Diagnosis and selection of method of combined treatment of local-distributed cancer of the rectum with invasion into organs of the genitals

Introduction: Diagnosis optimization and treatment choice of the locally advanced rectal cancer with invasion in the organs of the genitals. Methods: We analyzed the results of combined operations for rectal cancer with invasion in the genital organs, for 2013-2017 on the basis of the Department of Oncology and Radiology of the Tashkent Medical Academy. Under our supervision, there were 118 women aged 21 to 68 years. Methods of examination of patients included the following: colonoscopy with biopsy, irrigoscopy, transrectal ultrasonography (TRUS), CT, hysteroscopy. 12 patients underwent hormonal status examination. The tumor in the rectosigmoid section of the rectum was in 12 patients, in the upper ampullar department in 17 patients, in the middle-ampullar department in 32 patients, in the lower ampullar department in 45 patients, in the anal canal in 12 patients. The nature of operations on the rectum with combined surgical interventions was as follows: abdominal perineal extirpation of the rectum with sigmostomy was performed in 57 patients (48.3%), abdominal-anal rectal resection in 22 patients (18.6%), anterior resection of the rectum in 12 patients (10.2%), Hartmann's operation was performed in 27 patients (22.9%). Results: Vaginal resections were performed most often in 58 patients, nasal amputation of the uterus without appendages in 21, extirpation of the uterus with appendages in 22 patients, removal of the uterine appendages in 31 patients. It should be noted that more than one organ was resected or removed in 14 patients from these patients. It is important to note that the metastatic lesion of regional lymph nodes was established in 28.0% of patients (in 33 of 118), whereas for all radically operated patients this indicator was 29.1%. Postoperative complications of a purulent-inflammatory nature occurred in 21 patients (17.7%). The overall lethality was 3.4%, 4 patients from 118 patients died after combined operations. The incidence of relapse after combined operations for colorectal cancer was 28%. The average duration without a relapse period was 14 months. 5-year survival after combined operations with locally advanced rectal cancer in our observations was 47.1%. Conclusion: Thus, the data presented indicate that such important indicators as the rate of recurrence (28%), 5-year survival (47.1%), with combined interventions and standard volume operations for colon cancer are approximately the same. Given that the true invasion of a tumor into neighboring structures can often be established only after histological examination of a distant macro preparation and that combined surgical interventions currently do not actually worsen the immediate results of treatment (according to the number of postoperative complications and lethality from them), then the expediency of their implementation in our opinion there is no doubt.

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