[Mini-invasive technologies in complex treatment of esophagus cancer].

It was evaluated mini-invasive endovideosurgical technologies using in complex treatment of esophagus cancer. The investigation included 28 patients with thoracic esophagus cancer. Age of patients operated in terms from April 2012 to December 2013 was from 42 to 74 years (mean 61.7 ± 8.7 years). Only surgical treatment was used in 10 patients. Neoadjuvant chemotherapy and radiotherapy were performed in 18 patients. Hybrid mini-invasive esophagectomy (laparoscopic stomach mobilization and right-side thoracotomy) were used in 14 cases. The frequency of postoperative complications was 35.5%. Mini-invasive endovideosurgical esophagectomy was done in 14 patients. The frequency of postoperative complications was 57.1%. There were not deaths. Our experience demonstrates good results of mini-invasive technologies using in treatment of patients with esophagus cancer. Endovideosurgical methods permit to perform adequate volume of surgery in case of oncological diseases.

[Immediate and long-term results of brachytherapy in complex treatment for esophageal cancer].

For treatment of cancer of the thoracic esophagus, the method of neoadjuvant chemoradiotherapy (CRT) with a use of intraluminal brachytherapy (BT) was performed. The study included 51 patients (mean age 56.9 ± 4.3 years). The length of the primary tumor up to 6 cm was determined in 18 patients, more than 6 cm--33 patients. CRT included three BT sessions (7Gy X 3; q7d) and two cycles of chemotherapy (PF; q28d). After CRT in 30 (62.4%) patients there was marked a complete or partial radiological tumor regression. In 40-45 days after CRT surgery performed. Subtotal resection of esophagus of the Lewis type was performed in 29 cases, transtracheal ex- tirpation of the esophagus--in 2, minimally invasive esopha- gectomy--in 17 cases. Postoperative complications occurred in 22 (44%) patients; one patient died (2%). In 11 (23%) patients morphological investigation revealed a complete regression of the primary tumor. Thus, a use of intraluminal BT in combination with chemotherapy in many cases promoted reducing the size of the primary tumor of the esophagus, which was an effective factor in improving surgical results.

[Experience of the use of endovideotechnology in surgical treatment of esophageal cancer].

An investigation included 33 patients with cancer of thoracal section of the esophagus at the age from 42 to 74 years old. A surgical method of treatment was applied as only one in 13 patients and methods of nonadjuvant chemoradiation therapy were used for 20 patients. A hybrid minimally invasive esophagectomy (laparoscopic mobilization of the stomach and right-side thoracotomy) was performed on 16 patients. The rate of postoperative complications consisted of 31%. The minimally invasive esophagectomy (performed by totally endovideosurgical approach) was carried out in 15 cases. Postoperative complications developed in 53% of follow-up patients. There weren't cases of lethality. The experience of minimally invasive methods indicated the satisfactory results of application of given methods in patient treatment of esophageal cancer. The use of endovideosurgical approaches allowed performing oncologically adequate volume of operative interventions.

[Conservative treatment of locally advanced and inoperable esophageal cancer: possible methods and future directions].

This is an analysis of treatment results data for conservative (endosurgical and radiation therapy) treatment of patients with inoperable locally advanced esophageal cancer receiving therapy in 1990-2011. The original treatment tactics including recanalization of tumor-compressed esophageal lumen (argon plasma coagulation +/- high-frequency surgery or chemical tumor necrolysis) with consequent combined radiotherapy resulted in clinical response in 79,5% of cases, 89,3% of patients retained the possibility of enteral nutrition. One-year overall survival (OS) was 68,9% (58,8% in patients receiving combined radiotherapy), 2-year OS was 22,7% and 21,2% respectively.

[Concurrent chemoradiotherapy with moderate dose brachytherapy as remission induction for patients surgically treated for esophageal cancer].

The locally advanced cancer of thoracic esophagus was treated by induction chemo-irradiation therapy (IHRT) with intraluminal medium dose-rate brachytherapy (IMBT). From July 2009 to February 2012 twenty five patients (mean age 54.3 +/- 1.3 years) were included in the study. The length of the primary tumor was up to 6 cm in 10 pts and more than 6 cm in 15 pts. Induction therapy consisted of three IMBT sessions (7 Gy X 3; q7d) and two cycles of chemotherapy (PF; q28d), 26-31 days later the surgery was performed. Subtotal resection of the esophagus type of I Lewis was performed in 23 pts, transtracheal extirpation of the esophagus was performed in 2 pts.In all the cases 3F lymphodissection was performed. After IHRT in 15 of 25 pts. was obtained complete or partial response, in 10 of 25 pts was obtained disease stabilization. Perioperative complications occurred in 17 (68%) patients receiving conservative treatment, one patient (4%) died of treatment complications. In 6 cases (24%) morphology had shown the complete regression of primary tumor. Thus, the combination of intraluminal medium dose-rate brachytherapy and chemotherapy lead to reduction of primary tumor local spread and can be an efficient factor in improving the results of surgical treatment.

[An experience with clinical endoscopy and argon-plasma coagulation for removal of large bowel polyps].

Fifty-one loop polypectomies assisted by argon-plasma coagulation were performed in 40 patients, aged 18-85. Polyps presented as sitting on a wide pedicle (25), sprawling (19) or spreading flat (7) in rectum (24), sigmoid (18) or colon (9). Polyp diameter ranged 1.0-1.9 cm (12 adenomas), 2-2.9 (18) or 3-5 cm (21). Coagulation was carried out immediately after partial removal of polyp with the aid of diathermic loop. Endoscopic follow-up and biopsy were conducted after 1, 3, 6 and 12 months. Complete destruction of adenomas was achieved by 1-6 coagulations (mean - 1.4) performed at an interval of 3-4 weeks. During follow-up (6-24 months), out of 40 patients with 51 polyps, histologically identifiable villous adenoma was detected in 3 (during 12 months). The latter underwent repeat argon-plasma coagulation. That technique proved more effective and safer than traditional methods in dealing with large polyps of the large bowel having a wide pedicle and/or sprawling.

[An experience with argon-plasma coagulation in endoscopic management of obstructive tumors of the trachea and main bronchi]. / Opyt klinicheskogo primeneniia argonoplazmennoi koaguliatsii (APC) pri éndoskopicheskoi rekanalizatsii opukholei trakhei i krupnykh bronkhov.

Endoscopic management of obstructive tumors of the trachea and main bronchi was carried out using argon-plasma coagulation in 39 patients aged 15-75. Thirty four patients had primary malignancies, 2--secondary tumors and 1- metastasis to the lung. Two patients with benign tumors were cured completely. Lobar bronchus lesions involving the extrapulmonary bronchus were identified in 28 patients; involvement of both main bronchi and trachea--5, intermediate bronchus lesions--3, and involvement of one lobar bronchus--3. Stenosis was complete in most patients and full or partial lumen was restored in all of them. Follow-up checks were conducted at 2-, 4- and 12-week intervals under outpatient conditions. Bleeding from the bronchial arteries broke out in 1 patient during examination and was aborted. Our method may be used in emergency to manage tumor-induced obstruction of the trachea and main bronchi, to raise the quality of life in incurable cases and to improve the results of chemoradiotherapy.