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Query: UMLS:C0009402 (colorectal cancer)
 53,228 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Analysis of the clinical and autopsy reports of 200 deaths following surgery for colorectal cancer from 1956 to 1974, at the Dept. of Surgery, University of Heidelberg, revealed that pneumonia (24.5%) was the most common cause of death followed by peritonitis (22%), pulmonary embolism (15.5%), advanced tumor disease (14%), cardiac failure (9.5%), ileus (5.5%), and others (9%). The explanation for the postoperative mortality rate of 12% (cancer of colon) and 13.2% (cancer of rectum) lies in the fact that 82.5% of those who died postoperatively were beyond the age of 60, and 40.5% beyond 70 years at the time of surgery. Moreover, in 50.5% advanced tumors with regional and/or distant metastases were found. In 55.5% severe preoperative complications (ileus: 38%, peritonitis: 11%, abscess formation or hemorrhage: 6.5%) required an emergency operation. Only 38.5% of the procedures were considered for cure. Besides the need for early recognition of the cancer, intensification of pre- and postoper treatment appears to be the predominant task in the effort to decrease postoperative mortality.
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PMID:[Analysis of postoperative deaths in colon and rectal cancer (author's transl)]. 84 78

Therapeutic colonoscopy has replaced or lessened to a significant degree the need or extent of traditional open surgical procedures. The common uses of therapeutic colonoscopy are hemostasis, resection and ablation of benign and malignant disease, decompression and recanalization of obstructed or dilated bowel, as well as foreign body extraction. Bleeding from arteriovenous and other vascular abnormalities can be controlled with 40% to 80% success rates using endoscopically delivered, monopolar, bipolar, or laser coagulation. The palliation of bleeding recurrent or inoperable colorectal cancer is achieved in up to 90% of patients. Virtually all pedunculated adenomas and most sessile adenomas are regularly removed colonoscopically, while large and recurrent villous adenomas in high risk individuals can be successfully managed by endoscopically delivered laser ablation techniques. Emergency colonoscopic reduction of sigmoid volvulus is performed pre-operatively and decompression of the dilated colon of non-obstructive colonic ileus is now regularly achieved. Colonic strictures have been dilated with a variety of techniques ranging from divulsion with through-the-scope balloon dilators to laser recanalization. Pre-operative endoscopic laser relief of tumor obstruction is employed to avoid preliminary or decompressing colostomy. Endoscopic laser debulking and recanalization of recurrent or inoperable cancer has been achieved with up to 80% success and various foreign bodies may be extracted from the colon with a number of endoscopic techniques. The morbidity of therapeutic colonoscopy has ranged from 1% to 2% for polypectomy to 11% for laser palliation of bleeding from advanced cancer, often with obstruction.
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PMID:Therapeutic colonoscopy. 145 73

Fifty evaluable patients with advanced colorectal cancer, but without prior chemotherapy or immunotherapy, were randomized to one of two schedules of recombinant gamma-interferon (rGIFN). Twenty-four evaluable patients received rGIFN as a 2-h intravenous infusion daily x 5 every other week at a starting dose of 4.0 x 10(6) IU/m2/day (arm I). Twenty-six evaluable patients received rGIFN as a 24-h continuous intravenous infusion daily x 5 every month at a starting dose of 2.6 x 10(6) IU/m2/day (arm II). Toxicities on both schedules included flu-like symptoms, fevers/rigors, nausea/vomiting, hypotension, leukopenia, hepatotoxicity, nephrotoxicity, diarrhea, anemia, confusion, and ileus. Toxicity appeared to be more severe on arm I. No antitumor responses were observed, with 95% confidence intervals of 0 to 14% for arm I and 0 to 13% for arm II.
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PMID:Phase II trial of recombinant DNA gamma-interferon in advanced colorectal cancer: a Southwest Oncology Group study. 179 Jan 47

There are few actual published results about morbidity and mortality after elective resection of colorectal cancer. Out of 596 patients with colorectal cancer, the medical records of 492 who had been prepared preoperatively according to our predefined standards and electively operated on, were analysed. We studied the results of morbidity and mortality and their association with preexisting conditions and preoperative complications. We found that 50% of our patients had preexisting conditions and that 18.7% had preoperative complications (obstruction, ileus, infections). The rate of general postoperative complications was 30.5%. While for pneumonia (13%) there was age and sex relation, for urinary infection (12.7%) there was only sex relation. We were able to reduce urinary infections by half (5.7%), by using a suprapubic catheter. 11.4% of our patients had local complications (anastomotic leakage 2%, ileus 2.2%, bleeding 1.6%, fistula 1.2%). These were neither dependent on age or sex, nor on preoperative complications or preexisting conditions. Mortality within 30 days was 2% and overall mortality was 2.6%. Our results show that careful diagnosis and treatment of preexisting conditions, bowel preparation and an improvement in operating techniques can all lead to improved results after elective resection.
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PMID:[Morbidity and mortality after elective resections of colorectal cancers]. 205 45

84 patients aged over 80 years with colorectal cancer were evaluated. 54% had underlying associated illnesses. 27% underwent emergency surgery because of ileus or perforation. Resection rate for tumours was 74%, but only 64% of the operations were curative and 36% palliative. An early tumour stage (UICC stage I and II) was found in 51% of the patients. Operative mortality was 14.3%. The 3- and 5-year survival rate was 38% and 30% respectively. This study shows that even in elderly patients with suspicion of colorectal cancer a rapid assessment is mandatory to avoid tumour complications. This is the only way to lower the rate of emergency surgery; by gaining time the patient with risk factors can be prepared preoperatively for the abdominal operation. By early assessment and elective operation the high mortality rate of the elderly patient can be lowered. It would seem that diagnostic and therapeutic nihilism in the elderly is inappropriate. Although the crude 5-year survival rate approaches 30%, cautious assessment is necessary and individual evaluation of cases warranted.
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PMID:[Colorectal carcinoma in old age]. 244 23

Using endoscopic neodymium-YAG laser application permits successful treatment of ulcerated bleeding cancer. Further, palliative, ablative laser irradiation of tumors in inoperable patients avoids obstruction. Pre-operative recanalization of obstructive colorectal cancer causing ileus or subileus permits pre-operative orthograde bowel lavage as well as total colonoscopy, thus converting emergency surgery with staged procedures or intra-operative colon lavage into normal elective primary resection with all preoperative diagnostic and treatment modalities.
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PMID:Palliative and pre-operative endoscopic neodymium-YAG laser treatment of colorectal carcinoma. 244 33

A brief definition of the term of "relaparotomy" is followed by reference to some causes of erroneous or delayed decisionmaking on re-operation. The background of postoperative disorders is, basically, one and the same throughout acute surgery: haemorrhage, peritonitis, ileus. Relaparotomy was necessary in 0.6 per cent of the authors' cases, in the course of five years. Lethality amounted to 31 per cent at an average age of 50 years. Colorectal carcinoma was the most common cause of relaparotomy, with ileus of the small intestine being the most important of all indications. The average intervals between primary surgery and relaparotomy were seven days for ileus, 3.5 days for peritonitis, and up to 24 hours for postoperative bleeding. A lethality analysis after the first operation showed that only two of 96 deaths were attributable to omission of relaparotomy. Finally, reference is made to some clinical peculiarities in postoperative developments as well as to evaluation and interpretation of paraclinical data.
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PMID:[Disordered postoperative course. A retrospective analysis]. 338

The Hartmann procedure has been performed in 42 patients during a ten-year period. It is considered a good alternative in the emergency operative treatment for perforated diverticulas, perforated sigmoid cancer, anastomotic disrupture after an anterior resection or in ileus caused by stricturating colorectal cancer. It is also useful as an alternative in elective operations when there are unexpected difficulties in establishing colorectal continuity, as well as a palliative operation for advanced colorectal cancer. The overall operative mortality in the present series was 14%. Colorectal continuity could be reestablished in 13 of the 18 patients where it was attempted.
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PMID:Hartmann procedure. 643 65

A total of 232 patients with obturation neoplastic ileus of the colon are operated over a 12-year period (1979-1990). Colorectal carcinoma is the underlying cause of the development of obturation colonic impatency. Of the total of 654 patients with carcinoma of the colon and rectum operated on obturation colonic ileus is diagnosed in 232 cases (35.47 per cent). There is a tendency of the morbidity rate of obturation colonic ileus to increase during the observation period, rather markedly expressed in rectal carcinoma cases. In 160 patients (68.97 per cent) the neoplasm is located in the colon, and in seventy-two (31.03 per cent)--in the rectum. The morbidity rate recorded in men and among the urban population is higher. Obturation colonic impatency of a neoplastic origin is taken to be a pathological condition of advanced age. The mean age in men is 57.9 years, and in women--57.7 years.
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PMID:[The structure of colorectal carcinoma morbidity complicated by occlusive ileus]. 804 Oct 85

Results of the application of apparatus AKA-2 for the formation of compressive anastomoses under complicated conditions are discussed. Among them are: acute and chronic ileus, peritonitis, diabetes mellitus etc. Common negative factors for all the patients were symptoms of secondary immune deficiency and specific endogenous intoxication resulting from chronic internal irradiation by radionuclides (consequences of the disaster in Chernobyl atomic power station in 1986). In 1987-1990 operations were performed on 84 patients. Compressive colonic anastomoses were made with apparatus AKA-2. All the patients lived in Kiev and neighbouring regions from 1986. From the patients operated upon 81% had colorectal cancer localized in left portions of the colon, 19% of the patients had inflammatory diseases of the colon. The application of compressive colonic anastomoses under the complicated conditions proved to be sufficiently reliable in the nearest and late terms of observations.
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PMID:[Compression anastomoses of the large intestine under complicated conditions]. 809 92


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