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Vol 7, No 4 (2005)
Published online: 2006-02-06

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Prognostic factors of relaparotomy in patients operated on for colon cancer evaluated in our own material

Robert J. Rojewski, Grzegorz Szczęśniak, Krzysztof Noll, Grzegorz Noll, Robert Kozieł
Chirurgia Polska 2005;7(4):231-237.

Abstract

Background: Relaparotomy is a reoperation undertaken in the early postoperative period for complications resulting from a primary operation, which obligatorily involves a laparotomy as well as revision and sanation of the abdominal cavity. As reports in the Polish and foreign literature suggest, the frequency of relaparotomies has been increasing. This study analyzed 636 laparotomies performed in the Department of General Surgery at Radom Specialist Hospital. A relaparotomy was performed in 47 cases. The purpose of study was to evaluate the prognostic factors of relaparotomies in those patients.
Material and methods: During 1994-2003 there were 636 laparotomies performed for colon cancer and 47 patients who underwent relaparotomies (7.4%). These cases were analyzed taking account of the cancer’s progress, location, type of surgical procedure employed, concomitant diseases, patient’s age and character of the operation (emergency or elective).
Results: Cancer was most often located in the rectum (38.5%) and the sigmoid (29%). The biggest number of patients 203 (32%) was classified group B2 according to the Astler-Coller scale of cancer advancement. The biggest number of relaparotomies followed a left-side hemicolectomy - 4 (10.2%) all of which were fatal. The most frequent causes of relaparotomy were: evisceration - 17 (36.2%), anastomosis dehiscence - 15 (31.9%) and adhesional obstruction - 5 (10.6%). Most relaparotomies were performed in a group of patients who were over 60 years old - 35 (7.5%) and their mortality rate was significantly higher - 15 deaths (43%). In the group who were under 65 years old, 12 relaparotomies (6.9%) were performed and 3 patients died (25%). The mortality rate due to relaparotomies that followed emergency operations was twice as high (63%) in comparison to relaparotomies that followed elective operations (30%). Concomitant diseases were observed in 35 (74.5%) out of 47 patients who underwent a relaparotomy; circulatory diseases which featured in 22 patients, were the most common kind among them.
Conclusions: Factors that increase the risk of relaparotomy in patients operated on for colon cancer include; an advanced stage of cancer, concomitant diseases, the patient’s age and a primary laparotomy having been performed as emergency operation. Evisceration, anastomosis dehiscence and adhesional obstruction were among the most common causes of a relaparotomy. Left-side hemicolectomy was most frequently followed by a relaparotomy. Being aged over 60, as well as the emergency character of the operation, increase the ratio of postoperative mortality significantly.

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