Savenkov D. Yu., Romanukha K. G., Belosludtsev O. D.

CLINICAL AND EXPERIMENTAL MEDICINE

Scentific article

Abstract. Despite the vast worldwide experience of surgery on the rectum, the frequency of postoperative purulent-septic complications remains quite high and is in the range of 5-25%. The main reason for the unsatisfactory results is based on the failure of colorectal anastomosis sutures, which is present from 3 to 20% of cases according to various authors. Despite the development of surgical techniques in general, it is not yet clear whether the choice of end-to-end or end-to-side anastomosis affects the risk of anastomotic insufficiency. Thus, the aim of our study was to determine the impact of the surgical tactics choice of imposition of hardware colorectal anastomoses “end-to-end” using ICG techniques on the frequency and severity of anastomotic failures in patients with anterior rectal resection. We conducted a retrospective analysis of 48 case histories of patients who underwent anterior resection of the rectum at the Dnipropetrovsk Regional Oncology Center during 2019-2020 for rectal cancer. Depending on the type of anastomosis, patients were divided into two groups: group I – 49 patients (median age – 64 [55-70] years, including men – 18 (38.8%) with the imposition of an anastomosis “end-to-end “, group II – 48 patients (median age – 62.5 [57.5-70.5] years, among them men – 25 (52.1%) with the imposition of an “end-toend” anastomosis using ICG techniques. Patients in the groups were comparable in number and age. General clinical data and surgical complications including the frequency and severity of intestinal anastomosis failure were analyzed. The severity of intestinal anastomosis failure was determined according to the International Colon Cancer Research Group (ISGRC) classification system. Of particular interest was the analysis of the postoperative period and the development of complications directly related to surgery in patients of both groups. Thus, the total number of postoperative complications among patients of group I was 2 times higher than in patients of group II, and the analysis of their severity indicates the unconditional advantage of anastomosis with “end-to-end” using ICG techniques. Among patients of group II there were no cases of class C anastomosis failure associated with peritonitis and the need for repeated surgery. In addition, there was a statistically significant difference between the groups in the number of days from surgery to discharge in the operated patients. According to histological examination of the material obtained during surgery, in the vast majority of patients there was a moderate type of tumor differentiation (in 14 (93.3%) patients of group I and 11 (78.6%) patients of group II), which also could not influence the results of treatment of patients. Thereby, development of end-to-end anastomosis failure is most likely associated with impaired blood supply to the mesenteric edge of the intestine. It has also been shown that “end-to-end” using ICG techniques colorectal anastomosis reduces the frequency and severity of colorectal anastomosis failure, which reduces the postoperative and recovery period and decreases treatment costs. Thus, it was found that in patients with colorectal cancer after anterior resection of the rectum, the hardware colorectal anastomoses “end-to-end” using ICG techniques surgical tactics choice imposition affects the frequency of anastomoses failure.

rectal cancer, surgical tactics, colorectal anastomosis.

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«Bulletin of problems biology and medicine» Issue 1 (159), 2021 year, 124-128 pages, index UDK 6616.348+616.351]-006.6-089.86

10.29254/2077-4214-2021-1-159-124-128