[Enteral nutrition in postoperative rehabilitation after reconstructive esophageal and gastric surgery]. / Rol' enteral'nogo pitaniya v reabilitatsii patsientov posle rekonstruktivnykh vmeshatel'stv na pishchevode i zheludke.

OBJECTIVE: To investigate enteral nutrition as a component of postoperative rehabilitation after reconstructive esophageal and gastric surgeries. MATERIAL AND METHODS: The study included 217 patients who underwent reconstructive esophageal and gastric surgeries between 2010 and 2020. In the main group (n=121), patients underwent postoperative enhanced recovery program (ERAS). Early enteral feeding including micro-jejunostomy and early oral feeding was essential for postoperative management. The control group included 96 patients who were treated in traditional fashion. The primary endpoint was length of hospital-stay (LOS) and ICU-stay. Restoration of gastrointestinal function (peristalsis, stool, oral nutrition), anastomotic leakage rate and other complications comprised secondary endpoints. RESULTS: Both groups did not differ by sex, age, body mass index, diagnosis and comorbidities. There was significant reduction in postoperative LOS in the ERAS group (14 (12; 15.8) and 9 (6.3; 12) days, p<0.0001). In the same group, we observed less in ICU-stay (4.7 (3.6; 5.6) and to 3.5 (2; 4) days, p<0.001), earlier recovery of peristalsis and X-ray control of anastomosis in patients with and without anastomotic leakage. Incidence of respiratory complications was lower in the ERAS group (p=0.034). Overall postoperative morbidity and mortality were similar. CONCLUSION: Early enteral and oral feeding after esophageal and gastric reconstructive surgery reduces hospital-stay and accelerates postoperative rehabilitation.

[Reconstructive esophageal surgery in fast track epoch]. / Rekonstruktivnaya khirurgiya pishchevoda v epokhu fast track.

OBJECTIVE: To evaluate an efficiency and safety of perioperative fast track management in reconstructive esophageal surgery. MATERIAL AND METHODS: Perioperative fast track management protocol in reconstructive esophageal surgery has been applied since 2014 at the Department of Thoracoabdominal Surgery and Oncology of the Petrovsky Russian Scientific Center of Surgery. These patients (2017-2020) were included in the main group (n=75). Patients who underwent traditional perioperative care (2010-2013) were enrolled in the control group (n=63). The primary outcome was postoperative hospital-stay. We also evaluated ICU stay, incidence of complications according to Clavien-Dindo grading system with particular registration of respiratory complications, mortality, enteral and oral feeding onset. RESULTS: There were no significant between-group differences in sex, age, ASA grade, body mass index. Fast track management reduced hospital-stay from 14 (12; 17) days in the control group to 11 (8; 22) days in the main group (p=0.008). Mean ICU-stay decreased up to 1 (0.8; 2) day in the main group compared to the control group (4.1 (3.5; 5.6) days, p<0.0001). Pneumonia was noted in 5 patients after fast track recovery and 15 patients in the control group (p=0.004). No patients died in the main group, 3 (4.8%) patients - in the control group (p=1). CONCLUSION: Modern perioperative fast track management protocol is safe and effective for extensive reconstructive esophageal interventions. This approach reduces hospital-stay and ICU stay, as well as the incidence of respiratory complications.

[Enhanced recovery program in thoracoabdominal surgery]. / Programma uskorennogo vosstanovleniya v torakoabdominal'noi khirurgii.

Significant improvement of treatment outcomes and reduction of postoperative hospital stay can be achieved, provided a multifaceted approach used in the management of patients. The introduction of the enhanced recovery program addressing all possible factors of the perioperative period will contribute to the treatment protocol development for patients after extensive surgery on the esophagus. OBJECTIVE: To improve medical rehabilitation outcomes in patients after extensive surgery for benign and malignant diseases of the esophagus by implementing an enhanced recovery program. MATERIALS AND METHODS: Patients with benign and malignant esophageal diseases underwent radical surgical repair under general balanced anesthesia with mechanical ventilation. With the collaboration of surgery, anesthesiology, and intensive care staff, a proprietary day-by-day enhanced recovery program was developed based on existing guidelines for patient management and systematic reviews on the enhanced recovery protocol after surgical esophageal repair. RESULTS: The developed patient management program was effective due to the reduction of intensive care unit stay and the total postoperative stay in all main group patients. The use of minimally invasive video-endoscopic techniques contributed to the reduction of intensive care unit stay. A less severe surgical stress response was observed in patients in the group of thoracoscopic subtotal esophageal resections. CONCLUSION: The introduction of the enhanced recovery program promotes the reduction of hospital stay and ICU stay in surgical esophageal repair patients. Also, it allows optimizing the postoperative management of patients with complicated and uncomplicated postoperative periods.

[Gastrointestinal stromal tumors: surgical treatment and targeted therapy]. / Gastrointestinal'nye stromal'nye opukholi: khirurgicheskoe lechenie i targetnaia terapiia.

AIM: To improve surgical and complex treatment of patients with gastrointestinal stromal tumors (GIST). MATERIAL AND METHODS: Our analysis included 97 GIST patients who were at Petrovsky Russian Research Center of Surgery and Moscow City Oncological Hospital #62 from January 2006 to September 2016. RESULTS: Advisability of surgery for GIST patients was confirmed. We have assessed surgical outcomes, defined the indications for adjuvant targeted therapy depending on GIST prognostic risk and additional factors for unfavorable course of disease. CONCLUSION: It was concluded that surgical treatment is preferred for patients with resectable GISTs. Adjuvant therapy is indicated in patients with high risk of progression if mutations indicating tumor sensitivity to the drugs are revealed. Adjuvant targeted therapy is not indicated in patients with low and very low risk of progression.

[Minimally invasive methods for treatment of cholelithiasis, complicated by choledocholithiasis]. / Maloinvazivnye metody lecheniia zhelchnokamennoi bolezni, oslozhnennoi zabolevaniem obshchego zhelchnogo protoka.

Disease of the common bile duct (choledochal duct) was revealed in 18 from 531 patients with bile tract lithiasis (3.4%), who underwent laparoscopic cholecystectomy and in 3 of 72 patients (5.4%), who underwent cholecystectomy through minilaparotomy approach. Stenosis of the large duodenal papilla was observed in 14 patients, choledocholithiasis in 9 patients. Endoscopic papillosphincterotomy (EPST) was performed in all cases. There were no complications. In 2 cases moderate amylasemia was detected. Laparoscopic cholecystectomy was performed 5 days after the procedure on the large duodenal papilla (5.1 days mean). Intervention with the use of mini-approach after EPST was carried out in patient with concrement of gall bladder duct stump, which was revealed 3 months after laparoscopic cholecystectomy. Mini-approach made it possible to perform reconstructive operations on bile ducts in combination with cholecystectomy in 3 patients. At present there are many tools which enable combined treatment of the bile tract lithiasis complicated by bile ducts pathology with low-invasive technique.