Right-sided hemicolectomy in 90-year-old patient with cecum cancer

Abstract

A case of the disease and radical cure of colon cancer in woman aged 90 years is described. This case proves that the age of patient is not a contraindication for radical surgical treatment under conditions of the appropriate medical management tactics for such patients.

Purpose of the work is to describe a case of radical treatment of cecum cancer in 90-year-old patient.

It is generally known that most of the patients with malignant tumors are people of older age groups. According to WHO, men and women over the age of 60 years are considered the elderly ones, the period of old age is between 75 to 90 years, more than 90 years - long-lived persons. Currently, the main treatment of malignant tumors is surgical. The age changes in basal metabolism, reducing of compensatory-adaptive capacity of cardiovascular and respiratory systems, liver and kidney are particularly important for the anesthesiologist. In 70 years the basal metabolic rate is 60% of normal, which means slowing down of metabolism and expression of anesthetics. The total water content of the body is reduced by 20% on average. Aging is accompanied by loss of elasticity of the arterial bed, decreased volume of hemodynamic parameters (cardiac output is 60% of the performance of 30-year-old persons). The cardiovascular system in elderly people loses the ability to adapt to tachycardia, a sudden increase in load. Also, there is the high probability of thromboembolic complications after surgery or prolonged immobilization. Severe stiffness and deformity of the chest, fibrotic changes in the bronchial tree develop in old people, decreased lung compliance leads to poor oxygenation of the body. Pulmonary fibrosis and emphysema with changes in the number of alveoli and lung surface on the whole develop in all the elderly patients, production of surfactant and drainage function of the bronchial tubes deteriorates, which contributes to the development of atelectasis. Reduced lung capacity, increased residual volume and blood shunting lead to the reduction of РаO₂. Liver mass decreases by 40%, therefore hepatic blood flow is changed. Number of functioning glomeruli is reduced by 50% compared with young age. The early postoperative period is characterized by decrease in cardiac output, the development of tachycardia, increased peripheral venous resistance in the pulmonary artery. Clinical and biochemical parameters are characterized by neutrophilic leukocytosis with hypoproteinemia, hyperglycemia, increased ALT, AST, urea, creatinine, increased blood viscosity.

All of these factors reduce the compensatory abilities of patients and reduce tolerance to the surgical operation. Nevertheless, the patient's age is not a contraindication to surgery. After preoperative preparation, which included single-group transfusion of packed red blood cells, fresh frozen plasma, solutions, colloids, amino acids, 21.05.2011 laparotomy was performed in patient routinely under intravenous anesthesia with endotracheal ventilation. When revising the abdominal cavity cecum tumor, constricting the clearance, with access to the serous covering, up to 8 cm in diameter was found. There were multiple metastatic regional lymph nodes up to 3 cm in diameter along a.ileocolica. Distant metastases were not found. Right hemicolectomy was performed. The blood loss was 1000 ml, hemohydrobalance - 500.0. Arterial pressure varied from 120/70 to 140/80. Pulse - 60-86 per minute. Urine output was at least 1.5 l, oxygen saturation - 94-98%. Postoperatively, the patient received a full fluid therapy. After 4 days, the patient was transferred to the surgical ward out of the intensive care unit.

Morphological conclusion number 20 393-404 (27.05.11). Poorly differentiated adenocarcinoma of the colon with infiltration of the entire thickness of the wall and fat. In 7 lymph nodes there are metastases of adenocarcinoma pT4N2M0 G3. The postoperative period was uneventful. Sutures were removed on the 12^th day after surgery. Given the patient's age and comorbidities, adjuvant chemotherapy was not performed. The patient was discharged in good condition on the 14^th day after the operation.

The patient was examined in Zaporozhye regional clinical oncological dispensary 6 months after surgery. The general condition of the patient is satisfactory. There are no complaints. Activity on the Karnofsky scale - 90%, on ESOG - 1 point. Further dispensary observation is recommended.

Described clinical case strongly suggests that age is not a contraindication for radical surgery under conditions of adequate preoperative preparation, anesthetic management and optimal treatment tactics in the postoperative period.