[SIDE-TO-END ANASTOMOSIS IN LOW ANTERIOR RECTAL RESECTION].

The authors have launched a prospective randomized study aimed to make a comparison of functional results of formation of straight coloanal (control group) and side-to end (main group) anastomosis in case of low anterior rectal resection since 2012. Each group consisted of 40 patients undergoing operation concerning uncomplicated rectal cancer of medium-ampullar section of rectum. It was noted that patients of the main group had lower stool frequency in postoperative period. A function of the interior sphincter was less damaged and the rate of compliance of rectum was high.

[Effect of intraoperative intrapelvic chemotherapy with hyperthermia on the incidence of rectal cancer recurrences].

Often due to a severe somatic condition of the patient, the presence of perifocal inflammation, anemia, age, it is not possible to perform neoadjuvant chemoradiotherapy for rectal cancer. To improve cancer treatment outcomes in these patients intraoperative intrapelvic chemotherapy with hyperthermia is used at the Centre. In the present study there included 120 patients with rectal cancer at stage T3-4N0-2M0, while 60 patients underwent intraoperative intrapelvic chemotherapy with hyperthermia (cisplatin at a dose of 150 mg, the time of the procedure--60 minutes, the temperature of the perfusate--44-45 degrees C). Conducting of intraoperative intrapelvic chemotherapy with hyperthermia allowed reducing the frequency of local recurrence in 2 times from 16.7% to 8.3% and increasing a 3-year overall survival by 10%--from 63% to 73%, which shows intraoperative intrapelvic chemotherapy with hyperthermia as an effective method in the prevention of local recurrences.

[Is the localization of the tumor in intra-peritoneal part of the rectum contraindication to transanal endoscopic microsurgery].

Transanal endoscopic microsurgery (TEM) is the method used in cases of benign tumors at the early stages of rectal cancer. The tumor localization in peritonized part of the rectum indicates a limiting level for removal of the neoplasm. TEM was performed on 137 patients. The mean age was 63.8 ± 9.8 years and the number of women consisted of 65.7%. Neoplasms were located in the upper ampullar rectum and a potential possibility of connection with the peritoneal cavity was noted in 12 (8.7%) patients, but during TEM it was only in 5 cases. There wasn't any conversion to a peritoneal surgery. The wound closures were carried out from the side of the rectum lumen and all the operations were finished with the control laparoscopy and formation of sigmostoma. The stomas were closed in 3 patients on fifth- sixth weeks. A connection with the peritoneal cavity during TEM isn't critical event in the case of wound closure through surgical rectoscope and it doesn't lead to the conversion to radical operation.

[Molecular genetics study of hereditary predisposition to diffuse gastric cancer in Russian patients].

About 3% of cases of gastric cancer (GC) cases are due to hereditary predisposition. Molecular causes of inherited predisposition to diffuse GC among Russian patients have not been studied. In the present work there was performed the molecular genetics study in 9 probands with signet-ring cell GC. Search of hereditary mutations was conducted in a suppressor gene of diffuse GC - the gene CDH1. We have discovered a new hereditary mutation (c.1005delA) and one rare variant (s.2253C> T). Frequency of hereditary mutations in sample of patients Russian was 1/9 (11,1%).

[Colovesical fistula as a complication of diverticular disease].

The results of research on the clinical picture, features of manifestation, diagnosis, and treatment of patients with diverticular disease complicated by sigmovesical fistula are presented. The study included 31 patients (19 [61.3%] men, 12 [38.7%] women), aged 32-83 (55.6 +/- 7.1) years. Diagnostic program included physical examination, laboratory blood and urine tests, endoscopic, radiological, ultrasound examinations. All patients underwent different interventions according to the severity and extent of the inflammatory process, the involvement of other organs of the abdominal cavity and the extent of diverticular lesions of the colon. Long-term results were assessed in all patients in a period of 5 months to 12 years, with a median follow-up 4.7 years. It is shown that the clinical manifestations of intestinovesical fistula did not match the severity of complications, and were subclinical. Timing for referral the patient to coloproctologist was 5 months after the occurrence of first clinical signs. In any case, conservative treatment has not led to spontaneous colovesical fistula closure. Average size of parafistulous infiltration on the wall of the bladder and perivesical tissue was 6.5 +/- 2.4 cm. All the patients underwent different types of colon resection. Postoperative complications did not requiring recurrent surgery were detected in 5 (16.1%) patients. None of these has experienced recurrence complications of diverticular disease. For the optimization the treatment strategy, physicians should follow multidisciplinary approach immediately after revealing the patient with persistent bacteriuria, pneumaturia and fecaluria. The surgery is the method of choice in the treatment of colovesical fistula as a complication of diverticular disease.

[The weakened form of familial adenomatosis: clinical and genetic characteristics and methods of treatment].

Clinical and genetic analysis of 24 Russian patients with attenuated form of family colon adenomatosis was undertaken. On the basis of obtained clinical and genetic data it was defined the algorithm of therapeutic measures in this group of patients--from dynamic monitoring or endoscopic polypectomy to performing extensive resections of the colon in situations associated with cancer development, an increase of the intensity of growth of polyps or an appearance of villous lesions. Some of the patients had molecular-genetics causes of a weakened form of family adenomatosis.

[Multidisciplinary approach to the treatment of colorectal cancer, complicated by urinary tract invasion].

Results of treatment of 277 patients with colorectal cancer stage IV complicated by the urinary tract invasion, were analyzed. Men were 168 (60.7%); women - 109 (39.3%). Patients aged 31-79 years (59.6±5.7) years. All patients were operated on radically with the resection of the invaded parts of the urinary tract en bloc. Both abdominal surgeons and urologists took part in the operation. The study proved that the invasion of the urinary tract by colorectal cancer should not become a reason for the surgery refusal. The subtotal resection of the urinary bladder by its cancer invasion demonstrated the appropriate radicalism and functional postoperative results. The efficacy of such combined operations was proved by the high level of social adaptation of the operated patients - 18 (51.4%) of 35 followed up patients came back to the previous level of social activity. Urinary tracts' resection did not influenced the level of postoperative lethality.

[The comparative analysis of the surgical treatment of the familial adenomatosis of the colon with the use of cell transplantation].

Authors represent the surgical technique of colectomy with preserving the natural intestinal passage in the treatment of the familial colic adenomatosis. The technique is based on the preserving the distal part of the rectum with its demucosation and connecting with the ileal conduit. The rectal mucosa reconstruction is performed with the use of allogenic transplantation of fetal intestinal cells. 27 patients were operated on. The rectal mucosa reconstruction was registered in all cases range 4-12 weeks postoperatively. The long-term follow-up showed no disease recurrence within 5 years. The method demonstrated better intermediate and long-term functional results.

[The manually assisted laparoscopic surgery of colon cancer].

The experience of 193 manually assisted laparoscopic operations on the reason of colon cancer was analyzed. The mean age of the patients was 63.6±11.3 years. Men were 85 (44%), women - 108 (56%). The majority of patients had tumor of 2nd or 3rd stage. The mean body mass index was 27.6±4.6 kg/m2. The conversion was needed in 8 (4.1%) cases. There were no intraoperative complications. The duration of the manually assisted laparoscopic colon resection was 168±45min. 11 (5.7%) patients had postoperative complications. The thorough analysis of the results allow to recommend the method for the treatment of patients with colon cancer.

[Decrease of the number of involved lymph nodes after preoperative chemoradiotherapy in rectal carcinoma].

The total of 296 T3-4NO-2 Federal Coloproctology Science Center colon cancer patients received treatment since 2004 to 2011, 165 patients (main group) also received treatment (pre- and postoperative irradiation, surgery, adjuvant chemotherapy) in P.A.Herzen State Clinical Research Center for Oncology. The control group (131 patients) received only surgery with adjuvant chemotherapy. Based on our results, prolonged chemoradiotherapy leads to statistically significant decrease of regional mesorectal lymph nodes metastases, the decrease is most evident in N1 stage patients group (1-3 lymph nodes metastases). However, the number of diagnosed involved lymph nodes also depends on the depth of tumor penetration and the timing between chemoradiotherapy and surgery. The most important prognostic criterion is not the state of involved lymph nodes, but their number.

[Influence of a total focal dose of preoperative chemoradiotherapy on direct results of treatment of rectal cancer].

An analysis of complex treatment of 154 patients with T2-4N0-2 stage rectal cancer is presented who were given preoperative chemoradiotherapy in regimen of dynamic functioning with total focal dose 39.5 Gy (71 patients of the first group) and 47 Gy (83 patients of the second group) using 5-fluororacil and cisplatin. A multivariant analysis has demonstrated a reliably increased frequency of total and close to total regressions of rectal cancer (1-2 stage by Mandard) in the second group as compared with reduced duration of the operative intervention the 1st group (43.2% and 23.9). Frequency of postoperative complications did not have reliable difference in both groups as well as the number of sphinctersaving surgical procedures.

[Rationale for intraoperative intrapelvic chemotherapy in combination with hyperthermia in the treatment of rectal cancer].

Neoadjuvant treatment should not be given to grave cases of rectal cancer with concomitant perifocal inflammation, anemia and advanced age. To improve results, intraoperative intrapelvic chemotherapy in combination with hyperthermia was carried out at the Center's Clinic. Pre-clinical studies involved working out optimal cryo-temporal regimens to maximize cytotoxic effects of drugs and hyperthermia as well as establishing systemic influence of local hyperthermia and chemotherapy on the intraoperative intrapelvic one. Our optimal cryo-temporal regimens and intraoperative intrapelvic chemotherapy proved highly effective.

[Effect of the duration of time between chemo-radiotherapy and surgical intervention on the results of the combined treatment of rectal cancer].

Complex treatment included preoperative radiochemotherapy (fractionated TTD of 47 Gy), 5-FU 2.75-3.5 g, cisplatin 90 mg, surgery and postoperative adjuvant chemotherapy (XELOX). The radiochemotherapy/ surgery interval ranged 21-72 days (average--40; median--41.2 +/- 7.9). Patients were divided into two groups: those operated on within days 21-40 (1) and days 41-72 (2) to evaluate the impact of the interval between surgery and completion of radiochemotherapy. The intervals longer than 40 days were not followed by longer sphincter-saving operations, higher intraoperative blood loss or postoperative complication incidence, as compared with the 21-40 day interval. Besides, radiochemotherapy-related alterations in tumor tissues arising more than 40 days after exposure were more pronounced, yet unaccompanied by significantly better end results.

[Radiofrequency-assisted atypical resections of the liver for the colorectal cancer metastases].

The authors presented direct results of atypical resections of the liver for the colorectal cancer metastases fulfilled on 55 patients with the application of radiofrequency apparatus for the period from 2006 through 2010. The method used resulted in creation of 2.0 cm coagulation area which allowed dissection of the liver tissue practically without bleeding.

[Prognostic value of rectal cancer regression after preoperative chemoradiation therapy].

Despite the international experience enriched in the number of observations of combination treatment in patients with rectal cancer, many issues remain to be the subject-matter of the discussion. This also applies to the estimation of the value of tumor regression after neoadjuvant chemoradiation therapy in order to develop indications for sphincter-sparing operations depending on the site of a tumor in the organ and their impact on long-term treatment results. The authors have gained experience with combination treatment in 157 patients with rectal cancer (T2-4 N0-2 M0) receiving neoadjuvant chemoradiation therapy in a cumulative radiation dose of 39.5-47 Gy and radical surgery 4-6 weeks after radiation. The direct effect of chemoradiation therapy has been investigated using a set of studies involving ultrasonography, magnetic resonance imaging, endoscopic diagnosis, as well as the data of a postoperative morphological study of primary tumor and lymph nodes. The authors have evaluated the impact of preoperative chemoradiation therapy on the rate and degree of resorption of a primary tumor, including the depth of its invasion through the intestinal wall and exit into the cellular tissue, its localization in the organ and the distance to the anus, a difference in the preoperative estimation of stages and according to the data of pathomorphological studies of intraoperative specimens, etc. The degree of tumor resorption was comparatively analyzed with the long-term results and the rate of sphincter-sparing operations.

[Experimental foundation of using intraoperative endopelvic cisplatin with hyperthermia for rectal cancer].

Previously, significant increase in survival in locally-advanced rectal cancer as a result of heated intraoperative intraperitoneal chemotherapy was reported. Our study used cisplatin 0.5 mg/ml (0.05 per cent solution) in the culture of pharyngeal epidermoid carcinoma (PEC) cells (HEP-2) and A-549 culture of lung carcinoma cells. The number of viable cells was estimated colorimetrically after 24 and 48 hr incubation. 50%-rise in inhibition of culture growth was assumed to be biologically significant. Forty-eight hours after inoculation, single dose of cisplatin 8 mg/kg was injected in mice bearing transplanted lung carcinoma of Lewis (LLC). That was followed by death of tumor cells. Preheating (45 deg. C, 1 hr) did not influence either the cytostatic or therapeutic effect of cisplatin in vivo.That procedure inhibited tumor growth by 7-8% and the effect did not wear off until day 11 or longer. Survival in LLC-bearing mice rose by 26% which pointed to the advantages offered by heated cytostatic chemotherapy.

[Proctectomy with external sphincter preservation: long-term functional results].

52 patients with the lower ampullary rectal cancer with tumor localization on the dentate line level had been operated with the use of the originally developed reconstructive technique, permitting preservation of the external anal sphincter elements and, consequently, partial continence. Colonic rectal pouch and smooth muscle cuff were performed during the neorectum and neoanus plasty. A protective stoma was performed in all cases. Contractive activity of saved elements of EAS improved with a course of time and squeezing anal pressure increased as well. Consequent continence improvement occurred during the first year after the stoma closure, biofeed-back therapy provided faster rehabilitation. The achieved long-term functional results (73,4% actuarial 5-year disease-free survival) prove the oncological efficacy of the method on the strict assumption of indications observance. Thus, proctectomy with partial external anal sphincter preservation allows to avoid permanent colostomy and provides a satisfactory quality of life of the operated patients.

[Results of surgical treatment of residual and recurrent anal tumors].

Radio- or chemotherapy is a modern standard of anal cancer treatment. Recurrence or partial remission rate after radiochemotherapy achieves 20-40%. The study is aimed to evaluate the role of abdominoperineal resection in the treatment of residual and recurrent anal cancer. 120 patients (aged from 30 to 81 (59+/-11) years, men:women ratio--1:9) were prospectively studied in the period of 1995 to 2007. The TNM distribution was as follows: T1-2N0M0--66(55.0%), T3-4N0M0--18(15.0%), T1-2N1-3M0--15(12.5%) and T3-4N1-3M0--21(17.5%) patients. The radiotherapy delivered in a dose range of 55-65 Gy was used alone or in combination with chemotherapy with 5-fluoruracil, mitomycin C or Xeloda. The complete tumor regression after radiotherapy/radiochemotherapy was achieved in 74(61.1%) of 120 patients with cancer-specific survival rate of 81.7%. Partial tumor regression was registered in 46 of 120 patients. The abdominoperineal resection was performed in 39(84.8%) of patients with the residual tumor. Thus, surgical treatment allowed secondary local tumor control in 76.9% of patients with the 5-year survival rates of 69.0%. The median survival time for the non-operated patients, including those, received an extra course of radiotherapy, was 19 months. The locoregional tumor relapse was diagnosed in 10(13.74%) of 74 patients with the complete tumor regression. The use of abdominoperineal resection allowed the secondary local tumor control and 5 year survival. Thus, abdominoperineal resection remains the method of choice in the treatment of residual and recurrent anal tumors.

[Proctectomy with external sphincter elements' preservation in surgery of low-ampullary rectal cancer].

Operational technique for the rectum tumors, localized at the level of dentate line, developed in the State center of coloproctology, allows preservation of external anal sphincter elements and thus, partial preservation of defecation control. Technique is described and proved, preliminary treatment results of 42 patients are analysed. The operation is oncologically effective (local recurrence rate 4,8%). Preservation of external sphincter elements has a high functional value in complex with "neorectum" and "neosphincter". A majority of operated patients can keep the stool, 80% of able-bodied patients continued their professional activities.

[The hand-assisted laparoscopic resections of colon's left parts].

Authors have an experience of 88 hand-assisted laparoscopic procedures. Results of 32 hand-assisted resections of colon's left parts are analyzed. The special original sealing device was used for making of pneumoperitoneum during laparoscopic procedures. The study group consisted of 19 female and 13 male patients. Mean age was 60.0 +/- 9.8 years (42-76 ys). Overweight was seen at 23 (72%) patients, 12 of them had obesity of I-III stage. Previous abdominal operations have been performed at 11 (34.4%) patients. Mean time of surgery was 181 +/- 53 min, operative bleeding--92 +/- 65 ml, no intraoperative complications occurred. Length of minilaparotomy was 7.3 +/- 0.8 cm. Poltoperative complications were seen at 4 (12.5%) cases, there were no lethal outcomes. Mean hospital stay was 9.8 +/- 3.5 bed-days.