Evaluasi inkontinesia alvi pada penderita karsinoma rekti pasca tindakan reseksi dan anastomosis koloanal (Coloanal pullthrough)

INDRIAWAN, Ramses, Prof. dr. Marijata, Sp.B-KBD

2009 | Tesis | S2 Ilmu Bedah

Latar Belakang. Angka kejadian karsinoma rekti cukup tinggi. Bersama dengan karsinoma di kolon merupakan keganasan saluran pencernaan terbanyak. Di Indonesia jumlah penderita karsinoma kolorektal menempati peringkat kesepuluh. Di Jogjakarta, data dari laboratorium patologi anatomi menyebutkan karsinoma rekti pada wanita menduduki peringkat ke-5 setelah karsinoma cerviks uteri, sedangkan pada laki-laki menduduki peringkat ke-3 setelah karsinoma kulit dan nasofaring. Karsinoma rekti letak rendah lazim dilakukan operasi reseksi abdominoperineal, namun timbul permasalahan karena banyak penderita cenderung menolak adanya kolostomi permanen. Alternatif pilihannya adalah metode operasi reseksi dan anastomosis koloanal yang dilakukan tanpa kolostomi. Tujuan. Untuk mengevaluasi keberhasilan dari tindakan operasi reseksi dan anastomosis koloanal serta faktor-faktor yang mempengaruhinya., dan mengetahui lama waktu inkontinensia alvi pasca operasi dan faktor-faktor yang mempengaruhinya. Metode. Dilakukan secara retrospektif cross sectional pada penderita karsinoma rekti yang mendapatkan terapi kuratif reseksi dan anastomosis koloanal di RSUP Dr. Sardjito, RSKB Ringroad Selatan dan RSUD Muntilan sebagai RS Jejaring periode Januari 2006 - Juli 2009. Data dikoleksi dari tiap pasien, mencakup usia, jenis kelamin, kadar CEA dan albumin darah, stadium penyakit, tanggal masuk rumah sakit, gambaran histopatologis, derajat diferensiasi tanggal operasi, serta terapi adjuvan (kemoterapi atau radioterapi). Dievaluasi pula kontrol pasca rawat inap di poliklinik meliputi anamnesa lama inkontinensia alvi. Hasil. Didapatkan hasil 15 penderita terdiri 7 pria dan 8 wanita dengan usia rerata 51.33 tahun, 2 penderita mengalami komplikasi pasca operasi yaitu nekrosis ujung distal kolon sehingga dilakukan re-operasi pembuatan stoma. Dari ke-13 penderita lainnya mengalami masa inkontinensia alvi paling singkat 4 minggu sebanyak 6 orang dan terlama 16 minggu sebanyak 1 orang dengan rerata lama inkontinensia adalah 6.92 minggu. Analisis korelasi non parametrik Spearmans menunjukkan faktor jarak tepi distal tumor dengan anal verge memiliki korelasi negatif dengan lama inkontinensia alvi dengan r = - 0.569, p = 0.042 dan secara statistik terdapat perbedaan yang bermakna p < 0.05. Sedangkan variabel lainnya seperti usia, hasil laboratorium albumin dan CEA pra operasi, lama berlangsungnya operasi, dan lama perawatan tidak terdapat perbedaan yang bermakna p > 0.05. Kesimpulan. Terdapat korelasi negatif antara faktor jarak tepi distal tumor dengan anal verge dengan lama inkontinensia alvi.

Background. Incidence of rectal carcinoma is high. Along with colon carcinoma, they comprise the most prevalent gastrointestinal malignancy. In Indonesia, colon carcinoma is the tenth most common malignancy. In Jogjakarta, data from laboratory of pathology mentioned that rectal carcinoma in women ranked the fifth place after cervical carcinoma, while in men ranks the third after skin carcinoma dan nasopharyngeal carcinoma. Lower rectal carcinoma usually managed with abdominoperineal resection surgery, but then problems arose since many patients refused permanent colostomy. The alternative choice was to conduct resection and coloanal anastomosis surgery without colostomy. Aims. To evaluate the success rate of resection and coloanal anastomosis surgery and factors that may influence the procedure, and to figure out the duration of fecal incontinence post surgery and factors affecting the process. Methods. The research design was restrospective cross sectional, conducted in patients with rectal carcinoma that have been managed with curative therapy namely resection and coloanal anastomosis in Sardjito Hospital, RSKB Ringroad Selatan dan Muntilan District Hospital as networking hospitals for the period January 2006 - July 2009. Data then collected from each patient, including age, sex, level of CEA and blood albumin, stage of the disease, the date of admission, histopathologic appearance, date of operation, and adjuvant therapy (chemotherapy or radiotherapy). Patients were also controlled for post operative period in outpatient department for duration of fecal incontinence. Results. Fifteen patients were enrolled in the study, consisted of 7 males and 8 females with mean age 51.33 years old, 2 patients suffered post operative complication of distal-end colon necrosis so a re-surgery for creation of stoma must be carried out. From the other 13 patients the shortest duration of fecal incontinence was 4 weeks in 6 persons and the longest duration was 16 weeks in 1 patient with mean duration of 6.92 weeks. Spearman’s non parametric correlation analysis show that the distance from distal-end with anal verge had negative correlation with duration of fecal incontinence with r = - 0.569, p = 0.042 and statistically there was significant difference with p value < 0.05. While other variables such as age, pre operative albumin level and CEA, duration of operation, and duration of care don’t show significant difference with p > 0.05. Conclusion. There was a negative correlation between distance of distal tumor edge with anal verge with duration of fecal incontinence.

Kata Kunci : karsinoma rekti, operasi reseksi dan anastomosis koloanal, lama inkontinesia alvi, rectal carcinoma, coloanal resection and anastomosis, duration of fecal incontinence