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Abstrak :
Kanker rektum merupakan jenis kanker yang sering terjadi di masyarakat saat ini. Saat individu terdiagnosis kanker rektum, eliminasi fekal dapat terganggu sehingga diperlukan alternatif untuk eliminasi berupa pembuatan kolostomi. Tindakan kolostomi merupakan pengalaman baru bagi pasien sehingga pasien membutuhkan dukungan untuk penyesuaian diri bahkan sejak awal perawatan. Tujuan penulisan ialah menganalisis pelaksanaan edukasi perencanaan pulang yang dilakukan oleh perawat pada pasien dengan rencana pembuatan kolostomi. Perencanaan pulang telah dilakukan dalam bentuk edukasi dengan beragam strategi edukasi dan berlangsung pada periode pre-operatif dan periode post-operatif. Evaluasi pelaksanaan edukasi pada periode pre-operatif ialah pasien memahami kondisinya, siap menjalani prosedur pembedahan, serta mengetahui kondisinya setelah operasi. Evaluasi edukasi pada periode post-operatif ialah pasien memahami praktik perawatan stoma serta bentuk penyesuaian aktivitas sehari-hari dengan kolostomi. Rekomendasi penulisan perlunya pelaksanaan edukasi perencanaan pulang pada pasien rencana pembuatan stoma sejak awal perawatan dengan materi yang terstruktur dan strategi yang beragam. ...... Rectal cancer is a common type of cancer in today's society. Patient with rectal cancer has impaired elimination and need another alternative to maintain elimination function by formatting a colostomy. Colostomy is a new experience for patients so that they need support for adjustment from the beginning of treatment. The purpose of writing is to analyze the implementation of discharge planning education for patient with colostomy surgery schedule. Discharge planning education is done with several strategies and from the preoperative until postoperative period. Evaluation of the education in the preoperative period is the patient understands the condition, ready to undergo surgical procedure, and knows the condition after surgery. The evaluation education in the postoperative period is the patient understands the practice of stoma care as well as the form of adjustment of daily activities with colostomy. Recommendation to further discharge planning education is underdone from the beginning of treatment with structured materials and diverse strategies.

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PURPOSE: To clarify the risk factors for complications after diverting ileostomy closure in patients who have undergone rectal cancer surgery.

METHODS: The study group comprised 240 patients who underwent a diverting ileostomy at the time of lower anterior resection or internal anal sphincter resection, in our department, between 2004 and 2015. Univariate and multivariate analyses of 18 variables were performed to establish which of these are risk factors for postoperative complications.

RESULTS: The most common complications were intestinal obstruction and wound infection. Univariate analysis showed that an age of 72 years or older (p = 0.0028), an interval between surgery and closure of 6 months or longer (p = 0.0049), and an operation time of 145 min or longer (p = 0.0293) were significant risk factors for postoperative complications. Multivariate analysis showed that age (odds ratio, 3.4236; p = 0.0025), the interval between surgery and closure (odds ratio, 3.4780; p = 0.0039), and operation time (odds 2.5179; p = 0.0260) were independent risk factors.

CONCLUSIONS: Age, interval between surgery and closure, and operation time were independent risk factors for postoperative complications after diverting ileostomy closure. Thus, temporary ileostomy closure should be performed within 6 months after surgery for rectal cancer.

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ABSTRAK
Untuk memperbaiki survival dan angka rekurens dari karsinoma rekti, saat ini di Rumah Sakit Dr. Cipto Mangunkusumo sedang dilakukan penelitian prospektip penatalaksanaan karsinoma rekti dengan tehnik sandwich. Kasus dibagi dalam 2 golongan yaitu yang dapat direseksi dan tidak dapat direseksi.

Kasus yang dapat direseksi diberikan radiasi pra bedah 1,000 cGy. dalam 1 minggu dan 5 FU lalu dibedah. Pasca bedah diberikan radiasi 4500 cGy. dalam 4,5 minggu dan 5 FU.

Kasus yang tidak dapat direseksi pra bedah diberikan radiasi 4500 cGy./4,5 minggu dan 5 FU, pasca operasi diberikan radiasi 1.500 cGy. dan 5 FU.

Sebagai laporan pendahuluan, sejak Januari 1988 sampai dengan Maret 1990 di RSCM/FKUI telah dilakukan penelitian terhadap 35 penderita yang datang ke UPF Radioterapi RSCM. Dari 5 orang yang tidak dapat dilakukan reseksi, 2 dapat dilakukan reseksi, 2 dapat direseksi tapi inoperable karena sudah ada metastase jauh.

Didapatkan harapan yang menggembirakan dari kelompok tumor yang tidak dapat direseksi menjadi dapat direseksi setelah diberikan radiasi pra bedah yaitu sebesar 40%.

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Kanker rektum merupakan salah satu penyakit keganasan saluran gastrointestinal yang banyak dialami masyarakat perkotaan. Salah satu tindakan pembedahan yang dapat dilakukan adalah operasi metode ultra low anterior resection. Berdasarkan jurnal terkait, pasien paksa operasi metode ultra low anterior resection memiliki risiko sebesar 10-20% terkena sindrom anterior resection dengan gejala kelemahan sfingter anal sehingga mengakibatkan inkontinensia fekal. Salah satu tindakan yang dapat dilakukan kepada pasien untuk mencegah masalah tersebut adalah dengan latihan kegel. Latihan kegel yang dilakukan secara rutin dapat membantu meningkatkan kontrol anus dan menguatkan sfingter anus. Latihan dilakukan secara bertahap sebanyak 4x10 set dalam sehari. Evaluasi latihan kegel dilakukan menggunakan colok dubur untuk mengevaluasi kekuatan kontraksi anus. Sebelum latihan kegel dilakukan, penanganan manajemen nyeri pada pasien paska operasi harus dilaksanakan dengan baik terlebih dahulu agar toleransi latihan kegel tinggi dan latihan dapat dilakukan segera setelah operasi.

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ABSTRAK
Rectal cancer is a malignancy of the gastrointestinal tract that is experienced by the urban community. One of the surgery choices is ultra low anterior resection method. Based on the relevant journal, patients were treated with this method have 10-20% higher risk of anterior resection syndrome, which symptoms is weakness of the anal sphincter, resulting in fecal incontinence. One of the interventions that can prevent patients from the fecal incontinence is Kegel exercises. Regular exercises can help improve and strengthen control of the anal sphincter. Exercises done gradually as 4x10 sets in a day. The evaluation of exercises using a rectal tusche to evaluate the strength of anus contraction. Before Kegel exercises is started, handling the management of pain post-surgery must be performed well so that patients have a higher tolerance of Kegel exercises and the exercises can be done soon after surgery.;

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Pembedahan terbuka kolorektal mempunyai morbiditas yang tinggi. Laparoskopi kolorektal pertama kali diperkenalkan pada tahun 1991 dengan hasil morbiditas pascabedah yang rendah. Penelitian ini mengambil total sampel subjek kanker kolorektal yang menjalani pembedahan laparoskopi pada tahun 2010 hingga 2015. Data ditabulasi dan dianalsis untuk mendapatkan hasil jangka pendek dan kesintasan lima tahun. Didapatkan 65 data dengan 21 kasus kolon 32,3 dan 44 kasus rektum 67,7 ; 34 pria 52,3 31 wanita 47,7 dengan rata ndash;rata usia 57,17 tahun SD 13.380 . Pada kelompok kolon didapatkan rata ndash;rata durasi bedah 216,75 menit SD 65,94 dan kehilangan darah 159,75 mL SD 125,47 . Median VAS adalah empat; diet, mobilisasi dan lama rawat pascabedah didapatkan pada dua, empat dan tujuh hari. Kesintasan lima tahun pasien didapatkan 83 . Tidak ada komplikasi, pembedahan ulang dan infeksi luka operasi ILO pada kelompok ini. Pada kelompok rektum rata ndash;rata durasi bedah adalah 305,97 min SD 94,23 dan perdarahan intra operasi 150 mL SD 50 . Median VAS pascabedah tiga, diet dan mobilisasi pascabedah dua hari dan empat hari. Lama rawat pascabedah delapan hari. Kesintasan lima tahun adalah 58,5 . Morbiditas pascabedah lebih rendah dengan pembedahan laparoskopi dengan hasil kesintasan keseluruhan yang tidak berbeda dengan kesintasan pasien kanker kolorektal yang ditangani sebelumnya. ABSTRACT
Conventional colorectal cancer surgery is often associated with high post operative moribidities. Laparoscopic colorectal surgery has reduced post operative morbidities with same survival outcomes of open surgery. Retrospective data of laparoscopic colorectal cancer surgery from 2010 to 2015 were collected, tabulated and analyzed to get early results and five years survival rate. There were 65 data, 21 colon cancer 32.3 and 44 rectal cancer 67.7 . Higher incidence of male patients n 34, 52.3 than female n 31, 47.7 with mean age of 57,17 13.38 years. Length of operation for colon group was 216.75 SD 65.94 mins with intra operative blood loss 159.75 SD 125.47 mL and post operative pain, on visual analog score VAS , was 4 2 5 . Post operative diet, mobilization and length of stay were 2 1 3 days, 4 2 7 days and 7 4 12 days respectively. The five years survival rate was 83 . In rectal group, length of operation was 305,97 SD 94,23 mins with intra operative blood loss 150 SD 50 mL. Post operative VAS, diet, mobilization and length of stay were 3 2 5 , 2 1 4 days, 4 2 22 days and 8 5 36 days respectively. Five years survival rate was 58.5 . Post operative morbidities in colorectal cancer decreases with laparoscopic resection with satisfactory overall survival rate.

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Purpose: Postoperative pneumonia affects the length of stay and mortality after surgery in elderly patients with colorectal cancer (CRC). We aimed to determine the risk factors of postoperative pneumonia in elderly patients with CRC, and to evaluate the impact of laparoscopic surgery on elderly patients with CRC. Methods: We retrospectively investigated 1473 patients ≥ 80 years of age who underwent surgery for stage 0-III CRC between 2003 and 2007. Using a multivariate analysis, we determined the risk factors for pneumonia occurrence from each baseline characteristic. Results: Among all included patients, 26 (1.8%) experienced postoperative pneumonia, and restrictive respiratory impairment, obstructive respiratory impairment, history of cerebrovascular events, and open surgery were determined as risk factors (odds ratio [95% confidence interval], 2.78 [1.22-6.20], 2.71 [1.22-6.30], 3.60 [1.37-8.55], and 3.57 [1.22-15.2], respectively). Furthermore, postoperative pneumonia was more frequently accompanied by increasing cumulative numbers of these risk factors (area under the receiver operating characteristic curve = 0.763). Conclusions: Laparoscopic surgery may be safely performed in elderly CRC patients, even those with respiratory impairment and a history of cerebrovascular events.

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Purpose To compare the time-course change in the postoperative anorectal function between laparoscopic intersphincteric resection (ISR) and low anterior resection (LAR). Methods This is a single-institution observational study. We evaluated the time-course change in the anorectal function using functional questionnaires before and at 6, 12, and 24 months after laparoscopic ISR or LAR. Results Sixty-two patients answered the functional questionnaires (28 in the ISR group and 34 in the LAR group). In the ISR group, the Wexner scores at 6, 12, and 24 months postoperatively were significantly higher than preoperatively. Importantly, the Wexner score at 24 months postoperatively was significantly lower than that at 6 months postoperatively. The low GIFO scores at 6 and 12 months postoperatively tended to be recovered to some extent at 24 months postoperatively. In the LAR group, Wexner score at 6 months postoperatively was significantly higher than that preoperatively. Notably, the Wexner score at 12 months postoperatively was recovered to almost the same as that preoperatively. The GIFO scores at 12 months postoperatively were mostly recovered to the same levels as those preoperatively. Conclusions Laparoscopic ISR exhibits different time-course changes in the anorectal function from laparoscopic LAR.