Хірургічне лікування раку прямої кишки: обсяг лімфодисекції і проявів неспроможності швів колоректального анастомозу (ретроспективне дослідження)

Abstract

The purpose of the study was a retrospective analysis and evaluation of the effectiveness of surgical treatment of colorectal cancer, taking into account the technique of surgery, the volume of lymph dissection and postoperative incidence of colorectal anastomotic sutures failure. Materials and methods. The current retrospective analysis includes the results of a comprehensive examination and treatment of 102 patients divided into 2 groups depending on the technique of surgery: 53 people (52%) – laparoscopic anterior resection of the rectum with the formation of hardware "end-to-end" type and 49 (48%) – a similar operation using fluorescent angiography (ICG-technology). Results and discussion. According to the generalized results of retrospective analysis of examination and comprehensive treatment of 102 patients with colorectal cancer, the study groups were formed homogeneously and by statistically significant differences in age, sex, body mass index, nature and spread of tumor growth, location and stage of neoplastic process. The presence of a statistically significant correlation between rectosigmal localization of the nonplastic process, as well as the severity of the tumor response to preoperative chemotherapy / radiation therapy and the number of metastatic affected regional lymph nodes. It was demonstrated that in the study population of 102 patients with regional metastatic spread, the median number of affected lymph nodes was 2.0, and the lower and upper quartiles corresponded to 1 and 3 metastatic lymph nodes. At the same time, N0 samples were intentionally excluded from the analysis in order to ensure the adequacy of the results in the presence of metastatic lesions, because in this case it is important to assess the adequacy of the volume of lymphadenectomy. According to the results of fluorescent angiography, in 3 of 49 patients (6.1%) of group 2, the resection border was moved in the proximal direction to the area of adequate blood supply with subsequent formation of colorectal hardware anastomosis. At the same time, in 53 patients of group 1, the change of the place of application of the conjunctiva, taking into account the results of traditional visual inspection, was not performed at all. Preventive stoma, the need for which was determined by the surgeon, was formed in all 102 (100%) patients. Also in all 102 operated lymphadenectomy was performed. The median duration of surgery in both groups was 200.5 (125–310) minutes. Conclusion. Significant advantages of laparoscopic rectal resection using fluorescent angiography with green indocyanine have been demonstrated, as evidenced by a statistically significant reduction in lymphadenectomy volume – the number of intraoperatively removed lymph nodes, reduction in surgery duration and postoperative period compared with a group of patients who underwent radical surgery without the use of ICG-technology