COMBINED APPROACH IN THE TREATMENT OF MIDDLE RECTAL CANCER: EXPERIENCE AND PERSPECTIVES Sarimbekn@list.ru

 

COMBINED APPROACH IN THE TREATMENT OF MIDDLE RECTAL CANCER: EXPERIENCE AND PERSPECTIVES

3

Uzbekistan

Oral or Poster

Background. Middle rectal cancer is characterized by a high frequency of local spread (up to 80% stage III), technical difficulties in achieving surgical ablastics within the pelvic cavity, and a significant risk of locoregional recurrence. Despite the development of sphincter-preserving operations, the recurrence rate after surgery alone remains high, necessitating the search for combined treatment methods.

Materials and methods. A prospective randomized study was conducted at the Department of Oncocoloproctology, including more than 740 patients with middle rectal cancer. Among them, 350 patients underwent preoperative large-fraction radiotherapy (total dose 25 Gy, 5 Gy daily for 5 days), followed by surgical intervention.

Results. Sphincter-preserving operations were performed in 71.8% of patients while maintaining oncological radicality. The frequency of locoregional recurrences after combined treatment significantly decreased from 22.1% to 10.1%, and the 5-year disease-free survival rate increased by 15.1%. The most pronounced effect was observed in patients with T3 tumors and metastatic involvement of regional lymph nodes. Discussion. Comparative analysis showed that abdominoperineal resection provides no oncological advantage over abdominoanal resection, while the latter allows sphincter preservation. Preoperative hypofractionated radiotherapy enhances the efficacy of sphincter- preserving surgery and reduces the risk of tumor cell dissemination.

Conclusions. Surgery alone has limited potential in the treatment of middle rectal cancer. Combined therapy with preoperative hypofractionated radiotherapy should be considered the method of choice, especially when planning sphincter-preserving operations.