[Analysis of the results of ERAS protocol in real-life clinical practice AFTER radical cystectomy (the first prospective multicenter study in Russia)].

AIM: to carry out a multicenter prospective analysis of the results of the ERAS protocol in patients undergoing radical cystectomy in real-life clinical practice. The aims of the study were to assess the complication and mortality rate after radical cystectomy using the ERAS protocol and to assess how often ERAS protocol was imple- mented. MATERIALS AND METHODS: a multicenter study was carried out in 4 clinics in Russia. A total of 134 patients who underwent radical cystectomy in 2017 were prospectively analyzed. Open and laparoscopic radical cystectomy was performed in 35 (26.1%) and 99 (73.9%) patients, respectively. Bricker procedure prevailed as a method for urine derivation (91.7%). Complication and mortality rate, and each principle of ERAS protocol was analyzed both in the general sample of patients and separately for open and laparoscopic radical cystectomy. RESULTS: length of hospitalization before the radical cystectomy was 1 (1-2) day. The median duration of surgery was 260 (205-300) minutes, median blood loss was 300 (200-400) ml. The median of the patients time in ICU was 1 (0-2) day. A total of 95 (70%) complications were recorded in the 90-day period after the surgery, including Clavien I-II category in 52 (38.8%) cases and Clavien III-IV in 43 (32%) cases. Of these, gastrointestinal tract complications were predominated. Gastroparesis requiring a nasogastric tube was observed in 16 (11.9%) patients. Ileus developed in 43 (32.1%) cases, and 22 patients (16.4 %) were managed conservatively; however, 21 patients (15.7%) undergone to reoperation. A 90-days mortality reached 5.2% and the main causes included multiple organ failure as a complication of peritonitis, acute heart failure after myocardial infarction and massive bleeding. Re-hospitalization rate was 9.7% (n=13). Length of stay was 12 (9-16) days. According to univariate and multivariate analysis, an absence of antibacterial prophylaxis, a history of coronary heart disease and the patients age more than 75 years were predictors of an increased complication rate. A 30-days mortality rate is 5.2%, and re-hospitalization was required in 9.7% (n=13) cases. An average length of stay was 12 (9-16) days. Frequency of implementation of ERAS protocol in each of the participating clinic varied. Open and laparoscopic radical cystectomy have insignificant differences in some intra- and postoperative parameters, but, in general, both approaches are comparable in terms of complications, mortality, and length of stay. CONCLUSION: 1. Despite the use of the ERAS protocol, radical cystectomy has a high frequency of complications (up to 70%); most of them are Clavien I-II. A 30-days mortality rate is 5.2%, and re-hospitalization is required in 9.7% cases. 2. Univariate and multivariate analysis showed that an absence of antibacterial prophylaxis, a coronary heart disease and the patients age more than 75 years are predictors of an increased complication rate. 3. Open and laparoscopic radical cystectomy have insignificant differences in some intra- and postoperative parameters, but, in general, both approaches are comparable in terms of complications, mortality, and length of stay. 4. To obtain more convincing data on the ERAS protocol after radical cystectomy, long-term studies are required.

[The role of laparoscopic salvage lymphadenectomy in patients after initial extended lymphadenectomy for prostate cancer].

This work presents results of the analysis of safety and efficacy of laparoscopic superextended lymphadenectomy, which was performed in patients with clinical progression (the presence of lesions in the lymph nodes of the pelvis and beyond) after undergoing prostatectomy. A feature of the work is that these patients initially extended lymphadenectomy was performed. Clinical detection of foci was carried out by 11C-PET/ CT. Laparoscopic salvage lymphadenectomy appears to be the safe method of performing surgery. When monitoring patients there was evaluated the effectiveness of the operation - the percentage of patients with marked regression and stabilization of markers (PSA), duration of remission. The analysis of the data attempted to determine the predictors of non-response patients after salvage lymphadenectomy.

[Clinical value of transperineal saturation biopsy in patients with suspicious for prostate cancer].

The aim of the study was to evaluate clinical value of transperineal saturation biopsy (TPSB) in 52 patients with suspicious for prostate cancer (PCa): 31 - primary patients and 17 - men with non-effective transrectal biopsy. PCa was diagnosed in 31 of 52 (59,6%) patients. Focal lesions revealed in 6 (19,4%), multifocal - in another 25 (80,6%) cases. TPSB is very helpful in primary diagnosis and for therapy planning.

[Minimally invasive surgery with therapeutic effect in cancer patients].

During recent years ablative technologies have become very popular in tumor treatment. They are used in treatment for inoperable primary and metastatic tumors of the liver and the lung and also localized renal tumors of small sizes. The most studies on thermoablation in oncology are focused on the evaluation of tissue destruction and optimization of physical mechanisms, while potential mechanisms of immune response in thermoablation are still far from understanding. This study shows that with thermoablation of tumor within one month after the procedure the formation of a protective immune response is observed by increasing the content of activated T-helpers and cytotoxic T-lymphocytes.

[LAPAROSCOPIC AND OPEN RADICAL CYSTECTOMY FOR BLADDER CANCER].

Radical cystectomy is the standard method for treatment of muscle-invasive and locally advanced bladder cancer. Several less invasive approaches have been suggested recently, including totally laparoscopic radical cystectomy and robotic cystectomy. However despite significant improvements in surgical techniques the overall occurrence of perioperative complications is still high. Analysis of the literature data and comparison of these data with the results of our study was performed with respect to perioperative complications after radical cystectomy and oncological outcomes. In most of the studies, operating time during laparoscopic cystectomy was longer than that of open approach. Despite that, there was no influence of type of surgery on intraoperative complications. Major complication rates were similar between all groups. However laparoscopic cystectomy had lower rate of minor complications compared to open cystectomy. Laparoscopic cystectomy is safe and associated with lower blood loss, decreased postoperative ileus and lower length of stay compared with open radical cystectomy. Laparoscopic surgery for bladder cancer decreased minor complications (mainly due to lower bleeding and gastrointestinal complication rate) and had no impact on major complications. Moreover, if performed following the oncologic principles of open surgery, our results and literature data suggest that LRC is safe and determines non-inferior long-term cancer control compared with open surgery.

[CYTOREDUCTIVE NEPHRECTOMY IN METASTATIC RENAL CELL CANCER].

The role of cytoreductive nephrectomy in the current era of targeted therapy remains unknown. Two prospective randomized phase III trials (CARMENA and SURTIME) are now opened to evaluate the efficacy of cytoreductive nephrectomy in patients with metastatic renal cell carcinoma. So far it is not well known who will and who will not benefit from such surgery.