Abstract
The purpose of the study: to analyze short-term efficacy and tolerability of preoperative chemotherapy in patients with upper ampullary rectal carcinoma. Material and methods. A prospective study conducted at the cancer research institute (tomsk, russia) between 2018 and 2020 included 47 patients with operable cancer of the upper ampullary part of the rectum with mrt3n0m0 (mesorectal fascia involvement (crm+) or low-grade cancer), mrt4аn0m0 and mrt3–4аn1m0. All patients were divided into two groups. Group i comprised 22 patients, who received 3 cycles of chemotherapy with folfox-4 followed by surgery. Group ii consisted of 25 patients, who underwent surgery alone. All patients underwent arterior resection of the rectum. Results. Group i patients completed all three cycles of preoperative chemotherapy. Downstaging after chemotherapy was observed in 16 (72.7 %) patients. No severe side effects of chemotherapy were found. The frequency of radical surgeries (r0) was 100 %. No significant differences in the rate of postoperative complications between the treatment groups were observed (18.2 % and 16 %, respectively, p>0.05). There were no cases of postoperative mortality. Conclusion. Compared with surgery alone, preoperative chemotherapy followed by surgery demonstrates a high short-term efficacy, does not adversely affect the course of the perioperative period.
Highlights
Предоперационная химиотерапия позволяет оценить чувствительность опухоли к цитостатикам in vivo, оказывает раннее воздействие на субклинические микрометастазы, сокращает объем первичной опухоли и повышает её резектабельность
Group I comprised 22 patients, who received 3 cycles of chemotherapy with FOLFOX-4 followed by surgery
Group II consisted of 25 patients, who underwent surgery alone
Summary
Химиотерапия + операция/ Chemotherapy + surgery (n=22) Пол/Gender 13 (59,1 %) 9 (40,9 %) 58,9 (43–72) Стадия/Stage 3 (13,6 %) 4 (18,2 %) 15 (68,2 %). Результаты Предоперационная химиотерапия в запланированном объеме была завершена у всех 22 (100 %) больных основной группы; таким образом, всего было проведено 66 курсов химиотерапии. При анализе эффективности предоперационной химиотерапии выявлено снижение распространенности опухолевого процесса по первичному очагу (Т) у 12 (54,5 %) больных и по регионарным лимфатическим узлам (N) у 4 (18,2 %) больных В послеоперационном периоде при T4 и N+ у 18 (81,8 %) больных в основной группе и у 22 (88 %) больных в группе контроля проводилась адъювантная химиотерапия по схеме FOLFOX-4 общей длительностью до 6 мес, включая время предоперационного лечения. Обсуждение Выживаемость больных РПК после хирургического лечения зависит от исходной распространенности опухолевого процесса: если при T1–2 5-летняя выживаемость достигает 80–90 %, то при T3–4 она существенно снижается и не превышает 20–30 %. The frequency of postoperative complications according to the Slavien – Dindo scale (2004)
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