Oncological Coloproctology (E-Journal) / Онкологическая колопроктология
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Российский многоцентровой опыт выполнения робот-ассистированных операций у больных раком прямой кишки
Get PDFВлияние возраста на уровень тревожности и когнитивных функций у пациентов, страдающих колоректальным раком
Get PDFКлиническое наблюдение первично-множественных синхронных опухолей: аденокарциномы и гастроинтестинальной стромальной опухоли толстой кишки
No full textСинхронное возникновение опухолей ободочной кишки разной морфологической природы достаточно редко описаны в мировой литературе и не имеют между собой четкой этиологической связи. Представленное клиническое наблюдение пациента А., 56лет., демонстрирует редкое сочетание опухолей эпителиальной и неэпителиальной природы
ПЕРИОПЕРАЦИОННАЯ НУТРИТИВНАЯ ПОДДЕРЖКА БОЛЬНЫХ КОЛОРЕКТАЛЬНЫМ РАКОМ
Get PDFThe article is devoted to some issues of perioperative nutritional support of patients with colorectal cancer. This group is usually characterized by high proportion of patients with nutritional disorders and impossibility of quick return to usual good nutrition in the early postoperative period. Timely administration of medical nutrition reduces the risks of postoperative complications and death among these patients. Enteral support is associated with lower risk of postoperative complications and should be used in most of the patients. В данной статье рассматриваются вопросы назначения периоперационной нутритивной поддержки больным колоректальным раком. Спецификой данной группы является исходно высокая доля пациентов с нарушениями питания, а также невозможность возвращения к полноценному обычному режиму питания в раннем послеоперационном периоде. Своевременное назначение лечебного питания позволяет снизить риски послеоперационных осложнений и смертности у данной категории больных. Энтеральная поддержка связана с меньшим риском послеоперационных осложнений и должна применяться у большинства пациентов.
ЛЕЧЕБНАЯ ТАКТИКА ПРИ КOЛОРЕКТАЛЬНОМ РАКЕ, ОСЛОЖНЕННОМ ДЕКOМПЕНСИРОВАННЫМ НАРУШЕНИЕМ КИШЕЧНОЙ ПРОХОДИМОСТИ И ДИАCТАТИЧЕСКИМ РАЗРЫВОМ ТОЛСТОЙ КИШКИ
Get PDFObjective: to improve the results of treatment of patients with colorectal cancer complicated by acute bowel obstruction and diastatic rupture.Materials and methods. Retrospective analysis of treatment outcomes of patients with complicated colorectal cancer, treated at the Clinic of Hospital Surgery of theI.I.MechnikovNorth-WestStateMedicalUniversity from 1986 till 2015.Results. Of the 1206 patients with colorectal cancer complicated by intestinal patency violation injury breach of intestinal, decompensated violation intestinal patency (ABO) was detected in 245 (20.3 %) cases. The main principle of treatment of colonic obstruction in cancer was the intention for the simultaneous elimination of obstruction and the radical removal of the tumor. Radical surgery was performed in 152 (62 %) of 245 cases with ABO. In case of right-sided colon tumors generally colon resection with anastomosis formation were performed, in case of left-sided tumors colon resection in the majority ended with the terminal colostomy formation. Palliative operations were performed to 93 (37.9 %) patients. Postoperative complications were detected in 51 (20.8 %) cases. The death rate was 11.8 %. The mortality after radical surgical operations was 6.6 %. Diastatic rupture was diagnosed in 15 (1.2 %) patients. Subtotal colectomy with the formation or anastamosis was performed to 3 patients, operation ended with ileostomy formation – in 9 cases.Conclusion. In case of the left-side cancer of colon, complicated by АВО, a radical surgical operation with colostomy formation is beneficial. In the case of colorectal cancer, complicated by the diastatic rupture the operation of choice is subtotal colectomy.
Метаанализ исследований, посвященных изучению конкордантности мутационного статуса генов между первичной опухолью и метастазами рака толстой кишки
Get PDFBackground. During the last years several trials emerged demonstrating high tumour heterogeneity, including those on colorectal cancer.Objective. These findings made us initiate a meta-analysis of trials dedicated to this question.Materials and methods. We searched PubMed database, ASCO and ESMO abstracts for publications presented until August 2016. Studies which compared concordance of KRAS, NRAS, BRAF and PIK3CA mutations between primary tumour and metastases of colorectal cancer and which included more than 10 patients were included in meta-analysis. Meta-analysis was performed using Review Manager (RevMan), version 5.3.Results. Statistically significant differences were observed in KRAS (5 %; RR 0.95; 95 % CI 0.92–0.98; р = 0.003), PIK3CA (7 %; RR 0.93; 95 % CI 0.86–0.99; р = 0.04) mutational status, but not BRAF and NRAS. We observed no significant publication-associated systematic errors. KRAS discordance was significantly higher between primary tumour and lymph node metastases – 13.2 % (р = 0.036).Conclusions. A possibility of KRAS discordance between primary tumour and colorectal cancer metastases was demonstrated. Considering a small number of patients with discordance it is necessary to distinguish a high-risk discordance group, which will require an additional mutational analysis of metastatic nodes tissue
ОРГАНОСОХРАНЯЮЩЕЕ ЛЕЧЕНИЕ РАКА ПРЯМОЙ КИШКИ
Get PDFObjective: to evaluate the results of “watch and wait” approach for rectal cancer patients with complete clinical response after neoadjuvant chemoradiotherapy (CRT) followed by consolidation chemotherapy.Materials and methods. Between 2013 and 2016, 130 patients who were diagnosed with stage T2N0–1M0–T3(CRM+)–4N0–2M0 middle and low rectal cancer were treated by CRT (single dose 2 Gy to a total dose 50–54 Gy with concominant capecitabine 850 mg/m2 /day of radiotherapy) with consolidation chemotherapy (CapOx) (capecitabine 2000 mg/m2 14 days and oxaliplatin 130 mg/m2 intravenous once in 3 weeks).Results. 21 patient showed complete clinical response. During the time of observation (median 14.6 month) all patients alive without signs of recurrence and progression.Conclusion. Preliminary results showed that organ saving treatment for rectal cancer patients with a complete clinical response is oncologically safe when followed by strict selection criteria and active follow-up, including endoscopy and magnetic resonance imagin. Future investigation is needed to justify this statement. Probability of complete response is higher for early stages of rectal cancer.
Гетеротопическая оссификация рецидивной опухоли слепой кишки
Get PDFA rare observation of heterotopic ossification in the metastasis of cecal cancer after surgical treatment and polychemotherapy is presented in this article. This version of the metastatic process of colorectal cancer is not usual, and correct diagnosis in this case can be difficult.В статье представлено редкое наблюдение гетеротопической оссификации в метастазе рака слепой кишки после хирургического лечения и полихимиотерапии. Такой вариант течения метастатического процесса при колоректальном раке не является обычным, и установление правильного диагноза в данном случае может быть затруднительным
Результаты трансанальной мезоректумэктомии при раке прямой кишки
Get PDFObjective: comparative analysis of specific perioperative features and pathological characteristics of the removed sample after laparoscopic total mesorectumectomy (Lap-TME) and transanal total mesorectumectomy (Ta-TME).Materials and methods. A prospective non-randomized controlled study was carried out from November 2013 until September 2016. Patients with сТ1–4aN0–2M0 cancer of low- or medium-ampullar section of rectum were enrolled.Results. 55 and 54 patients were included in the Ta-TME and Lap-TME groups respectively. Duration of surgery was 285 min (Ta-TME group) and 260 min (Lap-TME group); median volume of blood loss was less than 100 ml; duration of hospital stay after surgery was 7 days in both groups. 1 (1.8 %) patient from Ta-TME group and 3 (5.6 %) patients from the control group had conversion to open surgery (р = 0.223). Transanal removal of the sample was done in 53.7 % of the cases in Ta-TME group and 25.5 % of the cases in Lap-TME group (p = 0.008). Complications were registered in 27,3 and 24,1 % of the patients respectively (р = 0,436). 90.9 % of the patients from Ta-TME group had Grade 2–3 quality of mesorectumectomy, while in Lap-TME group this parameter was 85.2 % (p = 0.266). Circumferential resection margin damage was observed in 7.3 % of cases from Ta-TME group and 9.3 % of cases from Lap-TME group (p = 0.488).Conclusion. Ta-TME does not worsen short-term oncological results. Further randomized studies are required to identify those patients who would benefit from bottoms up mesorectumectomy