POSSIBILITIES OF SURGICAL TREATMENT IN PATIENTS WITH LOCALLY ADVANCED RECTAL CANCER WITH INVOLVEMENT OF THE POSTERIOR URINARY BLADDER WALL

Abstract

The aim of investigation is the optimization of surgical treatment of patients with locally advanced rectal cancer with the involvement of posterior wall of urinary bladder. Materials and methods. The basis of investigation is the analysis of results of combined treatment of 67 patients with locally advanced rectal cancer involving triangle and cervix of urinary bladder. Radical operations of different volume were carried out in the department of common surgery during a period from 2000 till 2010. All patients had Т3–4N0–2M0 rectal cancer. Following types of surgery have been performed: 1. Ultra-low anterior resection with coloanal anastomosis or abdomino-perineal excision combined with resection of 2/3 of urinary bladder — main group (44 patients); 2. Pelvic exenteration — control group (23 patients). Results. The application of combined surgical intervention with the resection of posterior wall of urinary bladder didn’t lead to the increased post operative complications rate, which were diagnosed in 1 (2.27 %) of 44 patients in the main group. The patients, which had the operative treatment in the volume of pelvic exenteration (control group), had a complication rate of 4.34 % (1 patient). In both cases, pelvic abscess of with a favorable outcome took place. Three-year disease-free survival rate in main investigated group was 55.3 %, in control group (23 patients) — 74 %. Conclusion. The investigation showed that pelvic exenteration for locally advanced rectal cancer involving posterior wall of the bladder is not always justified. We consider, that it’s more reasonable to save even small part of urinary bladder for the better patients rehabilitation.