[Short-term outcomes of complete mesocolic excision for right colon cancer]. / Neposredstvennye rezul'taty pravostoronnei gemikoléktomii s total'noi mezokolonéktomiei i D3 limfodissektsiei pri lechenii raka pravoi poloviny obodochnoi kishki.

PURPOSE: Complete mesocolic excision (CME) appears to be a relatively new concept for colon cancer. The purpose is to evaluate the results of CME with high vascular ligation (D3 lymph node dissection) for right colon cancer. The presented study identifies possible risks and advantages of the proposed method, as well as the role of the laparoscopic approach. MATERIAL AND METHODS: The article included data from 39 patients with right colon cancer, TNM stage I-III, operated on between November 2015 and December 2016 in the oncoproctology Department of the Blokhin Cancer Research Center. The analysis of main intraoperative parameters, morbidity and mortality was carried out. RESULTS: There was no postoperative mortality. 17 (43.6%) of operations were performed by open and 22 - by laparoscopic approach. The conversion for laparoscopic approach was 1 (4.5%) in 22. The median duration of the operation was 180 (130-260) minutes for laparoscopic approach and 120 (90-280) minutes for open approach, р=0.0056. Median intraoperative blood loss was 30 (30-300) ml for laparoscopic approach, and 300 (30-500) ml for open approach (р=0.0001). The duration of lymphorrhoea, time to first bowel movement, time to start liquid and solid food intake were 5.1±2.4, 1.3±0.5, 1.26±0.4 and 3.2±0.7 days, respectively. The median number of removed lymph nodes was 35.7 (6-68), the median number of metastatic lymph nodes was 1.9 (0-16). The median number of removed apical lymph nodes was 10.3 (0-24). Metastases did not affect any of the lymph nodes of the apical group. CONCLUSION: Right mesocolic excision with D3 lymphadenectomy for right colon cancer is technically safe, and the laparoscopic approach provides all the benefits of minimally invasive surgery and excellent early treatment outcomes. Preliminary data shows no metastasis in apical lymphnodes for right colon cancer. Nonetheless, it is necessary to study the long-term results for the evaluation of oncological outcomes.

Short-course preoperative radiotherapy combined with chemotherapy, delayed surgery and local hyperthermia for rectal cancer: a phase II study.

PURPOSE: The aim of this study was to investigate the feasibility of short-course radiotherapy with oral capecitabine, hyperthermia and delayed surgery for neoadjuvant treatment of rectal cancer. METHODS: Patients with clinically staged T2-3N0-2M0 primary rectal cancer were included. All patients received short-course 25 Gy in 5 Gy fractions radiotherapy with capecitabine, local hyperthermia and metronidazole. Capecitabine 1000 mg/m2 twice a day was given on days 1-14. Local hyperthermia, 41-45 °C for 60 min, was performed on days 3-5. Metronidazole 10 g/m2 was administered per rectum on days 3 and 5. The time interval to surgery was not less than four weeks after neoadjuvant treatment. The primary end-point was pathological complete response (pCR). Secondary end-points included neoadjuvant treatment toxicity, tumour regression, surgical and oncological outcomes. RESULTS: A total of 81 patients were included in the analysis. Ten (12.3%) patients had grade 3 toxicity and one (1.2%) patient had grade 4 toxicity. Sphincter-sparing surgery was performed for 78 (96.3%) patients. There was no postoperative mortality. Postoperative complications occurred in 11 (13.8%) patients. Sixteen (20%) patients had a pCR. The median follow-up was 40.9 months. There were no local recurrences. Nine (11.1%) patients developed distant metastases. Three-year overall survival was 97% and the three-year disease-free survival was 85%. CONCLUSIONS: Short-course radiotherapy with chemotherapy, radiosensitizers and delayed surgery is a feasible treatment for rectal cancer and may lead to tumour regression rate comparable with long-course chemoradiation.

[Effectiveness of neoadjuvant chemoradiotherapy of locally advanced rectal cancer in conjunction with local hyperthermia and metronidazole].

Our study included 36 patients with hard fixed rectal tumors (T3, T4) who had received combined treatment at the Center's Clinics. On irrigoscopic evidence, lesions were more than 10 cm long. Radiotherapy was conducted thrice a week, STD of 4 Gy--TTD of 40 Gy; capecitabine, per os, 650 mg/m2 twice a day, days 1-22; oxaliplatin, 50 mg/m2, intravenously, days 3, 10 and 17; metronidazole in polymer composition, intrarectally, 10 mg/m2, twice, days 12 and 17 of radiotherapy; local hyperthermia (the <> installation), 460 mHz, 41-45 deg. C, 60 min, days 8, 12, 15 and 17. Diarrhea (stage III) was reported in 3 (8.3%); no toxicity (grade IV). Radical surgery was carried out in 35 (97.2%); sphincter-saving operation--20 (55.5%). Therapy-related pathomorphism (grade III-IV) was detected in 15 (42.8%). Combined neoadjuvant chemoradiotherapy plus polyradiomodification featured low toxicity and good tolerability and immediate effect.

[New technologies in the diagnosis and treatment of patients with squamous cell carcinoma of the anal canal].

PURPOSE OF THE STUDY: The development of the rectum preservation treatment for the squamous-cell carcinoma of the anal canal. MATERIALS AND METHODS: The following scheme of the rectum preservation treatment for the squamous-cell carcinoma of the anal canal was developed and has been used in the Cancer Research Center RAMS since 1995. The irradiation is performed to the small pelvis, perineum and ilioinguinal lymph nodes, at a single dose 2 Gy, 22 sessions, total dose 44 Gy. Radiotherapy is associated with chemotherapy: cisplatin 20 mg/m2, twice a week, No 8; bleomycin 15 mg, twice a week, No 8. Irradiation is combined with 4-5 sessions of local hyperthermia. Local hyperthermia (about 42.5-43 degrees C in the tumor) was given for 60 minutes after irradiation. Local hyperthermia increases the effect of chemoradiotherapy in 1.5-2 times. If the tumor resorbtion exceeds 75%, intrarectal irradiation is performed at a single dose 3 Gy, 7-8 sessions, total dose 21-24 Gy. If the tumor resorbtion is less than 75%, abdomino-perineal resection is performed. RESULTS: This scheme was used in the treatment of 92 patients, rectum preservation treatment was performed in 76 cases (83%), abdomino-perineal resection--in 16 cases (17%). Local recurrences were in 10.0%, the overall 5-year survival was 75.2 +/- 8.5%.

[Use of combined treatment of rectal cancer involving metastases to regional lymph nodes].

Use of combined pre- and intraoperative radiotherapy for rectal cancer involving metastases to regional lymph nodes failed to lower incidence of loco-regional recurrences or improve 5-year results, as compared with pre-operative radiotherapy alone. Besides, distant metastasis rates remained rather high (ca.30%). However, pre-operative radiotherapy plus local SHF-hyperthermia were followed by a significant drop in loco-regional recurrence incidence (to 2.3%), as compared with surgery alone and combined treatment using pre-operative hyper-fractionated-radiotherapy (TTD 25 Gy). Distant metastasis rates dropped to 25%. Also, 5-year survival increased significantly.