Abstract
<jats:p>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.</jats:p>