rpmjResearch'n Practical Medicine JournalResearch and Practical Medicine Journal2410-1893"QUASAR", LLC10.17709/2409-2231-2015-2-3-19-24rpmj-78Research ArticleОригинальные статьи. ХирургияOriginal Articles. SurgeryЦИЛИНДРИЧЕСКАЯ БРЮШНО-ПРОМЕЖНОСТНАЯ ЭКСТИРПАЦИЯ ПРЯМОЙ КИШКИ: НЕПОСРЕДСТВЕННЫЕ РЕЗУЛЬТАТЫ И НЕРЕШЕННЫЕ ВОПРОСЫTHE CYLINDRICAL ABDOMINOPERINEAL RESECTION: SHORT-TERM RESULTS AND OUTSTANDING ISSUESЧерниченкоМ. А.ChernichenkoM. A.

аспирант абдоминального отделения МНИОИ им. П.А. Герцена - филиал ФГБУ «НМИРЦ» Минздрава России

post graduate of abdominal department, P. Hertsen MORI

dvsidorov_65@mail.ruБойкоА. В.BoykoA. V.

д.м.н., проф., главный научный сотрудник отделения радиологии МНИОИ им. П.А. Герцена - филиал ФГБУ «НМИРЦ» Минздрава России

MD, prof, leading researcher of radiologicaldepartment, P. Hertsen MORI

dvsidorov_65@mail.ruСидоровД. В.SidorovD. V.

д.м.н., руководитель абдоминального отделения МНИОИ им. П.А. Герцена - филиал ФГБУ «НМИРЦ» Минздрава России

MD, head of abdominal department, P. Hertsen MORI

dvsidorov_65@mail.ruПетровЛ. О.PetrovL. O.

к.м.н., научный сотрудник абдоминального отделения МНИОИ им. П.А. Герцена - филиал ФГБУ «НМИРЦ» Минздрава России

PhD, researcher of abdominal department, P. Hertsen MORI

dvsidorov_65@mail.ruМНИОИ им. П.А. ГерценаРоссияP. Hertsen MORI (Moscow, Russian Federation)Russian Federation201501102015231924Copyright © Черниченко М.А., Бойко А.В., Сидоров Д.В., Петров Л.О., 20152015Черниченко М.А., Бойко А.В., Сидоров Д.В., Петров Л.О.Chernichenko M.A., Boyko A.V., Sidorov D.V., Petrov L.O.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.rpmj.ru/rpmj/article/view/78Резюме

Резюме:

Цель исследования

Цель исследования. Проанализировать непосредственные результаты лечения пациентов после выполнения цилиндрической брюшно-промежностной экстирпации прямой кишки.

Материалы и методы

Материалы и методы. Представлены собственные результаты хирургического и комбинированного лечения 20 пациентов с местно-распространенным нижнеампулярным раком прямой кишки с применением методики ЦБПЭ.

Основные результаты

Основные результаты. Анализ непосредственных результатов ЦБПЭ показал высокую частоту послеоперационных осложнений, особенно в группе больных, перенесших комбинированное лечение, что с одной стороны, диктует необходимость тщательного отбора пациентов для выполнения данного типа вмешательств, а с другой стороны побуждает совершенствовать технику выполнения операций.

Заключение

Заключение. Выполнение цилиндрических брюшно-промежностных экстирпаций прямой кишки позволяет достичь хорошего локального контроля у больных местно-распространенным раком нижнеампулярного отдела прямой кишки.

Abstract

Abstract:

Objective

Objective. Analysis of short-term outcomes patients with low rectal cancer after cylindrical abdominoperineal resection.

Materials and methods

Materials and methods. This study enrolled 20 patients with locally advanced low rectal cancer who underwent preoperative chemoradiotherapy and surgery or surgery alone after using the technique of CAPE.

Results

Results. Analysis of short-term outcomes after CAPE showed a high frequency of postoperative complications, especially in group of patients who underwent preoperative chemoradiotherapy. On the one hand it dictates need for careful patient selection for this type of operation, and on the other hand encourages us to improve the technique of operations.

Conclusions

Conclusions. The cylindrical abdominoperineal resection allows to achieve good local control in patients with locally advanced low rectal cancer.

рак нижнеампулярного отдела прямой кишкицилиндрическая брюшно-промежностная экстирпация прямой кишкициркулярный край резекцииlow rectal cancercylindrical abdominoperineal extirpation of the rectumcircumferential resection marginReferencesHeald R.J., Husband E.M., Ryall R.D. The mesorectum in rectal cancer surgery – the clue to pelvic recurrence? Br. J. Surg. 1982; 69(10): 613-616.Heald R.J., Husband E.M., Ryall R.D. The mesorectum in rectal cancer surgery – the clue to pelvic recurrence? Br. J. Surg. 1982; 69(10): 613-616.den Dulk M., Marijnen C.A., Collette L., et al. Multicentre analysis of oncological and survival outcomes following anastomotic leakage after rectal cancer surgery. Br J Surg. 2009; Sep; 96(9): 1066-75.den Dulk M., Marijnen C.A., Collette L., et al. Multicentre analysis of oncological and survival outcomes following anastomotic leakage after rectal cancer surgery. Br J Surg. 2009; Sep; 96(9): 1066-75.MacFarlane J.K., Ryall R.D., Heald R.J. Mesorectal excision for rectal cancer. Lancet. 1993; 341: 457-460.MacFarlane J.K., Ryall R.D., Heald R.J. Mesorectal excision for rectal cancer. Lancet. 1993; 341: 457-460.Martling A.L., Holm T., Rutvist L.E., et al. Effect of a surgical training programme on outcome of rectal cancer in the Contry of Stockholm. Stockholm Colorectal cancer Study Group, Basingstoke Bowel Cancer Research Project. Lancet. 2000; 356 (9224): 93-96.Martling A.L., Holm T., Rutvist L.E., et al. Effect of a surgical training programme on outcome of rectal cancer in the Contry of Stockholm. Stockholm Colorectal cancer Study Group, Basingstoke Bowel Cancer Research Project. Lancet. 2000; 356 (9224): 93-96.Heald R.J., Morgan B.J., Ryall R.D.H., et al. Rectal cancer: The Basingstoke experience of total mesorectal excision, 1978-1997. Arch. Surg. 1998; 133: 894-899.Heald R.J., Morgan B.J., Ryall R.D.H., et al. Rectal cancer: The Basingstoke experience of total mesorectal excision, 1978-1997. Arch. Surg. 1998; 133: 894-899.Havenga K., Enker W.E., Norstein J., et al. Improved susvival and local control after totalmesorectal excision or D3 lymphadenectomy in the treatment of primary rectal cancer: an international analysis of 1411 patients. Eur. J. Surg. Oncol. 1999; 25: 368-374.Havenga K., Enker W.E., Norstein J., et al. Improved susvival and local control after totalmesorectal excision or D3 lymphadenectomy in the treatment of primary rectal cancer: an international analysis of 1411 patients. Eur. J. Surg. Oncol. 1999; 25: 368-374.Visser O., Bakx R., Zoetmulder F.A. et al. The influence of total mesorectum excision on local recurrence and survival in rectal cancer patients: a population-based study in Greater Amsterdam. J. Surg. Oncol. 2007; 95: 447-454.Visser O., Bakx R., Zoetmulder F.A. et al. The influence of total mesorectum excision on local recurrence and survival in rectal cancer patients: a population-based study in Greater Amsterdam. J. Surg. Oncol. 2007; 95: 447-454.Den Dulk M., Krijnen C.A., Marijnen C.A., et al. Improved overall survival for patients with rectal cancer since 1990: the effects of TME surgery and pre-operative radiotherapy. Eur. J. Cancer. 2008; 44: 1710-1716.Den Dulk M., Krijnen C.A., Marijnen C.A., et al. Improved overall survival for patients with rectal cancer since 1990: the effects of TME surgery and pre-operative radiotherapy. Eur. J. Cancer. 2008; 44: 1710-1716.Kapiteijn E., Putter H., van de Velde C.J., et al. Cooperative investigations of the Dutch Colorectal Cancer Group. Impact of the introduction and training of total mesorectal excision on recurrence and survival in rectal cancer in the Netherlands. Br. J. Surg. 2008; 89: 1142-1149.Kapiteijn E., Putter H., van de Velde C.J., et al. Cooperative investigations of the Dutch Colorectal Cancer Group. Impact of the introduction and training of total mesorectal excision on recurrence and survival in rectal cancer in the Netherlands. Br. J. Surg. 2008; 89: 1142-1149.Wibe A., Møller B., Norstein J., et al. A national strategic change in treatment policy for rectal cancer – implementation of total mesorectal excision as routine treatment in Norway. A national audit. Dis. Colon Rectum. 2002; 45: 857-866.Wibe A., Møller B., Norstein J., et al. A national strategic change in treatment policy for rectal cancer – implementation of total mesorectal excision as routine treatment in Norway. A national audit. Dis. Colon Rectum. 2002; 45: 857-866.Martijn H., Voogd A.C., van de Poll-Franse L.V., et al. Improved survival of patients with rectal cancer since 1980: a populationbased study. Eur. J. Cancer. 2003; 39: 2073-2079.Martijn H., Voogd A.C., van de Poll-Franse L.V., et al. Improved survival of patients with rectal cancer since 1980: a populationbased study. Eur. J. Cancer. 2003; 39: 2073-2079.Faerden A.E., Naimy N., Wiik P., et al. Total mesorectal excision for rectal cancer: difference in outcome for low and high rectal cancer. Dis. Colon Rectum. 2005; 48: 2224-2231.Faerden A.E., Naimy N., Wiik P., et al. Total mesorectal excision for rectal cancer: difference in outcome for low and high rectal cancer. Dis. Colon Rectum. 2005; 48: 2224-2231.Yuan H.Y., Li Y., Yang G.L., et al. Study on the causes of local recurrence of rectal cancer after curative resection: analysis of 213 cases. World J. Gastroenterol. 1998; 4: 527-529.Yuan H.Y., Li Y., Yang G.L., et al. Study on the causes of local recurrence of rectal cancer after curative resection: analysis of 213 cases. World J. Gastroenterol. 1998; 4: 527-529.Cai Y., Li Z., Gu X., et al. Prognostic factors associated with locally recurrent rectal cancer following primary surgery (Review) Oncol Lett. 2014; 7: 10-16.Cai Y., Li Z., Gu X., et al. Prognostic factors associated with locally recurrent rectal cancer following primary surgery (Review) Oncol Lett. 2014; 7: 10-16.Wibe A., Syse A., Andersen E., et al. Norwegian Rectal Cancer Group. Oncological outcomes after total mesorectal excision for cure for cancer of the lower rectum: anterior vs. abdominoperineal resection. Dis. Colon Rectum. 2004; 47(1): 48-58.Wibe A., Syse A., Andersen E., et al. Norwegian Rectal Cancer Group. Oncological outcomes after total mesorectal excision for cure for cancer of the lower rectum: anterior vs. abdominoperineal resection. Dis. Colon Rectum. 2004; 47(1): 48-58.Bülow S., Christensen I.J., Iversen L.H. and Harling H. Danish Colorectal Cancer Group: Intraoperative perforation is an important predictor of local recurrence and impaired survival after abdominoperineal resection for rectal cancer. Colorectal Dis. 2011; 13: 1256-1264.Bülow S., Christensen I.J., Iversen L.H. and Harling H. Danish Colorectal Cancer Group: Intraoperative perforation is an important predictor of local recurrence and impaired survival after abdominoperineal resection for rectal cancer. Colorectal Dis. 2011; 13: 1256-1264.Eriksen M.T., Wibe A., Syse A., et al. Inadvertent perforation during rectal cancer resection in Norway. Br J Surg. 2004; 91: 210-216.Eriksen M.T., Wibe A., Syse A., et al. Inadvertent perforation during rectal cancer resection in Norway. Br J Surg. 2004; 91: 210-216.Jatzko G.R., Jagoditsch M., Lisborg P.H., et al. Long-term results of radical surgery for rectal cancer: multivariate analysis of prognostic factors influencing survival and local recurrence. Eur. J. Surg. Oncol. 1999; 25: 284-291.Jatzko G.R., Jagoditsch M., Lisborg P.H., et al. Long-term results of radical surgery for rectal cancer: multivariate analysis of prognostic factors influencing survival and local recurrence. Eur. J. Surg. Oncol. 1999; 25: 284-291.Holm T., Ljung A., Häggmark T., et al. Extended abdominoperineal resection with gluteus maximus flap reconstruction of the pelvic floor for rectal cancer. Br. J. Surg. 2007; 94(2): 232-238. 20. Holm T. Controversies in abdominoperineal excision. Surg. Oncol. Clin. N. Am. 2014; 23(1): 93-111.Holm T., Ljung A., Häggmark T., et al. Extended abdominoperineal resection with gluteus maximus flap reconstruction of the pelvic floor for rectal cancer. Br. J. Surg. 2007; 94(2): 232-238. 20. Holm T. Controversies in abdominoperineal excision. Surg. Oncol. Clin. N. Am. 2014; 23(1): 93-111.Huang A., Zhao H., Ling T., et al. Oncological superiority of extralevator abdominoperineal resection over conventional abdominoperineal resection: a meta-analysis. Int. J. Colorectal Dis. 2014; 29(3): 321-327.Huang A., Zhao H., Ling T., et al. Oncological superiority of extralevator abdominoperineal resection over conventional abdominoperineal resection: a meta-analysis. Int. J. Colorectal Dis. 2014; 29(3): 321-327.Jiang H.Y., Zhou Y.B., Zhang D.F. Meta-analysis of extralevator abdominoperineal excision and conventional abdominoperineal excision for low rectal cancer. Zhonghua Wei Chang Wai Ke Za Zhi. 2013; 16(7): 622-627.Jiang H.Y., Zhou Y.B., Zhang D.F. Meta-analysis of extralevator abdominoperineal excision and conventional abdominoperineal excision for low rectal cancer. Zhonghua Wei Chang Wai Ke Za Zhi. 2013; 16(7): 622-627.Vaughan-Shaw P.G., Cheung T., Knight J.S., et al. Mirnezami A.H. A prospective case-control study of extralevator abdominoperineal excision (ELAPE) of the rectum versus conventional laparoscopic and open abdominoperineal excision: comparative analysis of short-term outcomes and quality of life. Tech. Coloproctol. 2012; 16(5): 355-362.Vaughan-Shaw P.G., Cheung T., Knight J.S., et al. Mirnezami A.H. A prospective case-control study of extralevator abdominoperineal excision (ELAPE) of the rectum versus conventional laparoscopic and open abdominoperineal excision: comparative analysis of short-term outcomes and quality of life. Tech. Coloproctol. 2012; 16(5): 355-362.Asplund D., Haglind E., Angenete E. Outcome of extralevator abdominoperineal excision compared with standard surgery: results from a single centre. Colorectal Dis. 2012; 14(10):1191-1196.Asplund D., Haglind E., Angenete E. Outcome of extralevator abdominoperineal excision compared with standard surgery: results from a single centre. Colorectal Dis. 2012; 14(10):1191-1196.Krishna A., Rickard M.J., Keshava A., et al. A comparison of published rates of resection margin involvement and intraoperative perforation between standard and ‘cylindrical’ abdominoperineal excision for low rectal cancer. Colorectal Dis. 2013; 15(1): 57-65.Krishna A., Rickard M.J., Keshava A., et al. A comparison of published rates of resection margin involvement and intraoperative perforation between standard and ‘cylindrical’ abdominoperineal excision for low rectal cancer. Colorectal Dis. 2013; 15(1): 57-65.Stelzner S., Hellmich G., Schubert C., et al. Short-term outcome of extra-levator abdominoperineal excision for rectal cancer. Int. J. Colorectal Dis. 2011; 26(7): 919-25.Stelzner S., Hellmich G., Schubert C., et al. Short-term outcome of extra-levator abdominoperineal excision for rectal cancer. Int. J. Colorectal Dis. 2011; 26(7): 919-25.Stelzner S., Koehler C., Stelzer J., et al. Extended abdominoperineal excision vs. standard abdominoperineal excision in rectal cancer- a systematic overview. Int. J. Colorectal Dis. 2011; 26(10): 1227-1240.Stelzner S., Koehler C., Stelzer J., et al. Extended abdominoperineal excision vs. standard abdominoperineal excision in rectal cancer- a systematic overview. Int. J. Colorectal Dis. 2011; 26(10): 1227-1240.

The authors declare that there are no conflicts of interest present.