Surgery and OncologySurgery and OncologyХирургия и онкология2949-5857Publishing House ABV Press14810.17650/2220-3478-2015-5-4-19-23ORIGINAL REPORTSОРИГИНАЛЬНЫЕ ИССЛЕДОВАНИЯShort-term results of combined and complex treatment of patients with low rectal cancerНепосредственные результаты комбинированного и комплексного лечения пациентов с низколокализованным раком прямой кишкиYudinA. A.ЮдинА. А.
Belarus

agro Lesnoy, 223040

223040, агрогородок Лесной

anton_judin@mail.ruKokhnyukV. T.КохнюкВ. Т.
Belarus

agro Lesnoy, 223040

223040, агрогородок Лесной

KоlyadichG. I.КолядичГ. И.
Belarus

agro Lesnoy, 223040

223040, агрогородок Лесной

N.N. Alexandrov National Cancer Centre of BelarusГУ «Республиканский научно-практический центр онкологии и медицинской радиологии им. Н.Н. Александрова»160120165419231501201615012016Copyright ©; 2016, ABV-pressCopyright ©; 2016, АБВ-пресс2016ABV-pressАБВ-прессhttps://onco-surgery.info/jour/about/editorialPolicieshttps://onco-surgery.info/jour/article/view/148

The issue of sphincter preservation when low rectal cancer (rectal adenocarcinoma 0–6 сm from marge anal) remains topical.

Objective: to increase the number of sphincter preservation operations in patients with low rectal cancer.

Materials and methods. We analyzed data on 110 patients with low rectal cancer randomized into 3 groups: in the 1st group surgery was performed following 0–3 days after the end of short-term radiotherapy (RT) 25 Gy. In the 2nd group the interval before surgery after the identical RT was 42 ± 3 days. In the 3rd group, in 2 cycles of capecitabine chemotherapy were performed starting on the 1st day of RT.

Results. pCR was observed obly in 2nd and 3rd group: in 16.6 % patients in the 2nd group, and 12.8 % in the study group. The sphincter preservation rate was 40.0 % in the 1st control group, 70.0 % in the 2nd group and 77.0 % in the 3rd group. The postoperative complications rate was 37.5 % in the 1st group, 26.6 % in the 2nd group and 17.9 % in the 3rd group.

Conclusions. Preoperative chemoradiotherapy may increase sphincter preservation rate without increase in the number of postoperative complications.

low rectal cancerneoadjuvant radiotherapysurgical therapycombined therapycomplex treatmentsphincter preservation surgerychemotherapyнизколокализованный рак прямой кишкинеоадъювантная лучевая терапияхирургическое лечениекомбини­ рованное лечениекомплексное лечениесфинктеросохраняющие операциимонохимиотерапия1. Океанов А.Е., Моисеев П.И., Левин Л.Ф. Статистика онкологических заболеваний в Республике Беларусь (2004–2013). Под ред. О.Г. Суконко. Минск: РНПЦ ОМР им. Н.Н. Александрова, 2014. 382 с. [Okeanov A.E., Moiseev P.I., Levin L.F. Statistics of oncological diseases in the Republic of Belarus (2004–2013). Ed. by O.G. Sukonko. Minsk: N.N. Alexandrov SSPC of Oncology and Medical Radiology, 2014. 382 p. (In Russ.)].Океанов А.Е., Моисеев П.И., Левин Л.Ф. Статистика онкологических заболеваний в Республике Беларусь (2004–2013). Под ред. О.Г. Суконко. Минск: РНПЦ ОМР им. Н.Н. Александрова, 2014. 382 с. [Okeanov A.E., Moiseev P.I., Levin L.F. Statistics of oncological diseases in the Republic of Belarus (2004–2013). Ed. by O.G. Sukonko. Minsk: N.N. Alexandrov SSPC of Oncology and Medical Radiology, 2014. 382 p. (In Russ.)].2. Алгоритмы диагностики и лечения злокачественных новообразований. Под ред. О.Г. Суконко, С.А. Красного. Сборник научных статей. Вып. 2. Минск, 2012. 506 с. [Algorithms of diagnostics and treatment of malignant neoplasms. Ed. by: O.G. Sukonko, S.A. Krasnyi. Collection of scientific articles. Issue 2. Minsk, 2012. 506 p. (In Russ.)].Алгоритмы диагностики и лечения злокачественных новообразований. Под ред. О.Г. Суконко, С.А. Красного. Сборник научных статей. Вып. 2. Минск, 2012. 506 с. [Algorithms of diagnostics and treatment of malignant neoplasms. Ed. by: O.G. Sukonko, S.A. Krasnyi. Collection of scientific articles. Issue 2. Minsk, 2012. 506 p. (In Russ.)].3. Improved survival with preoperative radiotherapy in resectable rectal cancer. Swedish rectal cancer trial. N Engl J Med 1997;336(14):980–7.Improved survival with preoperative radiotherapy in resectable rectal cancer. Swedish rectal cancer trial. N Engl J Med 1997;336(14):980–7.4. Kapiteijn E., Marijnen C.A., Nagtegaal I.D. et al. Preoperative radiotherapy combined with total mesorectal excision for resectable rectal cancer. N Engl J Med 2001;345(9):638–46.Kapiteijn E., Marijnen C.A., Nagtegaal I.D. et al. Preoperative radiotherapy combined with total mesorectal excision for resectable rectal cancer. N Engl J Med 2001;345(9):638–46.5. Bosset J.F., Collette L., Calais G. et al. Chemotherapy with preoperative radiotherapy in rectal cancer. N Engl J Med 2006;355(11):1114–23.Bosset J.F., Collette L., Calais G. et al. Chemotherapy with preoperative radiotherapy in rectal cancer. N Engl J Med 2006;355(11):1114–23.6. Gerard J.P., Conroy T., Bonnetain F. et al. Preoperative radiotherapy with or without concurrent fluorouracil and leucovorin in T3–4 rectal cancers: results of FFCD 9203. J Clin Oncol 2006;24(28):4620–5.Gerard J.P., Conroy T., Bonnetain F. et al. Preoperative radiotherapy with or without concurrent fluorouracil and leucovorin in T3–4 rectal cancers: results of FFCD 9203. J Clin Oncol 2006;24(28):4620–5.7. Peeters K.C., Tollenaar R.A., Marijnen C.A. et al. Risk factors for anastomotic failure after total mesorectal excision of rectal cancer. Br J Surg 2005;92(2):211–6.Peeters K.C., Tollenaar R.A., Marijnen C.A. et al. Risk factors for anastomotic failure after total mesorectal excision of rectal cancer. Br J Surg 2005;92(2):211–6.8. Gastinger I., Marusch F., Steinert R. et al. Protective defunctioning stoma in low anterior resection for rectal carcinoma. Br J Surg 2005;92(9):1137–42.Gastinger I., Marusch F., Steinert R. et al. Protective defunctioning stoma in low anterior resection for rectal carcinoma. Br J Surg 2005;92(9):1137–42.9. Rullier E., Laurent C., Bretagnol F. et al. Sphincter-saving resection for all rectal carcinomas: the end of the 2-cm distal rule. Ann Surg 2005;241(3):465–9.Rullier E., Laurent C., Bretagnol F. et al. Sphincter-saving resection for all rectal carcinomas: the end of the 2-cm distal rule. Ann Surg 2005;241(3):465–9.10. Branagan G., Finnis D. Prognosis after anastomotic leakage in colorectal. Dis Colon Rectum 2005;48(5):1021–6.Branagan G., Finnis D. Prognosis after anastomotic leakage in colorectal. Dis Colon Rectum 2005;48(5):1021–6.11. Beppu N., Matsubara N., Noda M. et al. A “high tie” confers an increased risk of anastomotic leakage for lower rectal cancer surgery in patients treated with preoperative radiotherapy. Surg Today 2015;45(5):600–5.Beppu N., Matsubara N., Noda M. et al. A “high tie” confers an increased risk of anastomotic leakage for lower rectal cancer surgery in patients treated with preoperative radiotherapy. Surg Today 2015;45(5):600–5.12. Rutegård M., Hemmingsson O., Matthiessen P. et al. High tie in anterior resection for rectal cancer confers no increased risk of anastomotic leakage. Br J Surg 2012;99(1):127–32.Rutegård M., Hemmingsson O., Matthiessen P. et al. High tie in anterior resection for rectal cancer confers no increased risk of anastomotic leakage. Br J Surg 2012;99(1):127–32.13. Bujko K., Nowacki M.P., NasierowskaGuttmejer A. et al. Sphincter preservation following preoperative radiotherapy for rectal cancer: report of a randomised trial comparing short-term radiotherapy vs conventionally fractionated radiochemotherapy. Radiother Oncol 2004;72(1):15–24.Bujko K., Nowacki M.P., NasierowskaGuttmejer A. et al. Sphincter preservation following preoperative radiotherapy for rectal cancer: report of a randomised trial comparing short-term radiotherapy vs conventionally fractionated radiochemotherapy. Radiother Oncol 2004;72(1):15–24.14. Ortiz H., Ciga M.A., Armendariz P. et al. Multicentre propensity score-matched analysis of conventional versus extended abdominoperineal excision for low rectal cancer. Br J Surg 2014;101(7):874–82.Ortiz H., Ciga M.A., Armendariz P. et al. Multicentre propensity score-matched analysis of conventional versus extended abdominoperineal excision for low rectal cancer. Br J Surg 2014;101(7):874–82.15. Musters G.D., Buskens C.J., Bemelman W.A. et al. Perineal wound healing after abdominoperineal resection for rectal cancer: a systematic review and meta-analysis. Dis Colon Rectum 2014;57(9):1129–39.Musters G.D., Buskens C.J., Bemelman W.A. et al. Perineal wound healing after abdominoperineal resection for rectal cancer: a systematic review and meta-analysis. Dis Colon Rectum 2014;57(9):1129–39.16. den Dulk M., Marijnen C.A., Collette L. et al. Multicentre analysis of oncological and survival outcomes following anastomotic leakage after rectal cancer surgery. Br J Surg 2009;96(9):1066–75.den Dulk M., Marijnen C.A., Collette L. et al. Multicentre analysis of oncological and survival outcomes following anastomotic leakage after rectal cancer surgery. Br J Surg 2009;96(9):1066–75.