Oncological Coloproctology (E-Journal) / Онкологическая колопроктология
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Рак анального канала с крупными метастазами в параректальную клетчатку: дифференциальная диагностика и лечебная тактика
Get PDFSelected squamous-cell anal carcinoma (SCAC) patients are initially presented with large pararectal lymph node metastases.The aim of this study was to investigate safety, efficacy and long-term outcome of chemoradiotherapy in this patient group.Materials and methods. SCAC patients, initially referred with gastrointestinal stromal tumors, rectal cancer diagnosis or patients with regional metastatic lymph nodes more than twice the size of the primary tumour were included in this retrospective analysis. Previous treatment, diagnostic and clinical mistakes of primary care specialists, short- and long-term outcome of chemoradiotherapy were analyzed.Results. 6 patients were included. Primary tumour size varied between 0.5 and 6.5 cm (median – 1.7 cm), metastatic lymph node size varied between 4.2 and 7.4 cm (median – 6.4 cm). All patients received radical doses of chemoradiation. All patients developed grade 3 toxicities, 2 patients developed grade 4 toxicities. Median followup was 15.5 months. 5 out of 6 patients had persistent complete clinical response. 1 patient died of disease progression (incomplete response and metachronous distant metastases).Conclusion. SCAC patients with large regional lymph node metastases have equal prognosis with the rest of the patient group of adequate treatment was carried out
Влияние полноты реализации программы ускоренного выздоровления пациентов, перенесших резекцию ободочной кишки по поводу рака, на эффективность лечения
Get PDFObjective: to assess ERP implementation results in patients with colon cancer and to reveal correlation between compliance of ERP protocol and efficacy of perioperative care.Materials and methods. 124 patients were included in the study. Main group consisted of 62 patients with ERP, others were controls. ERP compliance was assessed using original formula which considers number of accomplished elements of the Protocol and quality of performance of each element.Results. No significant difference between the groups in morbidity was obtained (1.6 % in main group vs 9.8 % controls; р = 0.06). Minor dependence in self-care was obtained in 90.5 % at third post-op day in main group vs 58.0 % in controls (p < 0.0001). Postoperative hospital stay was lower in main group (4.7 ± 0.1 vs 9.0 ± 0.6 days; p < 0.0001). Total hospital stay was lower in main group as well (7.2 ± 0.1 vs 14.1 ± 0.7 days; р < 0.0001). No mortality and readmissions occurred. ERP compliance rate was 80.0 % (56.9–93.3 %). Рostoperative hospital stay in patients with high protocol compliance (≥ 80 %) was significantly shorter then in patients with low protocol compliance (< 80 %): 4.3 ± 0.2 vs 5.1 ± 0.2; р = 0,005).Conclusion. ERP is effective and safe method of postoperative care in patients after colon resection and the effectiveness of the treatment correlates with protocol compliance rate resulted in shorter hospital stay
Определение показаний и объема хирургического лечения больных с метастазами колоректального рака в легкие
No full textSurgical treatment of metastatic colorectal cancer in lungs is a relatively new trend of modern oncology. In this connection, still there are no clearly formulated criteria for patient selection for this type of intervention, approaches to repeated resections and scope of the surgical operation in case of multiple lesions. Established key prognostic factors include lesion of intrathoracic lymph nodes, timing of the development of metastatic disease, baseline level of carcinoembryonic antigen, number of foci and the volume of metastatic lesion, stage of the disease. Options for surgical access include lateral thoracotomy, sternotomy, thoracoscopy and thoracoscopy combined with additional minithoracotomy.If a patient has a single peripheral metastatic lesions, physician should prefer thoracoscopic operations. One of their advantages include minimum development of adhesions and possibility of subsequent re-thoracoscopy. Resection of pulmonary metastases from colorectal cancer (R0 resection rate) allows to achieve persistent healing of the tumor process in a significant number of patients
Влияние стандартизированного алгоритма периоперационного ведения на результаты правосторонней гемиколэктомии у пациентов пожилого и старческого возраста
Get PDFIntroduction. Standardized protocols for perioperative management of patients are increasingly used in colorectal surgery. We compared the results of right-sided hemicolectomy in elderly patients before and after implementation of this protocol.Materials and methods. The results of a prospective database of the department of surgical oncology of Treatment and Rehabilitation Center for 2009–2016 years were analyzed. A comparative analysis of 86 case of elective right-sided hemicolectomy was performed in patients aged 60 years and over as a part of standardized protocol for perioperative management of patients, and 34 similar surgeries carried out earlier without compliance with the protocol. Clinically, there was no significant differences between groups.Results. In the study group we revealed statistically significant decrease in the number of sever (grade III–V by Clavien–Dindo) postoperative complications and mortality from 33 % to 13 % and from 12 % to 1 %, respectively. Also, despite the fact that surgical operations in the test group were carried out by less experienced surgeons, introduction of the unified surgical technique reduced median duration of the surgery from 185 to 165 minutes.Conclusion. Introduction of the standardized protocol for perioperative management of elderly and old patients, that need right-sided hemicolectomy, reduces the number of complications and lethal cases
Первичная реконструкция тазового дна после эвисцерации малого таза с применением мембран «Коллост»
Get PDFThis article displays the results of successful combined treatment of patient with recurrence of rectal carcinoma with use of preoperative chemotherapy followed by infralevator pelvic exenteration and primary reconstruction of pelvic floor using xenotransplant “Kollost”.В статье представлено клиническое наблюдение успешного комбинированного лечения пациента с рецидивом рака прямой кишки посредством предоперационной химиотерапии и хирургического вмешательства в объеме инфралеваторной эвисцерации малого таза и первичной реконструкции тазового дна с применением ксенотрансплантата «Коллост»
Отдаленные результаты хирургического и комбинированного лечения больных раком верхнеампулярного отдела прямой кишки
Get PDFBackground. Сomparative assessment of long-term oncologic outcomes of surgical and combined treatment of patients with upper rectal cancer.Materials and methods. Patients aged > 18 with histologycally verified upper T1–4N0–2M0 rectal cancer were included. In group A patients received neoadjuvant chemoradiotherapy 25 Gy in 5 Gy fractions with capecitabine 850 mg/m2 bid per os on radiation days and surgery. In group B patients received surgery alone.Results. From january 2004 to december 2014, we selected 227 archival cases of patients with upper rectal cancer. Group A was 103 patients (45.4 %) in group B – 123 (54.6 %). We traced long-term results of treatment in 217 (96.6 %) patients. In the group A was 98 (95.1 %) patients, in the group B – 119 (96.7 %) patients. Local recurrence occurred in group A – 1 (1.2 %) patient, in group B – 3 (2.5 %) patients (p = 0.413). The frequency of distant metastases developed in group A in 10 (10.2 %) patients and in group B – 15 (12.6 %) patients (p = 0.581). Overall survival in group A was 90.6 %, and the disease-free survival – 89.6 %, in group B – 82.8 % and 81.9 %, respectively (p = 0.46).Conclusions. Surgical treatment of patients with upper rectal cancer stage I–III, in compliance with all oncological principles is justified
Трансанальные операции в лечении опухолей прямой кишки
Get PDFIn last two decades, transanal endoscopic microsurgery (TEM) in treatment of both benign and malignant tumor of rectum is actively developing. The aim of this review was to describe the current status of transanal interventions. Due to the low level of recurrens (mean about 6 %) TEM has become the method of choice for removal of rectal adenomas. Several studies have demonstrated the benefits of treatment TEM in cases of early T1 cancer compared to conventional resection. However, for more invasive adenocarcinomas performing TEM remains controversial, but it’s very promising method for the complex treatment. Just as transanal mesorectal exision in treatment of mid- and low rectal cancer as a new strategy – natural orifice transluminal surgery. However, it lack of evidence base and international experience in small series presented, so large randomized trials is needed.В последние два 10-летия активно развивается методика трансанальных эндоскопических операций (ТЭО) в лечении как доброкачественных, так и злокачественных опухолей прямой кишки. Цель данного обзора – описать текущий статус трансанальных вмешательств. ТЭО стала методом выбора для удаления «распластанных» аденом прямой кишки за счет низкой частоты рецидивирования (в среднем около 6 %). В ряде исследований показана ее эффективность в лечении раннего рака прямой кишки стадии рТ1 по сравнению с традиционными резекциями. Однако для более распространенных аденокарцином ТЭО остается противоречивой, но очень перспективной методикой в плане комплексного лечения. Новой стратегией – хирургией через естественные отверстия – стала трансанальная мезоректумэктомия при нижне- и среднеампулярном раке. Но до получения результатов рандомизированных исследований этот метод не может быть рекомендован к применению в рутинной практике, несмотря на оптимистичные результаты некоторых вмешательств
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Get PDFКонец года – время научных отчетов и подведения итогов. Мы с радостью можем отметить, что в нашу редакцию поступает все больше материалов, знакомящих читателей с оригинальными исследованиями. В связи с этим мы приняли решение посвятить номер работам только этой тематики.Конец года – время научных отчетов и подведения итогов. Мы с радостью можем отметить, что в нашу редакцию поступает все больше материалов, знакомящих читателей с оригинальными исследованиями. В связи с этим мы приняли решение посвятить номер работам только этой тематики