[Effect of intraoperative intrapelvic chemotherapy with hyperthermia on the incidence of rectal cancer recurrences].

Often due to a severe somatic condition of the patient, the presence of perifocal inflammation, anemia, age, it is not possible to perform neoadjuvant chemoradiotherapy for rectal cancer. To improve cancer treatment outcomes in these patients intraoperative intrapelvic chemotherapy with hyperthermia is used at the Centre. In the present study there included 120 patients with rectal cancer at stage T3-4N0-2M0, while 60 patients underwent intraoperative intrapelvic chemotherapy with hyperthermia (cisplatin at a dose of 150 mg, the time of the procedure--60 minutes, the temperature of the perfusate--44-45 degrees C). Conducting of intraoperative intrapelvic chemotherapy with hyperthermia allowed reducing the frequency of local recurrence in 2 times from 16.7% to 8.3% and increasing a 3-year overall survival by 10%--from 63% to 73%, which shows intraoperative intrapelvic chemotherapy with hyperthermia as an effective method in the prevention of local recurrences.

[Results of adjuvant chemotherapy (XELOX) of advanced colorectal cancer].

While the most frequent, surgery for colorectal cancer is avoided in patients with metastases to the regional lymph nodes (stage III) or distant ones (stage IV). Hence, it is being increasingly substituted with neoadjuvant treatment. Our investigation is concerned with prospective evaluation of the efficacy and toxicity profile of capecitabine (XELODA) in combination with oxaliplatin (XELOX) and adjuvant Mayo treatment (stage IIb-III). Patients had undergone radical surgery (somatic status < or = 2-ECOG). The prospective group (166) received 8 courses of adjuvant polychemotherapy (XELOX); the retrospective (2001-2005) one (152)--6 (Mayo). The groups matched one another as far as number, gender, age and primary tumor localization are concerned. Regional lymph node involvement in group 1 was 64.5%; group 2--59.8%. Lympho-vascular invasion by tumor was typical of group 1; gastrointestinal toxicity - 9.2% (Mayo) vs. 7.2% in group 1. Hematological complications were 5.4% (XELOX) and 5.3% (Mayo); neutropenia-- 5.0% (Mayo) and 3.0% (XELOX); polyneutropenia-- 3.6% (XELOX); capecitabine-related Papillon-Lefevre syndrome-- 8.4%. Three-year relapse-free survival was 53.0% (XELOX) and 47.5 % (Mayo). After adjuvant treatment, toxicity profile with XELOX was lower than that after Mayo, with the survival tending to improve.

[Proctectomy with external sphincter elements' preservation in surgery of low-ampullary rectal cancer].

Operational technique for the rectum tumors, localized at the level of dentate line, developed in the State center of coloproctology, allows preservation of external anal sphincter elements and thus, partial preservation of defecation control. Technique is described and proved, preliminary treatment results of 42 patients are analysed. The operation is oncologically effective (local recurrence rate 4,8%). Preservation of external sphincter elements has a high functional value in complex with "neorectum" and "neosphincter". A majority of operated patients can keep the stool, 80% of able-bodied patients continued their professional activities.

[Transanal resection of rectum with mesorectumectomy]. / Transanal'naia rezektsiia priamoi kishki s mezorektuméktomiei.

The possibility of sparing resection of the rectum in cancer is considered. The results of treatment in 27 patients with cancer of rectal lower ampulla (T1-10 patients, T2-12, T3-5) by transanal resection of distal part of the rectum are presented. The technique of operation, which provides the removal of all layers of rectal wall with surrounded tissues, e.g.--mesorectumectomy is described. The indications for this operation are formulated.

[Surgical treatment of paracolostomu hernias and prolapses]. / Khirurgicheskoe lechenie parakolostomicheskikh gryzh i prolapsov.

The results of surgical treatment for paracolostomy hernias and prolapses in 71 patients show insufficient effectiveness of this method for surgical correction of such paracolostomy complications as paracolostomy hernias and prolapses: the rate of their relapses reaches 50%. The authors have developed a new effective method for surgical treatment of complicated colostomy: intraabdominal reconstruction of colostomy with retroperitoneal pull and laying of prestomal segment of the sygmoid colon.

[Up-to-date approach to the treatment of rectal cancer]. / Sovremennyi podkhod k lecheniiu raka priamoi kishki.

During the last 15 years 2404 radical operations of various types were carried out for cancer of the rectum. The rate of postoperative complications made up 28.3% and mortality--2.9%. The tendency to increase of locally spread forms of cancer up to 96.2% with metastases to regional lymph nodes up to--52.3% was detected. The use of adequate chemotherapy, updated suturing devices and new variants of radical operations, combined and extended ones in particular havw much contributed to carrying out radical interventions with complete restoration of bowel continuity in 70% of patients. 5 year survival rate of patients after sphincter saving plastics and restorative procedures made up 60.2-65.3%, after extirpations with colostomy--54.2%. Promising results of improvement the indices of 5 year survival were obtained when preoperative irradiation in regime of multifractioning SOD 45-55 Gy was used together with administration of 5-fluorouracil (5-7.5 g).

[Aortoiliopelvic lymphadenectomy in surgical treatment of rectal cancer]. / Aortopodvzdoshno-tazovaia limfadenéktomiia v khirurgii raka priamoi kishki.

The results of aortoiliopelvic lymphadenectomy in macroscopic changes in lymphatic nodes being revealed intraoperatively in 73 patients with locally spread rectal cancer, are represented. Morphological examination of the removed tissues made it possible to reveal metastatic involvement of paraaortal and iliac lymphatic nodes in 57.3% of patients. In 36.9% of cases combined radical operations were performed. There were no lethal outcomes. Postoperative complications were detected in 37.9% of cases, among them atony of the urine bladder in 30.1% and inflammatory processes in pelvic cavity--in 8.2%. And in 9 men with normal sexual potency before the operation it resulted in impotency after surgery. 5-year survival made up 27.4% including cases with metastatic involvement of lymphatic nodes--19.3%, and without it--35.7%.

[Deep cystic colitis]. / Glubokii kistoznyi kolit.

From 1970 to 1990 the authors treated 4 patients with deep colitis (DCC). There were 2 males and 2 females aged from 19 to 48 years (average age 28.7 years). A local form of DCC with involvement of the rectum (infero- and preampullar part) was recognized in all cases. The only method for DCC treatment is an operative intervention whose volume is determined by the form of the disease and the results of emergency intraoperative morphological study of the affected parts of the large intestine. All 4 patients underwent organ- and sphincter-preserving operation-transanal resection of the rectum. The postoperative period was uneventful. None of the patients had a recurrence of the disease in follow-up periods of 3 to 7 years.

[Transanal resection of the rectum]. / Transanalnaia rezektsiia priamoi kishki.

A new method of an organ-preserving operation for the management of the initial forms of rectal carcinoma and benign tumors of the distal parts of the rectum has been elaborated and successfully used at the Scientific Research Institute of Proctology. It consists in transanal resection of the rectum with creation of a recto-anal anastomosis. Transanal resection of the rectum was performed on 34 patients. Sixteen patients had giant or recurrent villous tumours of the distal part of the rectum 6 of which had undergone malignant degeneration. In a group of 34 patients 14 had the initial forms of carcinoma of the inferoampular part of the rectum, 2 had a deep cystic colitis, and the other 2 patients were operated on for neurilemoma and teratoma. Recurrences were not revealed in patients with benign diseases in follow-up periods of 2 to 8 years. Recurrent carcinoma of the rectum in the region of the anastomosis was found in 2 patients in follow-up periods of 25 to 37 months. They underwent extirpation of the rectum. The new method enables stable recovery to be achieved and saves the patients from crippling abdomino-anal resections and extirpation of the rectum in the management of benign new growths and initial forms of carcinoma of the distal parts of this organ.

[Choice of a rational method and optimization of terminal colostomy]. / Vybor ratsional'nogo metoda i optimizatsiia sposobov formirovaniia kontsevoi kolostomy.

The author analyses the results of various methods of terminal colostomy, among which are the "column" technique, with stitching of the edges of the peritoneum to the skin and leaving the excess of the brought out intestine in 258 patients, the formation of a flat stoma by the ordinary method in 179 patients, and with retroperitoneal passing of the intestine in 752 patients in radical surgical treatment of rectal carcinoma and other diseases of the large intestine. The operations were conducted in the period from 1973 to 1987. The frequency of early paracolostomy complications (suppuration, retraction, etc.) in these groups of patients was, respectively, 31%, 22.9%, and 17.6%; that of late-term complications, 70.6%, 50.3%, and 20.3%. The article shows the results of study of the causes of these complications, which formed the basis for improving the methods and techniques of the operation the principal differences of which consisted in: (1) colostomy, except for the final formation of the opening at the level of the skin, was conducted before mobilization of the rectum; (2) retroperitoneal passing of the intestine was accomplished through the upper angle of a lyre-shaped incision of the pelvic peritoneum to the left of the sigmoid colon; (3) the use of a "closed" method of flat stoma formation by cutting the intestinal wall at the level of the skin down to the mucosa and attaching it to the skin by the musculoserous coat with interrupted catgut sutures, and only after that is the excessive mucosa cut off and the intestinal lumen opened.(ABSTRACT TRUNCATED AT 250 WORDS)

[Lymphatic system changes after the endolymphatic administration of an oil-based solution of dibunol]. / Izmeneniia limfaticheskoi sistemy pri éndolimfaticheskom vvedenii maslianogo rastvora dibunola.

Endolymphatic infusions of a 10 percent solution of dibunol in iodolipol or chromolymphotrast were given for prevention of lymphogenic dissemination of rectal cancer. Certain changes in X-ray pattern of lymphogenic metastases developed due to prolonged intravascular retention of the contrast agent. Under such conditions metastatic lesions took the form of collateral lymph flow development and enlargement and deformation of lymph nodes. The diagnostic value of lymphography appears to be still higher when several symptoms of metastatic involvement of the lymphatic system are in evidence.