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Introduction. Conventionally, hemodynamic significance of carotid stenosis is characterized with an increased peak systolic velocity up to 230 cm/s, which corresponds to 70 % carotid stenosis. This does not take into account changes of cerebral hemodynamics or collateral circulation, which can be determined by assessment of blood flow distribution in precerebral arteries. Aim – to evaluate blood flow redistribution in precerebral arteries in patients with critical carotid stenosis. Materials and methods. 40 patients (aged 49–80 y. o.) with critical carotid stenosis were studied (13 patients had 70–79 % stenosis, 11 patients – 80–89 %, and 16 patients – 90–99 % stenosis). Flow velocity index in precerebral arteries was determined with duplex scanning (Vivid e, USA), whereas linear blood flow velocity in intracranial arteries – with transcranial Doppler (MultiDop X, Germany). Results. In 60 % of patients, flow velocity index in ipsilateral carotid artery was reliably decreased (pConclusion. Thus, critical degree of carotid stenosis does not always indicate its hemodynamic significance. Flow velocity index distribution in precerebral arteries can be used as an additional criterion for assessing hemodynamic significance of carotid stenosis and, along with other indicators, should be taken into account when choosing treatment modality.

In modern surgery, choledocholithiasis has acquired the status of an independent problem, on the solution of which the further progress of surgery of the hepatobiliopancreatoduodenal zone depends. The article is based on a clinical case of surgical treatment with a diagnosis of a complicated form of cholelithiasis, choledocholithiasis. Purpose of the study. To demonstrate minimally invasive surgical treatment of choledocholithiasis in an elderly patient, based on the example of our own clinical case. Materials and methods. A retrospective analysis of a case of surgical treatment of a complicated form of cholelithiasis, choledocholithiasis, in an elderly patient was carried out. The patient is 84 years old. The patient underwent endoscopic retrograde cholangiopancreatography (ERCP), non-cannulation papillosphincterotomy (NPST) and stenting of the common bile duct for choledocholithiasis. The calculi were not removed due to their large size. Later she turned to JSC “NSC” Neftyanik” (Tyumen). Results. Taking into account the patient’s extrahepatic bile duct calculi, the phenomena of previous cholangitis, the patient underwent laparoscopic cholecystectomy, choledochotomy, extraction of calculi and stent, intraoperative choledochoscopy, and completed the operation with laparoscopic choledochoduodenoanastomosis under ETN on 11/19/2019. Conclusion. In this clinical case, we come to the conclusion that the only possible treatment option is the removal of calculi. If it is impossible to remove calculi by minimally invasive antegrade or retrograde methods, they can be considered as preparing the patient for further radical surgical treatment. Modern minimally invasive methods, in particular, laparoscopy, makes it possible to carry out an operation at almost any age aimed at completely eliminating the disease, thereby improving the quality of life.

Objective: to evaluate the efficacy of combination therapy in patients with stage сT3N0M0 and сT2–3N1–2M0 distal rectal cancer during a short course of neoadjuvant thermoradiotherapy compared to radiotherapy or surgical treatment alone.Materials and methods. A total of 166 patients received 3 sessions of local microwave hyperthermia (LMH) at a temperature of 43–45 °C for 60 minutes during a short course of radiotherapy (LMH + CT); 138 patients received combination treatment (CT) using preoperative radiotherapy alone; 197 patients received surgical treatment (ST) only.Results. In patients receiving LMH + CT, overall incidence of complications was 38.6 % and did not significantly differ from that in patients receiving ST (p = 0.8464) and CT (p = 0.5383). We observed no significant differences in the severity of postoperative complications (according to the Clavien–Dindo classification) between the three groups of study participants treated using different regimens. The incidence of relapses was 6 % in the LMH + CT group vs 17.3 % in the ST group (p Conclusions. LMH has a universal radiosensitizing potential that can increase tumor radiosensitivity and improve treatment outcomes.

In a retrospective study, we evaluated factors associated with the early development of septic shock in patients with severe COVID-19.We collected medical records of the intensive care unit patients submitted by the local COVID-19 hospitals across Russia to the Federal Center for the Critical Care at the Sechenov First Moscow State Medical University (Sechenov University). Septic shock in crticially ill patients requiring mechanical ventilation was defined as a need in vasopressors to maintain blood pressure.We studied 1078 patients with severe COVID-19 who were admitted to the intensive care units for respiratory support. There were 611 males and 467 females. The mean age was 61.013.7 years. Five hundred twenty five medical records (48.7%) were received from the Moscow hospitals, 159 (14.7%) from the Moscow region, and 394 (36.5%) from the hospitals located in 58 regions of the Russian Federation. In 613 (56.9%) patients, diagnosis of SARS-CoV-2 infection was confirmed by PCR, and in the other cases it was established on the basis of the clinical picture and the results of the chest CT scan. Septic shock developed in 214 (19.9%) of 1078 patients. In the logistic regression model, the risk of septic shock in patients older than 50 years was higher than in patients of a younger age (OR 2.34; 95% CI 1.533.67; p0.0001). In patients with more severe SARS-CoV-2 infection, there was an increase in the prevalence of cardiovascular diseases, including coronary heart disease and atrial fibrillation, type 2 diabetes and malignant tumors. The risk of septic shock in patients with three or more concomitant diseases was higher than in patients without any concomitant chronic diseases (OR 1.76; 95% CI 1.762.70).The risk of septic shock in patients with acute respiratory distress syndrome induced by SARS-CoV-2 is higher in patients older than 50 years with concomitant diseases, although a severe course of the disease is also possible in younger patients without any concomitant disorders.Цель. Анализ факторов, ассоциированных с ранним развитием септического шока у больных с тяжелым течением COVID-19. Материалы и методы. В исследование включены данные всех пациентов, проконсультированных до 1 мая 2020 г. на базе Федерального дистанционного консультативного центра анестезиологии и реаниматологии на базе ФГАОУ ВО Первый МГМУ им. И.М. Сеченова (Сеченовский Университет). Критерием септического шока считали снижение артериального давления, требовавшее введения вазопрессорных средств. Результаты. В исследование включены 1078 пациентов, 611 (56,7%) мужчин и 467 (43,3%) женщин. Средний возраст составил 61,013,7 года; 525 (48,7%) заявок на консультацию получены из стационаров Москвы, 159 (14,7%) Московской области, 394 (36,5%) лечебных учреждений в 58 регионах Российской Федерации. У 613 (56,9%) больных диагноз SARS-CoV-2-инфекции подтвержден с помощью полимеразной цепной реакции, а в остальных случаях установлен на основании клинической картины и результатов компьютерной томографии органов грудной клетки. Развитие септического шока отмечено у 214 (19,9%) из 1078 больных. В логистической регрессионной модели риск его развития у пациентов старше 50 лет выше, чем у больных более молодого возраста (отношение шансов 2,34; 95% доверительный интервал 1,533,67; р0,0001). У пациентов с более тяжелым течением SARS-CoV-2 отмечалось увеличение частоты сердечно-сосудистых заболеваний в целом, ишемической болезни сердца, фибрилляции предсердий, сахарного диабета 2-го типа, частота злокачественных опухолей выше. Риск развития септического шока у пациентов с тремя и более сопутствующими заболеваниями оказался выше, чем у пациентов без сопутствующих болезней (отношение шансов 1,76; 95% доверительный интервал 1,762,70). Заключение. Риск развития септического шока у пациентов с острым респираторным дистресс-синдромом, вызванным SARS-CoV-2, выше у пациентов старше 50 лет, страдающих несколькими сопутствующими заболеваниями, хотя тяжелое течение заболевания возможно и у более молодых людей без какой-либо сопутствующей патологии.

Objective: to analyze the outcomes of sphincter-sparing surgeries in patients with advanced distal rectal cancer depending on the therapy they receive.Materials and methods. This study included 289 patients with advanced (stage T3N0–2M0) distal rectal cancer who have undergone sphincter-sparing surgeries. Patients were divided into three groups according to their treatment scheme. In group 1, we used combination treatment that included a short course of neoadjuvant radiotherapy supplemented by 3 multidirectional radiomodifiers (local microwave hyperthermia, rectal administration of a biopolymer composition containing metronidazole, and chemotherapy with capecitabine). Patients in group 2 received combination treatment that included neoadjuvant radiotherapy alone. Treatment outcomes in patients receiving combination therapy was compared to those of patients with similar characteristics and location of rectal tumors who have undergone surgery alone in N. N. Blokhin National Medical Research Center of Oncology (group 3).Results. We observed a significant decrease in the incidence of locoregional cancer metastasis in patients from group 1 compared to those from groups 2 and 3 (0.8 % vs 7.9 % and 18.2 % respectively). Moreover, patients in group 1 demonstrated better relapse-free survival than participants in groups 2 and 3 (79.6 % vs 52.6 % and 51 % respectively). The new scheme of combination therapy developed by our team (used in group 1) did not increase the incidence of postoperative complications. The best local disease control in group 1 was achieved in patients with middle rectal cancer who have undergone sphincter-sparing surgeries: none of 81 patients developed relapses, whereas the relapse-free survival rate reached 83 % compared to 56.9 % in group 1 and 41.7 % in group 3.Conclusions. The new treatment scheme that includes neoadjuvant radiotherapy supplemented by 3 multidirectional radiomodifiers can be used as one of the options increasing efficacy of radiotherapy and, therefore, efficacy of combination treatment in patients with advanced rectal cancer who undergo sphincter-sparing surgeries.

Objective: comparison of the effectiveness of the results of neoadjuvant chemoradiotherapy in patients with locally advanced rectal cancer using classical and hypofractionated schedule of radiation therapy.Materials and methods. This study is based on a retrospective analysis of a database of patients with locally advanced rectal cancer (T3C–D, positive circumferential resection margin or T4) who underwent a prolonged course of neoadjuvant chemoradiotherapy followed by surgery. The patients were divided into two groups: the first (main) group, 71 patients who received a course of chemoradiotherapy in hypofractionation schedule as part of neoadjuvant treatment (4 Gy × 40 Gy, 3 fractions per week) in combination with chemotherapy with capecitabine 1650 mg / m2 in two doses on weekdays. The second group (control group) included 79 patients who treated with long-course chemoradiotherapy in the classic fractionation mode (2 Gy × 50–58 Gy, 5 fractions per week) in combination with chemotherapy with capecitabine 1650 mg / m2 in two doses on weekdays. In the preoperative period, along with chemoradiotherapy, 4–8 courses of the systemic chemotherapy in the CapOx mode was used. The primary endpoint of this study was pathological complete response. Secondary endpoints included the seve rity of early radiation and hematological toxicity, the incidence of local recurrence, distant metastases, overall and disease-free survival. Results. The study included 150 patients. The overall frequency of acute radiation toxicity of grade III–IV was 5.6 % in the main group and 8.9 % in the control group (p = 0.658), from them hematological toxicity – 2.82 % and 7.6 %, respectively (p = 0.350), skin and pelvic organ toxicity – 2.82 % and 1.3 %, respectively (p = 0.926). Complete pathological response of III degree in the groups achieved 22.5 % and 19 %, respectively (p = 0.593), grade IV – 18.3 % and 15.2 %, respectively (p = 0.829). In the main and control groups, 4.2 % and 3.8 % of local recurrence were registered, respectively (p = 0.954; hazard ratio (HR) 1.05; 95 % confidence interval (CI) 0.21–5.22). The median time of disease-free survival was 39.4 months. The three-year disease-free survival in the main group was 73.2 % and in the control group 64.6 %, respectively (p = 0.353; HR 0.79; 95 % CI 0.42–1.35). The three-year overall survival in the main and control groups were 84.5 % and 82.3 %, respectively (p = 0.743; HR 0.87; 95 % CI 0.39–1.92). Conclusions. The hypofractionation schedule can be considered as an alternative and not inferior to the standard dose fractionation regimen in a prolonged course of neoadjuvant chemoradiotherapy in patients with locally advanced rectal cancer.

Objective: to evaluate short-term and long-term outcomes of surgical treatment for colorectal cancer metastases to the lungs and to analyze factors affecting the efficacy of surgery. Materials and methods. This study included 211 patients with colorectal cancer metastases to the lungs treated between 1994 and 2014. We enrolled patients with resectable or conventionally resectable metastases (according to chest computed tomography evaluated by a thoracic surgeon); the exclusion criteria were as follows: multiple primary tumors and age more than 85 years. We assessed the type of surgeries, frequency of R0 resections, incidence of postoperative complications, overall survival, and progression-free survival. Results. One hundred and sixty-two patients out of 211 (76.8 %) have undergone atypical lung resection. Forty-nine patients (23.2 %) have undergone pneumonectomy, bilobectomy, or lobectomy. The majority of patients (96.2 %) have had R0 resection, whereas 2.9 % of study participants have had R1 or R2 resections. One patient has undergone a trial surgery. Clinically significant postoperative complications were observed in 4 (2 %) patients; postoperative mortality was 0.5 % (1 case). The five-year overall survival rate was 52.7 %; the 5-year progression-free survival rate was 45.8 %. Development of metastases within 24 months after primary surgery was found to be a significant factor negatively affecting overall survival (hazard ratio 0.347; 95 % confidence interval 0.227–0.53; р Conclusions. Surgical treatment is currently the only truly effective treatment, which can improve long-term survival of patients with colorectal cancer metastases to the lungs; the best treatment results are achieved in patients with a relapse-free interval of more than 24 months.

Objective: to evaluate feasibility and short-term results of the liver-first approach in our center.Materials and methods. Retrospective study of prospectively gathered group of patients who were treated in N. N. Blokhin National Medical Research Center of Oncology between 2017 and 2019. Patients with asymptomatic primary tumor located in rectum and rectosigmoid junction with synchronous resectable / borderline resectable metastasis in liver. 22 patients were planned to undergo the liver-first approach. Post-operative morbidity and mortality (Clavien–Dindo) as well as tumor regression grading (Dworak) were evaluated.Results. Of the 17 patients planned to undergo the liver-first strategy, the approach was completed in 15 (88,2 %) patients. The main reason for treatment failure was disease progression. Post-operative morbidity and mortality were 13,3 % and 0 %, respectively.Conclusions. Liver-first approach is justified in two cases: during waiting period after last day of chemoradiotherapy in patients with locally advanced (invasion depth T4a, positive circumferential resection margin, N+ status) mid-to-low rectal cancer and in patients with multiple borderline resectable bilobar liver damage.

This article demonstrates the experience of successful treatment of a patient with locally advanced rectal cancer, who received a combined treatment with a non-standard course of chemoradiotherapy in hypofractionation mode according to a prolonged program. After the end of a course of chemoradiation received the complete clinical response of the tumor.

Objective: to assess the frequency of liver resections in patients with metastatic colon cancer and isolated non-resectable liver metastases receiving FOLFOXIRI. Materials and methods. In this single-center non-randomized prospective study, we assessed the frequency of liver resections. According to the statistical hypothesis, the frequency of R0-resections in patients with metastatic colon cancer receiving FOLFOXIRI is between 11 % and 33 % (mean 20 %); to increase it up to 50 % in patients with isolated metastatic lesions in the liver, we had to recruit 20 patients (with β = 0.9 and a = 0.05). We enrolled 20 patients with potentially resectable metastases and 22 patients with non-resectable metastases. The primary endpoint was the frequency of R0 liver resections; secondary endpoints included objective response rate, progression-free survival, overall survival, and tolerability of therapy. Patients receiving targeted therapy (according to the tumor mutation status) were also included in the study.Results. Objective response was observed in 32 out of 42 patients (76 %) (in 17 out of 20 participants (85 %) with potentially resectable metastases), whereas progressive disease was registered in 2 patients (5 %). Radical resection of organs affected by metastasis was performed in 19 out of 42 patients (45 %): 15 out of 20 (75 %) in the group with potentially resectable metastases and 4 out of 22 (18 %) in the group with non-resectable metastasis (р Conclusions. FOLFOXIRI increased the frequency of metastasectomy in patients with potentially resectable liver metastases from colon cancer, which was associated with a pronounced increase in the length of life.

Objective : to improve the outcomes of combination treatment of patients with rectal cancer using polyradiomodification and short courses of neoadjuvant radiotheragy. Materials and methods . A total of 905patients were included into this retrospective study based on the data retrieved from a prospective database. Of them, 241 patients underwent combination treatment with polyradiomodification (CT + PRM); 271 patients underwent combination treatment with preoperative radiotherapy alone (CT); 393patients underwent surgical treatment only (ST). Combination treatment with polyradiomodification included a course of radiotherapy with a total dose of 25 Gy delivered in 5 fractions (5 Gy each), rectal administration of biopolymer composition containing metronidazole at a dose of 10 g/m 2 (5-h exposure in the rectum on days 3 and 5), and chemotherapy with capecitabine at a dose of 2 g/m2 on days 1—14 followed by surgery within the next 4—6 weeks. We analyzed the incidence of postoperative complications, 5-year relapse-free survival, and frequency of relapses. Results . The incidence of grade IIIB postoperative complications was significantly lower in patients who underwent combination treatment with polyradiomodification than in those who had surgery only (p = 0.0023) and those who had combination therapy without polyradiomodification (p = 0.0003). The 5-year relapse-free survival rate was 80.5 % in the group of CT + PRM compared to 64.9 % in the group of CT (p = 0.00315) and 60.1 % in the group of ST (p = 0.000001). The frequency of relapses was 0.4 %, 8.5 % (p = 0.00001), and 13.7 % (p = 0.00001) in the groups CT + PRM, CT, and ST respectively. There were no significant differences in the incidence of distant metastasis between the groups. Conclusions . The developed variant of combination treatment with polyradiomodification did not increase the number of complications and ensured better relapse-free survival due to improved locoregional control.

Background . Comparative assessment of the long-term oncological results of extended, combined and standard surgical interventions. Materials and methods . The study included women with histologically verified ovarian cancer T3—4N0—1M0—1. Group A (experimental) patients underwent advanced and combined surgical interventions; group B (control) patients underwent standard surgical interventions. In the postoperative period, all patients received 6 courses of polychemotherapy with a combination of platinum and taxanes. The authors compared the frequency of achieving optimal and conditionally radical operations after performing extended and combined operations and standard surgical interventions, the structure, frequency and causes of intra- and postoperative complications, and overall and disease-free survival. Results . From 2010 to 2018, we selected 150 archived case histories of patients with advanced ovarian cancer (III-IV stages). 135 (90 %) patients were able to track the long-term results of treatment. In group A (experimental), complete debulking was achieved in 52.8 %, in group B (control) — 26.7 %. In group A, 6 (19.9 %) patients had postoperative complications of I-II degree of severity, 1 patient had postoperative complications of IIIA degree of severity, complications of IIIB-IV degree of severity in the study group did not occur (p = 0.05). In group B, intraoperative complications were observed in 27 (22.5 %) patients. Postoperative I—II degrees of severity were observed in 28 (23.3 %) patients, III—IV degrees of severity — in 8 (6.6 %). In group B, the overall survival rate was 54.7 months, and re¬lapse-free was 14.3 months, in group A — 79.2 months and 19 months respectively (p = 0.004 and

Background. In this article, we analyze a 30-year experience of treating patients with rectal cancer and outcomes of sphincter-sparing surgeries (SSS) with manual coloanal anastomosis or mechanical colorectal anastomosis combined with various therapies. Objective: to optimize the indications for SSS considering tumor stage, treatment strategy, and overall performance status of a patient. Materials and methods . We analyzed short-term and long-term treatment outcomes of 1,440 patients with stage T2—3N0—2M0 rectal adenocarcinoma who underwent both surgery and various neoadjuvant therapies. A total of1,038 SSS were included into the final analysis. Four hundred and eighty-one patients underwent anterior rerections (AR) with mechanical anastomosis; 557patients underwent abdominoanal resections (AAR) with manual coloanal anastomosis; of them, 289 individuals had modified abdominoanal resection. Results. The overall frequency of postoperative complications after SSS was 24.3 %. The frequency of anastomosis leakage after AAR and AR was 9.5 % and 15 % respectively. Among patients with middle rectal cancer, there was no association between the type of surgery (AR or AAR) and the probability of relapse (p = 0.1823). In the subgroup with lower rectal cancer, patients that underwent abdominoperineal resection were more likely to have a relapse than those who underwent AAR (p = 0.042). The five-year overall survival rate reached 80 % in the group of SSS and 71 % in the group of abdominoperineal resection (p = 0.013). Year-on-year analysis of relapse-free survival after SSS demonstrated that it had significantly increased (from 63.5 % to 72.5%; p = 0.00077). The complex of rehabilitation measures in the early postoperative period after SSS ensures good functional effect in 51.5 % of cases. Conclusions. SSS planning should be considered from the standpoint of clinical experience as well as multivariate analysis of short-term and long-term treatment outcomes. Successful outcomes can be achieved by a combination of adequate surgical techniques and conservative rehabilitation even in patients with very low rectal cancer. Such combination ensures not only good cancer outcome, but also satisfactory functional results.

The article presents the data on the dynamics of cerebrovascular reserve indices according to various methods in the perioperative period of reconstructive surgical interventions. We analyzed the relationship between the cerebrovascular reserve and the comorbid factors, the informative value of its indices in predicting ischemic strokes and postoperative hyperperfusion complications.

Objective : to analyze short-term and long-term outcomes of surgical, combination, and comprehensive treatment in patients with metastatic rectal cancer. Materials and methods . We performed a retrospective analysis of prospectively collected data on the outcomes of rectal cancer patients receiving surgical, combination (surgery + chemotherapy), or comprehensive (chemoradiotherapy + surgery + chemotherapy) treatment in the Department of Proctology at the N.N. Blokhin National Medical Research Center of Oncology, Ministry of Health of Russia, between 1999 and 2015. We assessed overall survival, frequency of postoperative complications, postoperative death rates and frequency of complications associated with chemoradiotherapy. Results . The study included 366patients that were divided into 3 groups according to the treatment strategy. The 2-year survival rate was 83 % in group 3 (comprehensive treatment) vs 40 % in groups 1 and 2. Median survival was 43 months in group 3 compared to 18 and 14 months in groups 2 and 1 respectively. The number of postoperative complications was 19 %, 13.4 %, and 15.1 % in groups 1, 2 and 3 respectively. There was one postoperative death (1.1 %) in group 3. Conclusion . Comprehensive treatment significantly improves overall survival of rectal cancer patients without increasing the risk of postoperative complications.

Colon cancer is the 3rdmost common malignant neoplasm and the 4thleading cause of mortality from them. The majority of patients are diagnosed at stages II–IV, which indicates the need for markers that can predict disease progression, especially after surgical treatment. Recently, there has been a growing interest in exploring circulating tumor DNA as a marker of residual tumor in colon cancer. In 2018, the N.N. Blokhin National Medical Research Center of Oncology together with the Institute of Chemical Biology and Fundamental Medicine under the coordination of the Center for Strategic Planning and Management of Biomedical Health Risks initiated a research project entitled “Development of an assay for the diagnosis of various malignant tumors and treatment efficacy monitoring based on the analysis of circulating tumor DNA from patient blood”. This article provides a theoretical background for the project and a report on its progress made so far.

We report a case of successful treatment of a 15-year-old female patient (body mass index 16) diagnosed with Turcot syndrome (familial adenomatous polyposis of the colon) combined with multiple primary malignant tumors, including anaplastic astrocytoma (received combination therapy in 2007), metachronous cecal cancer (underwent subtotal colectomy and 12 courses of polychemotherapy in 2016–2017), and metachronous stage III pT3N1M0 rectal cancer at 8 cm. The patient underwent laparoscopic low resection with extirpation of the ileosigmoid anastomosis, creation of a reservoir-rectal anastomosis, and preventive ileostomy. The patient had minimal intraoperative blood loss and uneventful postoperative period (with an accelerated rehabilitation protocol). She was discharged from a hospital on day 9. Considering previous treatment episodes and the disease stage, we also included into the treatment regimen adjuvant FOLFOX polychemotherapy in a reduced dose for 6 months. During one-year follow up, there was no evidence of disease progression. Later, the patient underwent ileostomy closure with forming a side-to-side mechanical anastomosis. The patient is fully rehabilitated in term of her social activity.

Objective: to evaluate therapeutic pathomorphosis and Tand N-downstaging in response to various polyradiomodification regimens used in the combination therapy for rectal cancer.Materials and methods. A total of 241 patients received combination therapy for rectal cancer using 4 different polyradiomodification regimens. We assessed therapeutic pathomorphosis and tumor downstaging in these patients. Eighty-two participants (34 %) underwent polyradiomodification with a 14-day course of capecitabine (Cap) given in a therapeutic dose (2 g/m2body surface) (Cap14 + metronidazole (MZ) and Cap14 + MZ + microwave hyperthermia (MW-HT)), whereas the remaining 159 participants (66 %) underwent polyradiomodification with a 5-day course of Cap in a radiosensitizing dose (1.5 g/m2 body surface) (Cap5 + MZ and Cap5 + MZ + MW-HT).Results. Grade IV therapeutic pathomorphosis was observed in 19.5 % of patients treated with a 14-day course of Cap (Cap14 + MZ and Cap14 + MZ + MW-HT) and 1.3 % of patients treated with a 5-day course of Cap (Cap5 + MZ and Cap5 + MZ + MW-HT) (p = 0.00001). Patients receiving a 14-day course of Cap demonstrated T-downstaging significantly more often than those receiving a 5-day course (41.5 % compared to 9.4 % respectively, p = 0,00001). Regression of regional lymph node metastases was diagnosed in 51.1 % of patients from the Cap14 group only.Conclusion. Our findings suggest that grade III–IV therapeutic pathomorphosis and tumor downstaging are more frequently achieved in polyradiomodification regimens with a 14-day course of Cap at a dose of 2 g/m2 (Cap14 + MZ and Cap14 + MZ + MW-HT).

Objective: to assess short-term and long-term outcomes of right hemicolectomy with extensive lymph node dissection using the experience of one clinic.Materials and methods. This retrospective study analyzed data from a prospectively collected database containing information on all patients with right-sided colon cancer that underwent laparoscopic right hemicolectomy with D3 lymph node dissection between 2013 and 2018. We estimated intraoperative blood loss, surgery duration (taken from anesthetic records), frequency of postoperative complications, length of in-hospital stay, duration of lymphorrhea, time to gastrointestinal recovery, integrity of the mesocolon, number and location of removed lymph nodes.Results. A total of 50 underwent laparoscopic right hemicolectomy with D3 lymph node dissection. No cases of surgical conversion were registered. Median surgery duration was 185 min; median blood loss was 30 mL. No postoperative mortality was observed in the study cohort. Twelve (24 %) patients had postoperative complications; 2 (4 %) patients underwent repeated surgery. Median number of lymph nodes examined was 26; high-quality specimens (G ) were obtained in 48 (96 %) patients. At a median follow-up of 19.5 months, 2 (4 %) patients had disease progression (developed liver metastases).Conclusion. Our results confirm safety of laparoscopic approach for right colon resection with D3 lymph node dissection

Based on the results of worldwide clinical studies, survival of colorectal cancer patients with lung metastases is significantly influenced by curative resection, number of metastases and disease free interval. Intrathoracic lymph node metastases in combination with pulmonary metastases as well as the CEA level of greater than 10ng/ml are found to be the most unfavorable prognostic factors. Most studies have found no significant relationship between survival and the size of the primary tumor and unilateral/bilateral distribution of pulmonary metastases. However, some authors consider that bilateral metastasis and T3-4 tumors are unfavorable prognostic factors. The key factors for surgical treatment of pulmonary metastases are the feasibility of performing curative resection and the absence of other manifestations of the disease.

Objective: to evaluate the long-term outcomes of combined treatment with polyradiomodification in patients with rectal cancer depending on the grade of therapeutic pathomorphosis. Materials and methods. The study included 241 patients that received combined treatment with polyradiomodification for T2–3N0–2M0 resectable rectal adenocarcinoma of varying degree of differentiation. All patients received a course of preoperative radiation therapy (5 × 5 Gy) combined with capecitabine and metronidazole (in a polymer composition at a dose of 10 g/m2 per rectum) on days 3 and 5. Some patients additionally underwent local hyperthermia. Four different polyradiomodification regimens were used. We assessed the frequency of relapses, metastases, and relapse-free survival depending on the grade of therapeutic pathomorphosis and cancer stage. Results. Median follow-up time was 48.5 months. One patient with stage III therapeutic pathomorphosis had relapse. Distant metastases were diagnosed in 35 (19.7 %) out of 178 participants with grade 0–II therapeutic pathomorphosis and 4 (6.3 %) out of 63 participants with grade III therapeutic pathomorphosis; the difference between these groups was statistically significant (p = 0.01). No metastases were observed in patients with grade IV therapeutic pathomorphosis. Among patients with T2–3N1–2M0 rectal cancer, the five-year relapse-free survival was higher in the group with grade III–IV therapeutic pathomorphosis compared to the group with grade 0–II pathomorphosis: 95.7 % versus 56.7 % (p = 0.00422). Conclusion. Our treatment strategy ensures good local disease control. Patients with grade III–IV therapeutic pathomorphosis have significantly lower frequency of relapses and metastases and better relapse-free survival.

The article discusses the tactics and results of treatment of locally advanced colon cancer. We consider the reasonability of multivisceral colon resections in locally advanced colon cancer. The clinical case of locally advanced cancer of the left half of the colon, which got combined treatment, is presented.

Objective : to develop an effective, well-tolerated, convenient for outpatient care (without installing a subclavian catheter) three-component treatment regimen that includes ftorafur – an original oral fluoropyrimidine drug. Materials and methods . The study included 25 patients with disseminated colorectal cancer that have never received specific pharmacotherapy. We evaluated the efficacy and safety of a new first-line three-component treatment regimen with oxaliplatin + irinotecan + ftorafur. Patients in group 1 (n = 6) received this regimen for 3 weeks, whereas patients in group 2 (n = 19) received it for 2 weeks. Results. Only preliminary results of the study are currently available. Median time to progression and overall survival are not yet estimated. Three (50 %) patients from group 1 achieved partial regression of metastases; 3 patients from this group had long-term (≥6 months) disease stabilization. Therapeutic effect (partial remission + long-term stabilization) was observed in all patients. Time without progression varied between 6 and 20 months. In group 2, therapeutic effect was estimated in 18 patients that received at least 2 courses of chemotherapy. Eight out of these 18 patients had partial response (2 of them underwent radical surgery); 8 patients had disease stabilization. Thus, 88.8 % of patients from group 2 responded to treatment. In the whole study population (both groups), response to treatment was achieved in 91 % of patients. Conclusion. Our preliminary results suggest that the combination of oxaliplatin, irinotecan and ftorafur is safe and has an acceptable toxicity profile; therefore, it can be used in weakened patients.

In 1998, oncologists got a brand new antitumor drug – irinotecan. It’s been already 18 years since its approval for second-line polychemotherapy of metastatic colorectal cancer. Indications for irinotecan use were significantly expanded since that time; it is now used in combination with other therapeutic agents for first- or second-line treatment of metastatic colorectal cancer, in combination with targeted drugs or separately; there are some studies assessing the use of irinotecan in neoadjuvant therapy. The article describes the history and modern schemes of irinotecan administration in treatment of colorectal cancer.

A new approach to combined treatment of patients with colorectal cancer with synchronous distant liver metastases is discussed in the article. The approach is based on simultaneous surgical treatment of the colon using laparoscopic method and via open liver resection. This hybrid technology allows to reduce the frequency of postoperative complications, minimize the duration of in-patient care, therefore decreasing time until drugs administration as well as treatment costs, ensuring early start of combined treatment. The description of clinical observations demonstrated the benefits of this method implementation.

The clinical observation demonstrates a successful surgical treatment of a 61-year-old female patient K. (body mass index 38.4) diagnosed with locally advanced sigmoid colon cancer protruded into the bladder and uterus (сT4bN2M0) with formation of a colovesical fistula. The patient underwent surgical treatment in the form of laparoscopic resection of the sigmoid colon and supralevator anterior pelvic exenteration with formation of a Bricker conduit. Intraoperative blood loss was 200 ml. Postoperative period was smooth, with fast track rehabilitation; the patient was discharged on day 9. Considering cancer stage, the patient received XELOX as adjuvant chemotherapy for 6 months after the surgery. During a year of follow-up, no signs of disease progression were evident. The patient is fully socially rehabilitated.

This article deal with method of multimodal, opioid-free anesthesia for colorectal surgery in the perioperative period.To improve the quality of treatment for patients with colorectal cancer using non-opioid anesthesia and analgesia in the perioperative period.The study included 47 patients who underwent laparoscopic colon surgery. This anesthesia method consists of epidural anesthesia with sevoflurane during surgery end epidural analgesia after surgery. We describe the method of non-opioid anesthesia technics during colorectal surgery. The pain syndrome was evaluated at various time intervals. Harvard standard for monitoring during anesthesia is presented.Opioid-free anesthesia is safety method for colorectal surgery. It was also possible to reduce the incidence of postoperative nausea and vomiting, pain, intestinal paresis, the duration of hospitalization, and rise quality of medical care for patient with colorectal cancer.В данном исследовании предложен метод мультимодального, опиат-фри анестезиологического пособия при колоректальной хирургии в периоперационном периоде. Материал и методы. В исследование включены 47 пациентов, которым были выполнены лапароскопические вмешательства на толстой кишке. У данных пациентов была применена методика анестезии на основе севофлурана в комбинации с эпидуральной аналгезией на всем периоперационном этапе. Подробно изложены суть и методика проведения опиат-фри анестезии при данных хирургических вмешательствах. Произведена оценка болевого синдрома в различных временных интервалах. Приведены данные гарвардского стандарта мониторинга во время анестезии. Результаты. При использовании данной методики анестезии пациенты не отмечали болевого синдрома выше 2 баллов по визуальной шкале оценки боли на протяжении всего периоперационного периода. Также удалось снизить частоту послеоперационной тошноты и рвоты, сроки госпитализации.

Objective: to evaluate the impact of cytoreductive surgery on treatment results in patients with colorectal cancer and synchronous lung metastases. Materials and methods. This retrospective investigation analyzed the results of therapy in patients with colorectal cancer and synchronous lung metastases who had been treated in the period 2000 to 2012. The investigators studied the following indicators: the impact of cytoreductive surgery on the survival of patients with this condition, the clinical characteristics of a group of patients with isolated lung involvement, the dissimilarity of this group from a group of patients with extrapulmonary metastases, the possibility of performing complete cytoreductive surgery in patients with varying degrees of a metastatic process, and the number of patients with complications in primary tumor. Results. The investigations included the data of 112 patients with colorectal cancer and synchronous lung metastases. Out of them, 38 (33.9 %) patients had isolated lung involvement and the latter was associated with extrapulmonary metastases in 74 (64.1 %). In 16 of the 38 patients, isolated lung metastases were regarded as resectable and complete cytoreductive surgeries were performed. The median follow-up in the examined group was 15.2 months. One- and two-year overall survival rates were 63 and 45 %, respectively. The patients with isolated lung metastases were observed to have higher 2-year overall survival rates than those with multiple metastases (63.0 and 37.5 %, respectively; p = 0.055) and there were significantly higher 2-year overall survival rates in patients after removal of primary tumors than in those who had not undergone cytoreductive surgery (21.0 and 52.5 %, respectively; p = 0.004). Two-year overall survival rates were 72.5 % in the complete cytoreductive treatment group. Conclusion. The prognosis in the patients with colorectal cancer and synchronous lung metastases was better than that in those with isolated lung involvement and in those whose primary tumor had been removed. Complete cytoreductive surgical treatment can provide long-term survival in this category of patients.

Objective : to evaluate tolerability and efficacy of maintenance treatment in the absence of progression after 16 weeks of first-line therapy in patients with unresectable metastatic colon cancer. Materials and methods . We have analyzed medical case histories of patients with metastatic colorectal cancer who underwent treatment in the department of clinical pharmacology and chemotherapy of N. N. Blokhin Russian Cancer Research Center from 2007 to 2015 years. Inclusion criteria were the following: 16–24 weeks of first-line chemotherapy with no signs of progression and the inability to perform metastasectomy. Progression-free survival was the main criterion for effectiveness in our study. Results. 160 (44.5 %) of 359 treated patients met the inclusion criteria. 102 (63.7 %) patients were followed up, while the other 58 (36.3 % – comparison group) patients underwent maintenance chemotherapy. Grade I–II toxic reactions and grade III complications associated with first-line chemotherapy were insignificantly more common in the group of patients left on maintenance chemotherapy: 72.4 % and 37.9 % versus 57.8 % and 24.5 % in the comparison group, p = 0.07 and p = 0.07 respectively. The frequency of grade I–II toxic reactions and grade III complications in the second-line treatment did not differ between treatment groups (p = 0.9 and p = 0.8). The median of progression-free survival in observation group and comparison group was 4, and 6 months (odds ratio (OR) 0.6; p = 0.009), and life expectancy – 23 and 31 months (OR 0.75; p = 0.1), respectively. Statistically significant differences between groups with respect to achieving the objective response and/or normalization of carcinoembryonic antigen level were revealed: median of progression-free survival was 13 (n = 26 of 57; 45.6 %) and 4 months (n = 31 of 57, 54.4 %), respectively (HR 0.38; p = 0.002), median of life expectancy – 34 months versus 26 months (OR 0.37; p = 0.3). Conclusions . Carrying out maintenance therapy is associated with increased incidence of grade III complications during the first-line treatment, but does not affect the tolerability of the second-line treatment. Supportive chemotherapy with fluoropyrimidines remains to be the most effective in patients with favorable prognostic factors such as normalization of carcinoembryonic antigen and/or achievement of the objective response on the background of first-line chemotherapy.

Background. The aim of this study was to compare short and long-term outcomes after neoadjuvant short-course chemoradiotherapy with capecitabine ot tegafur for operable rectal cancer. Materials and methods. Patients with histologycally verified Т3N0M0, Т2–3N1–2M0 rectal cancer, who underwent 5 × 5 Gy neoadjuvant radiotherapy with local 41–45 °C hyperthermia on days 3–5 and metronidazole 10 g/m2 per rectum days 3, 5 were randomized to receive capecitabine 1000 mg/m2 bid per os days 1–14 or tegafur 400 mg/m2 bid per os days 1–21. Toxicity, tumor regression, sphincter preservation rate and long-term outcomes were analyzed. Results. During 2011–2013 26 patients were included in the tegafur group and 30 – in capecitabine group. Overall toxicity was 50 % in the tegafur arm and 36.7 % in the capecitabine arm (p = 0.42), grade III–IV toxicity (diarrhoea was the most common grade 3+ event) was observed in 23.1 % and 6.7 % (p = 0.13) patients accordingly. Grade III–IV tumor regression was observed in 34.6 % patients, who received tegafur and 53.3 % (p = 0.12) patients who received capecitabine. Sphincter-sparing surgery was performed in 84.6 % and 100 % (p = 0.04) patients who received tegafur and capecitabine accordingly. Median follow-up was 31.6 and 32.2 months accordingly. 3-year overall survival in capecitabine and tegafur arms was 95.4 and 82.1 % (р = 0.13), 3-year disease-free survival – 91 and 74 % (р = 0.029). Conclusions. Both fluorpyrimidines demonstrated comparable short-term outcomes with a tendency to better results in the capecitabine arm.

The modern model of inpatient surgical care of private and optimized state/govermental medical institutions allows us to change the paradigm of nosological attachment of the hospital bed to one profile of specialists for an adaptive model, when the wards can be reassigned depending on the needs of the hospital. In such multidisciplinary medical centers with mixed hospital beds without a nominal distinction in the nosological departments, a new therapeutic service is being developed - hospitalists, which provide a consistent curation of hospitalized patients, compensation of chronic therapeutic illnesses with patient's preparation for surgical interventions. Our work describes the experience of Fast Track recovery program with the active participation of a hospitalist in a surgical team, which is a new experience in the practice of Russian colorectal surgery.Современная модель стационарной хирургической помощи частных и оптимизированных государственных медицинских учреждений позволяет сменить парадигму нозологической привязанности коечного фонда к одному профилю специалистов на адаптивную модель, когда палаты могут перепрофилироваться в зависимости от потребностей стационара. В таких многопрофильных медицинских центрах со смешанным коечным фондом без номинального разграничения по нозологическим отделениям формируется новая терапевтическая служба - терапевты хирургического стационара (врач-госпиталист, hospitalist), которые обеспечивают преемственную курацию госпитализированных пациентов, компенсацию хронических терапевтических заболеваний, подготовку пациентов к хирургическим вмешательствам. В работе описан опыт ведения пациентов по Программе ускоренного выздоровления с активным участием терапевта хирургического стационара, что является новым опытом в практике отечественной колоректальной хирургии.

Adenocarcinoma of the anal canal is a rare cancer. There are a few publications dedicated to this problem only, since patients with this nosological entity are combined with groups of those with lower ampullary cancer of the rectum (despite differences in the nature of these diseases). This paper describes 2 clinical cases of multistep combination treatment for locally advanced and disseminated cancer (adenocarcinoma) of the anal canal. It shows that it is appropriate to apply an aggregate approach to diagnosing this rare disease. Successful experience in treating patients with locally advanced and disseminated cancer of the anal canal is demonstrated. Nonstandard therapeutic approaches and clinical decisions are used. Magnetic resonance imaging was a key technique to diagnose local disease advance in both cases. Radiation sensitizers with different mechanisms of action were used during chemotherapy; preference was given to organ-sparing surgical treatment in the patient with metastatic cancer to maintain quality of life. The paper gives a concise literature review of current methods for the diagnosis and treatment of this disease. Despite the fact that there are no uniform standards, most authors adhere to the opinion that treatment should be started with prolonged chemoradiation therapy cycles followed by surgery. The treatment of patients with the isseminated forms of the disease is strictly individual and calls for a special approach, by taking into account of quality of life and prognosis in a patient.

Research objective. To prove experimentally the possibility of forming a compression colonic anastomoses using nickel-titanium devices in comparison with traditional methods of anastomosis. Materials and methods. In experimental studies the quality of the compression anastomosis of the colon in comparison with sutured and stapled anastomoses was performed. There were three experimental groups in mongrel dogs formed: in the 1 st series (n = 30) compression anastomoses nickel-titanium implants were formed; in the 2 nd (n = 25) – circular stapling anastomoses; in the 3 rd (n = 25) – ligature way to Mateshuk– Lambert. In the experiment the physical durability, elasticity, and biological tightness, morphogenesis colonic anastomoses were studied. Results. Optimal sizes of compression devices are 32 × 18 and 28 × 15 mm with a wire diameter of 2.2 mm, the force of winding compression was 740 ± 180 g/mm 2 . Compression suture has a higher physical durability compared to stapled (W = –33.0; p < 0.05) and sutured (W = –28.0; p < 0.05), higher elasticity (p < 0.05) in all terms of tests and biological tightness since 3 days (p < 0.001) after surgery. The regularities of morphogenesis colonic anastomoses allocated by 4 periods of the regeneration of intestinal suture. Conclusion. Obtained experimental data of the use of compression anastomosis of the colon by the nickel-titanium devices are the convincing arguments for their clinical application.

To study cerebral autoregulation (CA) in region of the stenotic carotid artery.The study involved 35 patients with critical stenosis of the carotid arteries, including 24 patients were asymptomatic and 11 patients with symptomatic course. Blood flow velocity in middle cerebral arteries was monitored using Multi Dop X (DWL, Germany) with simultaneous noninvasive systemic blood pressure registration (CNAP, Austria). CA was assessed by calculating the phase shift (PS) between spontaneous oscillations of blood flow velocity and blood pressure within the range of systemic Mayer waves (80-120 mHz).In 18 patients, the CA indicators were in the normal range (PS 1.2±0.3 rad). Seventeen patients, including asymptomatic as well as symptomatic types, had impaired CA (PS 0.2±0.2 rad and 0.3±0.2 rad, respectively). Reconstructive surgery, irrespective of clinical manifestations, led to the significant increase in PS (p0.001) in the early postoperative period (0.9±0.5 and 0.9±0.3 rad, respectively).A significant variability in the cerebrovascular reserve capacity in symptomatic and asymptomatic types of carotid artery stenosis was found. CA can be used in determining the indications for surgical treatment and evaluation of its effectiveness in patients with stenosis of carotid arteries.Цель работы. Изучить состояние ауторегуляции мозгового кровотока (АРМК) в бассейне стенозированной внутренней сонной артерии (ВСА). Материал и методы. Обследованы 35 больных с критическими стенозами ВСА, из них 24 пациента были с бессимптомным, 11 - с симптомным типом течения заболевания. Проводили неинвазивный мониторинг системного артериального давления (САД) (CNAP, Австрия) и линейной скорости кровотока (ЛСК) в средних мозговых артериях (Multi Dop X, DWL, Германия). АРМК оценивали по значению фазового сдвига (ФС) между спонтанными колебаниями ЛСК и САД в диапазоне волн Майера (80-120 мГц). Результаты. У 18 пациентов показатели АРМК были в пределах нормы (ФС 1,2±0,3 рад). У остальных 17 больных отмечалось нарушение АРМК, которое выявлялось как при бессимптомном (0,2±0,2 рад), так и симптомном (0,3±0,2 рад) типах течения. Реконструктивные операции, независимо от клинических проявлений, приводили к достоверному (p0,001) повышению ФС в раннем послеоперационном периоде до 0,9±0,5 и 0,9±0,3 рад соответственно. Заключение. Выявлена значительная вариабельность цереброваскулярного резерва при обоих типах течения стенозов ВСА. Показатели АРМК могут быть использованы для определения показаний к хирургическому лечению и оценки его эффективности у пациентов со стенозами ВСА.

To present early and remote surgical outcomes in patients with locally-advanced right-sided colonic cancer, invasion of pancreatic head and/or duodenal wall.Early and remote surgical outcomes were analyzed in 27 patients who underwent gastropancreatoduodenectomy combined with right-sided hemicolectomy (ileotransversostomy extirpation) for locally-advanced right-sided colonic cancer.Mean time of surgery was 300 (240-460) minutes, intraoperative blood loss - 2000 (500-7200) ml. Postoperative complications were observed in 15 (55.6%) patients. 3 (11.1%) patients died in early postoperative period. Overall 1-, 3- and 5-year survival was 92.7%, 48% and 36,5% respectively. Median was 33 months.Advanced combined surgery for locally-advanced right-sided colonic cancer, invasion of pancreatic head and/or duodenal wall is associated with acceptable incidence of postoperative complications, early and long-term mortality.Цель - представить непосредственные и отдаленные результаты хирургического лечения больных местно-распространенным раком правой половины толстой кишки с вовлечением головки поджелудочной железы и/или стенки двенадцатиперстной кишки. Материал и методы. Проанализированы непосредственные и отдаленные результаты лечения 27 больных, которым выполнена гастропанкреатодуоденальная резекция в сочетании с правосторонней гемиколэктомией (экстирпацией илиотрансверзоанастомоза) по поводу местно-распространенного рака правой половины толстой кишки. Результаты. Медиана продолжительности оперативного вмешательства составила 300 мин (240-460 мин). Медиана объема интраоперационной кровопотери была на уровне 2000 мл (500-7200 мл). Послеоперационные осложнения диагностированы у 15 (55,6%) больных. В раннем послеоперационном периоде умерли 3 (11,1%) больных. Общая 1-летняя актуариальная выживаемость в рассматриваемой группе составила 92,7%, 3-летняя - 48%, 5-летняя - 36,5%. Медиана 33 мес. Вывод. Выполнение расширенных комбинированных оперативных вмешательств больных местно-распространенным раком правой половины толстой кишки с вовлечением головки поджелудочной железы и/или стенки двенадцатиперстной кишки позволяет получить приемлемых показателей выживаемости в отдаленные сроки, с приемлемым уровнем послеоперационных осложнений и летальности.

S S117 Background: There was still a controversy as to whether palliative resection of primary tumor in incurable colorectal cancer (ICRC) is beneficial in point of survival prolongation. However, there was a few studies for the extent of palliative resection. Purpose: The aim of this study is to estimate the extent of resection of primary tumor in ICRC by using case controlled study. Methods: A retrospective analysis was performed of 190 patients undergoing palliative surgery for ICRC between 1995 and 2004 in single institution. Variables in relation to patients’ demographics, histopathological characteristics of tumor, surgical procedures, and natural course of the disease were examined. Results: Seventy patients (45.5%) underwent complete resection of primary tumor in ICRC and 84 patients (55.5%) underwent excisional resection. In median months of survival, complete resection group was 22 months and excisional resection group was 12.6 months, and Kaplan-Meier survival curve showed a significant survival benefit in patients undergoing complete resection for primary tumor (p