Feasibility of adequate resectable rectal cancer treatment in a third-level hospital.

PURPOSE: The aim of this study was to determine the feasibility, concerning compliance to protocol and recommended clinical practice guidelines, as well as efficacy results of multidisciplinary treatment (surgery, radiotherapy and chemotherapy) of resectable rectal cancer in a third-level hospital devoid of radiotherapy and clinical oncology units. PATIENTS AND METHODS: A retrospective, single-institution analysis was completed for 45 consecutive patients diagnosed with resectable rectal cancer who entered an officially proposed multidisciplinary treatment protocol from October 1998 to September 2003. Adequacy of patient inclusion, according to clinical stage, was reviewed. Neoadjuvant radiotherapy schedule, surgery procedures and adjuvant chemotherapy indication were assessed. All treatment time intervals were analysed. Finally, efficacy results are discussed and contextualised by comparison with results of clinical trials which support this treatment strategy. RESULTS: According to an independent board review, 3 patients (6.7%) with stage I rectal cancer, 31 patients (68.9%) with stage II and 11 patients (24.4%) with stage III rectal cancer were included. Radiotherapy dosage, volume and schedule were as planned. Median time from diagnosis to start of radiotherapy was 26.36 days (24.26- 28.57; CI 95%). Median duration of radiotherapy was 6.00 days (5.56-6.44; CI 95%). Median time from start of radiotherapy to surgery was 15.67 days (14.47-16.87; CI 95%). Median time from completion of radiotherapy to surgery was 10.67 days (9.53-11.81; CI 95%). Most of the patients underwent low anterior resection [23 patients (51.2%)] and abdominoperineal resection [16 patients (35.6%)]. Correlation between clinical and pathologic staging was as expected. Twenty-nine patients (64.4%) of the 45 that were initially included started adjuvant chemotherapy. A statistically significant relationship between pathologic stage (grouped I-II vs. III) and the use of adjuvant chemotherapy was found (p=0.033; chi-square test). Radiotherapy- and chemotherapy-induced toxicity did not differ from that previously reported. With a median follow-up of 65.46 months, a total of 10 recurrences have been diagnosed, all of them in stage III patients. Overall survival rate at five years was 76% for the complete population included. CONCLUSION: Multidisciplinary treatment of resectable rectal cancer in a third-level hospital is feasible. Although efficacy results are comparable to those previously reported in the literature, further improvements in clinical staging as well as in adjuvant chemotherapy indication are desirable.

Current management of colonic volvulus. Results of a treatment protocol.

Colonic volvulus affects mainly the geriatric population and is associated with a high number of complications when treated by emergency surgery. The development of alternative methods has replaced and reduced the number of traditional surgical procedures. We present the results of treatment of colonic volvulus in a surgical service in Alicante, Spain. Between 1993 and 1997 a total of 17 cases in 15 patients were diagnosed, 16 in the sigmoid colon and 1 in the cecum. In 9 (60%) patients endoscopic devolvulation was successful. In 2 (22%) of these patients the problem recurred, and was resolved by a second endoscopic treatment. Three patients (20%) required surgery, and 3 others (20%) were treated with radiological reduction (barium enema) and rectal catheter. The average hospital stay of patients treated with endoscopy and barium enema was 2-3 days, being 7 days in patients who underwent surgery. Management with endoscopy is initially effective in most cases of volvulus of the sigmoid colon. This procedure affords decompression and adequate preparation of selected patients for surgical resection, which is the treatment of choice and provides the greatest guarantee against subsequent recurrence.