Oncological Coloproctology (E-Journal) / Онкологическая колопроктология
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Непосредственные результаты комбинированного и комплексного лечения пациентов с низколокализованным раком прямой кишки
Get PDFThe issue of sphincter preservation when low rectal cancer (rectal adenocarcinoma 0–6 сm from marge anal) remains topical.Objective: to increase the number of sphincter preservation operations in patients with low rectal cancer.Materials and methods. We analyzed data on 110 patients with low rectal cancer randomized into 3 groups: in the 1st group surgery was performed following 0–3 days after the end of short-term radiotherapy (RT) 25 Gy. In the 2nd group the interval before surgery after the identical RT was 42 ± 3 days. In the 3rd group, in 2 cycles of capecitabine chemotherapy were performed starting on the 1st day of RT.Results. pCR was observed obly in 2nd and 3rd group: in 16.6 % patients in the 2nd group, and 12.8 % in the study group. The sphincter preservation rate was 40.0 % in the 1st control group, 70.0 % in the 2nd group and 77.0 % in the 3rd group. The postoperative complications rate was 37.5 % in the 1st group, 26.6 % in the 2nd group and 17.9 % in the 3rd group.Conclusions. Preoperative chemoradiotherapy may increase sphincter preservation rate without increase in the number of postoperative complications
Хирургические и патоморфологические результаты тотальной мезоректумэктомии с применением методики водоструйной диссекции при раке прямой кишки
Get PDFBackground. The paper presents our own experience of using a waterjet dissector ERBEJET2® in the course of surgical interventions for colorectal cancer. This experience is unique for Russia.Materials and methods. Waterjet dissection method associated with total mesorectumectomy was used by us in 20 patients suffering from rectal cancer. An average age of patients was 59.2 ± 13.9 years. In all the patients surgeries were performed for adenogenic colorectal cancer, morphologically verified at the preoperative stage. Resected preparations were studied on morphological level. For comparison, two control groups of 20 patients were selected, in which the rectum mobilization was performed by using monopolar coagulator and harmonic scalpel. The studied groups were matched by gender, age, location and the tumor extent. All the surgeries were performed by one surgical team.Results. Results of the study demonstrated advantages of waterjet dissection when performing total mesorectumectomy due to a minimum depth of tissue damage on the lateral margin of resection.Conclusion. Waterjet dissectors have taken their place in the extensive list of tools used when performing surgical interventions for colorectal cancer, that allows to expect an improvement of functional and oncological results of the surgical treatment
Медиально-латеральная лимфодиссекция при радикальном лечении рака ободочной кишки, осложненного обтурационной толстокишечной непроходимостью
Get PDFBackground. Choosing a primary radical resection in treatment of large bowel obstruction, often oncologically justified by necessity to remove the obstructive tumor at the first stage. However, indicators of radicalism of this approach is not enough reflected in trials.Materials and methods. In prospective comparative trial in period from December 2012 till April 2014 of treatment outcomes and specimens of 70 patients, whom mobilization of the mesocolon were performed in medial to lateral direction and traditional way.Results. The average number of lymph nodes, complications of I, II and V level did not differ significantly. The median vascular tie length improved from 42 to 115 mm for right colon cancer and from 30 to 65 mm for left colon cancer.Conclusions. Benefits of the primary radical treatment for large bowel obstruction versus delayed surgery remains controversial. However, at the first case, the choice should be given to the medial-lateral approach, which allows to achieve best tissue morphometry and improving of treatment outcomes
Псевдомембранозный колит, осложненный токсическим мегаколоном, после закрытия превентивной стомы
Get PDFToxic megacolon complicating pseudomembranous colitis is a very rare condition that confirms by a few reports. In our case report probably described a case after extraperitoneal preventive colostomy closure toxic megacolon was developed with fatal final.Псевдомембранозный колит, осложненный токсическим мегаколоном, является очень редким состоянием, что подтверждается немногими сообщениями. В нашей работе, возможно, впервые описан случай, где после внебрюшинного закрытия колостомы фульминантно развилась картина токсического мегаколона с летальным исходом
Симультанное лапароскопическое и торакоскопическое вмешательство при раке прямой кишки с метастазом в легкое (клиническое наблюдение)
Get PDFThe paper describes a clinical case of successful treatment in a female patient with disseminated rectal cancer by minimally invasive technologies that could perform one-stage simultaneous intervention into the rectum and lung, which promoted rapid patient rehabilitation and reduced systemic chemotherapy initiation time.В статье описан клинический случай успешного лечения больной диссеминированным раком прямой кишки с использованием малоинвазивных технологий, позволивших провести одномоментное симультанное оперативное вмешательство на прямой кишке и легком, что способствовало быстрой реабилитации пациентки и сократило интервал времени до начала системной химиотерапи
Пероральные фторпиримидины в предоперационной химиолучевой терапии больных операбельным раком прямой кишки
Get PDFBackground. The aim of this study was to compare short and long-term outcomes after neoadjuvant short-course chemoradiotherapy with capecitabine ot tegafur for operable rectal cancer.Materials and methods. Patients with histologycally verified Т3N0M0, Т2–3N1–2M0 rectal cancer, who underwent 5 × 5 Gy neoadjuvant radiotherapy with local 41–45 °C hyperthermia on days 3–5 and metronidazole 10 g/m2 per rectum days 3, 5 were randomized to receive capecitabine 1000 mg/m2 bid per os days 1–14 or tegafur 400 mg/m2 bid per os days 1–21. Toxicity, tumor regression, sphincter preservation rate and long-term outcomes were analyzed.Results. During 2011–2013 26 patients were included in the tegafur group and 30 – in capecitabine group. Overall toxicity was 50 % in the tegafur arm and 36.7 % in the capecitabine arm (p = 0.42), grade III–IV toxicity (diarrhoea was the most common grade 3+ event) was observed in 23.1 % and 6.7 % (p = 0.13) patients accordingly. Grade III–IV tumor regression was observed in 34.6 % patients, who received tegafur and 53.3 % (p = 0.12) patients who received capecitabine. Sphincter-sparing surgery was performed in 84.6 % and 100 % (p = 0.04) patients who received tegafur and capecitabine accordingly. Median follow-up was 31.6 and 32.2 months accordingly. 3-year overall survival in capecitabine and tegafur arms was 95.4 and 82.1 % (р = 0.13), 3-year disease-free survival – 91 and 74 % (р = 0.029).Conclusions. Both fluorpyrimidines demonstrated comparable short-term outcomes with a tendency to better results in the capecitabine arm
Современное состояние проблемы малоинвазивных методов локального лечения метастазов колоректального рака в печени (обзор литературы)
Get PDFThe paper reviews the data available in modern Russian and foreign literature on the existing minimally invasive methods of local exposure of colorectal cancer liver metastases, which include ablation procedures (radiofrequency ablation, laser thermal ablation, and cryoablation), stereotactic radiotherapy and radiosurgery, as well as X-ray endovascular procedures (chemoinfusion, chemoembolization, and radioembolization). The characteristics of some treatment options and a surgical procedure, as well as those of each other were compared.В статье выполнен обзор по данным современной отечественной и зарубежной литературы существующих малоинвазивных методов локального воздействия на метастазы колоректального рака в печени, включающих: абляционные методики (радиочастотная абляция, лазерная термоабляция, криоабляция), стереотаксическую лучевую терапию и радиохирургию, а также рентгенэндоваскулярные методики (химиоинфузия, химиоэмболизация, радиоэмболизация). Проведена сравнительная характеристика отдельных методов лечения с хирургическим методом и между собой
