SELECTION OF OPTIMAL SURGERY IN THE TREATMENT OF CANCER OF THE DISTAL PARTS OF THE RECTUM
Authors: Bodyaka V.Yu. , Babin V.D. , Kravchuk S.Yu. , Chuprovska Yu.Ya. , Shulgina V.V. , Khalaturnic I.B. , Sinchishina L.V. 
Published: April 2022

Despite the development of modern oncology, rectal cancer is a leader in morbidity andmortality. Effective treatment of rectal cancer is possible only with surgical treatment.Recently, more and more attention is paid to sphincter-preserving operations, whichallow to avoid colostomy, improving in addition to that the life quality of the patient andreturn to the usual social environment. However, after such operations, some patientshave complications, especially in the form of incontinence and feces, that significantlyaffects the life quality of patients.Carrying out a comparative analysis of the results of the surgical treatment of cancerof the distal part of the rectum after colostomy and sphincter-preserving surgery, willfacilitate the choice of optimal surgery for this oncological localization.The aim of the study - to determine the optimal colostomy or sphincter-preserving surgeryfor the treatment of the distal parts of the rectum cancer by examining the duration ofoperations, clinical features of the early postoperative period, as well as the life qualityof patients in the long terms.Material and methods. A retrospective analysis of 82 medical records of an inpatient witha diagnosis of cancer of the distal parts of the rectum, from 2017 to 2019.These medical cards, depending on the method of surgery were divided into two groups.The first group consisted of 23 people who underwent perineal extirpation of the rectumaccording to Kenyu Miles, the second group consisted of 59 patients who underwentabdominal and anal resection of the rectum with reduction of the sigmoid colon.Patients' quality of life was assessed within 1 year of surgery, during a follow-upexamination of patients, using the American Society of Colorectal Surgeons (ASCRS)questionnaire, which included the Cleveland Clinical Incontinence Scale.Statistical processing of the obtained research results was performed on a personalcomputer using Microsoft Excel spreadsheets, as well as IBM SPSS Statistics.Results. Summing up the results of the study, it should be noted that the patient's age doesnot affect the choice of surgery. The duration of abdominal-anal resection of the rectumwith reduction of the sigmoid colon is shorter and does not depend on the location of thetumor, but the duration of the early postoperative period does not differ.Excision of the excess intestine after abdominal-anal resection of the rectum with reductionof the sigmoid does not depend on the stage of the disease and is mostly performed on the12th day. The quality of the continent after sigmoid resection of the rectum improves withtime after surgery, to the end of one year term 40% of patients have good fecal retention,and the percentage of people with complete incontinence is likely decreases.Quality of life after Keny-Miles surgery improves faster, but over time, after abdominaland anal resection of the rectum with reduction of the sigmoid colon, the percentage ofpatients with mild impairment of the life quality becomes 4.3 times higher. This feature isexplained by the time required to adapt and restore the closing function of the preserved sphincter, where the quality of life directly depends on the quality of the continent.Conclusions:1. After Kenyu-Miles surgery, the quality of life of patients improves fasterthan after rectum with sigmoid reduction, but in due course (1 year), after the latter one,the number of people with mild impairment of quality of life becomes almost 2 timeshigher (p <0, 01).2. In the treatment of distal rectal cancer, abdominal-anal resection of the rectum with asigmoid reduction should be preferred, but in patients with an unfavorable prognosis forlife expectancy, Kenyu-Miles surgery should be performed.