[Transanal specimen extraction after left-sided laparoscopic colectomy: a systematic review and meta-analysis]. / Transanal'naya ekstraktsiya preparata pri laparoskopicheskikh rezektsiyakh levykh otdelov obodochnoi kishki. Sistematicheskii obzor i metaanaliz randomizirovannykh issledovanii.

OBJECTIVE: To compare the short-term results after left-sided laparoscopic colectomy with transanal and transabdominal specimen extraction. MATERIAL LAND METHODS: We selected 998 appropriate manuscripts and subsequently excluded 995 ones due to exclusion criteria. Thus, the meta-analysis was based on 3 randomized trials in accordance with PRISMA recommendations. RESULTS: A total of 353 patients were enrolled in meta-analysis including 169 resections with transanal specimen extraction and 184 surgeries with transabdominal extraction. Overall risk of postoperative complications (OR=0.60; 95% CI 0.31-1.14; p=0.12) including anastomotic leakage (OR=1.83; 95% CI 0.43-7.89; p=0.42) was similar in both groups. At the same time, severity of pain syndrome (mean difference = -2.35; 95% CI -2.51-2.19), time to the first flatus discharge (mean difference = -0.92; 95% CI -0.99-0.85) and postoperative hospital stay (mean difference = -1.5; 95% CI -2.03-0.98) were significantly lower in the group of transanal extraction (p<0.00001). CONCLUSION: Transanal specimen extraction in left-sided laparoscopic colectomy does not increase overall risk of postoperative complications. In addition, the NOSE technique has some advantages in short-term results compared to procedures with transabdominal specimen extraction.

[Fluorescence angiography in colorectal surgery]. / Rol' fluorestsentnoi angiografii pri formirovanii kolorektal'nogo anastomoza.

OBJECTIVE: To evaluate the impact of indocyanine green fluorescence angiography on the incidence of colorectal anastomotic leakage. MATERIAL AND METHODS: We summarized the results of non-comparative and randomized clinical trials, as well as meta-analyses. RESULTS: Indocyanine green fluorescence angiography changes the anastomosis site in 10% of patients due to inadequate blood supply to intestinal wall at the initially scheduled level. This method can decrease the incidence of «low¼ colorectal anastomosis leakage. CONCLUSION: Routine intraoperative fluorescence angiography with indocyanine green can become a standard method for prevention of colorectal anastomotic leakage.

[One thousand endoscopic submucosal dissections. Experience of the national center]. / Odna tysyacha endoskopicheskikh podslizistykh dissektsii. Opyt natsional'nogo tsentra.

BACKGROUND: Endoscopic submucosal dissection (ESD) is a perspective method of organ-sparing treatment of benign colon tumors. MATERIAL AND METHODS: The study included 1.000 patients with colon neoplasms who underwent ESD between October 2016 and October 2021. All surgeries were performed under intravenous sedation. RESULTS: Mean dimension of tumors was 3.4 cm, median of surgery time - 51 (31; 101) minutes. Conversion of endoscopic approach occurred in 7.6% of cases. The main cause of conversion was unsatisfactory lifting in submucosal injection process. Incidence of en bloc and R0 resections was 84.1% and 68.3%, respectively. Postoperative morbidity was 2.9% that correlates with the world literature data. CONCLUSION: Endoscopic submucosal dissection is an effective and safe method for benign colon neoplasms. Considering high incidence of en bloc resection and low rate of local recurrence in benign neoplasms, further research of efficacy and safety of ESD in early colon cancer is needed.

[Endoscopic submucosal dissection versus endoscopic mucosal resection for colorectal tumors: a systematic review and meta-analysis]. / Dissektsiya v podslizistom sloe i mukozektomiya v lechenii epitelial'nykh novoobrazovanii tolstoi kishki. Sistematicheskii obzor literatury i metaanaliz.

OBJECTIVE: To compare early (resection quality, complication rate, surgery time) and long-term (recurrence rate) outcomes of endoscopic submucosal dissection versus endoscopic mucosal resection. MATERIAL AND METHODS: A systematic review and meta-analysis was performed in accordance with the PRISMA guidelines. Data were analyzed using the Rewiew Manager 5.3 software. RESULTS: The study included 8 manuscripts including 6 retrospective trials, 1 case-control and only 1 prospective study. These studies comprised the results of endoscopic resection of 1989 colonic tumors (EMR - 748, ESD - 1241). ESD is associated with higher incidence of en-bloc resection (OR 0.13; 95% CI 0.03 0.49; p=0.003) and R0 resection (OR 0.23; 95% CI 0.05 1.02; p=0.05) compared to EMR. Local recurrence rate is 13 times higher after EMR compared to ESD (OR 13.94; 95% CI 6.3 30.8; p=0.00001). However, ESD is followed by 4 times higher risk of colon wall perforation (OR 0.25; 95% CI 0.08 0.81; p=0.02). CONCLUSION: ESD is more advisable regarding resection quality compared to EMR. However, higher incidence of perforations, surgery time and technical features of ESD do not allow us to unambiguously interpret the results of our meta-analysis and determine the optimal surgical approach.

[Prevention of colorectal anastomotic leakage using its reinforcement (results of the randomized study)]. / Profilaktika nesostoyatel'nosti kolorektal'nogo anastomoza putem ego ukrepleniya (rezul'taty randomizirovannogo issledovaniya).

OBJECTIVE: To reduce the incidence of postoperative complications via reinforcement of colorectal anastomosis. MATERIAL AND METHODS: A randomized prospective study included 115 patients. In the main group (n=60), anterior resections were followed by reinforcement of colorectal anastomosis via suturing the muscular and serous layers at 2, 4, 6, 8, 10, 12 o'clock. In case of low anterior resection, all layers of intestinal wall were transanally sutured at the above-mentioned points. Reinforcement was not performed in the control group (n=55). RESULTS: In the main group, overall incidence of anastomotic leakage was 8.3% (5/60), in the control group - 25.5% (14/55) (p=0.01). We also analyzed the subgroups of anastomoses with high and low risk of leakage. In case of transabdominal reinforcement, incidence of anastomotic leakage was 11% (2/18) in the main group and 0% (0/14) in the control group (p=0.6). Transanal reinforcement was followed by anastomotic leakage in 7% (3/42) of patients in the main group and 34% (14/41) of patients in the control group (p=0.005). CONCLUSION: Reinforcement of colorectal instrumental anastomosis by additional sutures reduces the incidence of postoperative complications associated with anastomotic leakage.

[Stimulating electroneuromyography in the diagnosis of neurogenic disorders of the pelvic floor muscles]. / Stimulyatsionnaya elektroneiromiografiya v diagnostike neirogennykh narushenii funktsii myshts tazovogo dna.

The article describes the technology for detecting and studying late phenomenon in stimulating electroneuromyography in order to objectively assess the state of innervation. The standard study of the motor response (M-response), Pudendal nerve terminal motor latency testing (PNTML), using the St. Mark's electrode from the external sphincter and pelvic floor muscles provides information only about efferent innervation at the distal part of the n. pudendus. At the same time, there are sparse reports in the literature on the study of the state of the mixed-fiber pudendal nerve along its entire length from its exit from the intervertebral foramen to the distal part using the St. Mark's electrode, the method is not clearly described, which, accordingly, causes the lack of application of the technique in clinical practice. The authors of this article cite the methodology for studying the late phenomenon in the form of a mixed feedback-reflex in stimulating electroneuromyography, describing the need to consistently use both methods of its registration.

[Ultrasound diagnosis of chronic paracolic inflammatory mass in diverticular disease]. / Ul'trazvukovaya diagnostika khronicheskogo parakolicheskogo infil'trata pri divertikulyarnoi bolezni obodochnoi kishki.

OBJECTIVE: To evaluate the feasibility of ultrasound in diagnosis of chronic paracolic inflammatory mass in patients with diverticular disease. MATERIAL AND METHODS: We analyzed ultrasonic findings in 216 patients with chronic inflammatory complications of colonic diverticular disease. Chronic paracolic inflammatory mass as the most common and significant chronic complication of diverticular disease was analyzed in 116 patients. Ultrasonic findings were compared with specimen assessment, intraoperative data, irrigoscopy, colonoscopy, endoscopic ultrasound and computed tomography data. RESULTS: Sensitivity of ultrasound for diagnosis of chronic paracolic inflammatory mass was 76,7%, specificity - 100%, overall accuracy - 87,5%. CT and endoscopic ultrasound were the most informative among different diagnostic tools (sensitivity 79,6% and 77,8%, respectively). CONCLUSION: Ultrasonic examination and computed tomography are the most valuable methods for diagnosis of chronic paracolic inflammatory mass in patients with diverticular disease. Ultrasound is a first-line method for diagnosis and follow-up of complicated diverticular disease due to its availability, safety and unnecessary special preparation of patients.

[The role of neutrophil CD64 index in the diagnosis of infectious complications after colorectal resection]. / Rol' indeksa CD64-neitrofilov v diagnostike infektsionnykh oslozhnenii posle rezektsii tolstoi kishki.

OBJECTIVE: To determine diagnostic value of neutrophil CD64 index (iCD64n) in the diagnosis of postoperative infectious complications after colorectal resections. MATERIAL AND METHODS: Seventy-three patients underwent colorectal surgery for the period from January to December 2018. These patients were included into a single-center study. Peripheral blood samples were taken on 3 and 6 postoperative days (POD) to check iCD64n level. We analyzed incidence of postoperative infectious complications, sensitivity (Se) and specificity (Sp) of postoperative iCD64n level on the 3rd and 6th POD. RESULTS: Postoperative infectious complications developed in 10 (13.7%) patients. Median iCD64n was significantly higher (p=0.0017 for POD 3; p=0.018 for POD 6) in patients with infectious complications (1.6 on POD 3; 1.3 on POD 6) compared to those without complications (1.1 on POD 3; 0.9 on POD 6). Area under curve (AUC) on the 3rd POD was 0.8 with the cut-off value of 1.4, Se - 70%, Sp - 93.7% (p=0.002). On the 6th POD, AUC was 0.91 with cut-off value of 1.23, Se - 80%, Sp - 93.7% (p<0.001). CONCLUSION: Neutrophil CD64 index is a valuable predictor for the diagnosis of postoperative infectious complications after colorectal resections. It is a useful tool to ensure a safe early discharge.The study is registered on the website «clinictrials.gov¼ (registration number NCT03559335).

[Effectiveness of intraperitoneal chemotherapy for t4 colon cancer]. / Effektivnost' vnutribryushnoi khimioterapii pri rake obodochnoi kishki T4.

OBJECTIVE: To determine the effect of intraperitoneal chemotherapy (IPC) with mitomycin C on expression of intraperitoneal cancer cells markers in patients with T4 colon cancer. MATERIAL AND METHODS: For the period from January 2019 to April 2020, 65 patients with T4 colon cancer were included in prospective comparative study. There were 46 patients in the main group and 19 patients in the control group. In the main group, surgical procedure was followed by IPC with mitomycin C. No IPC was performed in the control group. An effectiveness of IPC was evaluated using CD133, CD24, CD26, CD44, CD184 markers expression in peritoneal lavages. RESULTS: Significant between-group differences were observed for CD133 (p=0.0168), CD24 (p=0.0455) and CD44 (p=0.0012). There was a tendency to decrease in the level of CD184 expression in both groups in the second lavage (p=0.0605). CONCLUSION: IPC in patients with T4 colon cancer can reduce the expression and proliferative potential of free cancer cells.

[Comparative assesement of postoperative quality of life in patients with ulcerative colitis]. / Sravnitel'naya otsenka kachestva zhizni patsientov, operirovannykh po povodu yazvennogo kolita.

OBJECTIVE: To compare quality of life in patients undergoing proctocolectomy with ileal pouch procedure and ileostomy taking into account sexual function. MATERIAL AND METHODS: The comparative observational study included 138 patients with ulcerative colitis for the period 2013-2018. All patients underwent surgery with one- or two-stage formation of pelvic pouch (n=76) or ileostomy (n=62). Validated questionnaires SF-36, The International Index of Erectile Function (IIEF), Female Sexual Function Index (FSFI) were used in the study. RESULTS: Patients with pelvic pouch were significantly younger than patients with terminal ileostomy (33.7±10.9 and 44.6±14.9 years, respectively, p<0.0001). The majority of the parameters of SF-36 questionnaire were similar in both groups. Pain syndrome intensity was the only sign demonstrating the advantage of ileostomy over pelvic pouch. However, regression analysis did not confirm the effect of surgical technique on pain severity. Orgasmic function was significantly better in men with pelvic pouch compared to ileostomy. Other indicators of sexual function were similar. According to FSFI questionnaire, women with pelvic pouch also showed significantly better results than patients with permanent ileostomy. However, multivariate regression analysis revealed no significant effect of surgical technique on sexual function in men and women. At the same time, significant negative correlation between IIEF and FSFI scores and age was revealed. CONCLUSION: No significant influence of surgical technique on postoperative QOL was observed in patients with ulcerative colitis. Better sexual function in men and women with pelvic pouch are due to younger age rather type of surgery.

[Recommendations for the Protocol of functional examination of the anorectal zone and disorders classification: the International Anorectal Physiology Working Group consensus and Russian real-world practice].

This manuscript summarizes consensus reached by the International Anorectal Physiology Working Group (IAPWG) for the performance, terminology used, and interpretation of anorectal function testing including anorectal manometry (focused on high-resolution manometry), the rectal sensory test, and the balloon expulsion test. Based on these measurements, a classification system for disorders of anorectal function is proposed. Aim to provide information about methods of diagnosis and new classification of functional anorectal disorders to a wide range of specialists general practitioners, therapists, gastroenterologists, coloproctologists all who face the manifestations of these diseases in everyday practice and determine the diagnostic and therapeutic algorithm. Current paper provides agreed statements of IAPWG Consensus and comments (in italics) of Russian experts on real-world practice, mainly on methodology of examination. These comments in no way intended to detract from the provisions agreed by the international group of experts. We hope that these comments will help to improve the quality of examination based on the systematization of local experience with the use of the methods discussed and the results obtained. Key recommendations: the International Anorectal Physiology Working Group protocol for the performance of anorectal function testing recommends a standardized sequence of maneuvers to test rectoanal reflexes, anal tone and contractility, rectoanal coordination, and rectal sensation. Major findings not seen in healthy controls defined by the classification are as follows: rectoanal areflexia, anal hypotension and hypocontractility, rectal hyposensitivity, and hypersensitivity. Minor and inconclusive findings that can be present in health and require additional information prior to diagnosis include anal hypertension and dyssynergia.

Short-term outcomes of a multicentre randomized clinical trial comparing D2 versus D3 lymph node dissection for colonic cancer (COLD trial).

BACKGROUND: It remains unclear whether extended lymphadenectomy provides oncological advantages in colorectal cancer. This multicentre RCT aimed to address this issue. METHODS: Patients with resectable primary colonic cancer were enrolled in four hospitals registered in the COLD trial, and randomized to D2 or D3 dissection in a 1 : 1 ratio. Data were analysed to assess the safety of D3 dissection. RESULTS: The study included the first 100 patients randomized in this ongoing trial. Ninety-nine patients were included in the intention-to-treat (ITT) analysis (43 D2, 56 D3). Ninety-two patients received the allocated treatment and were included in the per-protocol (PP) analysis: 39 of 43 in the D2 group and 53 of 56 in the D3 group. There were no deaths. The 30-day postoperative morbidity rate was 47 per cent in the D2 group and 48 per cent in the D3 group, with a risk ratio of 1·04 (95 per cent c.i. 0·68 to 1·58) (P = 0·867). There were two anastomotic leaks (5 per cent) in the D2 group and none in the D3 group. Postoperative recovery, complication and readmission rates did not differ between the groups in ITT and PP analyses. Mean lymph node yield was 26·6 and 27·8 in D2 and D3 procedures respectively. Good quality of complete mesocolic excision was more frequently noted in the D3 group (P = 0·048). Three patients in the D3 group (5 per cent) had metastases in D3 lymph nodes. D3 was never the only affected level of lymph nodes. N-positive status was more common in the D3 group (46 per cent versus 26 per cent in D2), with a risk ratio of 1·81 (95 per cent c.i. 1·01 to 3·24) (P = 0·044). CONCLUSION: D3 lymph node dissection is feasible and may be associated with better N staging. Registration number: NCT03009227 ( http://www.clinicaltrials.gov).

ANTECEDENTES: El beneficio oncológico de la linfadenectomía extendida en el cáncer colorrectal es controvertido. Este ensayo clínico aleatorizado multicéntrico tuvo como objetivo abordar esta discrepancia. MÉTODOS: Se analizaron los datos de los primeros 100 pacientes aleatorizados en un ensayo en curso para evaluar la seguridad de la disección D3. Los pacientes con cáncer de colon primario resecable incluidos en 4 hospitales participantes en el ensayo COLD, se aleatorizaron para la disección D2 y D3 en una proporción 1: 1. RESULTADOS: Se incluyeron 99 pacientes en el análisis por intención de tratamiento (intention-to-treat, ITT) (43 en D2, 56 en D3). Un total de 92 pacientes recibieron el tratamiento asignado y se incluyeron en el análisis por protocolo (per-protocol, PP): 90,7% (39 de 43) en D2, 94,6% (53 de 56) en D3. No hubo mortalidad. La morbilidad postoperatoria a los 30 días fue del 46,5% en el grupo D2 y del 48,2% en el grupo D3 con un riesgo relativo (RR) de 1,04 (i.c. del 95%: 0,68 a 1,58), P = 0,86. Hubo dos casos de fuga anastomótica (4,7%) en el grupo D2 y ninguna en D3. La recuperación postoperatoria, las complicaciones y las tasas de reingreso no difirieron entre los análisis ITT y PP. El recuento medio de ganglios linfáticos fue 26,6 y 27,8 en D2 y D3, respectivamente. Se observó una resección completa del mesorrecto de buena calidad con mayor frecuencia en el grupo D3 (P = 0,048). En el grupo D3, 3 pacientes (5,4%) tenían metástasis en los ganglios linfáticos D3. D3 nunca fue el único nivel afectado de ganglios linfáticos. El estadio pN positivo fue más frecuente en el grupo D3: 46,4% versus 25,6% en D2, con un RR para revelar enfermedad N positiva de 1,81 (i.c. del 95% 1,01 a 3,2), P = 0,04. CONCLUSIÓN: La disección de ganglios linfáticos D3 es factible y puede estar asociada con una mejor estadificación N.

[Prevention of carcinomatosis in colon cancer]. / Profilaktika kartsinomatoza pri rake obodochnoi kishki.

Colorectal cancer (CRC) is one of the leading forms of cancer. In 2017, over 72,000 of Russian citizens have been diagnosed with CRC. Cancer stage IV was diagnosed in 18 149 of them. Peritoneal carcinomatosis (PC) is one of the forms of metastatic dissemination throughout the peritoneum. There no any unified and standardized approaches to the treatment or prevention of PC associated with CRC. Therefore, it is advisable to identify PC predictors in patients with colon cancer and prevention measures.

[Factors affecting the survival of patients with peritoneal carcinomatosis of colorectal origin]. / Faktory prognoza vyzhivaemosti bol'nykh, operirovannykh po povodu peritoneal'nogo kartsinomatoza pri rake tolstoi kishki.

One of the main problems in the treatment of peritoneal carcinomatosis (PC) in colorectal cancer (CRC) is the adequate selection of patients for cytoreductive surgery (CS) and hyperthermic intraperitoneal chemotherapy (HIPEC). AIM: To determine the predictive factors of overall (OS) and disease-free survival (DFS) in CRC patients with PC after CS with HIPEC. MATERIAL AND METHODS: From 2010 to 2018 years 102 patients with CRC and PC were included in the study. The cytoreduction was complete (CC0, according to Sugabaker scale) in 96 (94.2%) cases. The age median of patients was 65 years. There were 63 (62%) women. In 81 (79%) patients, the PC was synchronous. The median level of CEA was 8.5 ng/ml. The median peritoneal carcinomatous index (PCI) was 3 (1-23). RESULTS: The median of follow-up was 18 (11; 33) months. The median of DFS and OS were 13 (9;31) and 32 (17; n/d) months, respectively. Multifactorial Cox-regression analysis showed the localization of the primary tumor in the right colon (OR=1.66; 95% CI 1.1-2.5; p=0.013) and the level of the PCI (OR = 1.08; 95% CI 1.024-1.15; p=0.008) were independent negative factors of OS. CONCLUSION: The CS and HIPEC in patients with CRC with PC allowes to achieve five-year survival in a part of patients, especially with low PCI. Identifying adverse prognostic factors preoperatively can help in selecting patients for CS in the future.

[Local recurrences of colon cancer (in Russian only)]. / Mestnyi retsidiv raka obodochnoi kishki: rezul'taty lecheniia.

AIM: To evaluate the outcomes in patients with local recurrences (LR) of colon cancer. MATERIAL AND METHODS: Prospective study included 52 patients with local recurrences of colon cancer MR and no distant metastases or disseminated carcinomatosis. Patients have been treated at Ryzhikh State Research Center for Coloproctology for the period 2009-2017. Median of local recurrence was 17.6 months. By the moment of diagnosis, CEA was increased in 24 (46.2%), CA 19-9 - in 4 (7.7%) patients. Forty-eight (92%) patients underwent surgery for local recurrences of colon cancer. In 26 (54%) cases, low ligation of supplying vessel was made during primary tumor excision that was confirmed by significant fragment of intact mesentery of the colon. RESULTS: Radical surgery for LR was possible in 34 (70.8%) patients, resection of more than one organ was required in 60% of cases. R1-resection was obtained in 12 (25.0%) cases, palliative resections - in 2 (4.2%) patients. Various complications occurred in 34 (70.8%) patients. Additional intraperitoneal chemotherapy was need in 12 (23.1%) cases. Lethal outcomes were absent. Forty-six out of 48 (95.8%) patients were followed-up. Mean follow-up was 19.5 (8.6-34.7) months. Twelve (26.1%) patients were free from recurrent cancer. Only distant metastases developed in 16 (34.8%) patients. Redo LR occurred in 18 (39.1%) patients including 12 of them with distant metastases. Overall 5-year survival was 38%, disease-free survival - 17.5%, median overall survival - 42.8 months, median disease-free survival - 15.2 months. Intraperitoneal chemotherapy did not significantly affect overall survival. Multivariate analysis confirmed high level of CEA and CA 19-9, positive resection margin as negative predictors. Moreover, impaired survival (p=0.03) was noted in case of LR after non-radical surgery for primary tumor with high ligation of the vessel. CONCLUSION: R0-resection is essential to improve survival and reduce incidence of recurrences. Intraoperative intra-abdominal chemotherapy does not affect the outcomes in patients with LR of colon cancer. Adherence to surgical principles for cancer can reduce the incidence of LR.

[Risk factors of postoperative complications in patients with synchronous colorectal cancer liver metastases]. / Faktory, assotsiirovannye s razvitiem posleoperatsionnykh oslozhnenii u bol'nykh s sinkhronnymi metastazami kolorektal'nogo raka v pecheni.

AIM: Univariate and multivariate analysis of various risk factors and morbidity in patients with synchronous colorectal cancer (CRC) liver metastases. MATERIAL AND METHODS: Prospective data of 173 patients with synchronous CRC liver metastases have been analyzed from January 2013 to February 2017 at the Ryzhikh State Coloproctology Research Center. RESULTS: In multivariate analysis significant risk factors of morbidity were age ≤61 years, the largest liver metastasis ≥ 2.1 cm (odds ratio (OR) 2.99; 95% CI 1.4-6.5), number of liver metastases >1 (OR 2.5; 95% CI 1.1-5.5), bilobar liver injury (OR 2.5; 95% CI 1.3-4.8), blood loss (OR 1.001; 95% CI 1.0001-1.002). Model for prediction of complications was constructed (AUC 0.79). CONCLUSION: Simultaneous surgery is not risk factor of complications. Probability of complications is increased in advanced tumor and consequently more traumatic surgery. Predictive model is useful for prognosis of complications and describes surgical experience of State Coloproctology Research Center.

[Meta-analysis of management of colorectal anastomotic leakage]. / Meta-analiz metodov lecheniia nesostoiatel'nosti kolorektal'nogo anastomoza.

AIM: To identify the most effective management of colorectal anastomosis failure via analysis of available literature sources. RESULTS: Systematic review included 20 original trials. Effectiveness of redo interventions for colorectal anastomosis failure including open, laparoscopic, minimally invasive techniques (transanal drainage, endoscopic vacuum therapy, endoscopic drainage) was described. Anastomotic failure rate was 6.5%. Medication was effective in 57% (95% CI 34-77%) of cases. Redo open surgery was applied in 43% (95% CI 23-66%) of patients. Postoperative mortality was 21-27%. Redo laparoscopic procedure was performed in 61% (95% CI 50-70%) of cases for anastomotic failure after previous laparoscopy, incidence of conversion was 12% (95% CI 4-28%). Transanal drainage was effective in 85% (95% CI 61-94%) of cases, endoscopic vacuum therapy - in 82% (95% CI 74-87%), healing of anastomosis without need for colostomy was achieved in 16% (95% CI 9-26%) of cases. Endoscopic clipping for colorectal anastomotic defect was effective in 73.3-77% of cases. CONCLUSION: Redo surgery for anastomotic failure is associated with advanced mortality and need for permanent colostomy. Laparoscopic approach reduces incidence of complications after redo surgery and followed by better functional outcomes. Minimally invasive procedures are advisable for colorectal anastomosis failure without need for redo surgery. However, effectiveness of these methods is controversial due to few reports and no comparative trials.

[Enhanced recovery program for colorectal surgery in cinical practice. Survey of surgeons of the Russian Federation]. / Vnedrenie programmy uskorennogo vyzdorovleniia koloproktologicheskikh patsientov v klinicheskuiu praktiku. Opros khirurgov Rossiiskoi Federatsii.

AIM: To analyze RF surgeons' attitude to accelerated recovery program (ERP) and to determine how often it is used in daily work. MATERIAL AND METHODS: 223 physicians from 42 Russian regions were interviewed in 2017. RESULTS: ERP is unknown among 11.7% of specialists; 8.9% heard about ERP but did not think that it is used in the Russian Federation; 16.6% know but do not apply the program; 55.6% use some elements of ERP; complete application of ERP was found in 7.2% of surgeons. This technique is more often used by more active surgeons (p = 0.001) and less often - by female surgeons (p = 0.0066). The most controversial and difficult elements of ERP are administration of carbohydrate mixtures prior to surgery, optimal body temperature maintenance, restrictive protocol of infusion therapy, refusal mechanical intestinal depuration and routine abdominal drainage, and administrative control over the protocol. CONCLUSION: The majority of surgeons are ready to apply ERP. Some elements are difficult to apply for use in real healthcare. More educational activities are needed for wider and complete use of the protocol. New scientific available data should be used to improve this approach.

[Short-term outcomes of laparoscopic-assisted procedures for chronic complications of diverticular disease]. / Rezul'taty laparoskopicheski-assistirovannykh vmeshatel'stv pri khirurgicheskom lechenii khronicheskikh oslozhnenii divertikuliarnoi bolezni.

AIM: To estimate efficacy of laparoscopic-assisted procedures for chronic complications of diverticular disease (DD). MATERIAL AND METHODS: It was made a prospective comparative study within 2007-2015. Inclusion criteria were verified chronic DD (>6 weeks after the first attack) and bowel resection followed by primary anastomosis. EXCLUSION CRITERIA: contraindications for pneumoperitoneum, BMI ≥35 kg/m2, infiltrate dimension >10 cm, preoperatively non-excluded neoplasm. RESULTS: 233 patients with chronic DD underwent elective surgery, 136 (58.4%) of them were included in the study. There were 80 (58.8%) females aged 57.2±6.2 (24-83) years. Main group consisted of 75 patients after laparoscopic-assisted procedures, 61 were in control group (open ones). Both groups were homogeneous in age, gender, BMI, type of chronic complications, extent of inflammation, extent of bowel resection, surgery time (211.1 vs 206.3 min; p=0.16), incidence of preventive stoma (12.9 vs 19.7%; p=0.32) and complications rate (10.7 vs 14.7%; p=0.47). Maximal time of surgery was noted in case of chronic abdominal mass with statistically significance for main group (240.0±12.2 min vs 207.6±13.7 min; р=0.01). Conversion rate was 12.0% in main group. Main group showed significant higher rate of stapler anastomoses (66.7 vs 22.9%; р<0.0001), less intraoperative blood loss (100 ml vs 350 ml; р=0.001). Early postoperative period was significantly shorter in main group (9.5±0.4 days vs 12.9±1.2 days, р=0.02). CONCLUSION: Laparoscopic-assisted procedures for diverticular disease are associated with more favorable early postoperative period with the same complication rate. Technical complexity and operative time depend on the extent of pelvic inflammatory changes.

The analysis of microRNAs miR-200C and miR-145 expression in colorectal cancer of different molecular subtypes.

The expression levels of microRNAs miR-200c and miR-145 in two groups of colorectal cancer differing by the presence/absence of epithelial-mesenchymal transition (EMF) were studied. In the EMF-positive cancer, the level of miR-145 is increased, whereas the level of miR-200c is reduced. The reverse situation is observed in the EMI-negative cancer. MiR-145 can serve as a marker of the mesenchymal subtype of cancer. Gene expression profiles and microRNAs allow prognostically unfavorable tumors of the mesenchymal subtype to be distinguished.