gnckКолопроктологияKoloproktologia2073-75562686-7303Russian Association of Coloproctology10.33878/2073-7556-2017-0-4-45-53gnck-333Research ArticleОРИГИНАЛЬНЫЕ СТАТЬИORIGINAL ARTICLESСИМУЛЬТАННЫЕ ОПЕРАЦИИ ПРИ КОЛОРЕКТАЛЬНОМ РАКЕ С СИНХРОННЫМИ МЕТАСТАЗАМИ В ПЕЧЕНИSIMULTANEOUS RESECTIONS FOR SYNCHRONOUS COLORECTAL CANCER LIVER METASTASESПономаренкоА. А.PonomarenkoA. A.info@gnck.ruАчкасовС. И.AchkasovS. I.noemail@neicon.ruПанинаМ. В.PaninaM. V.noemail@neicon.ruРыбаковЕ. Г.RybakovE. G.noemail@neicon.ruФГБУ «ГНЦК им. А.Н. Рыжих» Минздрава России; ФГБОУ ДПО РМАНПО Минздрава РоссииРоссияState Scientific Centre of Сoloproctology; Russian Medical Academy of Continuous Professional EducationRussian Federation201730122017044553Copyright © Пономаренко А.А., Ачкасов С.И., Панина М.В., Рыбаков Е.Г., 20172017Пономаренко А.А., Ачкасов С.И., Панина М.В., Рыбаков Е.Г.Ponomarenko A.A., Achkasov S.I., Panina M.V., Rybakov E.G.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.ruproctology.com/jour/article/view/333

ВВЕДЕНИЕ. Резекционная хирургия печени по поводу её метастатического поражения давно утвердилась в клинической практике. Тем не менее, сохраняется проблема выбора объема операции у больных колоректальным раком с синхронными метастазами в печени. Данное проспективное исследование сравнивает непосредственные результаты симультанных операций и этапного хирургического лечения у больных колоректальным раком с синхронными метастазами в печени. МАТЕРИАЛЫ И МЕТОДЫ. В ФГБУ «ГНЦК им. А.Н. Рыжих» Минздрава России с 2013 по февраль 2017 года включительно проведено хирургическое лечение 172 больным колоректальным раком с синхронными метастазами в печени: симультанные операции на толстой кишке и печени выполнены 128 больным, этапное хирургическое лечение - 44 больным. Проведен сравнительный анализ непосредственных результатов в зависимости от демографических, клинико-морфологических характеристик, типа операций. РЕЗУЛЬТАТЫ. Группа симультанных операций статистически достоверно отличалась от группы этапных операций меньшими размерами (медиана - 2,2 см vs 3,2 см, р=0,034) и меньшим числом метастазов в печени (медиана - 2 vs 3,5, р=0,0001). В группе симультанных операций реже выполнялись обширные резекции печени (20% vs 61 %, р=0,0001). Летальность и уровень осложнений в группе симультанных и этапных операций была сопоставима (1 % vs 2%, p=0,98 и 30% vs 45 %, р=0,08). Продолжительность послеоперационного госпитального периода в группе симультанных: операций не отличалась от таковой в группе резекций печени в качестве второго этапа хирургического лечения больных с синхронными метастазами в печени (14 (12; 21) койко-дней и 14 (12; 21) койко-дней, р=0,6).Частота передней резекции прямой кишки в группе симультанных обширных резекций печени выше, чем частота указанных операций в группе этапного хирургического лечения (37% vs 25%), хотя различия статистически недостоверны (p=0,22). Объем кровопотери при выполнении обширной резекции печени в группе симультанных операций был достоверно ниже, по сравнению с группой обширных резекций печени в качестве второго этапа хирургического лечения больных с синхронными метастазами колоректального рака в печени (медиана - 345 мл vs 900 мл, р=0,007). Летальность и уровень осложнений после обширных резекций печени в группе симультанных и этапных операций статистически не различались (0 vs 4 %, p=0,98 и 52 % vs 48 %, p=1,0). В структуре осложнений частота острой печёночной недостаточности после обширных резекций печени в составе симультанных операций не отличалась от таковой после обширных резекций печени в качестве второго этапа хирургического лечения (4 % vs 11 %, p=0,36). Продолжительность послеоперационного госпитального периода в группе симультанных обширных резекций печени не отличалась от таковой в группе обширных резекций печени в качестве второго этапа хирургического лечения больных с синхронными метастазами в печени (19 (15; 27) койко-дней и 19 (11; 27) койко-дней, р=0,1). ЗАКЛЮЧЕНИЕ. При синхронных метастазах колоректального рака в печени, требующих экономной операции на печени, показано выполнение симультанной операции. Симультанные обширные резекции печени не сопровождаются увеличением интраоперационной кровопотери, не увеличивают частоту осложнений, летальности, продолжительность послеоперационного госпитального периода по сравнению с обширными резекциями печени в качестве второго этапа хирургического лечения больных колоректальным раком с синхронными метастазами в печени, вне зависимости от локализации первичной опухоли и характера операции на толстой кишке.

BACKGROUND. The choice type of surgery between staged and simultaneous operations remains an actual issue in patients with colorectal cancer with synchronous liver metastases. The aim of this prospective study is to compare Short-term outcomes of patients with synchronous colorectal liver metastases treated by simultaneous or staged surgery. METHODS. 172 suitable patients were treated in State Scientific Centre of coloproctology named after А.N. Ryzhih, Moscow, Russia between January 2013 and February 2017. Simultaneous colorectal and hepatic resections were performed in 128 patients; 44 patients underwent delayed hepatectomy. Short-term outcomes were compared in patients who underwent simultaneous colorectal and hepatic resection and staged surgery depending on the demographic, clinical and morphological characteristics and type of operations. RESULTS. Median size and number of metastases in the liver were significantly smaller in the group of simultaneous operations: 2.2 cm vs 3.2 cm (p=0.034) and 2 vs 3.5 (p=0.0001), respectively. Major liver resections were rarely performed in group of simultaneous operations: 20 % vs 61 % (р=0,0001). Mortality and complications rates were similar in both groups: 1 % vs 2% (p=0,98) and 30% vs 45 % (р=0,08), respectively. Median days after surgery were also similar in both groups: 14 (12-21) vs 14 (12-21) days, (р=0,6), respectively. Median bloodloss in cases of major liver resections in group of simultaneous operations was lower than in analogical group in staged surgery: 345 ml vs 900 ml (р=0,007), respectively. There was no difference in mortality and complications rates between major liver resections in both groups: 0 vs 4 % (p=0,98) and 52 % vs 48 % (p=1,0), respectively. Rates of acute hepatic insufficiency were similar in both groups of major liver surgery: 4 % vs 11 %, (p=0,36). Median inpatient days were also similar in both groups of major liver surgery: 19 (15-27) vs 19 (11-27) days (р=0,1), respectively. CONCLUSION. Simultaneous operations, requiring economical resections are indicated in cases of synchronous metastases of colorectal cancer in the liver. Simultaneous major liver surgery do not lead to increased bloodloss, complications, mortality rates and inpatient days regardless on type of colorectal surgery in cases of synchronous colorectal cancer liver metastases.

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