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One of the most serious complications after low anterior resection is the failure of sutures of colorectal anastomosis, which is the most common surgical complication that results in patient’s death. Promptly diagnosed anastomotic leakage in postoperative period is challenging. Nevertheless, elimination of risk factors in preoperative period can significantly reduce complication rates.The purpose of this review article is to analyze possible risk factors and methods for preventing colorectal anastomosis leakage.An important area of prevention and optimization of treatment options for anastomotic leakage is the development of prognostic measures to eliminate risk factors. We see the prospects for this direction in the introduction of a nomogram, which allows the surgeon to assess the possible outcomes of the operation, to choose the optimal tactics with a minimum risk of complications, as well as the introduction of methods to avoid or prevent the development of complications of colorectal anastomosis.

To increase the effectiveness of combined treatment in patients with rectal cancer and moderate risk of progression based on the concept of polyradiomodification (PRM).The study included 337 patients with rectal cancer and moderate risk of tumor progression. A short course of radiotherapy (cRT) (5x5 Gy) combined with several radiomodifiers (cRT+PRM) was performed in 147 (43.6%) patients. Other 190 (56.4%) patients underwent cRT. The following radio modifiers were used: three-time application of local microwave hyperthermia (Yacht-3 or Yacht-4 devices), two-time intrarectal delivery of a biopolymer composition with Metronidazole before the 3rd and 5th irradiation sessions and two-week oral administration of Capecitabine (Xeloda) at a daily dose of 2.0 g/mCRT+PRM program increased 5-year relapse-free survival up to 81.3% compared to 60.3% after cRT alone (Radiomodification in neoadjuvant radiotherapy is justified in patients with moderate risk of tumor progression, improves long-term results and increases the incidence of sphincter-sparing surgery.Повысить эффективность комбинированного метода лечения больных раком прямой кишки со средним риском прогрессирования на основе концепции полирадиомодификации (ПРМ).В исследование включены 337 больных раком прямой кишки, имеющих средний риск прогрессирования опухолевого процесса. «Короткий» курс лучевой терапии (КЛ) (5×5 Гр) в сочетании с несколькими радиомодификаторами (КЛ+ПРМПрименение программы КЛ+ПРМ способствовало увеличению показателя 5-летней безрецидивной выживаемости до 81,3% по сравнению с 60,3% при использовании только КЛ (Использование полирадиомодификации в программе неоадъювантной лучевой терапии является обоснованным у пациентов со средним риском прогрессирования опухолевого процесса, улучшает отдаленные результаты и позволяет увеличить частоту выполнения сфинктеросохраняющих операций.

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.

Objective: to determine the minimum number of lymph nodes (LN) required for accurate prediction of overall survival in patients with stage II colon cancer and to assess the prognostic value of criteria used in the MOSAIC trial.Materials and methods. This retrospective study included patients with stage II colon cancer that underwent surgical treatment in the Department of Proctology and received adjuvant chemotherapy (if needed) in the Department of Clinical Pharmacology and Chemotherapy of N.N. Blokhin National Medical Research Center of Oncology between 2004 and 2013. Overall survival was considered as the main criterion of treatment efficacy.Results. A total of 445 patients met the inclusion criteria; of them, 60 (13.5 %) patients received adjuvant chemotherapy. The receiver operating characteristic (ROC) analysis was employed to evaluate the predictive value of the number of removed LN for disease progression and death in patients with stage II colon cancer. We found that specificity of >80 % was achieved by removing/examining at least 12 LN. The examination of 13 LN increases specificity by another 6 %. Further increase in the number of removed/examined LN (>13) did not significantly improve prognostic accuracy for death from the moment of disease progression. Only the removal of 13 or more LN ensured a significant impact on overall survival (hazard ratio (HR) 0.12; 95 % confidence interval (CI) 0.02—0.91; p = 0.04). At multivariate analysis, the following factors were found to affect overall survival: postoperative complications (HR 2.4; 95 % CI 1.4—4.3; p

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