SURGICAL MANAGEMENT OF CARCINOMA CAECUM

Objective: To determine the magnitude of carcinoma caecum and its surgical management in the department of Surgery, Hayatabad Medical Complex Peshawar- Pakistan. Methodology: This case series study was conducted at surgical Unit Hayatabad Medical Complex Peshawar from July 2006 to June 2009. A total of 32 patients of carcinoma of caecum were included that were admitted either through OPD as elective cases (22 patients) or in emergency (10 patients). In elective cases, diagnosis was made on colonoscopic biopsy while those who presented in emergency either with intestinal obstruction or with the suspicion of acute appendicitis, were diagnosed on the resected specimen histopathology. Results: Out of 32, 25 patients (78%) were male and 7 (22%) female, with a male to female ratio of 3.6:1. Their mean age at the time of presentation was 65±2.8 years. Right hemicolectomy with side to side or end to end ileotransverse anastomosis was performed in 23 cases (71.89%). In 3 cases (9.37%) ileotransverse bypass without resection was carried out as the tumour was locally advanced. In 3 other cases (9.37%), only omental biopsy was taken as the carcinoma was so advanced that any curative or palliative resection was not possible. In emergency situation, right hemicolectomy with exteriorization of bowel ends was done in 3 cases (9.37%). Postoperative morbidity included wound infection 12.50%, faecal fistula 9.37% and intraabdominal collection 6.25%. Conclusion: Majority of the patients were having operable disease, however late presentation is very common. Surgical intervention may prove to be a better option in such cases.