[Experience of surgical treatment of abdominal and intraabdominal desmoid fibromas].

It is presented the treatment results of abdominal and intraabdominal desmoid fibromas. Group of abdominal localization included 19 patients. 15 of them had primary tumors, 4 - recurrent tumors after surgical treatment. Radical (R0) operations were performed in all cases. Tumor removal was associated with plastic of abdominal wall by synthetic implant in 17 patients. Wide excision of surrounding tissues and musculo-aponeurotic layer of anterior abdominal wall allows to achieve long-term disease-free period. There weren't recurrent symptoms in terms from 4 to 60 months of observation. The second group included 28 patients with intraabdominal desmoid fibromas. Operations were performed in 11 (35.2%) patients including 3 cases of reoperations. There were 14 operations. Radical (R0) volume was applied in 11 (78.6%) operations, cytoreductive (R2) volume - in 1 (7%) operation. Explorative laparotomy was used in 3 (21.4%) cases because of involvement of mesenteric vessels. Combined treatment was performed in 4 (14.3%) patients. 14 (50%) patients received conservative therapy because of unresectable tumor including chemo-, hormone- and radiotherapy. Operated patients were under observation in terms from 11 to 156 months, median was 63.2 months. Recurrence developed in 4 of 10 (40%) patients after R0-surgery. Cytoreductive (R1/R2) volume is admitted for intraabdominal desmoid fibromas. But even in case of unresectable process and explorative intervention stabilization and regression of tumor is possible by means of chemo-, hormone- and radiotherapy in different combination. It allows to preserve a good life quality.

[Prevention and treatment of postoperative pain syndrome in extensive thoracoabdominal oncological surgery].

A procedure has been developed and tested to prevent and treat postoperative pain syndrome during extensive thoracoabdominal surgery for esophageal cancer. The procedure is based on the preventive (12 hours before anesthesia and surgery) application of Durogesic (fentanyl transdermal therapeutic system (TTS)) at an opioid release rate of 50 microg/h for 72 hours. By the end of surgery and anesthesia when intravenous injection of fentanyl is stopped, analgesia continues to be maintdined due to its therapeutic dose coming from TTS. This prevents the development of acute opioid tolerance, hyperalgesia, and destabilization state in the early postanesthetic period and creates the basis for continuous multimodal postoperative analgesia in combination with nonopioid components (lornoxicam, perfalgan) and with none or minimal need for the injectable opioid. This allows an operated patient to have a comfort and stable state. A further investigation on the comparative assessment of the developed procedure with other variants of perioperative systemic and combined anesthesia-analgesia is to be conducted.

[Prognostic factors for the definition of the extent of lymphadenectomy by the early gastric cancer].

The predictive role of submucosal invasion and metastatic spread to local lymph nodes at early gastric cancer was analyzed. Material from 32 patients was morphologically and immunohistochemically analyzed. The prognostic value of the depth of invasion, tenascin and positive MMP2 and MMP9 staining, proliferative activity and microvascular solidity in the lesion were studied. Watch lymph nodes were detected in 22 patients with the diagnosed early gastric cancer. The method is appropriate only by early cancer and in combination with other macro- and microscopic factors. Its' efficacy was 100% in the group of the early cancer (n=15), whereas in the group with the locally spread cancer the sensitivity, accuracy and specificity were 76, 71 and 100%, respectively. Though larger series are necessary to make definite conclusions about the predictive value of watch nodes in gastric cancer.

[Combined treatment of stomach neoplasms]. / Kombinirovannoe lechenie raka zheludka.

The results of treatment of 394 patients with gastric cancer were analysed to compare the effectiveness of surgical and two variants of combined treatment (preoperative irradiation with intensive-concentrated IKK method and dynamic DFD dose-fractioning). The advantages of combined treatment over surgical treatment are demonstrated. The 3-year survival in the combined treatment is 70.2%, in surgical treatment 34.5 +/- 6.2%. The advantages of SDF preoperative irradiation over IKK irradiation are revealed, that is proved by the increase of the 3-year survival rate (76 vs. 56.7%), and decrease in the rate of recurrence from 50 to 27.3%. The addition of metronidazol leads to increase of anticancer effectiveness, that is proved with the examination of tumor pathomorphosis and the rates of survival.

[The potentials for the organ-preserving treatment of early stomach cancer]. / Vozmozhnosti organosokhraniaiushchego lecheniia rannego raka zheludka.

The oncological substantiation of endoscopic and economical surgical treatment of T1N0-1M0 gastric carcinoma in 46 patients was appraised. The results were studied with due regard for the peculiarities of early gastric carcinoma (EGC) revealed in 290 patients after standard surgical management. It was established that organ-preserving treatment of ECG is possible--5-years survival was 96.2%. Endoscopic removal can be considered radical only in T1P1 tumors without invasion of the lymphatic vessels of the wall and was of a multistage character in 86.2% of cases. Careful surveillance after its completion is necessary. Surgical treatment in indicated in repeated recurrences; they were encountered in 44.8% of cases. The causes of the recurrences were noncoincidence of the macroscopic and histological boundaries of the tumor (33.6%), multicentric growth (30.4%), and invasion of the submucosa. Metastases are encountered in the lymph nodes in 9.1% of cases in economical treatment. In T1N0-1M0P1-2 carcinoma, absence of multicentric growth, and III degree dysplasia in the surrounding mucosa (reflecting increased risk of multicentric growth) the volume of organ resection may be limited on condition that P1 lymphadenectomy is performed. The results of organ-preserving treatment are comparable with those of surgical treatment conducted in a standard volume.

[Combined treatment of cancer of the stomach using a specific immunotherapy]. / Combinirovannoe lechenie raka zheludka s ispol'zovaniem spetsificheskoimmunoterapii.

Autoinoculation is suggested as an adjuvant means to augment the effect of surgery in gastric cancer which may prevent the development of recurrences and metastases. Surgery alone is not a curative method and 5-year survival in gastric cancer stage III ranges from 9.2 to 28%. The data have been obtained on comparative survival in a control group and a group of inoculated patients. The greatest effect was achieved in patients with poorly differentiated adenocarcinoma. Further investigation of the two groups adjusted for the patients' age, kind of surgery and morphological structure of the tumor will help to work out precise criteria for inoculation.

[The role of computerized tomography in the diagnosis of regional metastases of cancer of the esophagus and the proximal part of the stomach]. / Rol' komp'iuternoi tomografii v diagnostike regionarnykh metastazov raka pishchevoda i priksimal'nogo otdela zheludka.

Computed tomography (CT) findings were compared with operative ones for 50 patients with esophageal and proximal gastric cancer. In diagnosis of metastases to the upper abdominal and retroperitoneal lymph nodes ST sensitivity reached 93.3%, specificity 85% and accuracy 90.3%. The best diagnostic results were obtained in detection of metastases to the nodes of the celiac trunk branch and paraaortal fat (94.2%). Lower CT resolution appeared in diagnosis of perigastric node metastatic involvement in the primary tumor location in the proximal stomach.

[Diagnosis and treatment of pseudotumors of the abdominal cavity and retroperitoneal space]. / Diagnostika i lechenie psevdoopukholei briushnoi polosti i zabriushinnogo prostranstva.

The diagnosis and treatment of pseudotumors of the abdominal cavity and retroperitoneal space are discussed on the basis of 23 cases. It is pointed out that intraoperative morphological study is necessary for making a precise diagnosis. The use of the MK-14 antimicrobial glue improves the results of management of pseudotumors due to the creation of a depo of the antiseptic chlorhexidine in the abdominal cavity with simultaneous air-tightness of the wounds and hemostasis.

[Barrett's esophagus and cancer of the cardial section of the stomach]. / Pishchevod Bérretta i rak kardial'nogo otdela zheludka.

Morphological characteristics of Barrett's oesophagus were specified in 17 patients with cancer located in the cardiac orifice of the stomach. It was found that Barrett's oesophagus patients comprise 6.7% of all the authors' observations with relevant cancer diagnosis. The oesophagus appeared different in mucosal pattern, cells of the coat, glands, the degree of glandular epithelial dysplasia. Barrett's oesophagus is suggested to play a role in the genesis of cardiac gastric cancer whose malignant potential is the highest when oesophageal glands are cardiac. Applicability of the findings in general and in particular in clinical practice for deciding on the level of oesophageal resection in patients with cardiac gastric cancer is discussed.

[Results of the combined treatment of cancer of the cardial region of the stomach (a cooperative, randomized study)]. / Rezul'taty kombinirovannogo lecheniia raka kardial'nogo otdela zheludka (kooperirovannoe, randomizirovannoe issledovanie).

Immediate and long-term results of treatment of cancer of the proximal part of the stomach were compared in two groups of patients: (1) surgery and (2) combined treatment (preoperative Co-60 teletherapy + radical surgery). The patients were randomly assigned to the treatment schedules. The study was cooperative. Study group 1 included 128 patients, group 2-106. Radiotherapy was accompanied by mild complications; it neither adversely affected the terms of surgery nor resulted in an increased postoperative complication rate. Combination treatment was followed by a significant increase in 3-year survival matched by a decrease in relapse rate as well as metastasis development at a later stage, as compared with surgery alone. Application of standard preoperative irradiation procedures (NSD-20 Gy) led to degree 1-2 radiation pathomorphosis of tumor. Further search for higher effectiveness of the radiation component in causing injury to tumor should be continued.