Year 2017 Vol. 25 No 2




SBEE HPE "Ryazan State Medical University Named after Academician I.P. Pavlov"1
SBE RR "Regional Clinical Hospital", 2
The Russian Federation

Objectives. To analyze the results of performing the total mesorectumectomy (TME) via the an open and laparoscopic access and identification of the factors affecting the quality of TME specimen.
Methods. Open prospective randomized trials have been conducted, including patients (n=193) who underwent the total mesorectumectomy with the deriving the loop stoma due to middle- and lower-ampullar rectal cancer. The potential factors affecting TME quality were analyzed: age, sex, pelvic dimensions, previous operations on the abdominal and pelvic organs, neoadjuvant radiation therapy, the size and location of the tumor, a surgical access, TNM stage of the tumor process.
Results. Out of 193 resections, 117 (60,6%) have been carried out via laparoscopic access, and 76 (39,4%) via an open access. Within the operation conversion from laparoscopic to open surgery was made in 4 cases (2,07%). Quality of TME specimen in 132 (68,4%) cases was evaluated as "completed", in 56 (29%) as "almost completed", and in 5 (2,6%) as "uncompleted." "Uncompleted" samples of preparations were obtained in case of tumor location on the anterior wall 3 (60%) cases and on the posterior side 2 (40%) cases. Circular resection margin (CRM) was positive in 6 (3,1%) specimens, 5 (2,6%) of which were "completed" and 1 (0,51%) was "uncompleted". In one case (0,51%) "uncompleted" specimen in presence of N1c stage as well as in 1 (0,51%) case in the patient with the degree of tumor invasion T4b was obtained.
Conclusion. Male gender, "difficult" pelvis anatomy, the location of the tumor on the anterior surface of the rectum and circularly, may potentially affect the quality of the specimen in patients who had undergone TME for the rectal cancer.

Keywords: colorectal cancer, total mesorectumectomy, neoadjuvant radiation therapy, quality of TME specimen, completed TME, laparoscopic TME
p. 163-170 of the original issue
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Address for correspondence:
390026, Russian Federation,
Ryazan, Vyisokovoltnaya str., 9
Department of Surgery with the
course endosurgery FDPO,
Tel.: 7(952) 122-81-85
Dmitriy K.Puchkov
Information about the authors:
Puchkov K.V. MD, Professor of the surgery department with the course of endosurgery, the faculty of supplementary professional education, SBEE HPE "Ryazan State Medical University named after Academician I.P.Pavlov".
Khubezov D.A. MD, Professor, Head of the surgery department with the course of endosurgery of the faculty of supplementary professional education, SBEE HPE "Ryazan State Medical University named after Academician I.P.Pavlov", Head of the coloproctology department, SBE RR "Regional Clinical Hospital".
Puchkov D.K. PhD, Assistant of the surgery department with the course of endosurgery, the faculty of supplementary professional education, SBEE HPE "Ryazan State Medical University named after Academician I.P.Pavlov", Coloproctologist of the coloproctology department, SBE RR "Regional Clinical Hospital".
Lukanin R.V. Coloproctologist of the coloproctology department, SBE RR "Regional Clinical Hospital".
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