Oncological Coloproctology (E-Journal) / Онкологическая колопроктология
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ТАКТИКА СФИНКТЕРОСОХРАНЯЮЩЕЙ ХИРУРГИИ ПРИ МЕСТНО-РАСПРОСТРАНЕННОМ РАКЕ ПРЯМОЙ КИШКИ УЛЬТРАНИЗКОЙ ЛОКАЛИЗАЦИИ С ПОРАЖЕНИЕМ ЛАТЕРАЛЬНОЙ ГРУППЫ ЛИМФАТИЧЕСКИХ УЗЛОВ: КЛИНИЧЕСКОЕ НАБЛЮДЕНИЕ
Get PDFThe article considers the possibility of sphincter sparing surgery in patients with negative risk factors, such as localization in low third and lesion of lateral lymph nodes. Combined treatment and improved surgical approach allowed to achieve positive oncological and functional results. The discussion provides an analysis of the publications devoted to various approaches to the treatment of low rectal cancer with extended pelvic lymph node dissection and neoadjuvant chemoradiotherapy. В статье рассматривается возможность выполнения сфинктеросохраняющей операции у пациентки с наиболее неблагоприятными прогностическими факторами, такими как низкая локализация опухоли и поражение латеральной группы лимфатических узлов. Комплексный подход и усовершенствованная хирургическая тактика позволили достигнуть положительных онкологических и функциональных результатов. В обсуждении приводится анализ публикаций, посвященных различным подходам к лечению нижнеампулярного рака с расширенными тазовыми лимфодиссекциями и неоадъювантной химиолучевой терапией.
Влияние возраста на уровень тревожности и когнитивные функции у пациентов, страдающих колоректальным раком
Get PDFBackground. Colorectal cancer is highly prevalent in Russia, especially among the elderly patients. We analyzed the influence of age on anxiety level and cognitive function on patients with colorectal cancer.Materials and methods. In the period 2012–2015 we analyzed pre-operatively the level of anxiety (HADS scale) and cognitive disfunction (MoCA test) in 244 patients who underwent radical colorectal resection.Results. Patients younger than 60 constituted 34 %, 60–74 years – 31 %, 75 years and older – 35 %. We were able to show a correlation between age and anxiety level according to HADS. The same trend was found according to MoCA test.Conclusion. Oncopsychologist shall develop individualized treatment plan according to anxiety and cognitive levels in patients with colorectal cancer
Лапароскопическая передняя эвисцерация органов малого таза с резекцией сигмовидной кишки (клиническое наблюдение)
Get PDFThe clinical observation demonstrates a successful surgical treatment of a 61-year-old female patient K. (body mass index 38.4) diagnosed with locally advanced sigmoid colon cancer protruded into the bladder and uterus (сT4bN2M0) with formation of a colovesical fistula. The patient underwent surgical treatment in the form of laparoscopic resection of the sigmoid colon and supralevator anterior pelvic exenteration with formation of a Bricker conduit. Intraoperative blood loss was 200 ml. Postoperative period was smooth, with fast track rehabilitation; the patient was discharged on day 9. Considering cancer stage, the patient received XELOX as adjuvant chemotherapy for 6 months after the surgery. During a year of follow-up, no signs of disease progression were evident. The patient is fully socially rehabilitated. В клиническом наблюдении продемонстрировано успешное хирургическое лечение пациентки К. 61 года (индекс массы тела 38,4), у которой был диагностирован местно-распространенный рак сигмовидной кишки с врастанием в мочевой пузырь и матку (сT4bN2M0) с образованием толстокишечно-пузырного свища. Больной было выполнено хирургическое вмешательство в объеме лапароскопической резекции сигмовидной кишки, супралеваторной передней эвисцерации органов малого таза с формированием кондуита по Брикеру. Интраоперационная кровопотеря составила 200 мл. Течение послеоперационного периода гладкое, с применением протокола ускоренной реабилитации; больная выписана на 9-е сутки. С учетом стадии заболевания в течение 6 мес после операции проводилась адъювантная полихимиотерапия по схеме XELOX. В течение 1 года наблюдения данные за прогрессирование основного заболевания отсутствуют. Пациентка полностью реабилитирована в социальном аспекте.
Выбор оптимального объема лимфодиссекции в хирургическом лечении рака ободочной кишки: протокол клинического исследования
Get PDFBackground. The choice of the best surgical approach to colon cancer treatment remains a complicated and controversial problem of modern coloproctology. Current data shows better long-term outcomes after procedures performed in accordance with embryological layers and concept of complete mesocolic excision, while level of vessel ligation remains debatable. In the US and Europe D3 lymph node dissection is not routinely performed for colon cancer, while in eastern countries it is considered to be a standard. Up-to-date there is no published data from randomized trials comparing long-term outcomes of D2 and D3 dissection. Materials and methods. A literature review was performed to evaluate current data on colon cancer lymph node dissection. A design of ran-domized trial was proposed to obtain the evidence on the superiority of D3 over D2 lymph node dissection. Discussion. As evidence regarding long-term outcomes of D3 lymph node dissection is lacking the choice of lymph node dissection is made according to surgeon’s or clinic preferences. Conclusion. To objectify the preferred lymph node dissection extent randomized controlled studies are needed.
Робот-ассистированные и лапароскопические операции при колоректальном раке: кривая обучения и непосредственные результаты
Get PDFМикросателлитная нестабильность колоректального рака в детском возрасте (клиническое наблюдение)
Get PDFImmunohistochemical study of colon adenocarcinoma in the child showed microsatellite instability MLH1, MSH2, MSH6, a high level of proliferative activity of Ki-67 and apoptosis imbalance.Иммуногистохимическое исследование аденокарциномы толстой кишки у ребенка выявило микросателлитную нестабильность белков MLH1, MSH2, MSH6, высокий уровень пролиферативной активности Ki-67 и дисбаланс процессов апоптоза
Применение превентивных стом в хирургическом лечении колоректального рака
Get PDFObjective: to investigate the efficiency of defunctioning stomas in protection of the anastomosis formed during the resection of the colon due to cancer including the complicated colorectal cancer.Materials and methods. Retrospective analysis of treatment outcomes of patients with a colorectal cancer whom resections of the rectum were performed, treated at the V.A. Oppel Clinic of Hospital Surgery of the North-West I.I. MechnikovState Medical University from 2010 till 2015.Results. The article presents a retrospective analysis of the results of treatment of 46 patients with colorectal cancer. All the patients underwent a resection of the rectum with the formation of preventive colostoma and without it. The patients were divided into 2 matched by sex, age groups. Resection of the rectum with defunctioning stoma forming due to the complicated colorectal cancer was performed to 3 patients. Complications were found in 6 patients: 2 patients after resection of the rectum with the formation of preventive colostoma and in 4 patients after resection without its formation. Death rate was 4.3 %. 2 patients died, to both patients defunctioning stomas weren’t performed.Patients with defunctioning stomas stayed in hospital in average for 3 days longer comparing with patients whom defunctioning stoma wasn’t formed. The stoma closure operations were performed to 89.5 % of the patients with defunctioning stomas.Conclusion. The data demonstrate efficiency of defunctioning stoma in prevention of anastamosis complications in surgical treatment of colorectal cancer including complicated colorectal cancer. However, must be conducted a clear definition of indications for its formation
