[Intraabdominal chemotherapy of prevailing forms of colon cancer].

The efficacy of intraabdominal chemotherapy in patients with prevailing forms of colon cancer, such as peritoneal carcinomatosis, local disseminated and local recurrent colon cancer was estimated. The comparative analysis showed that the intraabdominal chemotherapy allowed to amend the remote results of the treatment in the cases with carcinomatosis, local disseminated colon cancer and local recurrence.

[Combined management of colon cancer local recurrences with using intraabdominal chemotherapy].

The efficacy of intraabdominal chemotherapy in management of local recurrences of colon cancer was studied. Intraabdominal intraoperative and early postoperative chemotherapy made it possible to prolong of the recurrenceless term and to improve the life quality of the patients with local recurrences of colon cancer. There was observed a tendency to increase the five-year survival.

[The noncomplicated colon cancer treatment].

531 patients with non-complicated and non-metastatic colon cancer were operated on during 1995-2008 years. Surgery was radical in all cases. Various types of surgical treatment of the colon cancer, postoperative complications and lethality were analyzed. Open methods reported a 1,6% complications rate and lethality rate was 0,4%. Whereas, laparoscopically operated patients showed the complication rate of 3,6% and lethality was 1,2%. Overall 5-year survival was 91,7% for T1-3N0M0; 75,6% for T4N0M0 and 55,3% for T1-4N1-2M0 stages.

[The extension of a physiologic hypoganglionic area in adults and its significance in the diagnosis of Hirschprung's disease].

The purpose of the investigation was to study the extension of a physiologic hypoganglionic area in the distal rectum in adults and to define its implication in diagnosing Hirschprung's disease. Thirty-five cadaver distal rectal portions were examined. The extension of a physiologic hypoganglionic area in adults ranged from 7.5 to 50.0 mm (24.4+/-10.9 mm). The authors could determine any element of the intramural nervous system to a level of 40 mm where there was a compact ganglionic deposit with nerve commissures, which is typical of the normal structure of an intermuscular nerve plexus. The extension of a physiologic hypoganglionic area was as large as 40.0 mm in 4 of the 35 cases and 50.0 mm in 1 case. By taking into account these data, it is expedient to use the modified O. Swenson transanal biopsy.

[Modification of Svenson's biopsy of rectal wall in diagnosis of malformations of intramural nervous system in adults].

Thirty-five autopsied specimens of rectum's distal part and anal canal part were studied. It was revealed that length of physiological hypogangliosis zone ranged from 7.5 to 50.0 mm (mean 24.4+/-10.9 mm). With regard to this wide range the modification of transanal Svenson's biopsy of rectal wall was proposed for diagnosis of malformations of intramural nervous system of the colon. The method was used in 21 patients with megacolon. The results demonstrate accuracy and safety of this diagnostic method.

[Systemic polychemotherapy in combined treatment of colon cancer]. / Sistemnaia polikhimioterapiia v kombinirovannom lechenii raka obodochnoi kishki.

Seven hundreds and fifty three patients with colon cancer were operated in the Unit of Colon Surgery of the State Scientific Centre of Coloproctology within the period from 1998 to 2003. 352 (46.7%) of them were subjected to systemic chemotherapy. The patients subjected to the surgical and antitumor drug therapy were divided into 3 groups according to the main disease stage: 103 (29.3%) patients with the disease stage T4N0M0 (including those with the tumor local spread), 116 (32.9%) patients with the disease stage T(3-4)N+M0 and 133 (37.8%) patients with the disease stage T(3-4)NxM1. In the patients with the colon serous membrane diffusion and locally spread tumors (total of 103 patients) 3- and 5-year survival was stated in 81.0 +/- 2.8% and 76.5 +/- 3.7% respectively. The control group included 85 patients subjected to the surgical treatment alone. In the latter group 5-year survival was recorded in 68.0 +/- 2.9% of the patients. In the group of the patients with affection of the regional lymph nodes subjected to antitumor drug therapy 3- and 5-year survival was recorded in 64.1 +/- 3.5% and 57.5 +/- 4.2% respectively. In 52 patients not subjected to the systemic chemotherapy the analogous index was equal to 44.5 +/- 3.4%. The systemic chemotherapy was applied to 111 (78.2%) patients with metastases to the liver. In 50 of them cytoreductive operations were performed and in 61 patients palliative resection of the colon was carried out. The average period without clinical manifestations of the disease in the patients subjected to the colon palliative resection and systemic chemotherapy was equal to 8.5 +/- 3.5 months. In the patients with metastases to the liver subjected to the cytoreductive operations the average lifespan after the operations amounted to 24.5 months. The average lifespan of the patients with canceromatosis subjected to the systemic chemotherapy and cytoreductive operations amounted to 13.5 months. When the chemotherapy in such patients was effective the average lifespan was 16 months, while in case of the therapy failure it was 8.5 months.

[Potentialities of modern clinical X-ray radiology in the differential diagnosis of tumor and other obstructive diseases of the large bowel]. / Vozmozhnosti sovremennoi klinicheskoi rentgenologii v differentsial'noi diagnostike opukholevykh i drugikh obstruktivnykh zabolevanii tolstoi kishki.

The misdiagnosis rate in defining the cause of obstructive colonic disease is 8.2-24.4%. This is consistent with the fact that every 5 patients with colonic obstruction present difficulties in establishing the nature of a pathological process. The paper provides the results of analysis of clinical and X-ray symptoms in 350 patients with difficult differentially diagnosed cases of narrowing of the rectum and colon. Based on the analysis, the authors identified the basically important X-ray signs that might differentiate tumor stenoses from other obstructive diseases. They also defined the specific X-ray signs of such diseases as infiltrative cancer; extraintestinal cancer involved in the large bowel; inflammatory strictures in ulcerative colitis, diverticulosis, actinomycosis, tuberculosis, intestinal endometriosis, invagination, and other obstructive diseases. The developed differentiated diagnostic criteria could enhance the overall accuracy of X-ray study in this difficult group of patients from 72.7-80% to 93%.

[Cytoreductive surgery with intraperitoneal chemotherapy in patients with colon cancer and peritoneal carcinomatosis]. / Rezul'taty vypolneniia tsitoreduktivnykh operatsii s primeneniem vnutribriushinnoi khimioterapii u bol'nykh rakom obodochnoi kishki s kantseromatozom briushiny.

The efficacy of cytoreductive approach for colon cancer with carcinomatosis was assessed. 34 patients (the main group) underwent colon resections, peritonectomy, omentectomy and intraperitoneal chemotherapy (mitomycin and 5-fluorouracil). 22 patients (control group) underwent palliative colon resections only. The spread of peritoneal dissemination was assessed in all patients, basing on Peritoneal Cancer Index (PCI). It was found, that the rate of postoperative morbidity is higher in the main group, but it was not accompanied by enhanced postoperative mortality. It was also detected, that cytoreductive approach permits to prolong the survival (17.0 +/- 3.5 months in main group vs. 7.5 +/- 2.1 months in controls). The main prognostic factor in these patients was the PCI. The most favorable prognosis is identified if PCI < 5 (few discrete implants are present); the survival in this group was 23.0 +/- 4.5 months and disease-free interval was 14.0 +/- 2.5 months. When PCI was higher then 5, the survival was 14.5 +/- 2.5 months and disease-free interval was 7.0 +/- 1.3 months.

[Functional activity of ABC transporters (markers of multidrug resistance) in human colon adenocarcinoma and normal colonic mucosa]. / Funktsional'naia aktivnost' ABC-transporterov (markerov mnozhestvennoi lekarstvennoi rezistentnosti) v adenokartsinomakh i normal'noi slizistoi tolstoi kishki cheloveka.

Functional activity of multidrug resistance (MDR) markers (total activity of ABC-transporters, P-glycoprotein (Pgp) and multidrug resistance-associated protein (MRP) activities) in human colon adenocarcinoma and normal mucosa was examined. Functional activity of ABC-transporters was revealed in all colon tumors and in 70% of normal mucosa samples investigated. Expression of Pgp and MRP functional activity was determined in about 50% and 70% of colon tumors respectively. Pgp+MRP+ phenotype was determined in 36% of normal mucosa and adenocarcinoma samples. Expression of Pgp+MRP- phenotype was practically the same in normal mucosa and tumors (in 10 and 18% of samples respectively). Pgp-MRP+ phenotype was revealed two times more often in tumors than in mucosa--in 36 and 18% respectively. On the contrary, Pgp-MRP- phenotype was detected more rarely in tumors than in mucosa (in 10 and 36% of samples respectively). Transporters different from Pgp and MRP were also determined in some tumors and normal mucosa. At the patients with expression of Pgp function in normal mucosa the activity of the transporter was revealed in 25% of tumor samples only. On the contrary, at the patients with expression of MRP function in normal mucosa the activity of the transporter was revealed in 70% of tumor samples. At the patients with no expression of Pgp or MRP activity in normal mucosa the function of the transporters in tumors was determined in 60% and 70% of samples respectively. It is concluded that functional activity of various ABC-transporters (Pgp, MRP and other different from Pgp and MRP) is expressed in human colon adenocarcinoma; expression of ABC-transporters functional activity in normal mucosa does not predict MDR phenotype of the tumor.

[A method of preparing the large intestine for surgery by using the peroral administration of a polyethylene oxide solution]. / Metod podgotovki tolstoi kishki k operatsii pomoshchi peroral'nogo vvedeniia rastvora poliétilenoksidov.

A new method for preparing the large intestine for operation is suggested, it is based on oral administration of a solution of polyethylene oxides with chloramphenicol. The preparation possesses a marked hydrophilic activity, which causes inhibition of absorption processes in the lumen of the intestinal tube. This leads to accumulation of the intestinal contents and their quicker passage. Polyethylene oxides also ensure accumulation of antibiotics in the tissues of the intestinal wall. The suggested method was used to prepare the intestine for operation in 93 patients. Comparative evaluation proved its advantages according to the main clinico-laboratory criteria: the method is technically simple, reduces the period of preparation of the intestine, has no negative effect on the homeostasis values, ensures adequate preparation of the large intestine with decrease of the level of its microbial contamination. With the use of the method the number of postoperative purulent complications in interventions on the large intestine reduced.

[Immediate results of combined treatment of cancer of the colon using intensive methods of preoperative radiotherapy]. / Neposredstvennye rezul'taty kombinirovannogo lecheniia raka obodochnoikishki s ispol'zovaniem intensivnykh metodik predoperatsionnoi luchevoi terapii.

Combined treatment with the use of intensive methods of preoperative radiotherapy was carried out in 41 patients with malignant tumors of the colon. Study of the specific features of the accomplished surgical interventions and the postoperative management of patients showed that short courses of irradiation on a betatron with energy of 25 MeV, given in 5 daily exposures to a total basic dose of 20 Gy or a single exposure to a basic dose of 7.5 Gy had no unfavourable effect on the performance of the operation and the patients' condition in the postoperative period. The immediate results of the operation were found to be good in all patients.

[Locally disseminated cancer of the sigmoid colon]. / Mestno-rasprostranennyi rak obodochnoi kishki.

The study discusses the experience of treatment of 207 patients with locally-advanced cancer of the sigmoid colon who made up 13.5% of the total number of cases of cancer of this site seen in the clinic in 1972-1990. Radical surgery was performed in 170 (82.1%) patients. Postoperative lethality rate was 5.8%, five-year survival rate--70.5 +/- 5.6%. The use of adjuvant preoperative radiotherapy assured a higher resection rate and had no adverse effect on immediate results.

[The diagnosis of perifocal inflammation in cancer of the colon]. / Diagnostika perifokal'nogo vospaleniia pri rake obodochnoi kishki.

The study discusses the experience gained with application of a complex of methods for early diagnosis of perifocal inflammation in 50 patients with cancer of the colon. Endoscopic, roentgenologic and radionuclide (using 67Ga citrate) methods were mainly employed. Perifocal inflammation was established in 38 (76%) patients. The diagnosis was further confirmed by morphologic examination of resected material. Application of the methods assured early diagnosis of asymptomatic perifocal inflammation associated with tumor.

[Radiation pathomorphosis in single and intensive-concentrated preoperative irradiation of colon cancer]. / Luchevoi patomorfoz v usloviiakh odnokratnogo i intensivno-kontsentrirovannogo preoperatsionnogo oblucheniia pri rake obodochnoi kishki.

Single (7.5 Gy) or intensive-concentrated (20 Gy at 5 daily fractions of 4 Gy each) preoperative irradiation was given to 42 colon cancer patients. Operation was performed not later than 24 h after single irradiation and 1-3 days after intensive-concentrated irradiation. Radiation pathomorphosis was studied on histological and electro-microscopic examination of biopsy specimens. Dystrophic changes of tumor cells were noted following the use of both methods, though more noticeable ones were observed after intensive-concentrated irradiation. Obstruction of the microcirculatory bed of a tumor appeared to be a characteristic sign of a tumor stroma response both in single and fractionated irradiation. It was assumed that the latter together with direct radiation damage of tumor cells could be very important to the prevention of implantation recurrences and metastases.

[Cancer of the right half of the colon: clinical aspects, diagnosis and immediate results of surgical treatment]. / Rak pravoi poloviny tolstoi kishki: klinika, diagnostika i blizhaishie rezul'taty khirurgicheskogo lecheniia.

Carcinoma of the right half of the colon (CRHC) is diagnosed in 21-35% of patients with colorectal carcinomas. The Research Institute of Proctology of the RSFSR Ministry of Health has an experience with treatment of 338 patients with CRHC. Most of them (84.9%) were admitted to the clinic with advanced forms of the disease because of poor clinical manifestations at early stages of the disease and resulting in late consultations with the doctor. Surgical treatment was performed in 332 patients. The operation of choice for locally removable tumors of the right half of the colon still remains right-side hemicolectomy. For locally spread CRHC combined operations are thought to be expedient. Immediate results of the surgical treatment of CRHC by the correct curative methods are perfectly favorable, the amount of postoperative complications was 14.5%, lethality--6.6%.

[Clinical aspects, diagnosis and treatment of hypoganglionosis of the colon in adults]. / Klinika, diagnostika i lechenie gipoganglioza tolstoi kishki u vzroslykh.

Surgical treatment of chronic colonic stasis is still a complicated and difficult for solution problem. The undertaken study characterizes one of the causes of chronic constipation in adults--the hypoganglionic variant of Hirschsprung's disease whose clinical course is marked by a prolonged period of compensation while the complex diagnosis is extremely difficult. The severe disorders of the motor-evacuation function of the large intestine make surgery necessary; operation leads to recovery of 96% of patients.