Treatment of the rectal cancer in casuistic clinic for abdominal surgery, Clinical centre of the University of Sarajevo (2006-2010.)
Authors: Kandic Z. , Firdus N. , Kandic A. , Catic L. , Kandic A. , Kandic E. 
Published: November 2012

Malignant disease of the colon and rectum is the most often human neoplasm
which comprises about 30% of all digestive tumours. Thereat, cancer of the
lower end the colon (rectum) comprises 45 to 48% of all CRC (colorectal
cancers). According to "American Society Cancer", only lung and prostate
cancer in men and breast and cervix cancer in women are more frequent than
CRC. The incidence of colorectal cancer is 20 to 30/100.000 citizens. Rectal
cancer is the result of interection of disturbed genetic factors with
external factors. The first surgical treatments began with Faget, who did the
first rectal extraperitoneal excision (1739). It was improved by Ernest
Milles in 1908, and in 1923, Hartman did the resection without anamnesis. In
the middle of 20th century, Dixon defined the resective interventions and in
Litre did a colostomy. The aim of this study is point out the necessity of
early diagnosis and protocolar chirurgical end oncological approach to the
treatment of this malignant disease which must be done before choosing any
operative procedure in order to prevent postoperative morbidity. On the
material of the Clinic for Abdominal Surgery at the Clinical centre
University of Sarajevo, during the four-year period (from 2006 to 2010), out
of the 406 patients with CRC, 261 of them (64.3%) had cancer of the final
part of the colon and rectum. In this case, all the time of the treatment,
protocol was strictly applied. Primary surgery was performed on the early
stages of the disease. Radiochemotherapy (RCT) followed by operation after 6
to 8 week is applied in th progressive state of the disease with the
penetration of the meso rectal fascia with positive lymph-gland assessment
(NMR-nuclear magnete resonance). Out of 261 operated patients, 5 of them
(1.9%) underwent transanal resections where the tumour was up to 2 cm; 104
patients (39.8%) underwent rectal resection with TME (II and III tumour
states of recto-sigma); 24 (9.2%) patients uderwent amputation; l56 (22.4%)
underwent left chemicolectomy with rectal resection and 29 (11%) underwent
intersphincteric colo-trans-versal-anal anastomosis. The operation by Hartman
was performed on 44 (16.8%) patients and colostomy on 10 (3.8%) patients in
emergency service. In the tumours with low localisation we do low
colo-transversal-rectal or ultra-low intersphincer colo-anal anastomosis.
Total meso rectal excision and lymhadenectomy is our priority. We fully
respect the oncologic approach, i.e. complete removement of the affected
organ with the lymphovascular arcade. Operative lethality up to 30 days was
2.5% (comorbidity, thromboembolism). Owing to combined protocolar approach of
surgical and radiochemotherapy, extirpational interventions are not so
frequent any more compared with resections with low and ultra-low
anastomosis. Team work and close cooperation of oncologic team of physicians
(surgeons, gastroenterologists, pathologists, oncologists,
radiotherapeutists) as well as respect for the protocol of the treatment are
the most important factors of a successful oncologic surgery.