[The distal resection margin in rectal cancer surgery].

Spread of the tumor in the distal direction is an important factor that must be considered when performing organ-serving surgery for rectal cancer. Particular relevance it has acquired in recent years due to the general tendency to expand the indications for the preservation of natural reflex-apparatus in patients with medium- and lower-ampullar part of the rectum.

[Combined treatment of patients with locally advanced rectal cancer].

The objective of this study was to improve the immediate and long-term results of combined treatment of patients with locally advanced rectal cancer. The study included 128 patients with morphologically confirmed diagnosis and clinical stage cT3/T4 and N-/N+, treated from 1998 to 2009. The comparison group had 64 patients, combined treatment included prolonged preoperative radiotherapy 4 Gy and 40 Gy, surgery was performed after 4 weeks. In the study group--also 64 patients--combined treatment consisted of preoperative chemoradiotherapy (continuous a-120 hour infusion of 5-fluorouracil at a dose of 500 mg/m2 in the first and last week of radiotherapy in 2 Gy to 50 Gy), surgery was performed through 6 weeks after chemoradiotherapy. Excision of the primary tumor was performed in 40 (62.5%) patients in the control group and in 53 (82.8%) patients in the study group. Wherein R-0 resections were performed in 32 (67%) patients and in 41 (73%), and R-1 resections--in 1 (2%) patients, and 7 (13%) patients in the control and study groups respectively. A 5-year survival rate was 43.6 ± 7.2% control and 62.7 ± 5.1 % in the study group.

[The influence of lymphadenectomy on the results of the gastric cancer treatment].

Results of randomized studies and meta-analyses of the long-term results of surgical treatment of the gastric cancer with lymphadenectomy were compared. The D2 lymphadenectomy permits low indices of postoperative morbidity and mortality. The further lymphadenectomy volume increase does not lead to the significant improvement of the long term treatment results. The splenectomy and pancreas resection are not obligatory by the gastric cancer treatment and should be performed only by certain indications. The prevailing volume of surgical resection is considered to be gastrectomy; the indications to the subtotal gastric resection should be limited for the reduction of the local recurrence rate. Thereby, the optimal algorithm of the gastric cancer treatment includes the gastrectomy and D2 lymphadenectomy, accomplished by the neo- and adjuvant chemotherapy.

[Pathomorphism of rectal cancer during neoadjuvant chemoradiotherapy].

The pathomorphism of rectal cancer (RC) was studied in 99 patients who received neoadjuvant chemoradiotherapy using two drugs (5-fluorouracil and xeloda). A morphological study indicated the qualitatively similar manifestations of pathomorphism (tumor necrosis, inflammation, and sclerosis) which were more pronounced in the use of xeloda. Three degrees of the pathomorphism of RC have been identified: the tumor was unchanged, changed, and undetectable.

[D2 lymphadenectomy for surgical and combined treatment of the gastric cancer].

Immediate results of 100 D2 lymphadenectomies, performed for gastric cancer, were analyzed. The combined treatment included preoperative radiotherapy (n=39), combinations of pre- and postoperative radiotherapy (n=18) and adjuvant chemotherapy (n=18). The majority of patients had tumors of the lower third of the stomach, histologically low- and non-differentiated adenocarcinomas. Gastrectomy was performed in majority of cases. Achieved results showed, that pre- and postoperative radiotherapy led neither to lethality nor to complication rate or to hospital stay time increase. Thus, D2 lymphadenectomy for surgical and combined treatment of the gastric cancer, is a safe procedure with an acceptable rate of postoperative complications. It does not prevent neo- and adjuvant chemo- or radiotherapy conduction. D2 lymphadenectomy allows a more thorough cancer staging, according both to international and Japanese classifications.

[Clinico-morphological parallels among stomach cancer patients].

The paper reports the demographic and clinical data on more than 1,100 stomach cancer patients who underwent radical surgery in 1970-2007. Significant changes in structure and histological pattern of that pathology and primarily the growing fraction of signet ring and undifferentiated cell cancer (30%) are evident. It was matched by similarly important changes in the demographic and clinical data on patients with different morphological patterns and extent of tumor cell differentiation. Precise correlations between morphological pattern and loco-regional extent, site, size, pattern of growth and polyneoplasia rate were identified. Such characteristics should be taken into account when devising diagnostic and therapeutic strategies.

[Effect of morphologic features on recurrence and metastasis in stomach cancer].

Data on examination of 192 patients radically operated for stomach cancer at the Center's Clinic were analyzed vis-a-vis postoperative recurrences. Marked dependence of metastatic spread features and pathway on histological pattern of tumor was established. This can be used in working out therapeutic strategies. Most patients revealed different patterns of relapse. High incidence of peritoneal tumorigenesis unaccompanied by invasion of serous membrane was reported patients with primary signet-cell and undifferentiated cell tumor among others. Considering high frequency of local relapse in signet-cell and mixed cell cancer, gastrectomy should be regarded as operation of choice irrespective of site and size of tumor.

[Comparative analysis of long-term results of combined and surgical treatment at the patients with signet ring cell carcinoma of stomach].

Overall 194 patients with signet ring cell carcinoma of stomach were treated, 124 (64%) of them underwent combined treatment (preoperative radiotherapy with subsequent operation), 70 (36%) - only surgical treatment. There were no differences in survival rate between two groups at early (pT1) cancer. The combined method has advantages over isolated surgical at T2 tumors (both with and without regional lymphatic metastases) and at T3 tumors without regional lymphatic metastases (p=0.03). At T3N1-2 tumors with regional lymphatic metastases and T4 tumor neither combined no surgical method demonstrated positive results of treatment. Generally combined treatment with preoperative radiotherapy has statistically significant advantage (p=0.007) over surgical treatment at the patient with signet ring cell carcinoma of stomach.

[Regularities of relapse and metastasis of signet ring cell carcinoma of the stomach following combined and surgical treatment].

Characteristics of recurrence and metastatic development of signet ring cell carcinoma of the stomach were studied in 59 cases after combined and surgical treatment. Peritoneal dissemination appeared to be the most frequent pattern of tumor progression. It accounted for 55% of all relapses and occurred in 27% of patients even without extension through serous membrane (pT2). Metastasizing through the lymphatic viae was fairly frequent mostly in cases of peritoneal carcinomatosis while blood flow-related dissemination was not. Subtotal resection in patients with early-stage signet ring cell carcinoma (pT1) was justified because local recurrences are extremely rare in that pathology. Since (pT2-4) stump relapse is fairly frequent (14-16%), the operation of choice was gastrectomy, whatever site of tumor. Regional metastasis recurrence was 20% among patients with relapsing tumor. It usually co-occurred with distant metastases and, therefore, was less clinically significant. However, when concomitant with local recurrence, it ruled out radical treatment. Preoperative radiotherapy was followed by a significant drop in regional metastasis recurrence rate (4.5 and 13.3%, p = 0.04).

[Comparative assessment of immediate results of combined and surgical treatment of gastric cancer].

The 30-year experience with combined and surgical treatment of gastric cancer gained at the Center is discussed. The results of surgery were improved due to use of intensive preoperative radiotherapy, metronidazole and dynamic fractionated treatment. There was no correlation between intensive preoperative radiotherapy and postoperative complication incidence or lethality, irrespective of extent of surgery or lymph node dissection. Moreover, radiotherapy was followed by a considerable decrease in postoperative incidence of pancreatitis due to inhibition of secretory function by the pancreas. Use of modern technology of radiotherapy planning and implementing left virtually no serious damage. Considering the recent changes introduced to standards for surgical treatment of gastric cancer, our findings point to a safe combination of preoperative radiotherapy with extended surgical and combined treatment.

[Comparative analysis of long-term results of combined and surgical treatment in gastric cancer].

The end-results of combined and surgical treatment of gastric cancer are compared. Survival rates were sufficiently high in both procedures in cases without extension through the serosa (T1-2) or regional metastases with adenocarcinoma cells were well differentiated (NO). However, combined treatment proved more effective in cases of the opposite situations (p=0.04-0.0001). Considering the possibility of inadequate staging, the following indications for preoperative radiotherapy are suggested: low cell differentiation, signet-cell or undifferentiated gastric tumor of 3-10 cm in diameter. In other words, early cancer of the stomach and total involvement must be excluded.

[Recurrences after surgical treatment of early (pT1) cancer of the stomach: laws of development, extended lymphadenectomy in prophylaxis of recurrences].

Long-term results of treatment of 175 patients with early cancer of the stomach are analyzed. Recurrences of the disease (local, regional recurrences and distant metastases) were diagnosed in 14 (8.2% of all operated) patients. Duration of recurrence-free period ranged from 2-3 months to 9.5 years; median was 12 months. Tumor spread, regional nodes affection, tumor morphological structure, age of patients were the main prognostic factors for recurrences. Extent of surgery and lymphodissection did not correlate with recurrences rate. It is concluded that extended lymphodissection in patients with early cancer of the stomach should not be regarded as a real method for an increase of treatment efficacy.

[Treatment for primary multiple malignant tumors, a gastric one included].

Cases of primary multiple malignant tumors, with one localized in the stomach, have been studied. In cases of radical surgery, second tumors were detected in 6.2% while in patients with early gastric cancer--twice as many (12.5%). Among second tumors, most frequent were neoplasms of large bowel, urogenital system, head and neck, lung, skin and breast. Radical surgery for gastric cancer was carried out in 94%, palliative resection--6%. Radical surgery for second tumors was performed in 53 (82%), palliative--7 (11%). Surgery for second tumors was used in 38%, combined treatment--27%. Synchronous and, in particular, metachronous tumors were mostly responsible for deaths among those radically treated for stomach cancer. In general, second tumors failed to significantly impact the end results of that pathology (p=0.13). Hence, primary multiple tumors should not be regarded as counterindications for radical treatment, a combined one included, of the either neoplasm, nor does it contribute to postoperative lethality rates. Prior to surgery and during clinical course, it is important to make sure that there are no synchronous or metachronous tumors in sites where they generally occur.

[Long-term results of pre- and intraoperative radiotherapy in the combined treatment for stomach cancer].

The paper discusses the end results of combined treatment of stomach cancer (radical surgery plus pre- and intraoperative radiotherapy). A randomized evaluation showed that it might be used for loco-regional monitoring. Five-year rates and median of survival rose significantly, as compared with surgery alone, in tumor extension through the stomach wall (T3-4), metastatic dissemination to lymph nodes (N1-2), combinations of such pathologies as well as in cases of low-differentiated, undifferentiated and signet- cell cancer.

[Early cancer of the stomach: pattern of lymphatic metastasizing and its influence on surgical approach].

Results of surgical treatment of 156 patients were analyzed. There were no metastases to the lymph nodes in patients with invasion of mucous membrane only. In patients with invasion of the tumor into a submucous layer regional metastases were revealed in 18 (19%) cases. Number of affected lymph nodes varied from 1 to 7 (2.7, on the average). Metastases to 1 lymph node were revealed in 9 (50%) patients, to 2-3 nodes -- in 5 patients, to 5-7 nodes -- in 4 patients. In 14.78% patients metastases were only to perigastric lymph nodes, in 4 cases -- to nodes of the second level (N2). Invasion of the tumor into submucous layer, location and size of the tumor were the main factor of risk of lymphatic cancer spread. Frequency of lymphatic cancer spread does not exceed 10% in any variant. In patients with proximal tumor, infiltrative growth and size more than 4 cm, tumor lymphatic metastases are diagnosed in each third person. It is concluded that gastrectomy or distal subtotal resection of the stomach with modified D2 lymphatic dissection is the method of choice in treatment of patients with invasion of stomach cancer into submucous layer.