tumorsMalignant tumoursMalignant tumours2224-50572587-6813Rosoncoweb10.18027/2224-5057-2014-3-64-67tumors-67Research ArticleОРИГИНАЛЬНЫЕ ИССЛЕДОВАНИЯORIGINAL REPORTSМУЛЬТИДИСЦИПЛИНАРНЫЙ ПОДХОД В ЛЕЧЕНИИ БОЛЬНЫХ РАКОМ ПРЯМОЙ КИШКИMULTIDISCIPLINARY APPROACH IN THE TREATMENT OF PATIENTS WITH RECTAL CANCERПравосудовИ. В.PravosudovIgor V.

Правосудов Игорь Витальевич – ФГБУ НИИ онкологии им. Н.Н. Петрова Минздрава РФ, Санкт  Петербург, pravosudov@rambler.ru, тел.:  +7 (921) 957-80-52

 

pravosudov@rambler.ruНИИ онкологии им. Н.Н. Петрова Минздрава РФ, Санкт ПетербургRussian Federation201420052015036467Copyright © Правосудов И.В., 20152015Правосудов И.В.Pravosudov I.V.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.malignanttumors.org/jour/article/view/67

Хирургический метод  является  «золотым стандартом»  в лечении больных раком прямой кишки. Целью хирургического лечения является сведение  к минимуму частоты местных рецидивов,  возникновение которых во многом зависит от качества операций.

Краеугольным камнем в выборе лечебной тактики следует считать отношение опухоли к собственной  фасции прямой кишки. Даже применяя современные  хирургические методики, большинство опухолей прямой кишки  ниже переходной складки брюшины следовало  бы лечить используя предоперационную лучевую терапию. Предоперационная  лучевая (х/л) терапия позволяет уменьшить частоту местных рецидивов и создать  условия для увеличения  числа сфинктеросохранающих операций.  Степень регресса  опухоли после  химиолучевой терапии напрямую коррелирует с выживаемостью и частотой местных рецидивов.  Регресс  опухоли создает  предпосылки для избавления больного с опухолью прямой кишки от послеоперационных  осложнений и летальности, связанных с выполнением обширных радикальных операций. Использование стандартизированных систем для оценки степени регресса  опухоли может предоставить ценную информацию центрам, специлизирующимся на лечении больных с данной патологией. МРТ малого таза является весьма эффективным инструментом в первичной оценке степени местнорегионарного распространения  рака прямой  кишки, включая отношение  к мезоректальной   фасции. Сложности в прогнозировании полного патологического регресса  опухоли с помощью МРТ связаны,  прежде  всего,  с проблемой дифференциальной диагностики между постлучевыми и опухолевыми изменениями  кишечной стенки и окружающих тканей. Мультидисциплинарный подход обеспечивает  точность стадирования  и способствует  выработке оптимальной лечебной тактики у больных раком прямой кишки.

Surgical treatment is the "gold standard" in the treatment of patients with rectal cancer. The aim of surgical treatment is to minimize the rate of local recurrence, the occurrence of which depends largely on the quality of procedures.

Relationship between the tumor and own fascia of the rectum is the cornerstone in the choice of treatment strategy. Even using modern surgical techniques, most tumors of the rectum below the peritoneum should be treated using preoperative radiotherapy. Preoperative radiation can reduce the incidence of local recurrence and to create conditions for increasing the number of sphincter-preserving operations. The degree of tumor regression after chemoradiation is directly correlated with survival and local recurrence. Tumor regression creates prerequisites for decrease of postoperative complications and mortality related to the implementation of extensive radical surgery in patients with a tumor of the rectum. The use of standardized systems for the assessment of tumor regression can provide valuable information for centers specializing in the treatment of patients with such pathology. MRI of the pelvic organs is a very effective tool in the initial evaluation of the degree local and regional spreading of colorectal cancer including relationship to the mesorectal fascia. Difficulties in predicting of complete pathologic regression of the tumor by MRI are associated primarily with the problem of differential diagnosis between tumor and post-radiation changes in the rectal wall and surrounding tissues. A multidisciplinary approach provides the accuracy of staging and facilitates the development of an optimal treatment strategy in patients with rectal cancer.

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The authors declare that there are no conflicts of interest present.