Возможности сфинктеросохраняющего лечения больных местно-распространенным первично-неоперабельным раком прямой кишки

The aim of this study was to compare results of sphincter-sparing operations (SSO) and abdominoperineal resections (APR) in patients  undergoing combined treatment for unresectable locally-advanced rectal cancer.

Methods. During September 2007 – January 2011 59 patients were enrolled. Original treatment scheme (RF patent № 2414936) was developed including radiotherapy 40 Gy in 4 Gy fractions, capecitabine 650 mg/m2 bid per os days 1-22, oxaliplatin 50 mg/m2 iv days 3, 10, 17, local hyperthermia on days 8, 12, 15, 17, 2 applications of metronidazole 10 g/m2 per rectum in a polymeric composition. Surgery was carried out following 6–8 weeks. SSO were carried out in 36 patients, APR in 23 patients. Study endpoints included 2-year OS and DFS, local recurrence and distant metastases rate, postoperative complications rate.

Results. No significant differences in survival were observed: 2-year OS was 93.2 and 85.6 % (log- rank test p = 0.157) for SSO and APR groups accordingly, 2-year DFS was 88 and 71.9 % (log-rank test p = 0.064). Four (11.1 %) patients in SSO group and 4 (17.4 %) patients in APR group (р = 0.5511) developed local recurrences, 4 (11.1 %) and 7 (30.4 %) (р = 0.1293) developed distant metastases. Postoperative complications rate was 27.8 % (n = 10) and 39.1 % (n = 9) (р = 0.5181) in SSO and APR groups accordingly.

Conclusions. Sphincter-sparting surgery is justified for unresectable locally advanced rectal cancer when technically feasible.

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