Sankt-Peterburg, St. Petersburg, Russian Federation
Tula, Russian Federation
UDC 61
Introduction. Colorectal cancer occupies one of the leading positions in the structure of oncological diseases, with rectal cancer (RC) accounting for more than a third of all cases. The improvement of RC treatment results is associated with the introduction of combined and complex treatment methods into medical practice, which include chemotherapy and radiation therapy at the preoperative stage. The aim of the study is to study the current state of surgical treatment of patients with RC, trends and prospects of using surgical treatment methods. Materials and methods. Domestic and foreign literary sources on modern surgical treatment of patients with RC have been studied. The results and their discussion. A study of literary sources has shown that surgical interventions are performed in most cases of RC treatment. The approach to the treatment of cancer of the upper rectum is considered equivalent to cancer of the sigmoid colon, where surgical intervention predominates mainly. Surgical treatment, including the stage of mesorectumectomy, in combination with neoadjuvant radiation therapy is the standard of treatment for middle and lower ampullary RC. The majority of surgical interventions are transabdominal sphincter-preserving operations, such as anterior and low anterior rectal resection, abdominal-anal resection. According to the indications, abdominal-perineal extirpation of the rectum with the formation of a permanent single-barrel colostomy is used. The Hartmann operation is performed as planned and urgently if there are contraindications to the formation of a primary anastomosis. In RC surgery, reconstructive operations are also performed to restore the natural passage with the closure of the colostomy. In stage II–III RC, mesorectumectomy and lateral lymphodissection are considered standard surgical options. Currently, total mesorectumectomy can be performed using open, laparoscopic, robotic, and transanal access. In generalized RC with synchronous liver and/or lung metastases, surgical intervention is recommended to remove them if they are resectable. Various types of palliative interventions are performed in RC surgery in the form of endoscopic coagulation, cryodestruction, colostomy, stenting, etc. Laparoscopic rectal resections have advantages in the surgical treatment of RC, due to the early rehabilitation of patients, a low risk of postoperative hernias and a better cosmetic result of the operation. Robotic surgery for RC can improve the postoperative urinary and reproductive function of male patients. In early RC, endoscopic resection methods can be used, including polypectomy, conventional endoscopic mucosal resection (EMR), endoscopic submucosal dissection (ESD), modified EMR. Transanal endoscopic resection of the rectum is an effective method of treating pT1N0M0 stage RC with high rates of relapse-free and overall patient survival and low complication rates. Conclusion. Thus, in the surgical treatment of RC, there is a tendency towards an increase in minimally invasive technologies using methods of local endoscopic resection of the mucosa/submucosa in the treatment of RC stage pT1N0M0 and transanal endoscopic resections with full-layer excision of the intestinal wall with adjacent mesorectal tissue. The use of transanal minimally invasive technologies leads to a decrease in the number of intra- and postoperative complications, local recurrence, postoperative mortality, and increased recurrence-free survival of patients.
rectal cancer, surgical treatment, transabdominal operations, laparoscopic and robot-assisted operations, mesorectumectomy, lymph dissection, consequences and complications of surgical treatment.
1. Alekseev M.V., Homyakov E.A., Rybakov E.G. Problemy predoperacionnoy diagnostiki porazheniya tazovyh limfouzlov pri rake pryamoy kishki (obzor literatury) //Koloproktologiya. 2023. T. 22. № 4. S. 129-134.
2. Bondarenko N.V., Zolotuhin C.E., Zaika A.N. i dr. Standarty hirurgicheskogo lecheniya raka pryamoy kishki stadii rT1 v SShA, Evrope i Yaponii //Novoobrazovanie. 2022. T. 14, № 2. S. 63-71.
3. Grishko P.Yu., Amelina I.D., Kulish A.V. i dr. Prognosticheskie vozmozhnosti magnitno-rezonansnoy tomografii v ocenke otveta na neoad'yuvantnoe lechenie mestnorasprostranennogo raka pryamoy kishki //Voprosy onkologii. 2023. T. 69, № 3S. S. 90-91.
4. Zaharenko A.A., Gaynullina, L.I., Cvechkova A.A. i dr. Sindrom nizkoy peredney rezekcii posle operaciy po povodu raka pryamoy kishki nizkoy lokalizacii: obzor literatury //Voprosy onkologii. 2024. T. 70, № 2. S. 224-232.
5. Ivanov Yu.V., Smirnov A. V., Davidovich D. L. i dr. Prediktory nesostoyatel'nosti kolorektal'nogo anastomoza posle perednih rezekciy pryamoy kishki pri lokalizovannyh zlokachestvennyh novoobrazovaniyah //Klinicheskaya praktika. 2024. T. 15, № 1. S. 7-16.
6. Klinicheskie rekomendacii obscheros. obsch. organizacii «Rossiyskoe obschestvo klin. onkologii», Rossiyskogo obschestva specialistov po kolorektal'nomu raku, obscheros. obschestv. organizaciya «Associaciya koloproktologov Rossii», obscheros. nac. soyuza «Associaciya onkologov Rossii». Rak pryamoy kishki. M, 2022. 111 s.
7. Kozyrev A.D., Agurina N.V. Vozmozhnosti magnitno-rezonansnoy tomografii v diagnostike raka nizhneampulyarnogo otdela pryamoy kishki //Innovacionnaya medicina Kubani. 2024. № 4-1. S. 36-37.
8. Lebed'ko M.S. Optimizaciya metodiki vypolneniya rezekcii pryamoy kishki po povodu raka: dis. … kand. med. nauk: 3.1.6. Onkologiya, luchevaya terapiya, 3.1.9. Hirurgiya /Lebed'ko Maksim Sergeevich; nauch. ruk. M.M. Mamedli, V.Yu. Kosyrev; FGAOU VO Pervyy Moskovskiy gos. med. universitet im. I.M. Sechenova MZ RF (Sechenovskiy Universitet), FGBU «Nacional'nyy med. issledovatel'skiy centr onkologii im. N.N. Blohina» MZ RF. Moskva, 2025. 134 s.
9. Maslov A.A., Gevorkyan Yu.A., Soldatkina N.V. i dr. Transanal'naya endoskopicheskaya rezekciya pryamoy kishki: neposredstvennye i otdalennye rezul'taty // Hirurgiya. Zhurnal im. N.I. Pirogova. 2022. № 1. S. 30 38.
10. Nevol'skih A.A., Brodskiy A.R., Avdeenko V.A. i dr. Transanal'nye endomikrohirurgicheskie vmeshatel'stva pri rake pryamoy kishki posle luchevoy ili himioluchevoy terapii – nyuansy i rezul'taty //Koloproktologiya. 2024. T. 23, № 1. S. 82-90.
11. Oschepkova S.Yu., Mironchenkov M.V., Mironchenkova E.S. Kolorektal'nyy rak. Osnovnye aspekty diagnostiki i lecheniya //Sovremennaya nauka: aktual'nye voprosy, dostizheniya i innovacii. 2022. S. 208-211.
12. Ryabov M.M. Oslozhneniya protivoopuholevogo lecheniya raka pryamoy kishki: strukturnye osobennosti i predposylki razvitiya //Koloproktologiya. 2025. T. 24. № 2. S. 112-120.
13. Suhin D.G., Pirogov S.S., Vodoleev A.S. i dr. Endoskopicheskaya diagnostika i lechenie «rannego» raka anal'nogo kanala //Eksperiment i klin. gastroenterologiya. 2022. № 5 (201). S. 103-109.
14. Fedyanin M.Yu., Gladkov O.A., Gordeev S.S. i dr. Rak obodochnoy kishki, rektosigmoidnogo soedineniya i pryamoy kishki. Prakticheskie rekomendacii RUSSCO, chast' 1. //Zlokachestvennye opuholi. 2023. T. 13, № 3s2-1. S. 425-482.
15. Shiraliev R.M.A., Polovinkin V.V., Murashko R.A. i dr. Dostizheniya i problemy primeneniya miniinvazivnyh tehnologiy v operativnom lechenii raka pryamoy kishki u pacientov pozhilogo vozrasta //Innovacionnaya medicina Kubani. 2023. № 1. S. 116-122.
16. Efron A.G., Schaeva S.N., Volynec L.I. Hirurgicheskaya taktika pri ostroy obturacionnoy neprohodimosti opuholevogo geneza u bol'nyh pozhilogo i starcheskogo vozrasta (obzor literatury) //Koloproktologiya. 2025. T. 24, № 1. S. 135-144.
17. Yamschikova A.S., Korotkov V.A., Petrov L.O. i dr. Taktika hirurgicheskogo lecheniya oslozhneniy bryushno-promezhnostnoy ekstirpacii pryamoy kishki u pacienta s mestno-rasprostranennym rakom na fone kombinirovannogo lecheniya progressirovaniya processa. Klinicheskoe nablyudenie //Andrologiya i genital'naya hirurgiya. 2024. T. 25, № 2. S. 127-132.
18. Alharbi R., Almosallam O., Albastaki S. et al. Role of body mass index in anastomotic leakage after curative treatment for rectal cancer //Annals of Saudi medicine. 2024. Vol. 44, № 3. R. 135-140.
19. Andersson J., Angenete E., Gellerstedt M. et al. Developing a multivariable prediction model of global health-related quality of life in patients treated for rectal cancer: a prospective study in five countries //International journal of colorectal disease. 2024. Vol. 39, № 1. P. 35.
20. Binda C., Secco M., Tuccillo L. et al. Early rectal cancer and local excision: a narrative review //Journal of clinical medicine. 2024. Vol. 13, № 8. P. 2292.
21. Chen M., Huang S., Luo M. et al. Radiological characteristics and diagnostic clues for persistent descending mesocolon in patients with rectal cancer //Langenbeck's archives of surgery. 2024. Vol. 409, № 1. P. 43.
22. Coco C., Rizzo G., Amodio L.E. et al. Current management of locally recurrent rectal cancer //Cancers. 2024. Vol. 16, № 23. R. 3906.
23. Doroudian S., Osterman E., Glimelius B. Risk factors for recurrence after surgery for rectal cancer in a modern, nationwide population-based cohort //Annals of surgical oncology. – 2024. Vol. 31, № 9. P. 5570-5584.
24. Flynn J., Larach J.T., Kong J.C.H. et al. Operative and oncological outcomes after robotic rectal resection compared with laparoscopy: a systematic review and meta-analysis // ANZ journal of surgery. 2023. Vol. 93, № 3. R. 510-21.
25. Geitenbeek R.T.J., Burghgraef T.A., Moes C.A. et al. Functional outcomes and quality of life following open versus laparoscopic versus robot-assisted versus transanal total mesorectal excision in rectal cancer patients: a systematic review and meta-analysis //Surgical Endoscopy. – 2024. Vol. 38, № 8. R. 4431-4444.
26. Glimelius B. Recent advances in rectal cancer treatment – are we on the right track? //Upsala journal of medical sciences. 2024. Vol. 129. P. 10.48101.
27. Huang C.K., Shih C.H., Kao Y.S. Elderly rectal cancer: an updated review //Current oncology reports. 2024. Vol. 26, № 2. P. 181-190.
28. Islam M.S., Abdullah K.S.M., Sadat C.M.A. et al. Surgical innovations and outcomes in the management of rectal cancer: a departmental study on advanced techniques and postoperative care //Asia pacific journal of cancer research. 2024. Vol. 1, № 1. R. 14-22.
29. Ivatury S.J., Underbakke D.L., Kang R. Regional colon and rectal surgeon density is associated with variation in rectal cancer surgical treatment: a Dartmouth atlas study //Journal of clinical medicine. 2025. Vol. 14, № 6. R. 2004.
30. Jepsen D. N. M., Høeg H., Bzorek M. et al. Digitally assessed lymphocyte infiltration in rectal cancer biopsies is associated with pathological response to neoadjuvant therapy //Human pathology. 2024. Vol. 144. P. 61-70.
31. Jiang X., Ji Z., Lei X. Et al. Cryotherapy for low rectal and anal cancer: recommendation and indications // Front. Oncol. 2023. Vol. 13. P. 984145.
32. Kasai S., Hino H., Hatakeyama K. et al. Risk factors for lateral lymph node metastasis based on the molecular profiling of rectal cancer //Colorectal disease. 2024. Vol. 26, № 1. P. 45-53.
33. Krzeszowiak J., Pach R., Richter P. et al. The impact of oncological package implementation on the treatment of rectal cancer in years 2013–2019 in Poland – multicenter study //Polish journal of surgery. 2024. Vol. 96, № 3. R. 18-25.
34. Li X., Huang K., Liu Y. et al. Diagnostic advantages of transrectal ultrasound with gastrointestinal agent instillation for rectal adenoma and early-stage rectal cancer: comparison of conventional transrectal ultrasound techniques //Quantitative imaging in medicine and surgery. 2024. Vol. 14, № 3. P. 2455.
35. Lian J., Li J., Liu C. et al. Research progress of robot and laparoscope in postoperative complications of rectal cancer //Journal of robotic surgery. 2024. Vol.18, № 1. R. 135.
36. Liu M., Cui N., Sun C. et al. A prospective study on using shear wave elastography to predict the ypT0 stage of rectal cancer after neoadjuvant therapy: a new support for the watch-and-wait approach? //Frontiers in molecular biosciences. 2024. Vol. 11. P. 1402498.
37. Lo A., Le B., Colin-Escobar J. et al. Disparities in diagnostic imaging for initial local staging for rectal cancer //Journal of the American college of radiology. 2024. Vol. 21, № 1. P. 154-164.
38. Ma L., Yu H.J., Zhu Y.B. et al. Laparoscopy is non‐inferior to open surgery for rectal cancer: A systematic review and meta‐analysis //Cancer Medicine. 2024. Vol. 13, № 13. R. e7363.
39. Numata M., Tamagawa H., Kazama K. et al. Lateral lymph node dissection for mid-to-low rectal cancer: is it safe and effective in a practice-based cohort? // BMC Surg. 2021, № 51. https://doi.org/10.1186/s12893-021-01053-1
40. Ouchi A., Iwahori Y., Suzuki K. et al. Artificial intelligence imaging diagnosis using super-resolution and 3D shape for lymph node metastasis of low rectal cancer: a pilot study from a single center //Diseases of the colon & rectum. 2024. №. 10. R. 1097.
41. Pinheiro M., Moreira D.N., Ghidini M. Colon and rectal cancer: An emergent public health problem //World journal of gastroenterology. 2024. Vol. 30, № 7. P. 644.
42. Suarez J., Alsina M., Castro N. et al. Higher rate of pathologic complete response in patients with early-onset locally advanced rectal cancer //ESMO gastrointestinal oncology. 2024. Vol. 3. R. 100033.
43. Takada K., Imai K., T. Yamada et al. Efficacy of endoscopic submucosal resection with a ligation device for small rectal neuroendocrine tumor: study protocol of a multicenter open-label randomized control trial (BANDIT trial) //BMC Gastroenterology. 2024. Vol. 24, № 1. R. 69.
44. Tang X., Yuan H., Mu X. et al. Endosonography, elastography and magnetic resonance imaging in the restaging and response assessment of rectal cancer after neoadjuvant therapy //Ultrasound quarterly. 2024. Vol. 40, № 2. P. 98-103.
45. Temmink S.J.D. Peeters K.C., Nilsson P.J. et al. Surgical outcomes after radiotherapy in rectal cancer //Cancers. 2024. Vol. 16, № 8. P. 1539.
46. Viktil E., Hanekamp B.A., Nesbakken A. et al. Early rectal cancer: The diagnostic performance of MRI supplemented with a rectal micro-enema and a modified staging system to identify tumors eligible for local excision //Acta radiologica open. 2024. Vol. 13, № 5. P. 20584601241241523.
47. Waddimba A.C., Halabi W.J., Ogola G.O. et al. Optimization of rectal cancer surgery outcomes in the United States: the influence of hospital volume on rates of sphincter preservation before and after practice standardization //Baylor university medical center proceedings. Taylor & Francis, 2025. R. 1-12.
48. Zhang Y.C., Li M., Jin Y.M. et al. Radiomics for differentiating tumor deposits from lymph node metastasis in rectal cancer //World journal of gastroenterology. 2022. Vol. 28, № 29. P. 3960.
49. Zhao W., Xu H., Zhao R. et al. MRI-based radiomics model for preoperative prediction of lateral pelvic lymph node metastasis in locally advanced rectal cancer //Academic radiology. 2024. Vol. 31, № 7. P. 2753-2772.
