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Operative treatment for Advanced
Colorectal Cancer In RSKD
Ajoedi, Dukut R KastomoDharmais National Cancer Center
Hospital
12 November, 2008
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In Indonesia:
* Advanced colorectal cancer very
high
In RSKD between 1994-2003 :
* 247 colorectal ca.
* 42,92% Dukes C
* 46,56% Dukes D
Introduction
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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
CASES
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Pre operative preparation
Ct Scan
Endoscopy
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Sign and symptom:
Partial obstruction
Abdominal mass
Pain CEA elevation
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Surgery
Right Hemicolectomy
Left Hemicolectomy
Transversectomy
Sigmoidectomy
Anteror/Low anterior Resection
Abdominoperineal Resection
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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
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Other Treatment
Radiotherapy
Chemotherapy
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Result
41 patient out of 139 could be followedfor more than 5
years.
3 of them survive more than 5 years
Improve of quality of life.
Decreased of pain
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Surgery In Dukes D CRC
surgery Standard With en block resec Total
R hemicolectomy 6 +2(release ureter)+1(abd wall wide excis)
+1(Jej&stomc resec)
10
L hemicolectomy 6 +1(l nephrectomy) 7
Transversectomy 8 +4(part gastrectomy +2(Part pancreatect
+1(Jej & Stom Resc)+2( Jej Resec)
17
Sigmoidectomy 10 +2(release ureter)
+2(Abd wall wideExcision)
+1 (Jej resect)
15
Anterior/LAR 32 +5(hysterectomy 37
Miles 34 +4(hysterectomy) +2(hyst and cystcm )
+1(debulk tum)
41
Colostomy 9 +3(debulking tu) 12
Total 105 21 139
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Discussion
Purpose of operation:
-Tumor resection/debulking GI
reconstruction
-pain release
-urine diversion
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Ca rectum + uterus infiltration
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Transverse colon ca + gastric and pancreas infiltration
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In advanced CRC:
Extensive surgery combined with
Radiation and chemotherapy willimprove quality of life
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