[Results of total mesorectal excision and transanal endoscopic microsurgery for rectal adenocarcinoma with submucosal invasion]. / Rezul'taty total'noi mezorektumektomii i transanal'noi endomikrokhirurgii pri adenokartsinomakh pryamoi kishki s invaziei v podslizistyi sloi.

OBJECTIVE: To analyze early and long-term outcomes after total mesorectal excision (TME) and transanal endoscopic microsurgery (TEM) in patients with T1 rectal cancer. MATERIAL AND METHODS: A retrospective non-randomized comparative study included 2 groups of patients: group 1 - total mesorectal excision, group 2 - transanal endoscopic microsurgery. In the second group, total mesorectal excision was proposed for patients with tumor invasion depth pT1sm3 and/or lymphovascular invasion and/or low differentiation. If total mesorectal excision was performed as a salvage surgery, the patient was excluded from further analysis. RESULTS: There were 156 patients with rectal adenocarcinoma pT1 between October 2011 and August 2019 (102 cases - TEM, 54 cases - TME). We excluded 10 patients from the TEM group due to salvage surgery. Duration of TEM was 40.0 (34; 50) min, TME - 139 (120; 180) min (p=0.00001). Postoperative hospital-stay was also significantly less in the TEM group (7 (6; 9) vs. 10 (7; 11) days, p=0.00001). Six (6.5%) patients in the TEM group and 1 (1.8%) patient in the TME group developed a local recurrence in pelvic cavity (p=0.1). There were no distant metastases. Disease-free 3-year survival was 92% after TEM and 96% after TME (p=0.058). CONCLUSION: Transanal endoscopic microsurgery is a relatively safe alternative to total mesorectal excision for early rectal cancer.

[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.

Risk factors for postoperative ileus after colorectal cancer surgery.

AIM: To assess the rate and independent risk factors of postoperative ileus (POI) after colorectal cancer surgery. METHODS: Three hundred consecutive patients underwent colorectal surgery for cancer at the State Scientific Centre of coloproctology, Moscow, Russia, between November 2015 and August 2016. POI was diagnosed as an absence of intestinal function for 72 hours or more after operation and confirmed by plain radiography. Uni- and multivariate logistic regression of the tumour-, patient- and treatment-related factors was performed. All patients had epidural catheters with multimodal analgesia. RESULTS: Thirty-nine patients (13%) had postoperative ileus. The variables associated with this condition in univariate analysis were age < 64 y.o. (p = 0.02), male gender (p = 0.02), BMI ≥ 25 kg/m2 (p = 0.02), moderate drinking (p = 0.02), heavier drinking (p < 0.0001), opioids (p = 0.02), history of abdominal operation (p = 0.003), firm, extensive adhesions as a result of previous surgery (p = 0.005), multivisceral resection (p = 0.009), blood loss ≥ 150 mL (p = 0.006), haemotransfusion (p = 0.01) and open approach (p = 0.006). In the multivariate logistic regression, BMI ≥ 26 kg/m2 (p = 0.008), opioids (p = 0.04) history of abdominal operation (p = 0.04) and adhesions (p = 0.03) were identified as independent risk factors. CONCLUSION: Postoperative ileus is a common complication in colorectal surgery. The results of our study suggest at least two surgeon-dependent risk factors, i.e., open approach and opioids in the postoperative period. This article is protected by copyright. All rights reserved.