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Operative treatment for Advanced

Colorectal Cancer In RSKD

Ajoedi, Dukut R Kastomo


Dharmais National Cancer Center Hospital
12 November, 2008
Introduction
In Indonesia:
* Advanced colorectal cancer very
high
In RSKD between 1994-2003 :
* 247 colorectal ca.
* 42,92% Dukes C
* 46,56% Dukes D
Introduction cont

Advanced CRC : metastatic Ca


Hematogenic
Lymphatogenic
Infiltrative to adjacent organ: small
intestine, stomach, pancreas, kidney,
ureter, bladder, internal genitalia in
female (locally advanced)
CASES

• Between 1994 – 2008 : op was done in 139


cases of Dukes D
• Cases : With and without history of
operation before
• Purpose of operation: palliative,
- decrease of pain
- Urine and feces diversion
Pre operative preparation
• Ct Scan
• Endoscopy
Sign and symptom:

• Partial obstruction
• Abdominal mass
• Pain
• CEA elevation
Surgery
• Right Hemicolectomy
• Left Hemicolectomy
• Transversectomy
• Sigmoidectomy
• Anteror/Low anterior Resection
• Abdominoperineal Resection
Surgery

• En block resection of tumor and part of


stomach, pancreas and spleen
• En block resection of tumor and uterus
• En block resection of tumor and
nephrectomy, partial ureterectomy,
ureterostomy, cystectomy or resection of
small intestine
• Other Treatment
• Radiotherapy
• Chemotherapy
Result
• 41 patient out of 139 could be followed
for more than 5 years.
• 3 of them survive more than 5 years
• Improve of quality of life.
• Decreased of pain
Result
Survive 2 years : 22
Survive 3 years : 14
Survive 4 years : 2
Survive 5 years : 3
Surgery In Dukes D CRC
surgery Standard With en block resec Total

R hemicolectomy 6 +2(release ureter) 10


+1(abd wall wide excis)
+1(Jej&stomc resec)
L hemicolectomy 6 +1(l nephrectomy) 7

Transversectomy 8 +4(part gastrectomy +2(Part pancreatect 17


+1(Jej & Stom Resc)
+2( Jej Resec)
Sigmoidectomy 10 +2(release ureter) 15
+2(Abd wall wideExcision)
+1 (Jej resect)

Anterior/LAR 32 +5(hysterectomy 37

Miles 34 +4(hysterectomy) +2(hyst and cystcm ) 41


+1(debulk tum)
Colostomy 9 +3(debulking tu) 12

Total 105 21 139


Discussion
Purpose of operation:
-Tumor resection/debulking GI
reconstruction
-pain release
-urine diversion
Discussion
• The patient mostly came in late state
• Refused surgery
• Poorly knowledge / patient delayed
• Doctor delayed
• Taylor et all: Partial resection survive 8-
12 month, En block resection 5 ysr 32%
- 79%
Ca rectum + uterus infiltration
Transverse colon ca + gastric and pancreas infiltration
• In advanced CRC:
• Extensive surgery combined with
Radiation and chemotherapy will
improve quality of life