Abstract

Objective: comparative assessment of long-term oncological results of laparoscopic extralevator and traditional abdominal-perineal resection (APR).Materials and methods. The analysis of immediate and long-term oncological results of treatment of 92 patients who underwent traditional laparoscopic and extralevator APR for low rectal cancer. Inclusion criteria were tumors of the lower ampullar rectum, excluding the performance of sphincter-sparing surgical interventions, and patients’ age up to 75 years. Exclusion criteria: distant metastases, histologically confirmed squamous cell carcinoma. Analysis of immediate and long-term results was carried out.Results. The main group included patients who underwent extralevator APR (n = 62), patients in the control group (n = 30) underwent traditional APR. There were no significant differences in the type of neoadjuvant and adjuvant treatment in the comparison groups (p >0.05). In the group of patients operated on in the volume of extralevator APR, 42 received neoadjuvant chemoradiotherapy versus 19 patients in the group of traditional APR, there was no statistically significant difference (p = 0.21). In the extralevator APR group, perineal plastic surgery was performed significantly more often than in the traditional APR group (p = 0.001). When evaluating the immediate results, there was a statistically significant difference in the total number of complications between the study groups, such complications as bladder dysfunction following after surgery, inflammatory pelvic disease in the perineal wound, perineal hernia occurred significantly more often in the traditional APR group than in the extralevator APR group (p >0.05). In terms of overall and disease-free survival, the groups differed statistically significantly: 5-year overall survival in the main group was 90 % versus 62.5 % in the control group (p = 0.03), 5-year disease-free survival in the main group was 98.5 % versus 65 % in the control group, respectively (p = 0.01).Conclusions. Extralevator APR of the rectum is the most radical surgical intervention than with the traditional APR technique due to the lower risk of a positive circumferention resection margin, therefore, reducing the incidence of local recurrence, and as a result, improving overall and disease-free survival rates compared to the traditional technique.

Highlights

  • Цель исследования – сравнительная оценка непосредственных и отдаленных онкологических результатов выполнения лапароскопических экстралеваторных и традиционных брюшно-промежностных экстирпаций (БПЭ) прямой кишки

  • There were no significant differences in the type of neoadjuvant and adjuvant treatment in the comparison groups (p >0.05)

  • When evaluating the immediate results, there was a statistically significant difference in the total number of complications between the study groups, such complications as bladder dysfunction following after surgery, inflammatory pelvic disease in the perineal wound, perineal hernia occurred significantly more often in the traditional abdominal-perineal resection (APR) group than in the extralevator APR group (p >0.05)

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Summary

Оригинальное исследование

В ретроспективное исследование были включены данные 92 пациентов, оперированных в объеме лапароскопической традиционной и экстралеваторной БПЭ прямой кишки по поводу рака нижнеампулярного отдела прямой кишки. When evaluating the immediate results, there was a statistically significant difference in the total number of complications between the study groups, such complications as bladder dysfunction following after surgery, inflammatory pelvic disease in the perineal wound, perineal hernia occurred significantly more often in the traditional APR group than in the extralevator APR group (p >0.05). Если пациентам 1‐м этапом проводилось неоадъпри выполнении традиционной брюшно-промежност- ювантное лечение, через 6–7 нед после завершения ной экстирпации (тБПЭ) прямой кишки [1, 2]. Дизурические явления в виде транзиторной задержрым была выполнена эБПЭ, в контрольную – 30 па- ки мочи наблюдались в основной группе у 4 (6 %) пациентов, которым выполнялась тБПЭ прямой кишки. Demographic, clinical, and pathological characteristics of patients in the groups studied

Индекс массы тела Body mass index
Findings
Количество пораженных лимфатических узлов Number of lymph nodes affected
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