[PROM a contemporary approach to assessing the quality of life of patients with cancer].

PRO (patient reported outcomes) is a patient's subjective assessment of health and quality of life, without interpretation by a specialist. PROM (patient reported outcomes measure) questionnaires are used to analyzing this data. Assessment of the quality of life is a perspective direction, which allows to improve the quality of medical care and treatment results. Today, there are many questionnaires PROM, their reliability and validity has been proven in numerous studies. Unified standards and methods for developing and evaluating questionnaires have been developed. Interest in the use of quality of life questionnaires is increasing constantly. However, studies analyzing the data of the PROM questionnaires are rarely found in the national literature. Quality of life is also poorly researched in clinical practice. The aim of the literature review is to present modern methods for assessing the quality of life of patients, especially with cancer. A review of the most widespread and reliable questionnaires and assessment instruments for the quality of life of a patient has been carried out. The analysis of world experience of their use in clinical practice, for patients with cancer has been performed. Examples of both general and specific questionnaires are given. PROM questionnaires are widely used among patients with cancer. However, incorrect use of PROMs is found in the literature, and in patients with certain nosologies PROM data studied poorly. Further analysis of the potential of PROM questionnaires implementation is required, as well as their translation and adaptation for use in Russian health care.

[Minimally invasive esophagectomy for benign esophageal diseases: results of a two-center study]. / Minimal'no invazivnaya ezofagektomiya pri dobrokachestvennykh zabolevaniyakh pishchevoda: rezul'taty dvukhtsentrovogo issledovaniya.

OBJECTIVE: To analyze the results of thoracoscopic esophagectomy for benign esophageal diseases. MATERIAL AND METHODS: The study included 78 patients who underwent thoracoscopic esophagectomy between 2011 and 2019. Peptic and burn strictures of the esophagus were diagnosed in 53 patients, achalasia - in 24 patients. Minimally invasive esophagectomy and esophagoplasty with isoperistaltic gastric tube and esophagogastrostomy on the neck was performed in 68 patients, Ivor Lewis esophagectomy - in 1 patient, coloesophagoplasty - in 9 patients. We used manual technique of anastomosis in 58 patients, stapling device - in 19 patients. In 1 case, surgery was finished with esophagostomy and gastrostomy. RESULTS: Mean blood loss was 200 ml (10-1200), surgery time - 450 min (265-765 min). Early postoperative complications occurred in 37 patients including anastomotic leakage in 24 cases. In long-term period, anastomotic strictures developed in 9 patients. No mortality was observed. CONCLUSION: Minimally invasive esophagectomy for benign esophageal diseases ensures favorable clinical outcomes. However, no consensus in the choice of surgical approach and indications, as well as small number of these patients cause challenges in implementation of this technique. There are different opinions regarding technique of anastomosis on the neck and surgical access in thoracoscopic esophagectomy.

[Minimally invasive esophagectomy]. / Minimal'no invazivnaia ézofagéktomiia.

Certain advantages of minimally invasive esophagectomy compared with conventional approaches were observed. Optimal surgical access, technique and features of anastomoses formation are still unclear despite common tendency to minimally invasive esophageal surgery. Further researches are necessary to resolve these problems and improve the outcomes.

[Thoracolaparoscopic simultaneous operations on esophagus].

Extirpation or subtotal resection of esophagus was performed in 14 patients by using of thoracolaparoscopic technique in terms from November 2011 to March 2014. The mean patients' age was 56 years old (27-67 years). In 10 patients indications for surgery included benign esophagus diseases such as cardiospasm stage IV (2 cases), peptic stricture (5 cases) and burn stricture (3 cases). 4 patients were operated for esophagus cancer including middle one-third cancer in 1 patient, lower one-third cancer in 3 cases. 10 patients underwent extirpation of esophagus with peristaltic gastric tube plasty. 1 patient had esophagus substituted by segment of the left colon. Esophageal anastomoses were formed on the neck (interrupted sutures were applied in 7 patients; staplers - in 3 cases). Lewis operation with intrapleural esophageal-gastric anastomosis forming was performed in 3 patients. The mean surgery duration was 579 minutes (305-710 min), mean blood loss - 141 ml (from 50 to 300 ml). Postoperative period had not complications in 8 of 14 patients. Different complications including partial failure of the anastomosis on the neck (5 cases), intrapleural anastomosis failure (1 case) were observed in 6 patients. Partial failure of the anastomosis on the neck was treated by using of therapy. All patients recovered. Patient with intrapleural anastomosis failure required additional surgery which included uncoupling of anastomosis, esophagostomy on the neck and gastrostomy forming. This patient died from recurrent myocardial infarction. Thus the authors consider that complete thoracolaparoscopic technique provides precise preparation of esophagus and stomach, adequate lymphadenectomy with minimal blood loss and operative trauma. The results after these operations are comparable with those after open interventions. Thoracolaparoscopic simultaneous operations must be applied in clinics having sufficient experience in esophagus surgery and thoracolaparoscopic technique.

[Surgeries on gastrointestinal tract without components of donor's blood].

Results of surgical treatment without transfusion of donor's blood in 58 patients were compared with ones in 40 patients treated with allogenous transfusions. Blood-saving program included preoperative storage of autoplasma, acute normovolemic hemodilution, recombinant human erythropoietin and perftoran. Both groups of patients were similar by types of surgeries performed on gastrointestinal tract. Results of treatment in the study group (58 patients) were better: there were less postoperative complications; period of postoperative rehabilitation was shorter. It is demonstrated that it is possible to refuse allogenous hemotransfusion in 96.6% cases of traumatic surgeries on gastrointestinal tract.

[Surgical treatment of diseases of operated stomach].

Experience with treatment of 262 patients with late complications after operations for duodenal ulcer was analyzed. Eighty-four (32.1%) patients underwent earlier suturing of perforated duodenal ulcer, 97 (37.0%) -- resection of the stomach and 81 (30.9%) -- various types of vagotomy. In recurrent ulcers after sutured perforation organ-saving operations (62, or 73.8%) have important advantages over resection of the stomach. Combined postgastrectomy syndromes (18, or 18.6%) were most difficult for surgical treatment. Resection of the stomach (70, or 86.4%) patients is the best reconstructive operation for postvagotomy syndromes.

[Surgical treatment of complicated ulcers of cardia and sub-cardia].

Two hundred and two patients with ulcers of a proximal part of the stomach (17.5% of all patients with gastric ulcer) were treated. In 135 (64.9%) patients these ulcers were complicated: in 28 (20.7%) -- malignant ulcers, in 42 (31.1%) -- bleeding ulcers, in 53 (39.3%) -- penetrating ones. Surgery was performed in 142 (70.3%) patients. A high rate of complications dictates a need to reduce period of conservative treatment of such ulcers to 6 months -- 1 year. Distal and proximal resection of the stomach are main surgeries in elective surgical treatment of patients with benign ulcers of cardia and sub-cardia. In malignant transformation gastrectomy is the most preferable. Suturing is indicated in perforated and bleeding ulcers, and if it is impossible -- distal subtotal resection of the stomach.

[Repeated surgeries after vagotomy in duodenal ulcers].

Experience of surgical treatment of 73 patients with different postvagotomic syndromes was analyzed. The recurrent ulcers were seen most often -- in 54 (74.0%) patients. All the patients have undergone selective proximal vagotomy including isolated surgery in 19 patients and in combination with different drainage surgeries in 54 patients. High gastric secretion was the cause of recurrent ulcers in all the cases. Resection of the stomach was the most often reconstructive surgery -- 58 (79.5%) patients. Three (4.1%) patients died. It is concluded that postvagotomic syndromes are severe diseases of operated stomach with difficult treatment, further studies are necessary.

[Surgery without donor's blood]. / Khirurgiia bez donorskoi krovi.

Complex program "Surgery without blood" was developed and introduced into a broad clinical practice. The main elements of this program are stimulation of erythropoesis, preparing in autoserum and autoblood before surgery with acute normovolemic hemodilution method, precise surgical technique, reinfusion of blood from wound and drainages, adequate anesthesia and correction of hemostasis system. This program permits one to minimize infusion of donor's blood components (DBC) in elective surgery (cardiosurgery, orthopedic surgery, neurosurgery, oncology, general surgery) and reduce significantly transfusion of DBC in urgent surgery. Rejection of DBC transfusion decreases number of postoperative complications and hospital stay, improves results of treatment and is cost-effective.

[Traumatic surgeries on organs of gastrointestinal tract without components of donor's blood]. / Travmatichnye operatsii na organakh pishchevarutel'nogo trakta bez ispol'zovaniia komponentov donorskoi krovi.

The authors propose a complex program aimed to refuse completely using donor's blood components in surgeries on organs of digestive tract. This method was used in 25 patients who underwent surgeries with 380-1500 ml of blood loss. No patients received transfusion of donor's blood components before, during and after surgery.

[One-stage esophagoplasty without transfusion of donor blood components]. / Odnomomentnaia plastika pishchevoda bez ispol'zovaniia komponentov donorskoi krovi.

Six patients aged from 27 to 62 years were operated for subtotal burn strictures, cancer and glandular polyp of a low-thoracic part of the esophagus using a complex program of non-blood surgery. The following methods were used: collection of autoplasma before surgery by plasmapheresis, collection of autologic packet red cells, normovolemic hemodilution during surgery, use of perftoran for oxygen transport and recombinant human erythropoetin to stimulate erythropoiesis and raise preporative level of hemoglobin. Components of donor blood were not used in these patients. There were no complications associated with these methods. Partial failure of esophagol-colonic anastomosis on the neck was seen in 1 patient. The complex program permits one to avoid completely transfusion of donor blood components in esophagol surgery.

[Surgical treatment of duodenal ulcers]. / Khirurgicheskoe lechenie iazvennoi bolezni dvenadtsatiperstnoi kishki.

Selective proximal vagotomy (SPV) was fulfilled in 440 patients with ulcer of the duodenum, 30.0% of them being operated upon for relative indications, and 70.0% for different complications of the ulcer. Different draining operations were made in 219 patients with stenosis. Draining operations were made in 10.6% of 254 patients without stenosis of the pylorus who had big and deep penetrating ulcers which could disturb duodenal passage on their healing. Resections of the stomach after Billroth-I were fulfilled in 20 of 43 patients with combined gastric and duodenal ulcers, and after Hofmeister-Finsterer in 23 patients in view of a danger of malignization. The best results were obtained after proper SPV and after operations eliminating stenosis and saving the evacuating mechanism of the pylorus (transversal duodeno-duodenostomy in 10 patients and duodenoplasty--in 22). Resection of the stomach should be performed by the Billroth-I method.

[The experience of 1100 esophagoplasties]. / Opyt 1100 plastik pishchevoda.

The experience of esophagoplasties in various benign diseases (566) and cancer (534) of the esophagus is outlined. The operation of choice now is extirpation of the esophagus by cervico-abdominal approach with one-state posterior-mediastinal esophagoplasty by the stomach or (in case of impossibility to form the graft from the stomach)--large bowel. If there are contraindications to such operation or in case of necessity of one-stage reconstruction of the pharynx the optimal operation is sub- and total bypass esophagoplasty by the large bowel.

[The device for placing ligature in deep wounds]. / Ustroistvo dlia ligatury v glubokikh ranakh.

A special device has been designed to provide safe and convenient placing of a ligature to the dissector or clamp in a deep wound. The device contains fork-shaped working part and a handle. The handle has an obtuse-angle curve and is connected with the working part by a hinge. It also has a handler-spring for fixing a ligature. The device prevents a chance of damaging nearby tissues in placing the ligature that makes it possible to hasten surgery.

[Method of treatment of volumetric liver masses]. / Sposob lecheniia ob''emnykh obrazovanií pecheni.

The authors propose the mode of treatment of volumetric masses of the liver which provides possibility to perform ablastic and atraumatic removal of the tumor with prophylaxis of bleeding by creation of the coagulation pellicle in the bed of the removed tumor. The method is based on the rational combination of cryodestruction, mechanical excision and laser coagulation: evaporation by the disfocused laser beam of the frozen bed of the tumor after its cryodestruction and mechanical excision, the principles of the ablastics are being completely kept; at the surface of the hepatic tissue the coagulation scab is being formed. Bleeding and biliary leakage are absent. This is prophylaxis of abscess, fistulas and haematomas after surgery.

[One-stage esophagoplasty with pathologically changed or previously operated stomach]. / Odnomomentnaia ézofagoplastika patologicheski izmenennym ili operirovannym zheludkom.

The results of esophagus extirpation with subsequent one-stage esophagoplasty by pathologically changed or previously operated stomach in 50 patients are analysed. 2 patients had gastric and esophagus cancer and 48 patients esophagus strictures. 36 patients had been previously operated on their stomach, 10 patients had scar deformation of the stomach after thermal burns, 2 patients had a giant leiomyoma. Isoperistaltic gastric tube was used as an esophagus substitute. The postoperative mortality rate was 2,1%. The optimal method of surgical treatment of the combined gastric and esophagus lesions is recommended.

[Enteral tube feeding of patients after esophagoplasty]. / Enteral'noe zondovoe pitanie u bol'nykh posle plastiki pishchevoda.

A method for enteral catheter feeding is suggested. It was applied in 60 patients after esophagoplasty. The main group consisted of 23 females and 37 males aged from 18 to 68 years. Esophageal carcinoma was observed in 31, burn stricture of the esophagus 18, and other benign diseases of the esophagus in 11 cases. All patients were subjected to extirpation of the esophagus with one-stage posteromedial esophagoplasty in 57 patients with an isoperistaltic gastric tube and in 3 patients with the colon. The control group was formed of 20 patients who underwent the same operations. Inpitan, ovolact, and hypernutril were used for enteral catheter feeding. The catheter was introduced via the nasal passage and transplant into the proximal segment of the jejunum. The mixtures were administered in drops of 5 to 7 days after the operation. Only parenteral feeding was conducted in the control group. The disorders of the alimentary status were removed quicker in patients of the main group than in the control and the incidence of postoperative complications was less. Body weight and the nitrogen balance were restored within a shorter time in the main group patients and incompetence of the esophageal anastomoses developed in a lesser number of cases.

[Removal of esophagus using a one-stage repair]. / Ekstirpatsiia pishchevoda s odnomomentnoi plastikoi.

The article deals with the results of operations performed on 306 patients for extirpation of the esophagus and one-stage total esophagoplasty with the formation of the anastomosis on the neck. The operation was conducted on 178 patients with carcinoma and 128 patients with benign esophageal strictures. The authors claim this operation to be the operation of choice in esophageal carcinoma, cardioesophageal carcinoma, burn and peptic strictures, and in patients with stage IV cardiospasm. An isoperistaltic gastric tube or the large intestine is used for replacement of the esophagus. The postoperative mortality rate was 3.3%. The immediate and late-term results of this operation are much better than those of the other types of esophagoplasty. The authors recommend the operation to be used widely in the practice of specialized clinics for the management of the above mentioned diseases.

One-stage surgery for esophageal cancer.

Of 102 patients operated on from 1985 to 1989, 75 patients had esophageal cancer, 21 had cancer of the cardia involving the thoracic portion of the esophagus, 3 had gastroesophageal cancer, 2 had leiomyosarcoma, and 1 had an epidermoid lesion of the middle third of the esophagus and cardial adenocarcinoma. All of them underwent extirpation of the esophagus with one-stage esophagoplasty and the establishment of a cervical anastomosis. The esophagus was replaced by an isoperistaltic tube made from the greater curvature of the stomach in 95 patients, from the colon in 4, and from the small intestine in 3 patients. The abdominocervical approach was employed in 86 patients and with additional right-side thoracotomy in 16 patients. The gastric graft was formed using a laser scalpel and suture instruments. Postoperative mortality was 4.9% (i.e., 5 deaths). A number of surgical approaches through the abdomen are suggested, permitting visual exposure of the esophagus up to the aortic arch.