Результаты хирургического лечения колоректального рака методом fast-track

Аннотация

Ключевые слова: Колоректальный рак продолжает быть наиболее часто колоректальный рак, встречающимся злокачественным новообразованием, при лапароскопическая этом хирургическое вмешательство является основным резекция толстой кишки, методом его лечения. В рамках исследования пациенты ускоренная хирургия. были разделены на три группы: первая группа подверглась открытым хирургическим вмешательствам (134 пациента), вторая группа – лапароскопическим вмешательствам (104 пациента), и третья группа – открытым вмешательствам с программой ускоренной реабилитации (64 пациента). В группе с открытыми вмешательствами ранние послеоперационные осложнения не наблюдались у 74,4% пациентов, в то время как в контрольной группе этот показатель составил 75,37%. Средняя продолжительность пребывания в больнице в основной группе составила 8,02±0,157 дня по сравнению с 8,8±0,246 дня в контрольной группе, что указывает на разницу в примерно один койко-день. Colorectal cancer is considered one of the most common malignant tumors. Back in 2017, it ranked 3rd in cancer incidence and 4th in mortality; already in 2019, in world statistics, colorectal cancer ranked 3rd among men and 2nd among women, while mortality was in 2nd place [1, 6]. According to Global Cancer Statistics, in 2019, colorectal cancer accounted for 10,2% of all malignant neoplasms, while in the Republic of Uzbekistan, among malignant neoplasms, colorectal cancer accounted for 6,7% [8]. Also, according to Global Cancer Statistics, in 2020, the mortality rate from colorectal cancer was 9.4%, and the number of new cases registered was about 2 million [2, 3, 4]. 57 Жамият ва инновациялар – Общество и инновации – Society and innovations Issue – 5 № 2 (2024) / ISSN 2181-1415 Today, surgery remains the main treatment method for colorectal cancer. Considering that in most underdeveloped and developing countries traditional surgical interventions are still performed, in the postoperative period the incidence of life- threatening complications remains at a high level [5, 7]. The use of modern minimally invasive technologies in surgery has made it possible to increase the efficiency of surgical treatment of patients with colorectal cancer, on the one hand, by minimizing surgical trauma and, on the other hand, through early rehabilitation of patients, which led to the creation of a multimodal early recovery program or the so-called “accelerated rehabilitation of patients” after operations [9]. The use of the fast-track surgery protocol leads to a reduction in the body’s stress reactions, a decrease in the dysfunction of internal organs, which significantly reduces the recovery time after surgery, and reduces hospital bed days, which leads to a reduction in the cost of treatment [9, 10]. The use of minimally invasive intervention methods, as well as the role and place of the developed “accelerated rehabilitation” program in patients with colorectal cancer, taking into account the characteristics of pre-, intra- and postoperative management, is an urgent problem of modern oncology. The purpose of the study was to optimize the treatment of patients with colorectal cancer through the use of minimally invasive interventions and accelerated rehabilitation. MATERIAL AND METHODS OF RESEARCH The study included 302 patients who received treatment at the Republican Specialized Scientific and Practical Medical Center of Oncology and Radiology. 134 patients were selected into the open intervention group, 104 patients into the laparoscopic intervention group, and 64 patients into the open surgery group using an fast-track protocol. For convenience and completeness of the analysis, during statistical processing of the material, patients were combined into the study group (168 patients who underwent either laparoscopic interventions or open operations using an accelerated rehabilitation protocol) and 134 patients in the control group. All patients underwent the following studies: rectoscopy, chest x-ray, ultrasound of the abdominal cavity, pelvis and inguinal lymph nodes, colonoscopy with biopsy (biopsy materials are stored in paraffin blocks), MRI of the pelvic organs, digital rectal examination, general blood test, biochemical blood test (urea creatinine, ALT/AST, alkaline phosphatase, total protein and albumin, glucose), general urine test, coagulogram, CEA, CA 19.9, ECG. Also, if necessary, an examination was carried out by narrow specialists. Assessment of general condition according to the ECOG scale. By gender, the study group included 89 men and 79 women, the control group – 79 men and 55 women (p = 0,299). The average age of patients in the study group was 56,82 ± 1 year, in the control group it reached 56,33 ± 1,054 years (p = 0,924), which also indicates the absence of a significant difference in this indicator, as well as in the indicators of the presence of certain concomitant diseases (p = 0,104).