Komparativna analiza rezultata lečenja karcinoma rektuma metodama totalne mezorektalne ekscizije i transsekcije mezorektuma

Abstract

Colorectal cancer (CRC) remains a significant medical problem world wide, despite ‘advances in medicine and locoregional control of the disease. The success of surgical treatment of rectal cancer is measured by the rate of complication and survival of patients. The decision on the most suitable type of surgical procedure and mesorectal excision - total mesorectal excision (TME) or partial mesorectal excision (PME) - is influenced by a number of factors, among which the localisation and disease stage are most importent. There is a question whether PME is appropriate for patients suffering from cancer located in the middle third of the rectum, where the additional 3 cm distance between the anocutaneous line and the tumour is sufficient for preventing malignant deposits within the distal mesorectum. The aims of this study were to determine and compare the number of patients in each experimental group (TME/PME) affected by anastomotic leakage and stenosis, local recurrence and nerve damage. To establish the risk factor for leakage and local recurrence using the analysis of variance; to determine the number of nonspecific compilation in the experimental groups; to determine the survival rate of patients in the experimental groups. The research was conducted at the General Surgery Clinic of the Clinical Centre of Nis. The clinical prospective study encompassed 84 patients suffering from colorectal cancer who were operated on using the TME (55 patients) and PME (33 patients) methods in the period from June 2013 to December 2014. Obtained results pointed to a statistically significant difference was found in the chosen type of mesorectal excision with respect to the localisation of the rectal cancer. It was established that leakage was more common in patients that underwent TME. The results of the doctoral thesis show that there was no significant difference in the incidence of recurrence between the experimental groups. It was also observed that there was no significant difference between the groups with respect to stenosis. The analysis of results showed a statistically significantly greater incidence of nerve damage in patients in the TME group. A greater percentage of patients in the PME group exhibited nonspecific compilations, but the difference between the two groups was not statistically significant. There was no significant difference in morality with respect to mesorectal excision. The results showed that localisation was a statistically significant independent risk factor for the appearance leakage and type of mesorectal excision. The stage of the tumour was a statistically significant risk factor for recurrence. The analysis of outcomes in patients with cancer in the middle third of the rectum showed that leakage was more common in the TME group, compared to the PME group. However, local occupance was not found to be affected by the type of mesorectal excision, but instead was solely influenced by the stage of the tumour. Incidence of nonspecific compilations was shown to be equal between the two experimental groups. The analysis of results revealed no significant difference in the rate of survival between the two groups during the monitoring period. Based on the information outlined above, it can be concluded that partial mesorectal excision can be used in select cases of cancers localised to the middle third of the rectum with the full application of oncological principles of radicalism.