Outcomes of sphincter-sparing surgeries in patients with rectal cancer: long-term experience of a specialized clinic

Objective: to compare short-term and long-term treatment outcomes between patients with lower and middle rectal cancer with complete clinical and pathomorphological response after comprehensive treatment.Materials and methods. we performed retrospective analysis of treatment outcomes in patients with lower and middle rectal cancer. The experimental group included 27 patients with complete clinical response, whereas the control group comprised 31 patients with complete pathomorphological response (ypT0n0m0) who had undergone total mesorectal excision following neoadjuvant therapy. The main evaluated parameters included postoperative complications, proportion of R0 resections, proportion of sphincter-preserving surgeries, 2-year overall survival, and progression-free survival.Results. At a median follow-up time of 41 months (range: 25–114 months), 2 patients from the experimental group had progressive disease registered 18 and 19 months after treatment initiation; both patients underwent abdominoperineal extirpation of the rectum. The remaining 25 patients had sphincter sparing surgeries. At a median follow-up time of 48 months (range: 24–101 months), one patient was found to have liver metastasis 5 months following treatment initiation. He underwent simultaneous surgery that included low anterior resection of the rectum and liver resection and had no postoperative complications. In the group of surgical treatment, all patients underwent radical surgeries (R0), including those with permanent stoma formation (n = 11; 35.5 %) or preventive stoma formation (n = 20; 64.5 %) with subsequent bowel repair. The 2-year overall survival rate was 100 % in both groups. The 2-year progression-free survival rate was 92.6 % in the experimental group and 96.8 % in the control group (p = 0.473).Conclusion. The watch and wait strategy with active dynamic follow-up is a safe alternative to surgery in patients with complete clinical response after neoadjuvant therapy, since it ensures the results equivalent to those in patients with complete pathomorphological response.

Transanal total mesorectal excision is a promising surgical treatment for rectal cancer. However, evidence regarding the differences in outcomes between the transanal and laparoscopic total mesorectal excisions is scarce. We compared the short-term outcomes of transanal and laparoscopic total mesorectal excisions for low and middle rectal cancers. This retrospective study included patients who underwent low anterior or intersphincteric resection for middle (5-10cm) or low (< 5cm) rectal cancer at the National Cancer Center Hospital East, Japan, from May 2013 to March 2020. Primary rectal adenocarcinoma was confirmed histologically. Circumferential resection margins (CRMs) of resected specimens were measured; margins ≤ 1mm were considered positive. The operative time, blood loss, hospitalization length, postoperative readmission rate, and short-term treatment results were compared. Four hundred twenty-nine patients were divided into two mesorectal excision groups: transanal (n = 295) and laparoscopic (n = 134). Operative times were significantly shorter in the transanal group than in the laparoscopic group (p < 0.001). The pathological T stage and N status were not significantly different. The transanal group had significantly lower positive CRM rates (p = 0.04), and significantly lower incidence of the Clavien-Dindo grade III (p = 0.02) and IV (p = 0.03) complications. Both groups had distal margin positivity rates of 0%. Compared to laparoscopic, transanal total mesorectal excision for low and middle rectal cancers has lower incident postoperative complication and CRM-positivity rates, demonstrating the safety and usefulness of local curability for middle and low rectal cancers.

The aim of this study was to compare results of sphincter-sparing operations (SSO) and abdominoperineal resections (APR) in patients undergoing combined treatment for unresectable locally-advanced rectal cancer.Methods. During September 2007 – January 2011 59 patients were enrolled. Original treatment scheme (RF patent № 2414936) was developed including radiotherapy 40 Gy in 4 Gy fractions, capecitabine 650 mg/m2 bid per os days 1-22, oxaliplatin 50 mg/m2 iv days 3, 10, 17, local hyperthermia on days 8, 12, 15, 17, 2 applications of metronidazole 10 g/m2 per rectum in a polymeric composition. Surgery was carried out following 6–8 weeks. SSO were carried out in 36 patients, APR in 23 patients. Study endpoints included 2-year OS and DFS, local recurrence and distant metastases rate, postoperative complications rate.Results. No significant differences in survival were observed: 2-year OS was 93.2 and 85.6 % (log- rank test p = 0.157) for SSO and APR groups accordingly, 2-year DFS was 88 and 71.9 % (log-rank test p = 0.064). Four (11.1 %) patients in SSO group and 4 (17.4 %) patients in APR group (р = 0.5511) developed local recurrences, 4 (11.1 %) and 7 (30.4 %) (р = 0.1293) developed distant metastases. Postoperative complications rate was 27.8 % (n = 10) and 39.1 % (n = 9) (р = 0.5181) in SSO and APR groups accordingly.Conclusions. Sphincter-sparting surgery is justified for unresectable locally advanced rectal cancer when technically feasible.

IntroductionTotal mesorectal excision (TME) performed for the first time by Held through an open approach, it has become the standard technique for the surgical treatment of rectal cancer. The aim the of this meta-analysis is to compare the outcomes provided by TaTME than LaTME. Material and methodsIn this meta-analysis, we included all comparative studies, prospective and retrospective, which addressed in low and middle rectal cancer, a comparison between TaTME and LaTME. A search was performed through MEDLINE and Cochrane Database. 846 records were identified. ResultsEight relevant studies have been included in this meta-analysis. The studies were from France, Russia, USA, Netherlands, Taiwan, Egypt. The eight studies including 471 patients with middle or low rectal cancer. ConclusionThe meta-analysis confirmed safety of TaTME for low and middle rectal cancer. TaTME can lead to a high quality of rectal cancer resection specimen.

Objective To evaluate the effect of biofeedback on bowel function among rectal cancer patients with chemoradiotherapy and temporary enterostomy. Methods This study was designed as a randomized controlled trial. The patients with low and middle rectal cancer in a Cancer Hospital of Guangzhou from June 2015 to December 2016 were randomly divided into pelvic floor muscle exercise group (control group, n=36) and biofeedback training group (intervention group, n=35) . The intestinal function questionnaire of the Chinese version of Memorial Sloan-Kettering Cancer Center (MSKCC) was used to longitudinally track and compare the intestinal function of the two groups for 16 months and 5 times in total. Results The total score of MSKCC, frequency and urgency of defecation and defecation sensory disturbance in intervention group were higher than those in control group at 4 days and 3 months after stoma inclusion operation, and the differences were statistically significant (P<0.05) . Conclusions Biofeedback training can improve the intestinal function of patients with middle and low rectal cancer, promote their recovery, and prevent intestinal and anal dysfunction of patients with middle and low rectal cancer. Key words: Rectal neoplasms; Biofeedback; Pelvic floor muscle exercise; Anus preserving operation; Intestinal function

Background. The development of local recurrences and distant metastases make the problem of treating locally advanced rectal cancer one of the main problems in modern oncoproctology. The organ-preserving approach, sphincter-preserving operations, the role of a complete clinical response to therapy and the low compliance of patients with adjuvant treatment remain in the focus of attention of scientists.Aim. Evaluation of the effectiveness of neoadjuvant sequential induction chemotherapy (CT), chemoradiotherapy (CRT), and CapOx consolidating chemotherapy in patients with locally advanced rectal cancer.Methods. From December 2019 to June 2024, an open-label, randomized phase III study enrolled patients with locally advanced rectal cancer from 3 centers. The inclusion criteria for patients in the study were: histologically confirmed adenocarcinoma, lower and middle rectal cancer, magnetic resonance imaging on a Tesla 3 machine CRM+/4N0-2M0, age 18–75 years, ECOG performance status 0–1. Patients were divided into 2 groups: in the study group, treatment began with 2 courses of induction CT according to the CapOx regimen (oxaliplatin 130 mg/m2 on the 1st day of the course intravenously by drip, capecitabine 2000 mg/m2 twice a day at 12-hour intervals for 14 days, 7 days break). Then, a long course of chemoradiotherapy was carried out: 44 Gy to the areas of regional metastasis, 50–54 Gy to the primary tumor against the background of CT with capecitabine 825 mg/m2 2 times a day per os on the days of radiation therapy. One to two weeks after the end of CRT, two more courses of consolidation CT were carried out according to the CapOx scheme. A control examination was performed 10–12 weeks after the end of CRT. In the control group, a prolonged course of CRT was carried out: ROD 2 Gy, SOD 44 Gy to the areas of regional metastasis and SOD 50–54 Gy to the primary tumor against the background of CT with capecitabine 825 mg/m2 2 times a day per os on the days of radiation therapy. The primary endpoint was 3-year disease-free survival, calculated from the start of treatment to the date of progression and/or death from any cause or the date of last follow-up. Situations when a patient did not die and did not have disease progression were considered as censored events. Survival was calculated using the Kaplan–Meier method.Results. 247 patients were included in the study, 178 (72.1 %) underwent a complete course of treatment, 12 (4.9 %) patients are in the process of treatment or waiting for surgery, 25 (10.1 %) patients were excluded from the study for various reasons: organizational problems, refusal of treatment after randomization, detection of a synchronous tumor or metastases before starting treatment. The remaining 32 (12.9 %) patients did not follow the planned treatment protocol due to progression, death or refusal to continue treatment. The prevalence of acute grade III–V toxicities during preoperative treatment was 6.8 % in the CRT + CT group versus 4.7 % in the CRT group. 19 patients with a complete clinical response refused surgical treatment. 6 (5.8 %) patients in the CRT group and 13 (12.1 %) patients from the group in the CRT + CT group (p = 0.05). The disease free median duration of follow-up in group complete clinical response was 1086 days (36.2 months). Sphincter-sparing operations in the CRT + CT group were performed in 54 (65.8 %) patients versus 41 (53.2 %) in the CRT group (p = 0.05). A subgroup analysis of patients with low rectal cancer showed a significant increase in the frequency of sphincter preservation operations in the main group – 23 (46.9 %) versus 16 (31.4 %) in the control group (p = 0.05). On the basis of the Clavien–Dindo classification, the prevalence of surgical complications was similar between the two groups. The total rate of pCR in the CRT + CT group was 41.2 %, which was significantly higher than that in the CRT group (29.8 %). We demonstrated that patients receiving CRT with neoadjuvant CT were well tolerated, with a compliance rate of 71.2 % than those received adjuvant CT (31.2 %, p = 0.05). In particular, 95 % of the patients in the main group underwent 4 planned courses of neoadjuvant CT. 32.5 % of patients in the chemoradiotherapy group did not start adjuvant CT versus 16 % in the study group. The median duration of follow-up was 36 month. Locoregional recurrence was observed in 5 patients: 3 (2.8 %) in the CRT + CT group (1 patient was operated in a non-specialized clinic, after completion of preoperative treatment within the protocol) and 2 (1.9 %) in the CRT group. There was no significant difference in distant metastases: 20 (19.2 %) patients in CRT group and 21 (19.6 %) patients in the study group. There was no significant difference in dieseas-free survival (75 % in the CRT group versus 77 % in the CRT + CT group). Conclusion. Chemoradiotherapy with preoperative CT followed by surgery was efficacious for locally advanced rectal cancer with a significant increase frequency complete clinical response, sphincter-preserving operations, organpreserving treatment including low rectal cancer and rate patient compliance with CT.

Objective: To investigate the safety and efficacy of pelvic peritoneal reconstruction and its effect on anal function in laparoscopy-assisted anterior resection of low and middle rectal cancer. Methods: A prospective cohort study was conducted. Consecutive patients with low and middle rectal cancer who underwent laparoscopy-assisted transabdominal anterior resection at Naval Military Medical University Changhai Hospital from February 2020 to February 2021 were enrolled. Inclusion criteria: (1) the distance from tumor to the anal verge ≤10 cm; (2) laparoscopy-assisted transabdominal anterior resection of rectal cancer; (3) complete clinical data; (4) rectal adenocarcinoma diagnosed by postoperative pathology. Exclusion criteria: (1) emergency surgery; (2) patients with a history of anal dysfunction or anal surgery; (3) preoperative diagnosis of distant (liver, lung) metastasis; (4) intestinal obstruction; (5) conversion to open surgery for various reasons. The pelvic floor was reconstructed using SXMD1B405 (Stratafix helical PGA-PCL, Ethicon). The first needle was sutured from the left anterior wall of the neorectum to the right. Insertion of the needle was continued to suture the root of the sigmoid mesentery while the Hemo-lok was used to fix the suture. The second needle was started from the beginning of the first needle, after 3-4 needles, a drainage tube was inserted through the left lower abdominal trocar to the presacral space. Then, the left peritoneal incision of the descending colon was sutured, after which Hemo-lok fixation was performed. The operative time, perioperative complications, postoperative Wexner anal function score and low anterior resection syndrome (LARS) score were compared between the study group and the control group. Three to six months after the operation, pelvic MRI was performed to observe and compare the pelvic floor anatomical structure of the two groups. Results: A total of 230 patients were enrolled, including 58 who underwent pelvic floor peritoneum reconstruction as the study group and 172 who did not undergo pelvic floor peritoneum reconstruction as the control group. There were no significant differences in general data between the two groups (all P>0.05). The operation time of the study group was longer than that of control group [(177.5±33.0) minutes vs. (148.7±45.5) minutes, P<0.001]. There was no significant difference in the incidence of perioperative complications (including anastomotic leakage, anastomotic bleeding, postoperative pneumonia, urinary tract infection, deep vein thrombosis, and intestinal obstruction) between the two groups (all P>0.05). Eight cases had anastomotic leakage, of whom 2 cases (3.4%) in the study group were discharged after conservative treatment, 5 cases (2.9%) of other 6 cases (3.5%) in the control group were discharged after the secondary surgical treatment. The Wexner score and LARS score were 3.1±2.8 and 23.0 (16.0-28.0) in the study group, which were lower than those in the control group [4.7±3.4 and 27.0 (18.0-32.0)], and the differences were statistically significant (t=-3.018, P=0.003 and Z=-2.257, P=0.024). Severe LARS was 16.5% (7/45) in study group and 35.5% (50/141) in control group, and the difference was no significant differences (Z=4.373, P=0.373). Pelvic MRI examination 3 to 6 months after surgery showed that the incidence of intestinal accumulation in the pelvic floor was 9.1% (3/33) in study group and 46.4% (64/138) in control group (χ(2)=15.537, P<0.001). Conclusion: Pelvic peritoneal reconstruction using stratafix in laparoscopic anterior resection of middle and low rectal cancer is safe and feasible, which may reduce the probability of the secondary operation in patients with anastomotic leakage and significantly improve postoperative anal function.

Based on a review of the literature, this paper provides an update on surgical treatment of middle and low rectal cancer and discusses issues of debate surrounding that treatment. The main goal of the surgical treatment of rectal cancer is radical resection of the tumor and surrounding lymphatic tissue. Local excision of early rectal cancer can be another treatment option, in which the patient can avoid possible complications related to radical surgery. Neoadjuvant chemoradiation therapy (CRT) has been recommended for patients with cT3-4N0 or any T N+ rectal cancer because CRT shows better local control and less toxicity than adjuvant CRT. However, recent clinical trials showed promising results for local excision after neoadjuvant CRT in selected patients with low rectal cancer. In addition, the "wait and see" concept is another modality that has been reported for the management of tumors that show complete clinical remission after neoadjuvant CRT. Although radical surgery for middle and low rectal cancer is the cornerstone therapy, an ultralow anterior resection with or without intersphincteric resection (ISR) has become an alternative standard surgical method for selected patients. Many studies have reported on the oncological safety of the ISR, but few of them have addressed the issue the functional outcome. Furthermore, an abdominoperineal resection (APR) has problems with high rates of tumor perforations and positive circumferential resection margins, and those factors have contributed to its having a high rate of local recurrence and a poor survival rate for rectal cancer compared with sphincter-saving procedures. Recently, great efforts have been made to reduce these problems, and the total levator excision or the extended APR concept has emerged. Surgical management for low rectal cancer should aim to radically excise the tumor and to preserve as much of the sphincter function as possible by using multidisciplinary approaches. However, further prospective clinical trials are needed for tailored treatment of rectal cancer patients.

Updates and Debate issues form the surgical treatment of middle or low rectal cancer The main goals for the surgical treatment of rectal cancer were the complete removal of the rectal cancer with surrounding lymphatic draining area, which subsequently result in decreasing the rate of local recurrence as well as prolong patient survival. If the tumor located at the near the anal canal, concerning issues will be whether anal sphincter can be preserved or not and furthermore autonomic pelvic nervous system could be saved or not. Multidisciplinary approach for rectal cancer has been more popular and treatment strategy rapidly changing based on more accurate preoperative local staging finding and minimal invasive surgical techniques become popular too. One of the advance technology is the development of transanal local excision techniques such Transanal endoscopic microsurgery technique such as TEM(transendoscopic microsurgery), TEO(transendoscopic operation) and TAMIS (transanal minimal invasive surgery). Those techniques make us be able to excise early rectal cancer with full thickness as well as unfragmented state, also can be approached to the upper rectum, which can not approach with previous conventional transanal approach method. Local excision for early T1 rectal cancer has been regards as good treatment option because patient can avoid complication related to the radial proctotectomy such as anastomoitc leakage, postoperative sexual and voiding dysfunction and dysregulated bowel movements. Neoadjuvant chemoradiation therapy has been recommended for patient with cT3N0 or cT3 N+ rectal cancer because some clinical trials showed us preoperative chemoradiation therapy showed better local control rate and less toxicities than postoperative chemoradiation treatment. Recent clinical trial both retrospective and prospective showed us a promising results about local excision after neoadjuvant chemoradiation selectively in patients with low rectal cancer. Neoadjuvant chemoradiation therapy for cT2N0 followed by local excision reported excellent oncologic outcomes quite comparable to the radical surgery group. In addition to that, there has been some reports which showed clinical complete remission after neoadjuvant chemoradiation therapy could be wait and see. A couple of observational studies showed wait and see can be possible option of treatment in selective patients. Radial surgery for middle and low rectal cancer still remains a cornerstone of surgical treatment Ultralow anterior resection with or without intersphincteric resection became a more standard surgical method for low rectal cancer. Oncologic and functional outcomes has been reported as safe even functional outcomes study was rare. Furthermore, Abdominoperineal resection has been famous for high intraoperative tumor perforation and positive circumferential resection margin, those factors have been contributed to the high rate of local recurrence and poor survival rate compared with sphincter saving procedures for rectal cancer. Recently, there have been great efforts for reducing theses problem and total levator excision or extended abdominoperineal resection concepts emerged. Surgeons who advocated this concept recommended perineal dissection under the Jack-knife position. Surgical management for low rectal cancer should be directed for radically and preserving function based on multimodality approach. We need more high level of evidence based on prospective clinical trials for tailored treatment of rectal cancer patients

To explore the imaging manifestations and clinical application value of contrast-enhanced ultrasound (CEUS) in liver metastases of middle and low rectal cancer by performing CEUS in patients. Additionally, we compared the results of CEUS with those of abdominal contrast-enhanced computed tomography (CECT) to assess the reliability of diagnosing liver metastases in patients with middle and low rectal cancer. Hepatic CEUS was performed in 1095 patients with middle and low rectal cancer, and all patients underwent abdominal CECT examinations to determine the presence or absence of liver metastases. The results of both examinations were compared to evaluate the value of hepatic CEUS for detecting liver metastases in patients with middle and low rectal cancer. Among 1095 patients with middle and low rectal cancer, 132 were diagnosed with liver metastases of middle and low rectal cancer. 130 cases of liver metastases of rectal cancer were identified using hepatic CEUS, whereas 126 cases were identified using abdominal CECT. The detection rates of hepatic CEUS and abdominal CECT for liver metastases of middle and low rectal cancer showed no statistically significant differences (P > 0.05). The Kappa value for the diagnosis of liver metastases of middle and low rectal cancer between hepatic CEUS and abdominal CECT was 0.974 (P < 0.001), indicating good consistency between the two imaging modalities in detecting liver metastases of middle and low rectal cancer. Hepatic CEUS can be used to diagnose liver metastases in middle and low rectal cancer, providing crucial imaging evidence for clinical treatment planning. It exhibited higher sensitivity than that of abdominal CECT in diagnosing liver metastases of middle and low rectal cancer, enabling the identification of higher number of liver metastases of middle and low rectal cancer cases.

Chapter 169 - Abdominoperineal Resection for Rectal Cancer

PurposeThe purpose of this study is to evaluate the short-term clinical and oncological outcome of prolonging operation interval to 11 weeks after the end of radiotherapy for locally advanced middle and low rectal cancer.MethodsA total of 123 patients with stage II/III (cT3/T4 or N+) low and middle rectal cancer who had undergone operation after neoadjuvant chemoradiotherapy were selected. According to the interval time between the last radiotherapy and operation, they were assigned to a short-interval group (SG, <11 weeks, n=66) and long-interval group (LG, ≥11 weeks, n=57). The relations among interval time and short-term clinical outcome and oncological outcome were analyzed.ResultsThe analysis found that basic information, clinical characteristics, and preoperative treatment between the two groups had no significant difference. There were no differences in operation time, estimated intraoperative blood loss and postoperative complications. The rate of sphincter preservation in the low and middle rectum was 66.7% in the short-interval group and 59.7% in the long-interval group (P=0.42). The incidence of anastomotic leak in the long-interval group was higher than that in the short-interval group (P=0.08). There was no significant difference in the recovery time of intestinal function and median duration of hospitalization between the two groups. The pathological complete remission rate was 17.07%. Multivariate analysis showed interval time had no influence on pathological complete remission. There was no significant difference in 3-year overall survival and 3-year disease-free survival between the two groups. The risk of recurrence and metastasis in patients with positive lymph nodes was higher than those with negative lymph nodes (P<0.05), HR=4.812 (95% CI 2.4–9.648).ConclusionProlonging the interval time of operation to 11 weeks after neoadjuvant chemoradiotherapy for middle and low rectal cancer does not improve the pathologic complete remission, morbidity, and mortality. There was no significant effect on oncologic outcome after prolonging the operation interval. Therefore, it is safe to prolong the interval of operation to 11 weeks.

To compare perioperative results of optimized laparoscopic and robotic TME for middle and low rectal cancer. A single-center retrospective non-randomized study included 100 patients with middle and low rectal cancer who underwent TME between 2018 and 2024 (65 patients - da Vinci Si unit, 35 patients - laparoscopic TME). Perioperative results were similar. The robotic surgery group had patients with lower tumors (4.7±1.9 vs. 5.8±1.8 cm, p=0.005). Mean surgery time was longer in the robotic surgery group (274.4±46.6 vs. 257.7±47.8 min, p=0.04). Postoperative complications occurred in 15 (23.1%) and 10 (28.6%) patients, respectively (p=0.56). Perioperative results of robotic and laparoscopic total mesorectal excision are comparable. Unification of these accesses allows equally effective minimally invasive surgical treatment of patients with low and middle rectal cancer.

Background: The aim of surgical treatment in cases of carcinoma of the distal rectum is to save the anal sphincter, decrease the number of postoperative complications and limit the risk of reoperation. Therefore, mechanical /stapler/ anastomosis is currently widely used. In our study we discussed the complications and the preconditions leading to them, when manual and mechanical anastomosis are performed. We clarified the role of extraperitonization of anastomosis and drainage. Aim: To analyze the early postoperative results - the leakage rate when performing manual and mechanical anastomosis following resection of the lower rectum. We aimed to estimate the significance of extraperitonization of the anastomosis and the drainage in the postoperative period. Materials and Methods: In the period January 1, 1995 - December 31, 2015, in the Clinic of General and Liver-Pancreatic Surgery, 389 patients with rectal carcinoma, who suffered frontal rectal resection, were operated on.Results: Out of the 389 patients, 216 /55.52%/ were male and 173 /44.48%/ - females. Mechanical suture anastomosis was performed on 183 /47.04%/, and a handmade one - on 206 /52.96%/. Anastomosis leakage was registered in 58 cases /14.91%/. From those, with mechanical suturing were 34 /18.57%/, and with handmade anastomosis - 14 /6.79%/. There were two cases of relaparotomy and no deceased patients with this complication for the researched period.Conclusions: Mechanical staplers give the opportunity to keep anastomosis at the possible lower limit, almost impossible for manual suturing. But even with mechanical suturing, we face the risk of anastomosis leakage. This is why we think that the extraperitonization of anastomosis is a reliable prevention of reoperation and fecal peritonitis.

Objective: to analyze the outcomes of sphincter-sparing surgeries in patients with advanced distal rectal cancer depending on the therapy they receive.Materials and methods. This study included 289 patients with advanced (stage T3N0–2M0) distal rectal cancer who have undergone sphincter-sparing surgeries. Patients were divided into three groups according to their treatment scheme. In group 1, we used combination treatment that included a short course of neoadjuvant radiotherapy supplemented by 3 multidirectional radiomodifiers (local microwave hyperthermia, rectal administration of a biopolymer composition containing metronidazole, and chemotherapy with capecitabine). Patients in group 2 received combination treatment that included neoadjuvant radiotherapy alone. Treatment outcomes in patients receiving combination therapy was compared to those of patients with similar characteristics and location of rectal tumors who have undergone surgery alone in N. N. Blokhin National Medical Research Center of Oncology (group 3).Results. We observed a significant decrease in the incidence of locoregional cancer metastasis in patients from group 1 compared to those from groups 2 and 3 (0.8 % vs 7.9 % and 18.2 % respectively). Moreover, patients in group 1 demonstrated better relapse-free survival than participants in groups 2 and 3 (79.6 % vs 52.6 % and 51 % respectively). The new scheme of combination therapy developed by our team (used in group 1) did not increase the incidence of postoperative complications. The best local disease control in group 1 was achieved in patients with middle rectal cancer who have undergone sphincter-sparing surgeries: none of 81 patients developed relapses, whereas the relapse-free survival rate reached 83 % compared to 56.9 % in group 1 and 41.7 % in group 3.Conclusions. The new treatment scheme that includes neoadjuvant radiotherapy supplemented by 3 multidirectional radiomodifiers can be used as one of the options increasing efficacy of radiotherapy and, therefore, efficacy of combination treatment in patients with advanced rectal cancer who undergo sphincter-sparing surgeries.