Surgical treatment tactics on the subject of colorectal cancer complicated with synchronous and metachronous liver damage
Results of 420 patients with colorectal cancer were analyzed. In 223 (53.1%) of them presence of liver metastases was detected, among them synchronous damage – in 109 (25.9%). Metachronous liver damage in distant postoperative terms (from 4 months till 3 years) was detected in 202 (48.1%) of patients. Nearly one third (112 (26.7%) of patients were admitted to the hospital urgently with acute intestinal obstruction symptoms, intestinal bleeding or tumour perforation. Urgent surgery was conducted to 112 (26.7%) patients. Right-side hemicolectomy was performed in 27 (24.1%) of patients, extended right-side hemicolectomy – in 17 (15.2%), left- side hemicolectomy- in 21 (18.8%), Hartmann’s procedure – in 47 (42%) of patients. Lethality was 8.9%. In 90 (21.4%) of patients with colorectal cancer complicated with liver synchronous metastases combine surgical procedures were performed: single-staged primary tumor resection with metastases. Lethality was 7.8%. Among 102 of patients with metachronous liver damage in 42 – laparoscopic and 14 – «open» cryoablation during reconstruction after Hartmann’s procedure was performed. In this group lethal cases were absent. So, liver resection, especially extended, is pretty dangerous procedure. It has been proved by lethality diversity – from 7.8% (during resectable procedures) up to its absence (during cryosurgery).
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