DIFFERENTIATED APPROACH TO THE TREATMENT OF PATIENTS WITH OBSTRUCTIVE CANCER OF THE LEFT HALF OF THE COLON
Authors:   Ivano-Frankivsk National Medical University, Ivano-Frankivsk, Ukraine, Skrypko V.D. , Bachynskyi D.V. ,   Ivano-Frankivsk National Medical University, Ivano-Frankivsk, Ukraine
Published: January 2025

Summary. Aim: to improve surgical treatment outcomes for patients with obstructive cancer of the left colon through the development and implementation of a comprehensive diagnostic and therapeutic approach, incorporating the correction of endogenous intoxication. Object and methods: the study is based on the results of comprehensive examination and treatment of 115 patients with obstructive cancer of the left colon, who presented with symptoms of obstructive colonic obstruction (OCO) and underwent surgical treatment. Two groups were formed: Group I (control) – 59 patients, whose treatment was carried out according to the recommendations of the Ministry of Health of Ukraine (02.04.2010 No. 297); Group II (main) – 56 patients, whose therapy was carried out according to the comprehensive method proposed by us, taking into account the correction of endogenous intoxication. In 25 patients, a preventive transverse colostomy was performed. In 34 patients, the procedure was completed with decompressive colonic intubation followed by postoperative lavage, аdditionally, medications with antioxidant, hepatoprotective, and detoxifying effects were administered. In both groups, the dynamics of changes in endogenous intoxication (EI) indicators were studied. Results: the study found that with the progression of obstructive colonic obstruction (OCO), there was an increase in EI markers in the blood serum, accompanied by a decrease in antioxidant system (AOS) parameters. An increase in the level of C-reactive protein (CRP) in the blood serum was observed from the 2–3rd postoperative day (15.2 mg/l), by the 6th day the CRP content continued to increase and remained at the level of 30.1 mg/l. An increase in the levels of procalcitonin was observed on the 2nd (1.27 ng/ml), 3rd (2.87 ng/ml); 6th day (3.21 ng/ml). The dynamics of these parameters suggest the development of purulent-inflammatory complications, which require antibiotic therapy and, if necessary, repeated surgical interventions. In the postoperative period, purulent-infectious complications occurred in 27 out of 115 patients. Relaparotomies were performed in 14 patients in the control group and in 5 patients in the main group. The use of complex surgical treatment contributed to a more intensive reduction in the degree of EI markers and a gradual increase in AOS indicators in patients of the main group. The reduction in EI markers occurred gradually and depended on the degree of liver parenchyma damage. Analysis of the results of treatment of patients with OCО showed that the additional use of antihypoxant-antioxidant and hepatoprotective therapy, as well as colon decompression with intestinal lavage, contributes to a reduction in such indicators as the number of postoperative complications (from 23 to 14%) and the number of forced relaparotomies (from 23 to 8%). Conclusions: a differentiated surgical approach to the treatment of obstructive left-sided colonic obstruction demonstrates advantages due to its comprehensive strategy, which includes retrograde colonic intubation, bowel lavage, as well as antioxidant, hepatoprotective, and detoxification therapy, all of which contribute to a reduction in ЕІ. Simultaneously, the use of preventive stomas does not affect the reduction in the likelihood of anastomotic insufficiency. For early detection of infectious-purulent complications, it is recommended to use markers of the acute inflammatory response, including procalcitonin and C-reactive protein.