Abstract
Introduction: Lower GI malignancies though more common in the western part of world and are increasing in our country for the past decade. Colorectal cancer is the most common malignancy in the gastrointestinal tract. In the United States, colorectal cancer ranks fourth in terms of both gender-specific annual cancer incidence and cancer mortality (behind lung, prostate, and breast, respectively. Colonic tumors are important for two reasons: they are frequent and account for both a significant mortality rate as well as high cumulative health care costs. The sequence of events leading from a normal mucosa to a manifest cancer occurs through largely preventable precursor stages over the course of several years. Therefore this study predominantly focuses on the detection, management, and prevention of these conditions.
Aims and Objective
The aim of the study is,
- To study the clinical presentation of lower GI malignancies, including the incidence of emergencies.
- To study the macroscopic and histopathological types of lower GI m
- To evaluate various types of surgeries for lower GI malignancies being performed.
Materials and Methods
- This study consists of patients admitted for the management of lower GI malignancies in Dept. of General Surgery, VSS Institute of Medical Science and Research, Burla, Odisha.
- Period of Study – November 2015 to October 2017.
- On admission all the patients were subjected to basic blood investigations, Test for fecal occult blood, USG Abdomen, Barium studies, CT abdomen and UGI scopy.
- Following clinical and proctoscopic examination, Colonoscopy was done for all patients – except for emergency cases , biopsies were taken.
- Bowel preparation was done preoperatively using plain oral fluids, and PEG preparation – the day before surgery.
- Per operative findings regarding peritoneal implants, liver secondaries, peritoneal implants and tumour invasion to the nearby structures were noted.
- Post operative course was closely observed until the first follow up visit.
- Patients with permanent colostomy were followed up for colostomy care.
Observation: Results are analysed using suitable statistical tables, graphs and methods.
Conclusion: To conclude, any patient above 40 years of age, when complaints of altered bowel habits or bleeding per rectum, every effort should be made thoroughly to investigate him to find out if he harbors malignancy of lower GI tract and the goal of treatment should be to either cure the disease or to prevent the sequele of disease there by reducing morbidity and mortality.
References
- Short Practice of Surgery. Bailey & Love 26th Edition (P. 1153 - 1272).
- Maingot’s Abdominal Operations 12th Edition (P. 479 to 757).
- Sabiston Textbook of Surgery 19th Edition Vol. 2 (P.1219 to 1241 & 1323 - 1573).
- Schwartz’s Principles of Surgery 10th Edition. (P. 1017 to 1137)
- Hamilton Bailey’s Emergency Surgery 13th Edition (P. 393 - 446).
- Mastery of Surgery Fourth Edition, RoberJ.Baker, Joseph E.Fischer, (P. 1399 - 1689).
- Principles of Oncology – Devita Hellman, Rosenberg (P. 1036 - 1135).
- Oxford Textbook of Surgery. 2nd Edition (P. 1345 - 1611).
- Principles and Management of Cancer – A Practical Guide (RanajitSen) (P. 154 - 157).
- UCSF Medical Centre TNM Staging of Colon & Rectum.
- Recent Advances in Surgery (26) 2003 (Wendy Atkin, John Marshover) (P. 111 - 120)
- Recent Advances in Surgery for Rectal Cancer (9) 2004. PJ Shukla, HA Kanhex SV Shrikand (P. 263 - 272)
- Sphincter Saving Surgery for Cancer Lower Rectum with Special Emphasis on Abdominosacral Resection (Recent Advances in Surgery - 9) Dhananjaya Sharma (P. 275 – 282)
- Current Surgical Diagnosis and Treatment – 12th Edition. 2006 (P. 652 - 763)
- Gastroenterology Clinics of North America - 2007 (Colorectal Cancer in IBD AIN & other Neoplastic Precursor lesions of the Anal Canal and Perianal region)
- Randomised Clinical trial of effect of Synbiotics, neomycin & mechanical bowel preparation on intestinal barrier function in patients undergoing colectomy. – British Journal of Surgery 2007-94 (546 - 554)
- Local Excision of rectal tumours by transanal endoscopic microsurgery – British Journal of Surgery 2007 – 94 (627 - 633)
- Early introduction of laparoscopic sigmoid colectomy during residency. – British Journal of Surgery 2007 – 94 (P. 634 - 641)
- Colorectal Cancer – Clinical Review (Anne B Ballinger, Clive Angiansah) (P.715 - 718) British Medical Journal Oct 2007 Vol. 335
- Signet ring cell Ca of Appendix presenting with intestinal Obstruction. – Indian Journal of Surgery Feb 2007 Vol. 69, (P. 22-24)
- Optical Adjuncts for Enhanced Colonoscopic Diagnosis. – British Journal of Surgery 2007; 94 (P. 6 - 16)
- Role of Circulating tumour cells in predicting recurrence after excision of primary colorectal carcinoma – British Journal of Surgery 2007. 94 (P. 96 - 105)
- Impact of Radiotherapy on local recurrence of rectal cancer in Norway. – British Journal of Surgery 2007 – 94 (P. 113 - 118)
- Multicentric Randomised clinical trial of mechanical bowel preparation in elective colonic resection. British Journal of Surgery 2007; 94 (P. 689 - 695)
- Young Age Colorectal Cancer and Identification of Hereditary Non– Polyposis Colorectal Cancer Cohorts. – British Journal of Surgery 2007; 94 (P. 1055 - 1056)
- Size of Surgical Margin does not influence recurrence rates after curative liver resection for colorectal cancer liver metastases – British Journal of Surgery 2007. 94 (P. 1133 - 1138)
- Oncological outcome of Ultra low coloanal anastomosis with and without intersphincteric resection for low rectal adenocarcinoma – British Journal of Surgery 2007. 94 (341 - 345)
- Leptin acts as a mitogenic and antiapoptotic factor for Colonic cancer cells. – British Journal of Surgery 2007. 94 (P. 346 - 354)
- Clinical risk score predicts yield of staging laparoscopy in patients with colorectal liver metastases. – British Journal of Surgery 2007.94 (P. 855 – 859
- Role of Ultrasonography in the detection of unresectable recurrence after lobectomy for colorectal liver metastases. – British Journal of Surgery 2007. 94 (P. 1403 - 1407)
- Population based study of local surgery for rectal cancer – British Journal of Surgery 2007. 94 (P. 1421 - 1426)
- Prediction of Lateral Pelvic node involvement in low rectal cancer by conventional Computed tomography. – British Journal of Surgery 2007. 94 (P. 1014 - 1019)
- Immuno Histochemical Staining for Mismatch repair proteins and its reliance in the diagnosis of HNPCC – British Journal of Surgery 2007.94 (P. 1020 - 1027)
- Preoperative but not postoperative systemic Inflammatory response correlates with survival in colorectal cancer. – British Journal of Surgery 2007.94 (P. 1028 - 1032)
- Inspired Supplemental Oxygen reduces markers of oxidative stress during elective colon surgery - British Journal of Surgery 2007.94 (P. 475 - 477).
- A Protocol in not enough to implement an enhanced recovery programme for colorectal resection – British Journal of Surgery 2007; 94 (P. 224 - 231)
- Extended abdominoperineal resection with gluteus maximus flap reconstruction of the pelvic floor for rectal cancer. – British Journal of Surgery 2007.94 (P. 232 - 238)
- Clinicopathological significance of microscopic abscess formation at the invasive margin of advanced low rectal cancer – British Journal of Surgery 2007 (P. 239 - 243)
- Impact of surgeon volume and specialization on short term outcomes in colorectal cancer surgery – British Journal of Surgery 2007.94 (P. 880 - 889)
- Differences in Patient post operative and long term outcomes between obstructive and perforated colonic cancer. (Dept. of Surgery, Colorectal Unit, University of Barcelona, Spain) Pub Med.
- 4Quality of Life Assessments in Colorectal Surgery (Jess.P. Hillaned Hospital, KirurgiskKlinik Pub Med.)
- Pathologic Basis of Disease – Robbins 7th Edition. P 828 – 875
- Principles of Internal Medicine – Harrison – 16th Edition (P. 1763 - 1808)
- S.I. Text Book of Surgery 2003 Edition (P. 431 - 523)
- Essential Surgical Practice by Cushierie (Third Edition) (P. 1297 - 1408)
- Atlas of Operative Surgery – Zollingher (P. 363 - 478)
- American College of Surgeons Textbook of Surgery(Principles & Practice) 2005 Edition (P. 403 - 755)
- Textbook of Radiology & Imaging. Vol 1.David Sufton 7th Edition. (P. 615 - 691)
- Clinicopathological characteristics of colonic carcinoma in relation to localization and histologic type. (Article in Serbian – Pub Med PMID 18 35 79 06)
- Results of Surgery for Colorectal Carcinoma with obstruction – Surgical Department, Didmotichon Gen. Hospital, Greece. Pub Med PMID : 18299883
- Second line chemotherapy use in metastatic colon cancer varies by disease responsiveness. (University of Texas Health Science Center, Honston, TX, USA) Pub Med PMID : 18279578.
- Chen VW, Fenoglio – Preiser CM, Wu XC, et al. Aggressiveness of colon carcinoma in blacks and whites. national Cancer Institute Black/White Cancer Survival Study Group. Cancer Epidemiol Biomarkers Prev. 1997;6(12):1087-1093.
- American Cancer Society. Cancer Facts & Figures 2009. http:// wwwcancerorg/ downloads/STT/500809 web pdf. Accessed November 10,2009.
Corresponding Author
Dr Balabhadra Samantaray
Post Graduate Students, Department of General Surgery
Vimsar, Burla, Odisha, India
Email: This email address is being protected from spambots. You need JavaScript enabled to view it., Mob: 9861839696