[Possibilities of surgery optimization for esophageal carcinoma in age-related aspect].

The article presents an experience of treatment of 180 patients with esophageal carcinoma. A resection of the esophagus with the gastric graft plasty was performed using original methods in 163 patients. There were 74 patients at a mature age and 89 patients at an elderly and senile age. The method of Doppler-echocardiography was applied for the assessment of cardiovascular and respiratory systems. Results of surgery correlated with both groups. It allowed the recommendation of more wide application of surgical aids in elderly age group. Postoperative lethality consisted of 4.1% for mature patients and 10.1% for the patients at the elderly and senile age.

[Minimally invasive two-stage treatment of cholecystocholedocholithiasis].

Two groups of patients in whom two-stage treatment of cholecystocholedocholithiasis was performed with different succession of using endoscopic papillosphincterotomy (EPST) and laparoscopic cholecystectomy (LCE) were compared. In 59 patients (1st group) EPST was used as the first stage, in 67 patients (2nd group) LCE and drainage of choledochus preceded the endoscopic intervention. The effectiveness of EPST was 93.3 and 95.5% correspondingly in the first and second groups. There were no considerable differences in the frequency of complications, period of treatment at the hospital in the two groups. Lythextraction was obtained considerably more often at the first attempt in the second group of patients (79.1% versus 59.9%, p < 0.05). Due to inefficiency of EPST in three cases in the second group of patients reoperations were required. Thus, EPST should be performed before LCE for the rationally planned further treatment in case of its inefficiency.

[Role of the tumor markers CA 19-9 and carcinoembryonic antigen (CEA) in diagnosis, treatment and prognosis of pancreatic cancer]. / Znachenie opukholevogo markera CA 19-9 i kartsino-émbrional'nogo antigena (KEA) v diagnostike, vybore lechebnoi taktiki i prognozirovanii raka podzheludochnoi zhelezy.

The investigation was concerned with diagnostic sensitivity, specificity and effectiveness of assay of CA 19-9 and carcinoembryonic antigen (CEA) in the choice of treatment modality and evaluation of therapy pancreatic carcinoma (PC). Either marker has been studied in 685 examinations for PC, 68--chronic pseudotumorous pancreatitis and 24--intestinal cancer at other sites since 1995. Tumor resection for PC was carried out in 31; conservative treatment--67; chemotherapy--56 and radiotherapy--in 29 cases. In CA 19-9 examinations, diagnostic sensitivity was 90.2; specificity--72.1 and effectiveness--85.3%, while in CEA determinations, 82.5; 30.9 and 68.5%, respectively. CA 19-9 and CEA levels proved to be prognostic factors of survival. An inverse correlation was observed between median survival and tumor marker concentrations: higher basal (preoperative) level of marker in blood was matched by lower median survival. A similar relationship was identified for CEA: 5-10--14.2 months; 10.1-20 ng/ml--8.0 months; 20.1-30 ng/ml--3.9 months, and more than 30 ng/ml--4.8 months. There was a direct correlation between CA 19-9 level and tumor stage. The dynamics of tumor markers, particularly, CA 19-9 correlated with treatment effectiveness during its course.

[Results of radiotherapy and combined, comprehensive treatment of pancreatic cancer]. / Rezul'taty luchevogo, kombinirovannogo i kompleksnogo lecheniia raka podzheludochnoi zhelezy.

The results of irradiation, combined and complex treatment of pancreatic cancer have been evaluated versus stage, site and extent of surgery. Radiotherapy was carried out in 63 patients (1988-1999): prior to gastropancreaticoduodenectomy (GPDE)--7; after GPDE--12; for local recurrence after GPDE--4, before and after left-sided resection--4, before and after conservative surgery--19, and after diagnostic verification (exploratory laparotomy or ultrasound-controlled fine-needle biopsy)--17. Diagnosis was established on the basis of clinical data and case histories, ultrasonographic, CT, histological, cytological, biopsy, blood serum-marker CA 19-9 and CEA findings. Two months after treatment, complete remission was registered in 5 (13%), partial response--5 (13%), stabilization--13 (33%), tumor progression--16 (41%). Before and after GPDE, tolerance to radiotherapy was sufficient. Median survival in this group was 12.9 months, controls--8.1 months; for conservative surgery--7.3 and 4.1 months, respectively; radiotherapy + exploratory laparotomy alone--16.8 and 4.3 months, respectively. Irradiation of locally-advanced tumors of the body and/or tail of pancreas proved effective: median survival was 7.3 months, control--2.2 months. Hence, radiotherapy made an important contribution to treatment of locally-advanced and resectable pancreatic tumors and longer survival.

[Prognostic factors influencing results of the surgical treatment of pancreatic cancer]. / Prognosticheskie faktory, vliiaiushchie na rezul'taty khirurgicheskogo lecheniia pri rake podzheludochnoi zhelezy.

In patients with carcinoma of the pancreas 128 gastropancreatoduodenal resections (GPDR), 15 distal resections of the pancreas and 3 pancreatectomies were performed. After GPDR 5-year survival was 12%, the survival median was 24.3 months. Only one patient is living 6 years after left-sided resection and pancreatectomy. Long-term results of the operative treatment for carcinoma of the pancreas depended on the amount of regional metastases, degree of differentiation of the tumor, its size and invasion into the vessels. The long-term results were considerably worse if the tumor was localized in the uncinate process, body and tail of the pancreas. The 5-year survival was noted mainly in patients with the 0 and I stages of the disease. It shows the early diagnostics to be necessary.

[Significance of ultrasound examination and computed tomography in the diagnosis of pancreatic cancer]. / Znachenie ul'trazvukovogo issledovaniia i komp'iuternoi tomografii v diagnostike raka podzheludochnoi zhelezy.

The diagnostic sensitivity of USI for localization of a tumor of the pancreatic head was 89.3%, specificity--69.7%, exactness--84.4%. When the tumor was localized in the body-tail these indices were 85.7%, 73.4% and 78.7% respectively. The sensitivity of CT in cases when the localization of the tumor was in the head of the pancreas was 84.9%, specificity--72.2%, exactness--76.5%. When the tumors were localized in the body-tail these indices were 89.5%, 75.4% and 80.9% respectively. An associated analysis of information of the ultrasound and CT concerning the structure of the pancreas made the exactness of the diagnosis of malignization as high as 87.6%, specificity as high as 81.3%, sensitivity as high as 93.7%. The informative value of USI and CT depended on the tumor size, the presence of an inflammatory reaction of the pancreas, the character of a complication, if any, or of their combinations, localization and size of the pathological focus. In the investigation no alterations in the pancreas characteristic only of cancer were found. Thus, a comparison of diagnostic potentials of USI and CT has shown that one method does not exclude, but only supplements the other. CT gives more reliable results in the assessment of the process spread to the surrounding tissues and regional lymph nodes, especially when the tumor is localized in the area of the pancreas tail. USI helps to make more exact assessment of the involvement in the process of the common bile duct, pancreatic duct, and of the visceral vessels by the Doppler examination.

[Specific features of pancreatoduodenal resection in cancer of the head and unciform process of the pancreas]. / Osobennosti pankreatoduodenal'noi rezektsii pri rake golovki i kriuchkovidnogo otrostka podzheludochnoi zhelezy.

Pancreato-duodenal resections (PDR) were made in 134 patients with cancer of the pancreas, in 31 (23.1%) of them the tumor was localized in the unciform process of the pancreas. In 7 patients the destructive pancreatitis which complicated cancer PDR was completed by the external drainage of the pancreatic duct. Combined PDR were fulfilled in 14 (10.4%) patients including 9 (29.0%) of 31 patients who had cancer of the unciform process. In 48 (35.8%) patients PDR was followed by complications. The most frequent of them were acute pancreatitis of the stump (32.1%) and incompetent pancreatoenteroanastomosis (18.7%). Postoperative lethality after PDR was 6.7%. During the recent six years no lethal outcomes have been observed after 45 PDR. Cancer of the uniform process of the pancreas is the least favorable localization. Combined PDR are followed by a great number of intraoperative, postoperative complications and high lethality rate. If the patients had mechanical jaundice, the use of double step PDR gave better results. If there were intraoperative signs of acute pancreatitis it was necessary to drain the pancreatic duct outside. The using of intraoperative occlusions of the pancreatic ducts is hardly justified because of a high risk of the development of acute pancreatitis.

[Experience with chemotherapy for advanced pancreatic carcinoma]. / Opyt khimioterapii rasprostranennogo raka podzheludochnoi zhelezy.

The effectiveness of different regimens of chemotherapy for advanced pancreatic cancer was compared in 74 cases (1995-1999). 5-fluorouracil (5FU), adriamycin and mitomycin C (FAM) were given to 12 patients, 5FU alone--23, 5FU plus leukovorin--29, and gemcitabine alone--10. Metastases to the liver were detected in 42 (57%) patients. Partial response (40) was registered in: FAM--1 (8%); 5FU--1 (4%); 5FU + leukovorin--3 (10%); gemcitabine--3 (30%). Mean duration (40) was 5.4; 4; 6.1 and 9 months, respectively. Stabilization was recorded in 17 (23%), mean duration--4.4 months; tumor progression--49 (66%). Toxic side-effects of all the regimens were insignificant. Mean survival rates following FAM, 5FU, 5FU + leukovorin were 4.4; 4.2 and 5.6 months, respectively, while that for gemcitabine varied 3-24 months (on average--7.9 months). Survival in patients responsive to chemotherapy was 9.8; remaining patients--4.7 (p (0.05). Chemotherapy for advanced pancreatic carcinoma is a measure of palliation; its use was followed by a 20% increase in survival. Gemcitabine treatment appeared most effective.

[Plasmapheresis in radiotherapy for pancreatic cancer]. / Plazmaferez pri luchevoi terapii raka podzheludochnoi zhelezy.

Although radiotherapy is known to improve the results of treatment for pancreatic carcinoma, its application is limited due to such side effects and complications as anemia, leuko-, thrombocytopenia and dyspeptic disorders. It was suggested that since these complications are primarily caused by radiotherapy itself and mass death of tumor cells, plasmapheresis might raise tolerance to radiation. This was confirmed by our experience with its use during radiotherapy course in 22 patients with pancreatic cancer.