[Questionnaire of the Ryzhikh National Medical Research Centre for Coloproctology is a new tool for assessing chronic pelvic pain and pelvic organ dysfunction]. / Oprosnik NMITs koloproktologii imeni A.N. Ryzhikh ­ novyi instrument otsenki khronicheskoi tazovoi boli i narusheniya funktsii tazovykh organov.

The article presents the work of a multidisciplinary team of experts from various fields of medicine to optimize the «Questionnaire for assessing chronic pelvic pain and pelvic organ dysfunction (QCPPD) of the Ryzhikh National Medical Research Centre for Coloproctology¼ for use in clinical practice. The survey of respondents was conducted from June 28 to September 28, 2021. As a result of this survey, by repeatedly making edits and clarifications during communication with respondents, the final version was obtained, which allows assessing the patient's subjective sensations by the nature and localization of pelvic pain, sensitivity disorders and pelvic organ function. The main objective of this Questionnaire is to differentiate patients with neurogenic pain from a huge number of patients with chronic pelvic pain. This aspect will allow a more targeted approach to the diagnosis and pathogenetically justified treatment of patients, including after appropriate instrumental examinations. The work of a multidisciplinary team implies a higher degree of objectification and terminological accuracy of the Questionnaire under discussion. The presented version of the «Questionnaire for assessing chronic pelvic pain and pelvic organ dysfunction (QCPPD) of the Ryzhikh National Medical Research Centre for Coloproctology¼ will be primarily used in coloproctological patients with pelvic pain problems and anal incontinence and obstructive defecation. Further studies will be directed to the clinical evaluation of the results of the work carried out.

[One thousand endoscopic submucosal dissections. Experience of the national center]. / Odna tysyacha endoskopicheskikh podslizistykh dissektsii. Opyt natsional'nogo tsentra.

BACKGROUND: Endoscopic submucosal dissection (ESD) is a perspective method of organ-sparing treatment of benign colon tumors. MATERIAL AND METHODS: The study included 1.000 patients with colon neoplasms who underwent ESD between October 2016 and October 2021. All surgeries were performed under intravenous sedation. RESULTS: Mean dimension of tumors was 3.4 cm, median of surgery time - 51 (31; 101) minutes. Conversion of endoscopic approach occurred in 7.6% of cases. The main cause of conversion was unsatisfactory lifting in submucosal injection process. Incidence of en bloc and R0 resections was 84.1% and 68.3%, respectively. Postoperative morbidity was 2.9% that correlates with the world literature data. CONCLUSION: Endoscopic submucosal dissection is an effective and safe method for benign colon neoplasms. Considering high incidence of en bloc resection and low rate of local recurrence in benign neoplasms, further research of efficacy and safety of ESD in early colon cancer is needed.

[Risk factors associated with non-closure of defunctioning stoma in patients with rectal cancer: univariate and multivariate analysis]. / Faktory riska, vliyayushchie na otkaz ot likvidatsii preventivnoi stomy u bol'nykh rakom pryamoi kishki: uni- i mul'tivariantnyi analizy.

OBJECTIVE: To identify the risk factors associated with non-closure of defunctioning stoma in patients with rectal cancer. MATERIAL AND METHODS: A retrospective analysis included patients who underwent surgical treatment at the Ryzhikh National Medical Research Centre of Coloproctology for the period from March 2017 to August 2019. Inclusion criterion was anterior or low anterior resection followed by anastomosis and preventive stoma. Univariate and multivariate analysis enrolled 28 factors for identifying the risk factors of non-closure of defunctioning stoma. RESULTS: There were 246 patients with rectal cancer. Intraoperative fluorescence angiography was applied in 145 cases to assess blood supply within the anastomosis and reduce the risk of anastomotic leakage. According to multivariate analysis, only two factors had significant influence on non-closure of preventive stoma - any grade of anastomotic leakage (OR 6.5; 95% CI 2.2-18.8, p=0.001) and rectal cancer stage IV (OR 7.2; 95% CI 1.9-27.6, p=0.004). CONCLUSION: According to our data, permanent stoma is observed in 15% of patients.

[Effectiveness of intraperitoneal chemotherapy for t4 colon cancer]. / Effektivnost' vnutribryushnoi khimioterapii pri rake obodochnoi kishki T4.

OBJECTIVE: To determine the effect of intraperitoneal chemotherapy (IPC) with mitomycin C on expression of intraperitoneal cancer cells markers in patients with T4 colon cancer. MATERIAL AND METHODS: For the period from January 2019 to April 2020, 65 patients with T4 colon cancer were included in prospective comparative study. There were 46 patients in the main group and 19 patients in the control group. In the main group, surgical procedure was followed by IPC with mitomycin C. No IPC was performed in the control group. An effectiveness of IPC was evaluated using CD133, CD24, CD26, CD44, CD184 markers expression in peritoneal lavages. RESULTS: Significant between-group differences were observed for CD133 (p=0.0168), CD24 (p=0.0455) and CD44 (p=0.0012). There was a tendency to decrease in the level of CD184 expression in both groups in the second lavage (p=0.0605). CONCLUSION: IPC in patients with T4 colon cancer can reduce the expression and proliferative potential of free cancer cells.

[Factors affecting the survival of patients with peritoneal carcinomatosis of colorectal origin]. / Faktory prognoza vyzhivaemosti bol'nykh, operirovannykh po povodu peritoneal'nogo kartsinomatoza pri rake tolstoi kishki.

One of the main problems in the treatment of peritoneal carcinomatosis (PC) in colorectal cancer (CRC) is the adequate selection of patients for cytoreductive surgery (CS) and hyperthermic intraperitoneal chemotherapy (HIPEC). AIM: To determine the predictive factors of overall (OS) and disease-free survival (DFS) in CRC patients with PC after CS with HIPEC. MATERIAL AND METHODS: From 2010 to 2018 years 102 patients with CRC and PC were included in the study. The cytoreduction was complete (CC0, according to Sugabaker scale) in 96 (94.2%) cases. The age median of patients was 65 years. There were 63 (62%) women. In 81 (79%) patients, the PC was synchronous. The median level of CEA was 8.5 ng/ml. The median peritoneal carcinomatous index (PCI) was 3 (1-23). RESULTS: The median of follow-up was 18 (11; 33) months. The median of DFS and OS were 13 (9;31) and 32 (17; n/d) months, respectively. Multifactorial Cox-regression analysis showed the localization of the primary tumor in the right colon (OR=1.66; 95% CI 1.1-2.5; p=0.013) and the level of the PCI (OR = 1.08; 95% CI 1.024-1.15; p=0.008) were independent negative factors of OS. CONCLUSION: The CS and HIPEC in patients with CRC with PC allowes to achieve five-year survival in a part of patients, especially with low PCI. Identifying adverse prognostic factors preoperatively can help in selecting patients for CS in the future.

MutYH-associated polyposis.

MutYH-associated polyposis is the only polyposis syndrome with an autosomal recessive type of inheritance, often phenotypically similar to a weakened form of familial adenomatous polyposis. For the development of the disease mutations in both alleles of the gene are required, but an increased risk of developing colorectal cancer in carriers of monoallelic mutations is noted. The diagnosis of MutYH-associated polyposis should be suspected in a patient with colorectal cancer over 45 years old on the background of polyps in the colon. The review presents modern algorithms for diagnostic and treatment of the disease.

[Risk factors of regional lymph node metastases in pT1 colorectal cancer]. / Faktory riska porazheniia regionarnykh limfaticheskikh uzlov pri rake priamoi kishki rT1.

AIM: To identify risk factors of lymph node metastases in patients with pT1 rectal cancer. MATERIAL AND METHODS: There were 43 patients aged 62.3±11.3 years with pT1 rectal cancer who underwent mesorectal excision in 2012 - 2018. There were 34 (64%) females and 19 (36%) males. RESULTS: Histological examination revealed SM1-2 in 22/43 (51%) cases, SM3 - in 21/43 (49%) cases. Lymph node metastases were identified in specimens with submucosal invasion: SM3 - in 8/21 (38.1%) cases and SM1-2 - in 3/22 (13.6%) cases (p=0.08). Logistic regression confirmed lymphovascular invasion (p=0.005) and mucosal and/or poorly differentiated carcinoma (p=0.014) as independent predictors of lymph node metastases. CONCLUSION: Lymphovascular invasion and poorly differentiated carcinoma are indications for transabdominal mesorectal excision.

[Risk factors of postoperative complications in patients with synchronous colorectal cancer liver metastases]. / Faktory, assotsiirovannye s razvitiem posleoperatsionnykh oslozhnenii u bol'nykh s sinkhronnymi metastazami kolorektal'nogo raka v pecheni.

AIM: Univariate and multivariate analysis of various risk factors and morbidity in patients with synchronous colorectal cancer (CRC) liver metastases. MATERIAL AND METHODS: Prospective data of 173 patients with synchronous CRC liver metastases have been analyzed from January 2013 to February 2017 at the Ryzhikh State Coloproctology Research Center. RESULTS: In multivariate analysis significant risk factors of morbidity were age ≤61 years, the largest liver metastasis ≥ 2.1 cm (odds ratio (OR) 2.99; 95% CI 1.4-6.5), number of liver metastases >1 (OR 2.5; 95% CI 1.1-5.5), bilobar liver injury (OR 2.5; 95% CI 1.3-4.8), blood loss (OR 1.001; 95% CI 1.0001-1.002). Model for prediction of complications was constructed (AUC 0.79). CONCLUSION: Simultaneous surgery is not risk factor of complications. Probability of complications is increased in advanced tumor and consequently more traumatic surgery. Predictive model is useful for prognosis of complications and describes surgical experience of State Coloproctology Research Center.

[Meta-analysis of management of colorectal anastomotic leakage]. / Meta-analiz metodov lecheniia nesostoiatel'nosti kolorektal'nogo anastomoza.

AIM: To identify the most effective management of colorectal anastomosis failure via analysis of available literature sources. RESULTS: Systematic review included 20 original trials. Effectiveness of redo interventions for colorectal anastomosis failure including open, laparoscopic, minimally invasive techniques (transanal drainage, endoscopic vacuum therapy, endoscopic drainage) was described. Anastomotic failure rate was 6.5%. Medication was effective in 57% (95% CI 34-77%) of cases. Redo open surgery was applied in 43% (95% CI 23-66%) of patients. Postoperative mortality was 21-27%. Redo laparoscopic procedure was performed in 61% (95% CI 50-70%) of cases for anastomotic failure after previous laparoscopy, incidence of conversion was 12% (95% CI 4-28%). Transanal drainage was effective in 85% (95% CI 61-94%) of cases, endoscopic vacuum therapy - in 82% (95% CI 74-87%), healing of anastomosis without need for colostomy was achieved in 16% (95% CI 9-26%) of cases. Endoscopic clipping for colorectal anastomotic defect was effective in 73.3-77% of cases. CONCLUSION: Redo surgery for anastomotic failure is associated with advanced mortality and need for permanent colostomy. Laparoscopic approach reduces incidence of complications after redo surgery and followed by better functional outcomes. Minimally invasive procedures are advisable for colorectal anastomosis failure without need for redo surgery. However, effectiveness of these methods is controversial due to few reports and no comparative trials.

[Prevention of colorectal anastomotic leakage by using of intraoperative fluorescent angiography: prospective trial data]. / Primenenie intraoperatsionnoi fliuorestsentnoi angiografii v kachestve metoda profilaktiki nesostoiatel'nosti kolorektal'nogo anastomoza: rezul'taty prospektivnogo issledovaniia.

AIM: To evaluate the effect of intraoperative fluorescent angiography on the incidence of colorectal anastomosis failure. MATERIAL AND METHODS: Prospective, non-comparative study included 52 patients with rectal or sigmoid cancer who underwent surgery with stapled colorectal anastomosis. Intraoperative fluorescent angiography with indocyanine green was performed to determine colon perfusion. All patients underwent proctography with water-soluble contrast agent in 6-8 days after surgery in order to determine anastomotic leakage. RESULTS: Fluorescent angiography was followed by changed volume of proximal colectomy in 14 (27%) patients due to inadequate blood supply of intestinal wall at previous surgical level. Additionally, 1-5 cm of intestinal wall were excised. Postoperative anastomotic leakage occurred in 3 (5.8%) patients. CONCLUSION: Fluorescent angiography with indocyanine green is accompanied by reduced incidence of anastomotic failure in colorectal suregry.

[Li-Fraumeni syndrome in a patient with multiple anaplastic oligodendrogliomas of the brain (a case report and literature review)]. / Sindrom Li-Fraumeni u patsienta so mnozhestvennymi anaplasticheskimi oligodendrogliomami golovnogo mozga (klinicheskoe nabliudenie i obzor literatury).

Li-Fraumeni syndrome (LFS) is a clinically and genetically heterogeneous hereditary syndrome with predominantly oncological manifestations, which is associated with mutations in the TP53, MDM2, and CHEK2 genes. The most common variant is a TP53 mutation. OBJECTIVE: To analyze the literature and present a clinical case of a patient with Li-Fraumeni syndrome and multiple anaplastic oligodendrogliomas of the brain. CLINICAL CASE: A 42-year-old male patient presented with complaints of headaches, word finding difficulty, memory loss, right hemianopsia, and generalized convulsive attacks. For 10 years, he underwent multiple interventions and chemotherapy courses for colon adenocarcinoma and recurrent B-cell lymphoma. MRI revealed multiple space-occupying lesions of the cerebraln hemispheres, which were located in the left temporo-occipital and right frontal regions. RESULTS: The patient underwent resection of multiple space-occupying lesions of the left temporo-occipital and right frontal regions. The postoperative period proceeded without complications. The histological diagnosis was WHO grade III anaplastic oligodendroglioma. The patient and one of his sons were detected with a R248W missense mutation in the TP53 gene. The patient underwent six courses of temozolomide chemotherapy. At a follow-up examination 20 months after surgery and chemotherapy, the patient's condition was satisfactory; he returned to work. Control MRI of the brain revealed no signs of continued tumor growth. CONCLUSION: An analysis of the literature and the clinical case indicate the success of multiple surgical interventions and chemotherapy courses performed for a long time in the patient with Li-Fraumeni syndrome manifested by colon adenocarcinoma, recurrent B-cell lymphoma, and multiple anaplastic oligodendroglioma of the brain. The patient had a good quality of life and returned to professional activity.

[Short-term outcomes of laparoscopic-assisted procedures for chronic complications of diverticular disease]. / Rezul'taty laparoskopicheski-assistirovannykh vmeshatel'stv pri khirurgicheskom lechenii khronicheskikh oslozhnenii divertikuliarnoi bolezni.

AIM: To estimate efficacy of laparoscopic-assisted procedures for chronic complications of diverticular disease (DD). MATERIAL AND METHODS: It was made a prospective comparative study within 2007-2015. Inclusion criteria were verified chronic DD (>6 weeks after the first attack) and bowel resection followed by primary anastomosis. EXCLUSION CRITERIA: contraindications for pneumoperitoneum, BMI ≥35 kg/m2, infiltrate dimension >10 cm, preoperatively non-excluded neoplasm. RESULTS: 233 patients with chronic DD underwent elective surgery, 136 (58.4%) of them were included in the study. There were 80 (58.8%) females aged 57.2±6.2 (24-83) years. Main group consisted of 75 patients after laparoscopic-assisted procedures, 61 were in control group (open ones). Both groups were homogeneous in age, gender, BMI, type of chronic complications, extent of inflammation, extent of bowel resection, surgery time (211.1 vs 206.3 min; p=0.16), incidence of preventive stoma (12.9 vs 19.7%; p=0.32) and complications rate (10.7 vs 14.7%; p=0.47). Maximal time of surgery was noted in case of chronic abdominal mass with statistically significance for main group (240.0±12.2 min vs 207.6±13.7 min; р=0.01). Conversion rate was 12.0% in main group. Main group showed significant higher rate of stapler anastomoses (66.7 vs 22.9%; р<0.0001), less intraoperative blood loss (100 ml vs 350 ml; р=0.001). Early postoperative period was significantly shorter in main group (9.5±0.4 days vs 12.9±1.2 days, р=0.02). CONCLUSION: Laparoscopic-assisted procedures for diverticular disease are associated with more favorable early postoperative period with the same complication rate. Technical complexity and operative time depend on the extent of pelvic inflammatory changes.

Side-to-end vs. straight stapled colorectal anastomosis after low anterior resection: results of randomized clinical trial.

AIM: The aim of this study is to compare surgical, functional, physiologic outcomes and QOL after low anterior resection (LAR) with andside-to-end or straight colorectal anastomosis. METHOD: Between 2012 and 2015, 86 patients with mid and low rectal tumors were enrolled into randomized trial. Wexner score, number of defecations, use of antidiarrheal medicine or laxatives, enemas, pads, episodes of nocturnal incontinence, and urgency were recorded. The Fecal Incontinence Quality of Life (FIQL) scale was used for assessment of QOL. Anal manometry and volumetric examination were performed. RESULTS: Six patients were excluded from the study. There was no mortality. The morbidity rate was 6 (14.6 %) for side-to-end vs. 8 (20.0 %) for straight anastomosis (p = 0.57). The median Wexner score was 5 vs. 6 (p = 0.033), 4 vs. 5 (p = 0.006), and 2 vs. 3 (p = 0.1) at 1, 3, and 6 months after stoma reversal, respectively. Side-to-end anastomosis resulted in a fewer mean numbers of bowel movements per day at the same check points of follow-up: 5.8 ± 0.14 vs. 6.4 ± 0.15 (p = 0.006), 3.7 ± 0.1 vs. 4.2 ± 0.1 (p = 0.003), and 2.5 ± 0.1 vs. 3.0 ± 0.10 (p = 0.0002), correspondingly. Maximal tolerated volume was higher for side-to-end anastomosis at 3 and 6 months of follow-up: 152.0 vs. 137.8 cm(3) (p = 0.002) and 180.5 vs. 167.0 cm(3) (p = 0.006), respectively. Better FIQL score was found at 1 and 3 months in the side-to-end group. CONCLUSION: Better functional outcomes and QOL were observed in a short period after stoma closure, but at 6 months of follow-up, the only benefit of side-to-end anastomosis was a lower number of bowel movements.

[Pilot clinical and genetic study of Russian patients with Peutz-Jeghers syndrome].

Peutz-Jeghers syndrome is a rare hereditary syndrome characterized by presence of hamartoma polyps in intestinal tract and usually by mucocutaneous pigmentation. Clinical-genetic characteristics of Russian patients with Peutz-Jeghers syndrome were studied for the first time. Four germline mutations in STK11gene were found in probands from six families and three of them had not been described previously. Clinical pattern of disease in Russian patients included: frequent polyposis of colon and stomach (62,5% and 75%, respectively) along with small bowel; frequent presence of malignant tumors (62,5%). These clinical aspects can help physicians to find out Peutz-Jeghers syndrome. Molecular-genetic testing of individuals should be recommended.

NORMAL MEASUREMENTS OF PRESSURE IN ANAL CANAL DURING SPHINCTEROMETRY ON S4402 MSM AND WMP SOLAR GI DEVICES.

AIM: To assess normal measurements of pressure in anal canal during sphincterometry on S4402 MSM and WPM Solar GI devices. MATERIALS AND METHODS: The study included 126 patients with colonic polyps. inclusion criteria were absence of anal incon- tinence and defecation disorders. Seventy-three patients were assessed with S4402 MSM device, Included were 28 males (mean age 56,2±10,2 years) and 45 females (mean age 54,9±13,7 years). Fifty-three subjects were assessed via WPM Solar GI device: 23 women (mean age 51,4±11,1 years) and 30 males (mean age 65,1±15,9 years). RESULTS: Sphincterometry results using S4402 MSM device in males were as follows: mean resting pressure - 52,1+198 mm Hg; maximal resting pressure - 60,3±21,9mm Hg; mean pressure at voluntary contraction - 118,2±41,5 mm Hg and maximal pressure at voluntary contraction - 174,2±56,8 mm Hg. Corresponding values in females were 37,1±15,3 mm Hg, 43,8±15,5 mm Hg; 75,1±29,5 mm Hg and 99,1±39,7 mm Hg, respectively. Using WPM Solar GI sphincterometry the following figures were obtained in males: resting pressure - 43-61 mm Hg; maximal voluntary contraction pressure - 121-227 mm Hg; mean pressure - 106-190 mm Hg; maximal pressure with coughing test - 45-175 mm Hg; at straining minimal pressure decreased to 19-43 mm Hg (20-60%). In females the results were as follows: resting pressure - 41-63 mm Hg; maximal pressure at voluntary contraction 110-178 mm Hg; mean pressure - 88-146 mm Hg; maximal pressure at coughing test - 76-126 mm Hg, pressure decrease at straining to 28-52 mm Hg, relaxation up to 19-40%.

[Possibilities of transanal endoscopic microsurgery: the experience of 202 operations].

Transanal endoscopic microsurgery (TEM/TEO) is a standard treatment for rectal adenomas but can also be used for selected malignant tumors. Rectal adenomas, selected adenocarcinomas and carcinoids were chosen for operations. Preoperative work-up included: digital rectal examination, rectoscopy with biopsy, colonoscopy, EUS, pelvic CT (MRI). Two hundred and two patients [mean age of 62.4 ± 10.3 (33-86)] had TEO. The mean size ± SD of tumors was 3.2 ± 1.4 cm (0.6-8.0). Mean distance from anal verge and dental line was 7.1 ± 2.4 cm (2.5-14.0) and 4.6 ± 2.6 cm (0.5-12.0), respectively. Preoperative biopsy revealed: adenoma--156/202 (77.2%), adenocarcinoma--39/202 (19.3%) and carcinoid--7/202 (3.5%). The median operating time was 40 (20-180) min. Tumor-free margins were obtained in 200/202 (99%) operative specimens, 2/202 (1.0%) cases tumors were fragmented. Morbidity was 7/202 (3.5%). Pathological investigation revealed: adenoma in 109/202 (54.0%) cases, adenocarcinoma stage Tis, T1, T2 and T3 in 86/202 (42.5%), carcinoid in 5/202 (2.5%), neurilemoma in 1/202 (0.5%), neurofibroma in 1/202 (0.5%). One hundred and two patients had follow-up (95%). Median follow-up at 20 (1-41) months; 3/192 patients with adenocarcinoma, 1/192 patient with adenoma and 1/192 patient with carcinoid had local recurrence. Thus, transanal endoscopic microsurgery for rectal adenomas and selected malignant tumors is associated with low morbidity and low recurrents rates.

Cell reconstruction of the rectal mucosa in patients with familial adenomatous polyposis: endoscopy, morphology, immunohistochemistry.

We propose a new surgical approach to the treatment of familial colorectal adenomatous polyposis implying preservation of a portion of the rectum with removed mucosa. For reconstruction of the rectum, allotransplantation of the mixed culture of fetal allogenic somatic cells of the intestinal epithelium and mesenchymal cells of various origin is used. The mechanisms of mucosa reparation were studied in 34 patients. Endoscopic, morphological, and immunohistochemical studies showed that cell transplantation considerably accelerated reparation of the mucosa in mucosectomized rectum. The proposed treatment of familial colorectal adenomatous polyposis allows delaying the development of rectal polyps and cancer for many years.