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The authors studied the results of repeated radical operations performed in 73 patients who had been subjected earlier to exploratory and palliative operations. During repeated interventions radical operations were conducted on 54 (74%) patients which were of a combined character in 11 (20.4%) of them. Localized-radical palliative resections and extirpations in the presence of remote metastases were performed on 3 (4.1%) patients. Palliative operations were carried out on 16 (21.9%) patients. Postoperative mortality was 6.8%. The data provides evidence that the performance of repeated operations is expedient and justified because they make it possible to raise the resectability index among patients with rectal carcinoma.

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Of 153 patients with confirmed rectal cancer CEA was recorded in 139 (90.8%); erroneous results were noted in 14 (9.2%) patients; in scintigraphy with 67Ga-citrate and 111In-bleomycin diagnoses coincided in 147 (96.1%) patients, and false-negative results were noted in 6 (3.9%) patients. During the investigation 16 patients who had undergone radical operation with any signs of recurrence and 36 patients with suspected tumor recurrence, scintigraphic false-positive results were observed in 12.5 and 30.6% patients, and a false-positive increase in the CEA titer was observed in 12.5 and 11.1%. Of 11 patients with false-positive scintigraphic results a rise of the CEA level was noted in 2 cases making it possible to rule out with a great degree of assurance the presence of a recurrent tumor. The results obtained suggest the appropriateness of the combination of these methods to improve the diagnosis of rectal cancer recurrences.

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The levels of tumor markers were determined in 173 patients with rectal cancer recurrences by radioimmunoassay. An increase in a CEA level was observed most frequently (92.5%). An increase in the levels of alpha-fetoprotein, ferritin and beta 2-microglobulin was observed in 61.7, 56.6 and 46.3%, respectively. CA-19-9, a carbohydrate antigen, was of no importance for the detection of cancer of this site, and an increase in its titer was observed in 15.5% only. Thus the most specific and effective diagnostic test for the diagnosis of rectal cancer recurrences is the determination of a CEA level.

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The carcinoembryonic antigen content (CEA) was studied in 163 patients who had been subjected to surgical treatment. The content of antigen in blood plasma was determined by the radioassay. It is shown that a high pre- and postoperative CEA level may be indicative of the spread of the neoplastic process, nonradical character of the treatment, and an unfavourable prognosis.

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Scintigraphy with 67Ga-citrate and 111In-bleomycin was performed in 26 patients with primary rectal cancer, 176 patients with suspected recurrent tumors, and in 34 patients without clinicoroentgenological signs of cancer recurrence. A focus of higher accumulation of these radionuclides in the rectal area was recorded in all 26 patients. Of 176 patients with symptoms of recurrence tumors were detected by means of ultrasonic and computed tomography of the small pelvis in 158 patients. False-positive results were marked in 18 (10.2%) patients with chronic inflammatory processes at the site of the resected rectum, in anastomosis, and prostatic adenoma. In the control group of 34 patients false-positive results were marked in 8.8%. Positive scintigraphy used in combined diagnosis of rectal cancer recurrences holds promise.

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Results of reoperations for recurrent cancer of the large bowel in 164 patients are analyzed. Radical operations were performed in 110 patients (67.0%). The main operations used were resections of the malignized segment of the bowel (48 patients) and abdomino-perineal extirpation of the bowel with the anastomosed portion of the colon or its stump after the Hartmann operation (38 patients). Postoperative complications were noted in 27.6% of the patients. Lethality after radical operations was 10%. The follow-up analysis has shown that of all the discharged patients 40.7% survived more than 3 years, 31%--more than 5 years.

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A definition of rectal cancer recurrence and a relevant classification are given on the basis of the literature data and the authors' findings, thus providing a means for comparing treatment results and establishing rational procedures of rectal cancer recurrence therapy.

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A study was made of the results of measuring the carcinoembryonic and carbohydrate antigens using a kit of reagents in 75 patients with rectal cancer recurrences and metastases. The concentration of these antigens in healthy persons was for CEA 6.4 +/- 0.71 micrograms/l, the carbohydrate antigen--19.6 +/- 2.51 units/ml. In this group of patients rectal cancer local recurrence was found in 52, metastases to the liver in 19 and metastatic involvement of the liver and lungs in 4. An elevated level of the CEA was detected in 92.8% of the patients with cancer recurrence (the mean concentration was 99.9 +/- 9.29 micrograms/l), and in 100% of the patients with metastases (the mean concentration was 193.4 +/- 30.42 micrograms/l). The content of the carbohydrate antigen in cancer recurrences was raised in 21.3% of the cases only, in metastases to the liver in 31.6% and in 2 patients with metastatic liver and lung involvement. Thus, measuring the CEA content turned out to be the most specific and sensitive test for the diagnosis of rectal cancer recurrences and metastases. The use of the carbohydrate antigen for this purpose was found ineffective.

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The paper is concerned with an analysis of transverse slices of male and female small pelvis in CT-images. A high CT resolution in the characteristics of topical interrelationships of the pelvic organs was shown. A variability of the interrelationships of the pelvic organs with respect to their condition and the value of this factor for correct interpretation of tomograms were shown. A thorough preparation of patients for examination of the pelvic organs is very important for establishing diagnosis, topical characteristics and determination of a degree of dissemination of a pathological process.

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The paper is concerned with the results of the determination of beta 2-microglobulin (beta 2-MG) and CEA concentrations in rectal cancer patients to improve diagnosis of recurrences. The CEA content was shown to be the most specific indicator reflecting the course of a recurring tumor process whereas the beta 2-MG test was found inappropriate for the purpose though it might be used in suspected involvement of the urinary organs in a tumor process.

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A treatment modality employing radiotherapy with subsequent hyperglycemia induction was evolved in experiments on mice and then clinically tested in 32 cases of inoperable locally--extensive primary and recurrent cancer of the rectum. A 50% regression of tumor was registered in 14 (43.0%) out of 32 patients treated with radiotherapy in combination with hyperglycemia. Similar degree of regression was observed only in 6 (15.0%) out of 40 patients who received the same radiation treatment unaccompanied by hyperglycemia. The difference was statistically significant. No untoward side--effects developed. The results are encouraging and seem to open up new vistas of clinical research.

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The results of thermography and computed tomography of 168 patients following rectum extirpation for cancer were analysed. Of them 116 had symptoms of cancer recurrence and 52 with a poor prognosis were without signs of recurrence. In the 1st group thermography made it possible to record recurrences in 106 (91.4%) patients whereas computed tomography in 102 (87.9%). In thermography overdiagnosis was observed in 8 (6.9%) cases as a result of chronic inflammatory processes in the small pelvis. In computed tomography erroneous results were obtained in 4 (3.5%) cases. In the absence of recurrence symptoms the use of both methods made it possible to detect tumor recurrences in 11 (21.2%) patients at a preclinical stage. In the authors' opinion, thermography provides an opportunity to assume the presence of a recurring tumor and to make up a high risk group of patients who are in need of an active follow-up and thorough examination using other methods.

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