[Prognosis of epidermoid anal carcinoma regression after conservative treatment]. / Prognoz regressii opukholi pri konservativnoi terapii épidermoidnogo raka anal'nogo kanala.

The prospective study was concerned with definition of the clinical and therapeutic factors behind poor response of anal cancer to radio- (RT) or chemoradiotherapy (CRT). Out of 64 female and 8 male patients at the mean age of 57 (33-81), thirty six had split-course of 60-65 Gy (RT), twenty--60-65 Gy, 5-FU and mitomycin C (CRT) and eighteen--up to 55-65 Gy (1.5 Gy--session 1, 1.0 Gy--session 2) (hyper-fractionated RT) plus 5-FU, for squamous cell anal carcinoma. There was no endorectal ultrasound evidence of perirectal lymph node involvement (uN0): T1-2uN-M0 (n=46), T3-4uN0M0 (n=11), uN1 or N2-3 (groin or endorectal ultrasound: T1-2uN-M0 (n=46), T3-4uN0M0 (n=11), uN1 or N2-3 (groin metastases) were detected in 7 patients: T1-2uN1-2M0 (n=7), T3-4N1-3M0 (n=10). Endorectal ultrasound staging (ERUS) used a linear 7.5 MHz transducer. The uTNM system was devised on the basis of tumor invasion parameters. There were no tumors confined to the subendothelial layer of the anal canal (uT1); 24 (32.4%) tumors were confined to the internal anal sphincter (uT2); 19 (25.7%) invaded the external anal sphincter (uT3) and 31 (41.9%)--levator ani (uT4). All carcinomas T4 (n=9) corresponded to the uT4 category. Only T-stage and tumor invasion (uT) proved significant prognostic variables. Complete response of T1-2 was 79.2%, T3-4--33.3% (p=0.0003); uT2--95.8%, uT3--68.4%, and uT4--41.9% (except T4) (p=0.0001). In multivariate logistic analysis, uT alone appeared an independent variable (p=0.015). ERUS uTNM staging is more effective in prognosis for RT and CRT and, therefore, should be recommended for preliminary management of epidermoid anal carcinoma.

[Transanal endoscopic surgical method of removing rectal tumors]. / Transanal'nyi éndokhirurgicheskii metod udaleniia opukholei priamoi kishki.

Experience in endosurgical removal of rectal tumors in 96 patients is presented. Performed from 1999, open non-gas method and closed method of transanal endomicrosurgery (TEM) have reduced rate of adenoma recurrences to 8.8%. Development of the open method increased it accessibility for hospitals using endoscopic techniques.

[Short- and long-term results of sphincter preserving operations with creation of colonic J-reservoir]. / Blizhaishie i otdalennye rezul'taty sfinkterosokhraniaiushchikh operatsii s formiorovaniem tolstokishechnogo J-obraznogo rezervuara.

The aim of this study was to evaluate short- and long-term results of sphincter preserving operations with forming a colonic J-reservoir. This study examined the results of the treatment of 63 patients with medioampullary carcinoma of the rectum. Sphincter preserving operations with forming a reservoiroanal anastomosis were made in 34 patients (test group), 29 patients had sphincter preserving operations with forming coloanal and supraanal colorectal anastomoses (control group). In the test group complications were observed in 6 (17.6%) patients and in the control group in 6 (20.7%) patients (p = 0.3962). The defecation frequency in the test group 3 months after the operation was 1.87 +/- (1-3) time a day, in the control group even through 12 months--3.0 +/- 1.5 times a day (p = 0.0001). In terms up to 6 months tenesmus, imperative desire to defecate and defecation's multistage more often disturbed the patients of the control group (p = 0.0005). The function of the faeces continence was satisfactory in both the patients' groups, however in the control group the events of the anal incontinence of I-II degree (p > 0.05) occurred more often. The negative aspect of the colonic reservoir's forming is frequent change of the evacuation function with constipation, however, the differences were statistically insignificant (p > 0.05). Creation of a colonic reservoir doesn't increase lethality and postoperative complications rate, allows to reduce clinical manifestations of a "low anterior resection" syndrome.

[Long-term result of hemicorporectomy]. / Otdalennyi rezul'tat gemikorporéktomii.

A 12-year follow up result of hemicorporectomy in a patient is represented. The patient was operated several times since 1983 for massive perianal condylomas. In 1985 the ulcer with hard edges was revealed in the perianal region, spreading to the perineum and root of the scrotum. Biopsy data evidenced for epidermoid carcinoma Abdominoperineal extirpation of the rectum was carried out with broad dissection of the skin of the perineum and with resection of the seminal follicle. Postoperative period was complicated by prolonged pyogenous infection of the perineal wound which prevented from radiation treatment. 9 months later the relapse of the tumor was detected in the perineum with deep pyogenic fistulas formation. 6 courses of chemotherapy by 5-fluorouracyl were carried out. During the process of examination in September 1987 in the perineal area a large massive tumor occupying the whole pelvic cavity and growing into the posterior wall of the urine bladder and left ishial bone, spreading to the scrotal root and surrounded by the net of fistulous tracts was revealed. Hemicorporectomy was carried out with previously layed one-stem sygmostomy keeping intact, and retroperitoneal Y-shaped uretero-ureter anastomosis being formed and right ureter being fixed at the skin of the right abdominal wall. A special prosthesis--"a glass"--was made for the patient, in which he could move from the bed to the chair or the wheeled chair, to move at home or in the street and to drive his own car. Later, evacuation of the uroliths through the uretherocutaneous stoma was observed. Gradually urolithiasis progressed, mainly in the right kidney, and in 1995 the development of purulent rightsided paranephritis was detected which demanded right-sided nephrectomy. Thus, in spite of a number of complications we can state, that hemicorporectomy has cured the patient of advanced, cancer and he feels satisfied with this treatment and saving 12 years of life.

[Is it possible to improve the quality of life of patients who have undergone pelvic evisceration?]. / Vozmozhno li uluchshenie kachestva zhizni bol'nykh pri évistseratsii taza?

Locally spread cancer makes up considerable percent (20-30%) in statistical structure of rectal tumors. In cases of cancer spread into the area of urine bladder triangle the operation of choice is pelvic evisceration. From 1977 to 1997 in the State research Centre of the Ministry of Health for Coloproctology pelvic evisceration in cancer spread to back wall of urine bladder in the area of triangle was carried out in 22 patients (20 male and 2 female). Mean age was 43.4 (29-56) years, 16 patients have undergone typical infralevator pelvic evisceration. There were no intraoperative lethality. Postoperative lethality made up 6.3%, complications--68.8%, 5-years survival rate--25%. Presence of two fecal fistulas on the anterior abdominal wall has decreased considerably the quality of life of the patients. Since 1993 the conception of preservation and restoration of natural passage of urine and bowel contents was adopted. In 4 cases infralevator pelvic evisceration with various types of ileocystoplasty and pull-through of colon into small pelvis with creation of smooth muscle cuff in perineal colostomy was carried out. In 2 patients evisceration was of supralevator-character cystoplasty of local tissues and performance of coloanal anastomosis were carried out. The application of reconstructive-restorative ways in coloproctology and urology considerably contributed to the improvement of the quality of life of the patients after pelvic evisceration.

[Up-to-date approach to the treatment of rectal cancer]. / Sovremennyi podkhod k lecheniiu raka priamoi kishki.

During the last 15 years 2404 radical operations of various types were carried out for cancer of the rectum. The rate of postoperative complications made up 28.3% and mortality--2.9%. The tendency to increase of locally spread forms of cancer up to 96.2% with metastases to regional lymph nodes up to--52.3% was detected. The use of adequate chemotherapy, updated suturing devices and new variants of radical operations, combined and extended ones in particular havw much contributed to carrying out radical interventions with complete restoration of bowel continuity in 70% of patients. 5 year survival rate of patients after sphincter saving plastics and restorative procedures made up 60.2-65.3%, after extirpations with colostomy--54.2%. Promising results of improvement the indices of 5 year survival were obtained when preoperative irradiation in regime of multifractioning SOD 45-55 Gy was used together with administration of 5-fluorouracil (5-7.5 g).

[Aortoiliopelvic lymphadenectomy in surgical treatment of rectal cancer]. / Aortopodvzdoshno-tazovaia limfadenéktomiia v khirurgii raka priamoi kishki.

The results of aortoiliopelvic lymphadenectomy in macroscopic changes in lymphatic nodes being revealed intraoperatively in 73 patients with locally spread rectal cancer, are represented. Morphological examination of the removed tissues made it possible to reveal metastatic involvement of paraaortal and iliac lymphatic nodes in 57.3% of patients. In 36.9% of cases combined radical operations were performed. There were no lethal outcomes. Postoperative complications were detected in 37.9% of cases, among them atony of the urine bladder in 30.1% and inflammatory processes in pelvic cavity--in 8.2%. And in 9 men with normal sexual potency before the operation it resulted in impotency after surgery. 5-year survival made up 27.4% including cases with metastatic involvement of lymphatic nodes--19.3%, and without it--35.7%.

[Differential diagnosis of non-epithelial rectal neoplasms]. / Differentsialnaia diagnostika neépitelialnykh opukholei priamoi kishki.

Experience in the treatment of 118 patients with nonepithelial new growths of the rectum has been accumulated at the Scientific Research Institute of Proctology in the period from 1970 to 1991. They accounted for 1.5% of all benign and malignant tumors of this organ. Leiomyoma was diagnosed in 44, leiomyosarcoma in 18, lipoma in 30, fibroma in 17, neurinoma in 7 and rhabdomyoma in 2 of these patients. A differential diagnosis was made between benign and malignant tumors, as well as with other nonepithelial new growth of the rectum. On the basis of the clinical picture and the results of digital and instrumental (radiological, endoscopic, and ultrasonic) examination of the rectum the correct preoperative diagnosis may be established with certain probability. This influences directly the choice of the volume of the operative intervention in various types of nonepithelial rectal tumors. Morphological verification of the tumor is the principal method of examination in establishing the differential diagnosis in the preoperative and postoperative periods.

[Long-term results of formation of smooth muscle sphincter in the perineal colostomy area in patients after rectal extirpation]. / Otdalennye rezul'taty formirovaniia gladkomyshechnogo zhoma v oblasti promezhnostnoi kolostomy u bol'nykh posle ékstirpatsii priamoi kishki.

The authors discuss an original method for formation of a smooth-muscle cuff from the wall of a pulled-through colon in the region of a perineal colostoma. It was applied in 89 patients who had undergone extirpation of the rectum for malignant neoplasms. The smooth-muscle sphincter was formed during removal of the rectum in 72 patients and no earlier than 2 years after the extirpation in 17 patients. Inflammatory complications developed in the region of the perineal colostoa in the early postoperative period in 13.5% of cases. They were due to necrosis of the distal part of the pulled-through intestine in 3.4% of cases. There were no fatal outcomes. The late-term results were studied in follow-up periods of up to 7.5 years. Satisfactory functional results were produced in 83% of the patients. Physiological examination showed the presence of a functioning sphincter in the region of the perineal colostoma.

[The groups at risk for a recurrence of rectal cancer after radical operations]. / Gruppy riska retsidiva raka priamoi kishki posle radikal'nykh operatsii.

The article discusses a group of patients with rectal carcinoma who underwent radical operations at the Scientific Research Institute of Proctology in 1982-1983. The terms and frequency of rectal carcinoma recurrences are analysed and the factors influencing these indices are studied. The results made it possible to form a group with a risk of a recurrence among patients with carcinoma of the rectum and suggest new schedules of regular medical observation over these patients with consideration for the risk group.

[The surgical treatment of benign smooth-muscle tumors of the rectum]. / Khirurgicheskoe lechenie dobrokachestvennykh gladkomyshechnykh opukholei priamoi kishki.

From analysis of the surgical treatment of 36 patients with rectal leiomyoma the authors suggest and substantiate the indications for various types of operative interventions according to the size and location of the tumor. The late-term results of the treatment were studied in all patients who underwent surgery and a brief review of literature on the methods of diagnosis and surgical management of benign smooth-muscle tumors of the rectum is given.

[Simultaneous radical surgery in patients with cancer of the rectum with metastases to the liver]. / Odnomomentnye radikal'nye operatsii u bol'nykh rakom priamoi kishki s metastazami v pechen'.

From 1972 to 1987, a total of 3.033 operations were carried out for carcinoma of the rectum at the Research Institute of Proctology. Various types of resection of the liver were conducted in one stage in 51 cases. The postoperative mortality in the group of patients who underwent operation in association with resection of the liver was 5.9%, which was only slightly higher than that in the general group of patients with rectal carcinoma (4.9%) operated on in the same period of time. Among 35 patients dismissed from the clinic after removal of verified metastases of the liver 15 had been operated on more than 5 years ago. Four of them have a survival period of more than 5 years and 2 have a survival period of over 10 years. On basis of their experience, the authors claim that the performance of one-stage radical operations for rectal carcinoma with removal of solitary metastases from the liver is admissible and, most probably, expedient.

[Surgical tactics in extensive necrosis of the sigmoid which had been brought downwards]. / Khirurgicheskaia taktika pri obshirnom nekroze nizvedennoi sigmovidnoi kishki.

Since 1982 the authors perform early (on the 4th-10th day) reoperations in extensive necroses of the sigmoid colon which had been transposed downwards after abdomino-anal resection of the rectum. The reoperation consists in resection of the affected segment of the intestine (usually the whole remaining sigmoid colon) and downward retransposition of the descending or the left half of the transverse colon. Nine such operations were performed; in 8 patients the results were favorable, one 70-year-old female patient died. The first operations had been performed for carcinoma (5 patients), endometriosis (one patient), and anorectal developmental anomalies (3 adult females). It proved that it is advisable to undertake downward retransposition as an emergency manipulation immediately after diagnosing extensive necrosis of the downward transposed sigmoid colon, which usually happens on the 4th-6th day after the main operation. The intestinal wall is still not undergoing disintegration in this period and there is no purulent melting of the areolar tissue of the walls of the true pelvis, i.e., the danger of purulent complications developing after downward retransposition is relatively small, particularly if the cavity of the true pelvis is drained abundantly and lavaged regularly with antiseptic solutions in the postoperative period. Such reoperations are especially advisable in individuals under the age of 60, and usually ensure favorable immediate and late-term functional results.

[A comparative evaluation of methods for diagnosing recurrence of rectal cancer after radical surgery]. / Sravnitel'naia otsenka metodov diagnostiki retsidivov raka priamoi kishki posle radikal'nykh operatsii.

As a result of a study of 173 cases of rectal cancer, applicability of bleomycin-111indium for diagnosis of tumor recurrences was shown. Assays of carcinoembryonic antigen (CEA) as a separate diagnostic procedure proved inadequate due to their low sensitivity (42.1%). Since the effectiveness of ultrasonography application in diagnosing rectal cancer was as high as 91%, it should be recommended for follow-up of radically operated patients.