hirurzi za totalnu mezorektalnu eksciziju (TME), a u drugoj N2 bilo je 45 bolesnika koje su operisali hirurzi bez edukacije iz TME. Rezultati. Preoperativnu hemioiradijaciju primilo je 49 (33,56%) bolesnika. Utvrđena je statistički značajna razlika između dve grupe u trajanju operacije i potrebi za krvnim derivatima tokom operacije. Dehiscenciju anastomoze indentifikovali smo kod 3 bolesnika iz N1 grupe i kod 10 bolesnika iz N2 grupe. Sedam (4,79%) bolesnika razvilo je lokalni recidiv nakon operativnog lečenja. Statistički značajna razlika ustanovljena je u broju lokalnih recidiva i dehiscencije anastomoze između dve upoređivane grupe. Zaključak. Neophodno je kontinuirano obrazovanje i obuka u hirurgiji karcinoma rektuma kako bi se savladale nove tehnologije i hirurške tehnike, te unapredili rezultati hirurškog lečenja.
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Reference
Kapiteijn E, Marijnen CA, Nagtegaal ID, Putter H, Steup WH, Wiggers T, et al. Preoperative radiotherapy combined with total mesorectal excision for resectable rectal cancer. N Engl J Med 2001; 345(9): 638−46.
Sauer R, Becker H, Hohenberger W, Rödel C, Wittekind C, Fietkau R, et al. Preoperative versus postoperative chemoradiotherapy for rectal cancer. N Engl J Med 2004; 351(17): 1731−740.
Fazio VW, Zutshi M, Remzi FH, Parc Y, Ruppert R, Fürst A, et al. A randomized multicenter trial to compare long-term functional outcome, quality of life, and complications of surgical procedures for low rectal cancers. Ann Surg 2007; 246(3): 481−8.
Pietra N, Sarli L, Costi R, Ouchemi C, Grattarola M, Peracchia A. Role of follow-up in management of local recurrences of colorectal cancer: A prospective, randomized study. Dis Colon Rectum 1998; 41(9): 1127−33.
Taylor FG, Quirke P, Heald RJ, Moran B, Blomqvist L, Swift I, et al. Preoperative high-resolution magnetic resonance imaging can identify good prognosis stage I, II, and III rectal cancer best managed by surgery alone: a prospective, multicenter, European study. Ann Surg 2011; 253(4): 711−9.
Richardson DP, Porter GA, Johnson PM. Surgeon knowledge contributes to the relationship between surgeon volume and patient outcomes in rectal cancer. Ann. Surg 2013; 257(2): 295−301.
Pelletier JS, Degara C, Porter G, Ghosh S, Schiller D. Retrospective review of rectal cancer surgery in northern Alberta. Can J Surg 2013; 56(4): 51−8.
Martling A, Cedermark B, Johansson H, Rutqvist LE, Holm T. The surgeon as a prognostic factor after the introduction of total mesorectal excision in the treatment of rectal cancer. Br J Surg 2002; 89(8): 1008−13.
Ricciardi R, Roberts PL, Read TE, Baxter NN, Marcello PW, Schoetz DJ. Presence of specialty surgeons reduces the likelihood of colostomy after proctectomy for rectal cancer. Dis Colon Rec-tum 2011; 54(2): 207−13.
Cong Z, Fu C, Wang H, Liu L, Zhang W, Wang H. Influencing factors of symptomatic anastomotic leakage after anterior resection of the rectum for cancer. World J Surg 2009; 33(6): 1292−7.
Meyerhardt JA, Tepper JE, Niedzwiecki D, Hollis DR, Schrag D, Ayanian JZ, et al. Impact of hospital procedure volume on surgical operation and long-term outcomes in high-risk curatively resected rectal cancer: Findings from the Intergroup 0114 Study. J Clin Oncol 2004; 22(1): 166−74.
Phang TP. Evolving rectal cancer management in British Columbia. Can J Surg 2010; 53(4): 222−4.
Simunovic M, Coates A, Goldsmith CH, Thabane L, Reeson D, Smith A, et al. The cluster-randomized Quality Initiative in Rectal Cancer trial: Evaluating a quality-improvement strategy in surgery. CMAJ 2010; 182(12): 301−6.
Taflampas P, Christodoulakis M, Tsiftsis DD. Anastomotic leakage after low anterior resection for rectal cancer: Facts, obscurity, and fiction. Surg Today 2009; 39(3): 183−8.
Vignali A, Fazio VW, Lavery IC, Milsom JW, Church JM, Hull TL, et al. Factors associated with the occurrence of leaks in stapled rectal anastomoses: A review of 1,014 patients. J Am Coll Surg 1997; 185(2): 105−13.
Radovanovic Z, Petrovic T, Radovanovic D, Breberina M, Golubovic A, Lukic D. Single versus double stapling anastomotic technique in rectal cancer surgery. Surg Today 2014; 44(6): 1026−31.
Matthiessen P, Hallböök O, Rutegård J, Simert G, Sjödahl R. Defunctioning stoma reduces symptomatic anastomotic leakage after low anterior resection of the rectum for cancer: A randomized multicenter trial. Ann Surg 2007; 246(2): 207−14.
Martling A, Holm T, Rutqvist LE, Johansson H, Moran BJ, Heald RJ, et al. Impact of a surgical training programme on rectal cancer outcomes in Stockholm. Br J Surg 2005; 92(2): 225−9.
Swedish rectal cancer trial. Improved survival with preoperative radiotherapy in resectable rectal cancer. N Engl J Med 1997; 336(14): 980−7.
Harnsberger JR, Vernava VM, Longo WE. Radical abdominopelvic lymphadenectomy: Historic perspective and current role in the surgical management of rectal cancer. Dis Colon Rectum 1994; 37(1): 73−87.