[Local recurrences of colon cancer (in Russian only)]. / Mestnyi retsidiv raka obodochnoi kishki: rezul'taty lecheniia.

AIM: To evaluate the outcomes in patients with local recurrences (LR) of colon cancer. MATERIAL AND METHODS: Prospective study included 52 patients with local recurrences of colon cancer MR and no distant metastases or disseminated carcinomatosis. Patients have been treated at Ryzhikh State Research Center for Coloproctology for the period 2009-2017. Median of local recurrence was 17.6 months. By the moment of diagnosis, CEA was increased in 24 (46.2%), CA 19-9 - in 4 (7.7%) patients. Forty-eight (92%) patients underwent surgery for local recurrences of colon cancer. In 26 (54%) cases, low ligation of supplying vessel was made during primary tumor excision that was confirmed by significant fragment of intact mesentery of the colon. RESULTS: Radical surgery for LR was possible in 34 (70.8%) patients, resection of more than one organ was required in 60% of cases. R1-resection was obtained in 12 (25.0%) cases, palliative resections - in 2 (4.2%) patients. Various complications occurred in 34 (70.8%) patients. Additional intraperitoneal chemotherapy was need in 12 (23.1%) cases. Lethal outcomes were absent. Forty-six out of 48 (95.8%) patients were followed-up. Mean follow-up was 19.5 (8.6-34.7) months. Twelve (26.1%) patients were free from recurrent cancer. Only distant metastases developed in 16 (34.8%) patients. Redo LR occurred in 18 (39.1%) patients including 12 of them with distant metastases. Overall 5-year survival was 38%, disease-free survival - 17.5%, median overall survival - 42.8 months, median disease-free survival - 15.2 months. Intraperitoneal chemotherapy did not significantly affect overall survival. Multivariate analysis confirmed high level of CEA and CA 19-9, positive resection margin as negative predictors. Moreover, impaired survival (p=0.03) was noted in case of LR after non-radical surgery for primary tumor with high ligation of the vessel. CONCLUSION: R0-resection is essential to improve survival and reduce incidence of recurrences. Intraoperative intra-abdominal chemotherapy does not affect the outcomes in patients with LR of colon cancer. Adherence to surgical principles for cancer can reduce the incidence of LR.

[Is implantation metastasis of colorectal cancer to the kidney possible?]

Kidney metastasis in colorectal cancer are rare. A number of publications dedicated to this topic is quite limited. In this article a rare observation of metastasis of colorectal cancer to the kidney is described.

[Colovesical fistula as a complication of diverticular disease].

The results of research on the clinical picture, features of manifestation, diagnosis, and treatment of patients with diverticular disease complicated by sigmovesical fistula are presented. The study included 31 patients (19 [61.3%] men, 12 [38.7%] women), aged 32-83 (55.6 +/- 7.1) years. Diagnostic program included physical examination, laboratory blood and urine tests, endoscopic, radiological, ultrasound examinations. All patients underwent different interventions according to the severity and extent of the inflammatory process, the involvement of other organs of the abdominal cavity and the extent of diverticular lesions of the colon. Long-term results were assessed in all patients in a period of 5 months to 12 years, with a median follow-up 4.7 years. It is shown that the clinical manifestations of intestinovesical fistula did not match the severity of complications, and were subclinical. Timing for referral the patient to coloproctologist was 5 months after the occurrence of first clinical signs. In any case, conservative treatment has not led to spontaneous colovesical fistula closure. Average size of parafistulous infiltration on the wall of the bladder and perivesical tissue was 6.5 +/- 2.4 cm. All the patients underwent different types of colon resection. Postoperative complications did not requiring recurrent surgery were detected in 5 (16.1%) patients. None of these has experienced recurrence complications of diverticular disease. For the optimization the treatment strategy, physicians should follow multidisciplinary approach immediately after revealing the patient with persistent bacteriuria, pneumaturia and fecaluria. The surgery is the method of choice in the treatment of colovesical fistula as a complication of diverticular disease.

[Multidisciplinary approach to the treatment of colorectal cancer, complicated by urinary tract invasion].

Results of treatment of 277 patients with colorectal cancer stage IV complicated by the urinary tract invasion, were analyzed. Men were 168 (60.7%); women - 109 (39.3%). Patients aged 31-79 years (59.6±5.7) years. All patients were operated on radically with the resection of the invaded parts of the urinary tract en bloc. Both abdominal surgeons and urologists took part in the operation. The study proved that the invasion of the urinary tract by colorectal cancer should not become a reason for the surgery refusal. The subtotal resection of the urinary bladder by its cancer invasion demonstrated the appropriate radicalism and functional postoperative results. The efficacy of such combined operations was proved by the high level of social adaptation of the operated patients - 18 (51.4%) of 35 followed up patients came back to the previous level of social activity. Urinary tracts' resection did not influenced the level of postoperative lethality.

[Treatment of patients of local colorectal cancer with involvement of the urinary organs: participation of the urologist].

We treated 314 patients with local colorectal cancer (LCRC). Of them, 189 (60.2%) were males, 125 (39.8%)--females, age from 31 to 79 years (mean age 59.6 +/- 5.7 years). Combined surgery with resection of the affected urinary system components en bloc was made in 277 (88.2%) patients. Palliative urological care for obstructive lesions of the urinary system was delivered to 37 (11.8%) patients. Surgical intervention was performed by a surgical team consisting of coloproctologists and urologist. Treatment of most of the patients was multimodal. As a result, it became clear that involvement of the urinary system in tumor process in LCRC patients must not entail rejection of combined surgery. Subtotal resection of the urinary bladder affected by a tumor in LCRC patients is functionally valid and oncologically radical. Efficacy of this intervention is confirmed by a satisfactory social adaptation--18 (51.4%) of 35 followed up patients resumed their jobs. Resection of different parts of the urinary system has insignificant impact on postoperative lethality. Palliative urological care in urinary obstruction in LCRC patients improves quality of life and efficacy of conventional treatment. Treatment of such severe patients should be conducted with participation of the urologist who decides on optimal methods of urinary derivation, performs surgical reconstruction and follow-up of the patients after the operation.

[Combined management of colon cancer local recurrences with using intraabdominal chemotherapy].

The efficacy of intraabdominal chemotherapy in management of local recurrences of colon cancer was studied. Intraabdominal intraoperative and early postoperative chemotherapy made it possible to prolong of the recurrenceless term and to improve the life quality of the patients with local recurrences of colon cancer. There was observed a tendency to increase the five-year survival.