Oncology

doi: 10.25005/2074-0581-2020-22-1-82-90
EXPERIENCE OF MULTIVISCERAL RESECTIONS IN LOCALLY ADVANCED AND PRIMARY-MULTIPLE RECTAL CANCER

S.G. Afanasyev1, I.B. Khadagaev2, S.A. Fursov3,4, E.A. Usynin1, A.K. Gorbunov1, U.B. Urmonov1, A.V. Usova1, A.V. Avgustinovich1, A.S. Tarasova1

1Cancer Research Institute, Tomsk National Research Medical Center, Russian Academy of Sciences, Tomsk, Russian Federation
2Novosibirsk Regional Clinical Oncology Center, Novosibirsk, Russian Federation
3A.I. Yevdokimov Moscow State University of Medicine and Dentistry, Moscow, Russian Federation
4Bakhrushin Brothers City Clinical Hospital, Moscow, Russian Federation

Objective: Assessing short-term and long-term results of multivisceral resections (MVR) performed for rectal cancer (RC) with invasion into adjacent pelvic organs, as well as the effectiveness of bladder reconstruction with the formation of a urinary reservoir of «low» pressure.

Methods: The work was based on the results of surgical treatment of 37 patients with locally advanced or primary multiple RC underwent MVR. Invasion of adjacent small organs was observed in 89.2%, primary multiple malignant tumors (PMMT) – in 10.8% of patients included in the study.

Results: According to the preoperative examination of tumor infiltration of one adjacent organ was diagnosed in 20 (54.1%), two or more organs – in 17 (45.9%) observations; more often affected the bladder – in 18 (48.6%) cases. Volumes of performed operations: in 6 (16.2%) cases of complete pelvic organs evisceration, in 10 (27%) cases of MVR with rectal extirpation, in 21 (56.8%) cases of MVR with resection of the rectum and adjacent organs. More often in 27 (72.9%) patients, there was urinary tract resection, of which 11 (29.7%) patients underwent primary bladder repair with the formation of ortho- (n=3) or heterotopic (n=6) urinary reservoir of «low» pressure. Postoperative complications developed in 14 (37.8%) patients, what required re-surgery in 8 (21.6%) observed, of which urological complications occurred in 4 (10.8%) patients. Complications were not observed during the formation of the artificial bladder according to the presented method. Long-term results: RC – overall and disease-free 2-year survival – 78.1% and 65.6% respectively, PMMT – all patients are alive without signs of relapse, the timeline of observation is 24 months.

Conclusions: The immediate results of MVR on locally advanced RC can be considered as satisfactory. The level of postoperative complications is primarily due to the prevalence of primary tumors. In case of urinary tract resection, primary plastic surgery is preferred. Long-term results allows to examine such operations as a method of choice in the treatment of RC with invasion in adjacent organs.

Keywords: Rectal cancer, surgical treatment, multivisceral resection, bladder reconstruction, postoperative complications, disease-free survival.

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Authors informations:

Afanasyev Sergey Gennadievich
Doctor of Medical Sciences, Full Professor, Head of the Department of Abdominal Oncology, Cancer Research Institute, Tomsk National Research Medical Center, Russian Academy of Sciences
Researcher ID: D-2084-2012
Scopus ID: 21333316900
ORCID ID: 0000-0002-4701-0375
SPIN: 9206-3037
E-mail: afanasievsg@oncology.tomsk.ru.

Khadagaev Igor Bairovich
Physician of Oncology Department № 1, Novosibirsk Regional Clinical Oncology Center
E-mail: khadagaev@mail.ru

Fursov Sergey Aleksandrovich
Doctor of Medical Sciences, Professor of Department of Operative Surgery and Topographic Anatomy, Medical Faculty, A.I. Yevdokimov Moscow State University of Medicine and Dentistry; Chief Medical Officer, Bakhrushin Brothers City Clinical Hospital
Author ID: 463352
E-mail: fursov.serega2011@yandex.ru

Usynin Evgeniy Anatolievich
Doctor of Medical Sciences, Head of the General Oncology Department, Cancer Research Institute, Tomsk National Research Medical Center, Russian Academy of Sciences
Scopus ID: 56204320500
SPIN: 1804-0292
E-mail: gusi@list.ru

Gorbunov Aleksey Konstantinovich
Junior Researcher, General Oncology Department, Cancer Research Institute, Tomsk National Research Medical Center, Russian Academy of Sciences
SPIN: 3590-6479
E-mail: goorbunov@yandex.ru

Urmonov Umidzhon Butabekovich
Postgraduate Student, Department of Abdominal Oncology, Cancer Research Institute, Tomsk National Research Medical Center, Russian Academy of Sciences
ORCID ID: 0000-0003-2804-4227
SPIN: 7150-7291
Author ID: 967755
E-mail: urmonovUB@oncology.tomsk.ru

Usova Anna Vladimirovna
Candidate of Medical Sciences, Senior Researcher, Department of Radiology Diagnostics, Cancer Research Institute, Tomsk National Research Medical Center, Russian Academy of Sciences
SPIN: 3000-6564
E-mail: afina.tsk@gmail.com

Avgustinovich Aleksandra Vladimirovna
Candidate of Medical Sciences, Researcher, Department of Abdominal Oncology, Cancer Research Institute, Tomsk National Research Medical Center, Russian Academy of Sciences
SPIN: 2952-6119
E-mail: aov862@yandex.ru

Tarasova Anna Sergeevna
Candidate of Medical Sciences, Junior Researcher, Department of Abdominal Oncology, Cancer Research Institute, Tomsk National Research Medical Center, Russian Academy of Sciences
SPIN: 1554-3063
E-mail: anna_tarasova@sibmail.com

Information about the source of support in the form of grants, equipment, and drugs

The authors did not receive financial support from manufacturers of medicines and medical equipment

Conflict of interest: No conflict

Address for correspondence:

Afanasyev Sergey Gennadievich
Doctor of Medical Sciences, Full Professor, Head of the Department of Abdominal Oncology, Cancer Research Institute, Tomsk National Research Medical Center, Russian Academy of Sciences

634009, Russian Federation, Tomsk, Kooperativny Str., 5

Tel.: +7 (903) 9132574

E-mail: afanasievsg@oncology.tomsk.ru

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