Surgical tactics in the treatment of patients with recurrent tumors of the pelvic organs

Abstract

Introduction. Despite the wide introduction of the principles of total mesorectumectomy and effective schemes of neoadjuvant chemoradiotherapy, the development of local recurrences of tumors of the rectum and female reproductive system remains a complex and unsolved surgical problem. The lack of a unified classification and algorithms for choosing the optimal volume of surgery are one of the reasons for unsatisfactory results of treatment of this group of diseases.The aim. To standardize the choice of surgery volume based on the proposed unified classification.Materials and Methods. The experience of surgical treatment of 108 patients with pelvic organ tumor recurrence (pOTR) is summarized in the article. Inclusion criteria: age 18 years and older, confirmation of the diagnosis of tumor recurrence of rectum, uterine body, cervix, ovaries by radiation methods of examination and histologically if the tumor was available for biopsy, the primary tumor was surgically removed with achievement of negative peripheral resection margin (R0), signed informed consent. Inclusion criteria: health status according to the Eastern Cooperative Oncology group (ECOg) 2 or more; distant visceral metastases and/or carcinomatosis of the peritoneum and pleura were diagnosed; complicated course of the tumor process was detected, which did not allow performing a planned surgical intervention.Results. According to the location of the primary tumor, the distribution was as follows: 66 patients with rectal cancer, 12 with cervical, 9 with uterine body and 21 with ovarian cancer. The sex distribution was as follows: 38 (35.1 %) – males and 70 (64.8 %) females. The median age was 63.0 (53.0; 70.0) years. The ECOg overall status was: 0 points in 44 (66.7 %) patients and 1 point in 64 (59.3 %) patients. The median duration of relapse-free period was 15.25 (6.2; 19.6) months. On the basis of the analysis of the nature and type of local tumor spreading, a classification was developed, distinguishing 8 types of recurrence: anterior-upper, anterior-lower, central, lower, posterior-upper, posterior-lower, lateral-left and lateral-right. The characteristics of the entire cohort of patients were analyzed to determine the extent of surgery appropriate for a particular type of recurrence or their combinations.