[Results of redo liver resections for metastatic colorectal cancer]. / Rezul'taty povtornykh rezektsii pecheni pri metastaticheskom kolorektal'nom rake.

OBJECTIVE: To analyze patients undergoing redo liver resections for metastatic colorectal cancer. MATERIAL AND METHODS: The study included 14 patients with colorectal cancer who underwent several redo liver resections for metastatic lesions between September 2011 and June 2021. Mean age of patients was 63.5 years. Left-sided colonic G2 adenocarcinoma T4N1-2 prevailed (wild-type KRAS). RESULTS: Fourteen patients (100%) underwent two liver resections, 7 (50%) - three resections, 1 (7.1%) - four resections. Mean period between the first and the second liver resections was 16.2 months, between the second and the third resections - 9.9 months, between the third and the fourth resections - 5 months. Maximum follow-up period after primary surgery was 9 years and 9 months. Seventy-five percent of patients were alive after 34.2 months, 50% - after 58.9 months. N+ status of colorectal tumor decreased survival while KRAS mutation and synchronous metastatic liver lesions increased survival. CONCLUSION: Redo liver resections for metastatic colorectal cancer are safe and ensure favorable long-term survival in certain patients.

[Gastrointestinal stromal tumors: potential of minimally invasive surgical interventions]. / Gastrointestinal'nye stromal'nye opukholi: vozmozhnosti maloinvazivnykh operativnykh vmeshatel'stv.

OBJECTIVE: To analyze the issue of gastrointestinal stromal tumors (GISTs) and potential of minimally invasive surgical interventions. MATERIAL AND METHODS: We analyzed postoperative outcomes in 97 patients with gastric and intestinal GISTs who underwent surgical treatment at the National Medical Research Centre for Oncology between 2015 and 2020. RESULTS: Twenty (24.7) patients with gastric GISTs underwent laparoscopic partial and distal gastric resections. Five (35.7%) patients with GISTs of the small intestine underwent minimally invasive segmental bowel resections. Only minimally invasive interventions were performed in patients with rectal GISTs. Analysis of laparoscopic and open surgeries for GISTs found no significant differences. Analysis of laparoscopic and open surgeries for gastric and small bowel GISTs revealed the obvious advantages of minimally invasive access regarding postoperative outcomes. Indeed, we found no need for nasogastric drainage in 50% of patients (p<0.001), earlier recovery of intestinal motility and oral feeding (p<0.001), lower postoperative morbidity (p=0.036), fast recovery of motor activity (p<0.001) and shorter postoperative hospital-stay (p<0.001). CONCLUSION: Despite small incidence, GISTs are a complex problem in modern oncology. Diagnosis and treatment require a multidisciplinary medical team (morphologists, geneticists, radiologists, surgeons, chemotherapists, gastroenterologists and other specialists) that is possible in a reference center. Minimally invasive interventions for GISTs of the stomach, small intestine and rectum improve postoperative course.

[Transanal endoscopic rectal resection: immediate and long-term results]. / Transanal'naya endoskopicheskaya rezektsiya pryamoi kishki: neposredstvennye i otdalennye rezul'taty.

OBJECTIVE: To analyze the results of transanal endoscopic microsurgery in patients with rectal tumors. MATERIAL AND METHODS: We analyzed 87 transanal endoscopic resections of rectal benign tumors (35 patients) and rectal cancer cT1N0M0 (52 patients) for the period since 2012. RESULTS: There were 2 (3.8%) intraoperative intestinal wall perforations into abdominal cavity and 2 (3.8%) postoperative bleedings among patients with rectal cancer. Four (7.7%) patients developed recurrent rectal cancer (pT1N0M0 - 1 patient, pT2N0M0 - 3 patients; by tumor grades: G1 - 2 patients, G2 - 2 patients) within 1.6-5.2 years. All recurrent tumors were located on anterior rectal wall. In patients with rectal cancer, cumulative relapse-free survival was 0.923 (standard error 0.037), cumulative overall survival - 0.926 (standard error 0.043). There was 1 (4.3%) intraoperative intestinal wall perforation among patients with benign rectal tumors. Postoperative anastomotic leakage occurred in 1 (4.3%) patient. Recurrent benign tumors occurred in 2 (8.7%) patients with villous rectal tumors. No relapses were observed in patients with rectal adenomas (p=1.0). CONCLUSION: Transanal endoscopic rectal resection is effective for benign rectal tumors and rectal cancer pT1N0M0 with high relapse-free and overall survival and low complication rate. Risk factors of recurrence are tumor stage pT2N0M0, tumor location on anterior wall and distance from the anus over 10 cm.

[Conversion of laparoscopic access in colorectal cancer surgery (in Russian only)]. / Konversiia laparoskopicheskogo dostupa v khirurgii kolorektal'nogo raka.

AIM: To analyze the problem of access conversion in laparoscopic surgery for colorectal cancer. MATERIAL AND METHODS: There were 876 procedures for colorectal cancer T14N01M0 performed at the Rostov Research Institute of Oncology in 2015-2017. Open and laparoscopic surgery was applied in 562 and 309 patients, respectively. Conversion of laparoscopic procedures was required in 35 (10.2%) patients. RESULTS: Conversions were 2.7 times more frequent in men (p<0.05) (probably due to anatomical features - a narrow pelvis) and predominantly with rectosigmoid (22.2%, 2 patients) and rectal cancer (12%, 22 patients). Conversions in women were as well in right-sided colon cancer (9.7%, 3 cases) and sigmoid cancer (7.4%, 4 patients). Conversions were performed mostly due to locally advanced tumors (37.1%, 13 patients) which are especially baffling in case of narrow pelvis. Visceral obesity (20%, 7 patients) and abdominal adhesions (17.1%, 6 patients) were also important causes of conversions. Conversions did not affect time of surgery (256 min vs. 240 min in laparoscopic and 237 min in open surgery). Intraoperative blood loss (284 ml) was higher than in laparoscopy (240 ml) but did not exceed that in open surgery (291 ml). CONCLUSION: It is necessary to assess risks and benefits of laparoscopy in patients with high probability of conversion in colorectal cancer surgery.

[Combined surgery for locally advanced colorectal cancer]. / Kombinirovannye operativnye vmeshatel'stva pri mestno-rasprostranennom kolorektal'nom rake.

AIM: To study the types and early outcomes of combined interventions for locally advanced colorectal cancer. MATERIAL AND METHODS: Since 2009 four hundreds and ninety eight patients underwent surgery in the Rostov Research Institute of Oncology for locally advanced colorectal cancer. Most cases of surgical procedures on adjacent organs included resection of small intestine (23.69%), supravaginal hysterectomy (16.47%), resection of bladder (12.25%), total hysterectomy (11.45%). RESULTS: Postoperative complications occurred in 178 (35.7%) patients. Their incidence was significantly lower in case of laparoscopic approach (12.5%). Functional-sparing interventions on bladder followed by its augmentation with enteric graft improves rehabilitation. CONCLUSION: Laparoscopic approach and functional-sparing surgery improve the results of locally advanced colorectal cancer management.