[D2 and D3 lymph node dissection for colon cancer]. / Rezul'taty limfodissektsii d2 i d3 pri rake obodochnoi kishki.

OBJECTIVE: To evaluate surgical and oncological results of standard and extended lymph node dissection (D2 and D3) in patients with colon cancer. MATERIAL AND METHODS: We analyzed treatment outcomes in 74 patients with colon cancer stage T1-4aN0-2M0 who underwent right- and left-sided hemicolectomy, resection of sigmoid colon with standard and extended lymph node dissection (D2 and D3). RESULTS: Surgical approach and level of D3 lymph node dissection did not increase intra- and postoperative morbidity. Laparoscopic interventions were followed by significantly lower intraoperative blood loss and earlier gas discharge. Metastatic lesion of apical lymph nodes was observed in 5 out of 36 patients who underwent D3 lymph node dissection (13.8%), and metastases in regional lymph nodes rN1-2 were found in all these patients. Overall 5-year survival was 86%. Disease-free and overall 5-year survival were similar after D2 and D3 lymph node dissection. CONCLUSION: D3 lymph node dissection is safe for colon cancer. Metastatic lesions of apical lymph nodes during D3 lymph node dissection were detected only in patients with lesions of regional lymph nodes (rN1-2). Disease-free and overall 5-year survival were similar after D2 and D3 lymph node dissection.

[Gastrointestinal stromal tumors: potential of minimally invasive surgical interventions]. / Gastrointestinal'nye stromal'nye opukholi: vozmozhnosti maloinvazivnykh operativnykh vmeshatel'stv.

OBJECTIVE: To analyze the issue of gastrointestinal stromal tumors (GISTs) and potential of minimally invasive surgical interventions. MATERIAL AND METHODS: We analyzed postoperative outcomes in 97 patients with gastric and intestinal GISTs who underwent surgical treatment at the National Medical Research Centre for Oncology between 2015 and 2020. RESULTS: Twenty (24.7) patients with gastric GISTs underwent laparoscopic partial and distal gastric resections. Five (35.7%) patients with GISTs of the small intestine underwent minimally invasive segmental bowel resections. Only minimally invasive interventions were performed in patients with rectal GISTs. Analysis of laparoscopic and open surgeries for GISTs found no significant differences. Analysis of laparoscopic and open surgeries for gastric and small bowel GISTs revealed the obvious advantages of minimally invasive access regarding postoperative outcomes. Indeed, we found no need for nasogastric drainage in 50% of patients (p<0.001), earlier recovery of intestinal motility and oral feeding (p<0.001), lower postoperative morbidity (p=0.036), fast recovery of motor activity (p<0.001) and shorter postoperative hospital-stay (p<0.001). CONCLUSION: Despite small incidence, GISTs are a complex problem in modern oncology. Diagnosis and treatment require a multidisciplinary medical team (morphologists, geneticists, radiologists, surgeons, chemotherapists, gastroenterologists and other specialists) that is possible in a reference center. Minimally invasive interventions for GISTs of the stomach, small intestine and rectum improve postoperative course.

[Results of redo liver resections for metastatic colorectal cancer]. / Rezul'taty povtornykh rezektsii pecheni pri metastaticheskom kolorektal'nom rake.

OBJECTIVE: To analyze patients undergoing redo liver resections for metastatic colorectal cancer. MATERIAL AND METHODS: The study included 14 patients with colorectal cancer who underwent several redo liver resections for metastatic lesions between September 2011 and June 2021. Mean age of patients was 63.5 years. Left-sided colonic G2 adenocarcinoma T4N1-2 prevailed (wild-type KRAS). RESULTS: Fourteen patients (100%) underwent two liver resections, 7 (50%) - three resections, 1 (7.1%) - four resections. Mean period between the first and the second liver resections was 16.2 months, between the second and the third resections - 9.9 months, between the third and the fourth resections - 5 months. Maximum follow-up period after primary surgery was 9 years and 9 months. Seventy-five percent of patients were alive after 34.2 months, 50% - after 58.9 months. N+ status of colorectal tumor decreased survival while KRAS mutation and synchronous metastatic liver lesions increased survival. CONCLUSION: Redo liver resections for metastatic colorectal cancer are safe and ensure favorable long-term survival in certain patients.

[Transanal endoscopic rectal resection: immediate and long-term results]. / Transanal'naya endoskopicheskaya rezektsiya pryamoi kishki: neposredstvennye i otdalennye rezul'taty.

OBJECTIVE: To analyze the results of transanal endoscopic microsurgery in patients with rectal tumors. MATERIAL AND METHODS: We analyzed 87 transanal endoscopic resections of rectal benign tumors (35 patients) and rectal cancer cT1N0M0 (52 patients) for the period since 2012. RESULTS: There were 2 (3.8%) intraoperative intestinal wall perforations into abdominal cavity and 2 (3.8%) postoperative bleedings among patients with rectal cancer. Four (7.7%) patients developed recurrent rectal cancer (pT1N0M0 - 1 patient, pT2N0M0 - 3 patients; by tumor grades: G1 - 2 patients, G2 - 2 patients) within 1.6-5.2 years. All recurrent tumors were located on anterior rectal wall. In patients with rectal cancer, cumulative relapse-free survival was 0.923 (standard error 0.037), cumulative overall survival - 0.926 (standard error 0.043). There was 1 (4.3%) intraoperative intestinal wall perforation among patients with benign rectal tumors. Postoperative anastomotic leakage occurred in 1 (4.3%) patient. Recurrent benign tumors occurred in 2 (8.7%) patients with villous rectal tumors. No relapses were observed in patients with rectal adenomas (p=1.0). CONCLUSION: Transanal endoscopic rectal resection is effective for benign rectal tumors and rectal cancer pT1N0M0 with high relapse-free and overall survival and low complication rate. Risk factors of recurrence are tumor stage pT2N0M0, tumor location on anterior wall and distance from the anus over 10 cm.

[Conversion of laparoscopic access in colorectal cancer surgery (in Russian only)]. / Konversiia laparoskopicheskogo dostupa v khirurgii kolorektal'nogo raka.

AIM: To analyze the problem of access conversion in laparoscopic surgery for colorectal cancer. MATERIAL AND METHODS: There were 876 procedures for colorectal cancer T14N01M0 performed at the Rostov Research Institute of Oncology in 2015-2017. Open and laparoscopic surgery was applied in 562 and 309 patients, respectively. Conversion of laparoscopic procedures was required in 35 (10.2%) patients. RESULTS: Conversions were 2.7 times more frequent in men (p<0.05) (probably due to anatomical features - a narrow pelvis) and predominantly with rectosigmoid (22.2%, 2 patients) and rectal cancer (12%, 22 patients). Conversions in women were as well in right-sided colon cancer (9.7%, 3 cases) and sigmoid cancer (7.4%, 4 patients). Conversions were performed mostly due to locally advanced tumors (37.1%, 13 patients) which are especially baffling in case of narrow pelvis. Visceral obesity (20%, 7 patients) and abdominal adhesions (17.1%, 6 patients) were also important causes of conversions. Conversions did not affect time of surgery (256 min vs. 240 min in laparoscopic and 237 min in open surgery). Intraoperative blood loss (284 ml) was higher than in laparoscopy (240 ml) but did not exceed that in open surgery (291 ml). CONCLUSION: It is necessary to assess risks and benefits of laparoscopy in patients with high probability of conversion in colorectal cancer surgery.

Familial adenomatosis of the colon: current state of the problem.

AIM: The urgency of the problem of familial adenomatosis of the colon (FAC) is caused both by the severity of the disease with the inevitable development of cancer without timely treatment, and the involvement of the patient's blood relatives in this problem. Due to the rare inci- dence of this disease, many issues require discussion. To determine the possibility of timely treatment of FAC patients maintaining a satisfactory quality of life. MATERIALS AND METHODS: The data on 5 FAC patients and 12 their blood relatives were studied. Clinical, endoscopic and genetic characteristics of the disease and treatment were analyzed. Results. Demonstrated that family history, genetic and endoscopic examinations allow diagnosis of FAC. Colectomy with rectal resection and the creation of a small intestine reservoir with reservoir-rectal anastomosis provide a sufficient quality of life for patients. Examination of the patient's blood relatives reveals new patients requiring additional examination and treatment. CONCLUSION: The problem of FAC is multidisciplinary and involves therapists, gastroenterologists, pediatricians, geneticists, endoscopists, radi- ologists, surgeons and oncologists. Only a timely diagnosis can help the patient to undergo radical treatment before the development of colon cancer.

[Multiple primary colorectal cancer: Clinical aspects]. / Pervichno-mnozhestvennyi kolorektal'nyi rak: klinicheskie aspekty.

AIM: to define some clinical characteristics of synchronous and metachronous colorectal cancer (CRC). MATERIAL AND METHODS: The investigation was concerned with the data of 150 patients with T1-4N0-2M0-1 multiple primary CRC. The clinical, biological, and morphological characteristics of synchronous and metachronous tumors were analyzed. RESULTS: Multiple primary tumors were 6.01% of all the cases of CRC. There was a preponderance of synchronous CRC (63.75%) with the tumor localized in the sigmoid colon and rectum. In women, synchronous colorectal tumors were more often concurrent with breast tumors; metachronous ones were detected after treatment for genital tumors. In men, synchronous colorectal tumors were more frequently concurrent with kidney cancer; metachronous ones were identified after treatment for gastric cancer. CONCLUSION: The found characteristics of multiple primary colorectal tumors may be taken in account in programs for both primary diagnosis and follow-up after treatment for malignant tumors, which will be able to improve the early detection of cancer patients and their treatment results.

[Combined surgery for locally advanced colorectal cancer]. / Kombinirovannye operativnye vmeshatel'stva pri mestno-rasprostranennom kolorektal'nom rake.

AIM: To study the types and early outcomes of combined interventions for locally advanced colorectal cancer. MATERIAL AND METHODS: Since 2009 four hundreds and ninety eight patients underwent surgery in the Rostov Research Institute of Oncology for locally advanced colorectal cancer. Most cases of surgical procedures on adjacent organs included resection of small intestine (23.69%), supravaginal hysterectomy (16.47%), resection of bladder (12.25%), total hysterectomy (11.45%). RESULTS: Postoperative complications occurred in 178 (35.7%) patients. Their incidence was significantly lower in case of laparoscopic approach (12.5%). Functional-sparing interventions on bladder followed by its augmentation with enteric graft improves rehabilitation. CONCLUSION: Laparoscopic approach and functional-sparing surgery improve the results of locally advanced colorectal cancer management.

[Ways to improve the results of the staple suture use for the rectal anastomosis].

Treatment results of 311 patients with rectal cancer T1-4N0-2M0-1, who received the anterior rectal resection with mechanic circular colorectal anastomosis, were analyzed. The minimal frequency of the anastomotic insufficiency was registered among the "end-to-side" anastomosis (3.75%). Mechanical suturing of the rectal stump did not increase the risk of insufficiency. The use of the preventive colostoma allows the formation of the primary anastomosis even in conditions of partial intestinal obstruction. The laparoscopic anterior rectal resections did not influence the insufficiency rate, being preferable considering the postoperative rehabilitation terms.

[Method of surgical chemotherapy on organism automedia during surgical procedures for breast and colon cancer].

Method of surgical chemotherapy on organism automedia during surgical procedures for breast and colon malignant tumors has been developed. The method consists in intravenous autohemochemotherapy and local autoplasmochemotherapy (into residuary mammary tissue or regional arterial mesenteric vessel).