Laparoscopic technologies in the treatment of patients with locally advanced rectal cancer: The possibilities and prospects
Abstract
Introduction: To improve the results of treatment of patients with locally advanced rectal cancer by using a combined approach in the treatment with the use of minimally invasive technologies. Methods: The study included 39 patients with locally advanced rectal cancer in the stage of cT3-4 cN0-2 cM0-1 treated at the Department of Oncology and Radiology of the Tashkent Medical Academy from 2014 to 2017. Radiation therapy was performed using the classical fractionation of the dose at the RPM of 2 Gy, 5 days a week, up to a total of 50 Gy. Chemotherapy: oxaliplatin 50 mg/m 2 IV on days 1, 8, 22, 29 and capecitabine at a dose of 825 mg/m 2 2 times a day from 1 to 14 and from 22 to 33 days of radiotherapy. Evaluation of the rectal tumor response to chemoradiotherapy was performed after 8-10 weeks, based on pelvic MRI findings, and according to the mrTRG criteria (Brown G.). The surgical stage was carried out in accordance with modern principles of surgery for rectal cancer: high vasoconstriction, total or partial mesorectomyectomy, nerve-preserving interventions. Adjuvant therapy: was performed by all patients, except patients with stage ypT0N0, in standard regimens. Results: The study included 39 patients with locally advanced rectal cancer in the stage of cT3-4 cN0-2 cM0-1 treated at the Department of Oncology and Radiology of the Tashkent Medical Academy from 2014 to 2017. Radiation therapy was performed using the classical fractionation of the dose at the RPM of 2 Gy, 5 days a week, up to a total of 50 Gy. Chemotherapy: oxaliplatin 50 mg/m 2 IV on days 1, 8, 22, 29 and capecitabine at a dose of 825 mg/m 2 2 times a day from 1 to 14 and from 22 to 33 days of radiotherapy. The surgical stage was carried out in accordance with modern principles of surgery for rectal cancer: high vasoconstriction, total or partial mesorectomyectomy, nerve-preserving interventions. Adjuvant therapy: was performed by all patients, except patients with stage ypT0N0, in standard regimens. Conclusion: Disadvantages of laparoscopic interventions: increase in the duration of the operation (p < 0.05); difficulty in visualization in the small pelvis due to the size of the tumor; The presence of edema of tissues after chemoradiotherapy; lack of tactile sensitivity in determining the level of rectal resection and the presence of tumor invasion in neighboring structures; cost of consumables. Advantages: low traumatism; early activation of the patient; reduction of postoperative blood pressure (p < 0.01); previously started adjuvant or curative chemotherapy; Requirements: thorough preoperative diagnosis of the prevalence of the tumor in order to determine the critical organs in relation to the line the proposed resection; preparation and coordinated work of the operating team, anesthesiologist; availability of energy devices for the quality of surgical intervention. Prospects: increased use of laparoscopy in the treatment of patients with rectum cancer; introduction in practice of multivisceral resections.