Contemporary diagnosis and treatment of rectal cancer

Abstract

Background. The main arguments the scientific justification of the research problem is based on are the following: increased incidence of the rectal cancer (RC) in Moldova, the lack of a national strategy for the early detection of RC. The main purpose of the research was to elaborate the diagnosis and therapeutic management which should lead to the increase of the health comfort of the patients with rectal neoplasm. Materials and methods. The study that constitutes the object of the present research was conducted on 287 patients with RC, admitted in the Municipal Hospital of Chisinau over a period of 5 years (2010 – 2014). Preoperative examination included: digital rectal examination, endoscopic (colonoscopy), radiological (barium enema), imagistic (ultrasound, computerized tomography) and biological explorations. 172 of these pacients underwent open surgery, respecting oncological principles. Rectum amputation (Miles) was performed for tumors located in the lower and mid third of the rectum whereas for the tumors located in the upper third an anterior rectum resection (Dixon) was performed. A protective colostomy was performed in the cases in which the anastomosis was considered to be precarious. Results and discussion. During the early postoperative period 33 complications were recorded, representing 19.18% of the total cases of operated RC. Out of these, 21 (12.20%) complications were specific, related to the surgical act and the basic illness, and 12 (6.9%) were unspecific, determined by the comorbidities and the patients’ old age.Conclusions. The main risk factors incriminated in the occurrence of CR are: diet, colorectal polyps and diverticula, inflammatory bowel disease, genetic syndromes (PAF, Lynch syndrome), RC in the history of relatives. Rectal cancer treatment is a multimodal one, surgical method being the primary therapeutic sequence, often combined with radio- and chemotherapy. Originality and scientific relevance of the presented study. RC is one of the most common form of malignancy in the whole world bringing humanity a significant loss through important financial aspect, but also the high rate of physical and intellectual disabilities caused. Although medicine has made remarkable progress in the past 30 years, survival in RC remains a prospective issue of permanent interes.