Sphincter-preserving operations in the lower ampular cancer of rectum

Abstract

The purpose of the study: is to determine the indications and contraindications for sphincter-preserving surgeries in lower rectal cancer. Material and methods: In the Coloproctology Department of the Republican Cancer Research Center (RCRC) for the period 2011-2015, 1,346 patients with a verified diagnosis of colorectal cancer (CRC) received inpatient treatment. Based on the results, the following therapeutic measures were performed before the operation. At the same time, in contrast to the previously proposed methods of preoperative therapy, we carried out complex therapy, including neoadjuvant endolymphalum chemotherapy and intensive hypoxeradiotherapy. Among 1346 patients, 496 patients with T2-3N0-1M0 stage of the process performed radical operations. Cancer of the lower ampoule was in 142 (28.6%). Among 142 (28.6%) patients, 64 (45.1%) performed sphincter-preserving operations named abdominal-anal resection of the rectum (AARR), the average age of the patients was 59.8 years, in 78 (54.9%) patients abdomino-perineal extirpation of the rectum (APER) was performed, during which the entire switching apparatus of the rectum is removed - the average age of 54.2 years. Results: The results of the morphological study of remote macropreparations according to the histological structure of the tumor and the type of growth were studied depending on the location of the tumor to the dentate line. The complications associated with the surgical interventions were studied, dividing them into 2 groups: intraoperative and postoperative. Intraoperative complications occurred with AARR in 3.5% and in APER - 7.2%. Postoperative complications with AARR were observed in 5.5%, with APER - 6.3% of cases. Long-term postoperative results were studied in 51 (79.7%) patients with AARR and in 63 (80.1%) patients of APER. When AARR out of 51 patients, 3 (5.8%) had a relapse of the disease, the median of a relapse-free period was 17.3 months. Metastasis in the long-term period occurred in 6 (11.7%) patients, the average duration of the nonmetastatic period was 11.4 months. In contrast, of 63 patients after APER, 3 (4.7%) had a relapse and 8 (12.7%) had distant metastases. Accordingly, the median of relapse-free and metastatic-free period was 16.1 and 12.5 months. The rate of one-year mortality after AARR was 13.7% (7 patients) and after APER 12.7% (8 patients). Conclusions: The sphincter-preserving resection of the rectum can be the operation of choice in the treatment of highly differentiated adenocarcinomas (HDA) and moderately differentiated adenocarcinomas (MDA) in T2-3 stage with the lower pole of the tumor, localized within 1 cm above the toothed line (TL) and worn combined character. At the location of the lower edge of the tumor, at the level of TL in patients with MDA and HDA in 4% and 2.2% of cases, intercontinental rectum resection is indicated due to the particular aggressiveness of NDA.