Savenkov D. Tactical and technical features of surgical treatment of rectal cancer and their improvement

The dissertation is devoted to improving the quality of surgical treatment of colorectal cancer by reducing the incidence of colorectal anastomosis suture failure and the quality of lymphadissection using ICG technology and minimally invasive surgery. The study was based on the data from medical records (outpatient charts, medical histories, operating journals) generated during the examination, treatment and dynamic follow-up of 102 patients at the Dnipro Regional Oncology Center, taking into account the practical recommendations of the European Society of Medical Oncologists (ESMO) and international guidelines (NCCN) 2016-2019. The study included 102 patients (55 female and 47 male) with neoplastic lesions (adenocarcinoma) of the distal colon of Ia-IV degree. Depending on the technique of the surgical intervention, two clinical groups were identified. Group I included 53 patients (52.0%) with CRC who underwent laparoscopic anterior resection of the rectum using a standardized technique with the formation of a hardware colorectal anastomosis of the "end-to-end" type. The study group consisted of 49 patients (48.0%) who underwent a similar operation, but before the formation of the anastomosis, fluorescence angiography (FAG) with indocyanine green (ICG technology) was performed to objectively assess the degree of blood supply to the anastomosed intestinal areas. In addition, lymphography was performed in 42 (85.7 %) patients to determine its effectiveness in relation to the amount of lymphadissection performed. Scientific novelty of the study. The study has confirmed that standard anterior resection of the rectum in patients with colorectal cancer after neoadjuvant chemoradiotherapy often has a serious complication in the form of colorectal anastomosis failure, the main reason for which is the lack of objective assessment of blood circulation in the resected and anastomosed bowel. In the course of the study, new data were obtained on the presence of a correlation between the frequency of development and severity of postoperative complications and the morphological analysis of the state of the microcirculatory channel of the rectum in the area of its resection and the formation of anastomosis after chemoradiation neoadjuvant therapy. The general characteristics and advantages of the technology of intraoperative fluorescence angiography with indocyanine green are determined and the possibility of including this technique in the standards of surgical treatment of colorectal cancer is substantiated. The relationship between the results of intraoperative fluorescence angiography and the subsequent viability of the tissues of the anastomosed intestinal regions was established. We have proved the high efficiency of the intraoperative ICG angiography technique, which is associated with a decrease in the incidence of colorectal anastomosis failure in the early postoperative period, which increases the effectiveness of the operation due to a better postoperative period and a reduction in the duration of inpatient treatment. Reducing the number of complications helps to accelerate the social and labor rehabilitation of patients and improve their quality of life. Practical significance of the study results. Based on the results obtained, the tactics and technical features of surgical treatment of patients with colorectal cancer have been improved. It was proved that the developed algorithm for the use of intraoperative fluorescent ICG angiography allowed to effectively prevent early postoperative complications of the colorectal junction, which affects the quality of surgery and treatment outcomes. The studies have shown that intraoperative ICG technology is an easily feasible and safe surgical technique for choosing the intersection of the colon and rectum for colorectal anastomosis in the surgical treatment of rectal cancer. Intraoperative fluorescence angiography in patients undergoing surgery for rectal cancer can be considered a method of preventing anastomotic failure, since the use of this technology prevented the possibility of developing anastomotic failure in the early postoperative period in 100% of patients in this category due to the objectification of the state of blood microcirculation in the anastomosis area