[Fluorescence lymphoscopy with sentinel lymph node biopsy in research of lymphatic flow in early gastric cancer]. / Vozmozhnosti flyuorestsentnoi limfoskopii s biopsiei signal'nykh limfaticheskikh uzlov v izuchenii kharaktera limfoottoka pri rannem rake zheludka.

OBJECTIVE: To analyze the incidence and risk factors of regional lymph node metastatic lesions, as well as patterns of lymphatic drainage in early gastric cancer using indocyanine green (ICG). MATERIAL AND METHODS: A prospective single-center non-randomized study included 67 patients with early gastric cancer between 2016 and 2019. All patients underwent endoscopic dissection or surgical resection with sentinel lymph node biopsy. RESULTS: Regional lymph node metastatic lesions were detected in 12 (20.2%) out of 59 patients with examined lymph nodes. Of these, 11 out of 12 patients had sentinel lymph node lesion, and only 1 patient had metastasis outside this lymph node. The proposed technique for sentinel lymph node biopsy demonstrated high sensitivity, specificity and accuracy (93.2%, 100% and 98.3%, respectively). Risk factors for metastasis of early gastric cancer to regional lymph nodes were high grade adenocarcinoma (p=0.038) and tumor of anterior gastric wall (p=0.013). All patients with tumors of the upper third of the stomach had sentinel lymph node in the left gastric artery basin. Lymph flow was multidirectional in patients with tumors of the middle third of the stomach. In tumors of the lower third of the stomach, sentinel lymph node was located in the right gastroepiploic artery (50%) and left gastric artery basins (36.84%) (p=0.002). Sentinel lymph node was located in the left gastric artery basin in 84% of patients with tumors of the lesser curvature (p<0.001). Lymphatic drainage was multidirectional if tumors were localized on anterior and posterior walls, as well as on the greater curvature. CONCLUSION: The proposed technique for sentinel lymph node biopsy demonstrated high sensitivity, specificity and accuracy (93.2%, 100% and 98.3%, respectively). ICG is valuable to identify the first lymph node in lymphatic drainage pathway in 83.6% of cases that makes it possible to assess the regional lymphatic collector. In addition, sentinel lymph node biopsy with ICG contributes to analysis of lymphatic drainage in early gastric cancer. The last one has both scientific and practical significance.

[Modern possibilities of fluorescent imaging in liver surgery]. / Sovremennye vozmozhnosti flyuorestsentnoi vizualizatsii v khirurgii pecheni.

The article presents a literature review of modern methods of fluorescent navigation in liver surgery. The technique of tumor «staining¼, mapping of liver segments, fluorescent cholangiography is covered. The own results of the use of indocyanine green in liver surgery are presented.

[Interim results and safety assessment of indocyanine green peritumoral injection for regional lymphatic outflow area mapping in colon cancer as a part of the ISCAPE TRIAL]. / Promezhutochnye rezul'taty i otsenka bezopasnosti paratumoroznogo vvedeniya indotsianina zelenogo dlya kartirovaniya zony regionarnogo limfoottoka pri rake obodochnoi kishki v ramkakh ISCAPE trial.

The individual approach to determining colon resection extension, known as tailored surgery, has been actively discussed for several years. However, despite the consistency and validity of the idea, it still has few followers, primarily due to the lack of high-level evidence confirming the validity of this approach. OBJECTIVE: To determine whether the boundaries of the lymphatic outflow area, mapped with indocyanine green, match the lymphogenic metastasis area according to the surgical specimens' pathological study. MATERIALS AND METHODS: From 26.07.2022 to 13.02.2023, 27 patients with resectable colon cancer were included in the study; 25 of them underwent intraoperative imaging of the lymphatic outflow from the affected area of the intestine using the peritumoral injection of indocyanine green, assessment of infrared light fluorescence, followed by a comparison of the glow area with a pathologically defined zone of lymphogenic metastasis. RESULTS: Of the 25 mapping procedures, 17 (68%) were typical (no deviations from the standard injection schedule and solution extraperitonization); in 8 (32%) cases, there were technique defects. No allergic reactions to indocyanine or side effects were observed. Of the 25 patients who received peritumoral indocyanine green, 17 (68%) had no complications during the postoperative period. There were no postoperative deaths. Technique defects during the injection did not interfere with the outcome interpretations: all patients showed the indocyanine green fluorescence within the paracolic basin proximal and distal to the tumor; fluorescence along the main feed vessel was recorded in 24 (96%) patients. Fluorescence of the aberrant lymphatic vessels was reported in 3 (12%) cases and required extension of the resection in 1 patient. The time to the indocyanine green appearance in the D1 basin lymphatic vessels and along the main feed vessel varied widely (from 15 minutes to 1 hour or more). It was also noted that the boundaries of indocyanine distribution varied significantly (from 3 to 16.3 cm) depending on individual characteristics. The analysis of pathological data showed no cases of secondary involved lymph nodes beyond the boundaries of indocyanine distribution. In most cases, secondary altered paracolic lymph nodes were localized directly in the projection of the tumor, and concomitant lesions of mesocolic nodes were more common than metastatic lesions of D1 nodes located laterally from the tumor. CONCLUSIONS: The study results show that mapping the regional lymphatic basin is a reproducible and feasible technique. It does not increase the rate of complications and contributes to identifying individual lymphatic outflow characteristics to ensure oncological radicality in non-standard lymphatic anatomy.

[Current view on variety of bowel preparation for elective colorectal surgery]. / Sovremennyi vzgliad na optimal'nye sposoby podgotovki tolstoi kishki pered planovymi kolorektal'nymi operatsiiami.

Mechanical bowel preparation used to be a standard procedure for a long time. Nowadays routine use of MBP seems to be debatable thus alternative approaches, e.g. avoiding any bowel preparation completely or using of MBP with oral antibiotics are considered. Data on performing different kinds of bowel preparation is reviewed in this article.

[Influence of anastomotic leakage on the long-term outcomes in patients with colorectal cancer]. / Vliianie nesostoiatel'nosti shvov anastomozov na otdalennye rezul'taty lecheniia bol'nykh kolorektal'nym rakom.

Anastomotic leakage after surgery for colorectal cancer is a widely known factor aggravating immediate outcomes. At the same time, deterioration of oncological results is under much less attention. Long-term consequences of anastomotic leakage and possible mechanism of negative effect of this complication on long-term results are reviewed in the article.

[Modern trends in surgery of gastrointestinal tract tumors].

Development of cancer surgery in recent decades occurs on a background of continuing scientific and technical progress. New technologies after the completion of clinical trials maximally quickly are included in the routine practice of specialized medical centers. At present an escalation of indications for extensive advanced and combined operations in locally advanced and even metastatic tumors goes in parallel with the introduction of minimally invasive interventions, search categories of patients, for whom the radicalism of treatment can be achieved without significant surgical aggression. The study of modern trends of this process will allow seeing the promising areas of scientific research, assuming the image of the future of surgery for cancer.

[New approaches to treatment for malignant tumors using perfusion technologies].

The paper summarizes and analyzes the results of complex treatment of patients with malignant tumors performed in the N.N.Petrov Research Institute of Oncology using perfusion technologies. Safety and efficacy data on various chemoperfusion is presented: intraperitoneal chemoperfusion combined with cytoreductive surgery in patients with locally advanced and disseminated gastric cancer, recurrent ovarian cancer and pseudomyxoma peritonei; isolated lung perfusion combined with metastasectomy in patients with lung metastases; isolated limb perfusion with/without cytoreduction in patients with locally advanced skin melanoma and locally advanced soft-tissue sarcoma. The conclusion is made that both intraperitoneal and isolated chemoperfusions are not associated with higher incidence of intra- and postoperative morbidity. However safety of the procedures could be increased through optimizing tactics of surgical procedures prior to chemoperfusions. The use of perfusion technologies provides significant survival advantage in patients who can't benefit from conservative treatment.

[Role and place of the surgical complex "Da Vinci" in treatment for the right half of colon cancer].

Currently there are a large number of publications, in which the data demonstrate advantages of laparoscopy-assisted colectomy against open surgery. These advantages include: fewer complications in the postoperative wounds, reducing the intensity of pain in the postoperative period, a decrease in length of hospital stay, faster recovery of bowel function in the postoperative period as well as the best cosmetic effect. Also it is proved that when performing laparoscopic surgery it is possible to achieve the criteria of oncological radicalism. A number of clinical studies have reported similar rates of a 3-and 5-year survival rate between these two approaches, which makes laparoscopy-assisted colectomy an attractive alternative to traditional open surgery. Despite significant advances in laparoscopic treatment for colon cancer surgeons are still faced limitations inherent to traditional laparoscopic technique. Development and distribution of surgical instruments for a robotic complex in the middle of the 2000s made it possible to overcome limitations through the use of tools with multiple degrees of freedom and stable three-dimensional high-definition images. The use of robotic technologies in laparoscopic surgery has showed their safety and effective alternative to standard laparoscopic surgery.

[MINIMALLY INVASIVE ESOPHAGECTOMY].

During the period from April 2012 to December 2014 54 patients aged 29-76 years, 36 (66.6%) males and 18 (33.4%) females, with esophageal cancer underwent minimally invasive esophagectomy as final phase of treatment. Squamous cell carcinoma was diagnosed in 50 patients and adenocarcinoma identified in 4 patients. The disease was staged as follows: IA--5 (9.3%) patients, IB--11 (20.4%) patients, IIA-- (16,.%) cases, III -- (3,.%) cases, IIII --8 (33,.%), IIII -- (14,8%), III -- (1,.%). 37 (68,.%) patients had surgery after induction chemoradiation therapy. Of 54 surgical interventions there were 20 hybrid and 34 minimally invasive operations. 19 (35,.%) patients developed complications, postoperative mortality was 2 (3,.)%. Minimally invasive esophagectomy meets basic oncological principles and leads to tolerable short-term results.

[CHEMOPERFUSION TECHNOLOGIES IN TREATMENT FOR MALIGNANT TUMORS].

The data of literature on possibility of the use of perfusion technologies in combined treatment for malignant tumors of different sites are presented. Possible complications during hyperthermic chemoperfusion are discussed and the effectiveness of this method is analyzed.

[Mini-invasive technologies in complex treatment of esophagus cancer].

It was evaluated mini-invasive endovideosurgical technologies using in complex treatment of esophagus cancer. The investigation included 28 patients with thoracic esophagus cancer. Age of patients operated in terms from April 2012 to December 2013 was from 42 to 74 years (mean 61.7 ± 8.7 years). Only surgical treatment was used in 10 patients. Neoadjuvant chemotherapy and radiotherapy were performed in 18 patients. Hybrid mini-invasive esophagectomy (laparoscopic stomach mobilization and right-side thoracotomy) were used in 14 cases. The frequency of postoperative complications was 35.5%. Mini-invasive endovideosurgical esophagectomy was done in 14 patients. The frequency of postoperative complications was 57.1%. There were not deaths. Our experience demonstrates good results of mini-invasive technologies using in treatment of patients with esophagus cancer. Endovideosurgical methods permit to perform adequate volume of surgery in case of oncological diseases.

[Laparoscopic surgery for rectal cancer: a literature review and own experience].

The main treatment option for rectal cancer is surgery, which "gold standard" is the total mesorectumectomy. There are presented literature review and the results of own research devoted to comparative analysis of outcomes of laparoscopic and open total mesorectumectomy. Current data and own experience show the oncological adequacy and safety of laparoscopic approach however the controversy of some results reveal the necessity of further investigation.

[Comparative analysis of immediate results of surgery for colon cancer using laparoscopic and robot-assisted surgical interventions].

In recent decades there has been achieved significant progress in treatment for colorectal cancer. Minimally invasive surgery (including robot-assisted) is rapidly gaining widespread acceptance in treatment of this form of cancer. Today robotic surgery is a revolutionary technology that opens a new stage in the development of surgery of the 21st century. Currently in the world there have been performed more than 2 million surgical interventions of the colon using a robotic surgical complex Da Vinci. To date it was accumulated a large number of single-center studies comparing laparoscopic and robot-assisted interventions in cancer of various parts of the colon for short-term and long-term treatment outcomes, which showed their effectiveness and safety. Modern colorectal surgery could not be imagined without the latest technology, the use of which directly affects the quality of life of patients after surgery.

[100 ROBOTIC-ASSISTED OPERATIONS IN COLORECTAL CANCER (FIRST OUTCOMES)].

This article analyzed the immediate treatment results of 210 patients, underwent endovideosurgical operative treatment concerning colorectal cancer (106 laparoscopic and 104 robotic-assisted operations). According to the first results, there was no significant difference between two methods in such medical indices as the volume of intraoperative hemorrhage, terms of hospital stay and peristalsis recovery, the rate of conversion and complications in. early postoperative period, quantity of removed lymph nodes, quality of TME. The application of robotics allowed performance of precision work in conditions of limited space of the small pelvis.

[Options for pelvic floor reconstruction after extralevatory abdomino-perineal resection of the rectum].

Extralevatory surgery requires a use of additional techniques for closure of extensive defects of the pelvic floor. This study analyzed the results of 55 extralevatory abdomino-perineal extirpations of the rectum using a variety of methods of plastic of defects of the pelvic floor. There were performed 20 simple plastics, 13 alloplastics and 22 myoplastics. Complications in the perineal wound were observed in 10 (50%) cases after a simple plastic, 4 (32%) after plastic using mesh endoprosthesis and 5 (23%) after myoplastic. It is showed that the highest rate of postoperative complications in the perineal wound (up to 50%) occurs in a case of "simple" plastic. Complication rate reduces to 23-32% when alloplastic and myoplastic are used. It is concluded that alloplastic and myoplastic have significant advantages over the simple plastic.

[Experience of the use of endovideotechnology in surgical treatment of esophageal cancer].

An investigation included 33 patients with cancer of thoracal section of the esophagus at the age from 42 to 74 years old. A surgical method of treatment was applied as only one in 13 patients and methods of nonadjuvant chemoradiation therapy were used for 20 patients. A hybrid minimally invasive esophagectomy (laparoscopic mobilization of the stomach and right-side thoracotomy) was performed on 16 patients. The rate of postoperative complications consisted of 31%. The minimally invasive esophagectomy (performed by totally endovideosurgical approach) was carried out in 15 cases. Postoperative complications developed in 53% of follow-up patients. There weren't cases of lethality. The experience of minimally invasive methods indicated the satisfactory results of application of given methods in patient treatment of esophageal cancer. The use of endovideosurgical approaches allowed performing oncologically adequate volume of operative interventions.

[Current principles and approaches to the treatment for patients with locally advanced rectal cancer].

The short-term treatment results of 91 patients with locally advanced rectal cancer are presented. All patients received surgical treatment and neoadjuvant chemotherapy. The chemoradiotherapy effect was evaluated by comparison of pre- and post-therapeutic MRI data. MRI data was also compared with post-operation tumor morphology data. In 23% of resected tumor samples complete tumor regression was evident, in 47.2% of cases partial regression was revealed. Lymph node metastases were found in 21.9% of cases. The discrepancy in MRI and morphology data can be explained by the limited ability of MRI in differentiation between viable tumor, fibronecrotic tissue and inflammatory reaction after chemoradiotherapy.