[Comparative effectiveness of various methods of surgical, combined and comprehensive treatment of patients with colonic cancer]. / Sravnitel'naia éffektivnost' razlichnykh metodov khirurgicheskogo, kombinirovannogo i kompleksnogo lecheniia bol'nykh rakom priamoi kishki.

The results of radical treatment of cancer recti using surgical and combined methods, which had envisaged application of preoperative irradiation, systemic chemotherapy with the add of fluorouracil and calcium folinate, intraarterial polychemotherapy with the help of fluorouracil, adriablastinum on background of verapamil, endolymphatic polychemotherapy with local hyperthermy of ultra-high frequency, intraoperative intraperitoneal polychemotherapy and autoimmunotherapy with application of antitumoral vaccine. After application of autoimmunotherapy, endolymphatic polychemotherapy, preoperative intensive gamma-therapy in combined treatment of patients with cancer recti II-III stages the indexes of five-year survival had improved.

[Primary multiple malignant tumors of the stomach and colon]. / Pervichno-mnozhestvennye zlokachestvennye opukholi zheludka i tolstoi kishki.

Experience of diagnosis and treatment of primarily-multiple gastric cancer, combined with malignant colonic tumors in 27 patients was summarized. One-stage combined radical treatment of the patients is the most effective one.

[The use of neoadjuvant selective intra-arterial polychemotherapy and its modifier verapamil in the combined treatment of colorectal cancer]. / Primenenie neoad'iuvantnoi selektivnoi vnutriarterial'noi polikhimioterapii i ee modifikatora verapamila v kombinirovannom lechenii kolorektal'nogo raka.

After combined treatment of 74 patients for colorectal cancer using preoperative neoadjuvant intraarterial selective polychemotherapy (IAPCT) three-year survival index have constituted (77.0 +/- 5.2)%, the cancer recurrence have occurred in (10.8 +/- 2.8)%, distant metastases were revealed in (17.5 +/- 4.2)%. Using verapamil as a IAPCT modifier in 54 patient three-year survival have increased by 11.8%, the frequency of distant metastases occurrence have reduced by 10.1%.

[Immediate and early results of combined treatment of colonic cancer using neoadjuvant selective intra-arterial polychemotherapy]. / Neposredstvennye i blizhaishie rezul'taty kombinirovannogo lecheniia raka obodochnoi kishki s primeneniem neoad"iuvantnoi selektivnoi vnutriarterial'noipolikhimioterapii.

The combined treatment of 53 patients with colonic cancer, using neoadjuvant intraarterial polychemotherapy (IAPCT), was conducted. The trustworthy lowering of the catheterized artery thrombosis occurrence rate, the tumor recurrence-by 7%, distant metastases-by 13.9%, two-year survival increase-by 15.5% was promoted by verapamil application as a IAPCT modifier.

Neoadjuvant intra-arterial polychemotherapy of locally advanced rectal cancer.

In order to evaluate the usefulness of pre-operative intra-arterial selective polychemotherapy (PIASP), we carried out a retrospective study of 107 patients (65 males, 42 females) with locally advanced rectal cancer (LARC) (pT3-4 N0-1 M0), who were treated between 1988 and 1991. Fifty-two patients (MG) underwent PIASP (Adriablastin 60-90 mg, fluorouracil 3-4 g) with subsequent radical surgery. Fifty-five patients (R0) received surgery alone. Angiographic findings after PIASP showed approximately 50-70% reduction in the vascular network in the tumour and surrounding tissues. A post-operative morphological study confirmed the considerable tumour dystrophy, necrobiosis and necrosis. Comparative statistical analysis in two patient groups showed that overall 5-year survival was significantly better in MG (64.76 +/- 1.85%) than in R0 (38.23 +/- 1.74%; chi 2 = 9.1; P < 0.05). A similar situation was observed in all research subgroups: T3 N0 M0 (MG, 85.71 +/- 3.29% and R0, 65.63 +/- 2.85%; chi 2 = 2.61; P < 0.05); T3 N1 M0 (MG, 47.06 +/- 4.68% and R0, 0.0, chi 2 = 14.37; P < 0.05); T4 N0-1 M0 (MG, 8.57 +/- 4.29% and R0, 0.0, chi 2 = 2.09; P < 0.05). Significantly better 5-year survival rates were seen in MG than in R0 with the medial cellular differentiation in carcinoma (77.42 +/- 2.98% and 36.23 +/- 2.41%, chi 2 = 9.81; P < 0.05, respectively), the most frequent histological tumour structures. There is a trend for improved 5-year survival in low differentiation carcinoma (MG, 47.62 + 5.29% and R0, 35.29 +/- 4.37%, chi 2 = 0.28, P > 0.05). The MG group showed eight local relapses of disease (15.38%), while the R0 group showed 21 (38.1%), the MG group demonstrated 12 distant metastasis (23.07%) while R0 demonstrated 19 (34.54%), the median relapse-free survival was 101.6 weeks in MG and 74.45 weeks in R0. The use of the combined PIASP with subsequent surgery treatment of patients with LARC allows a better prognosis than does surgery alone.

[The immediate results of the combined treatment of rectal cancer using intra-arterial selective polychemotherapy]. / Neposredstvennye rezul'taty kombinirovannogo lecheniia raka priamoi kishki s ispol'zovaniem vnutriarterial'noi selektivnoi polikhimioterapii.

The treatment experience of 127 patients with the locally spread rectal cancer was summarized. The combined with preoperative intraarterial chemotherapy course application causes significant injurious effect on the tumor (more than 3 times decrease of the viable tumor tissue part by volume in rectal adenocarcinoma, the appearance of subcapsular necrosis regions in metastatically injured regional lymphatic nodes in 32.2% of observations) and is characterized by low common toxicity.

[Endolymphatic polychemotherapy with local ultra high frequency hyperthermia for the combined treatment of invasive rectal cancer]. / Endolimfaticheskaia polikhimioterapiia s lokalnoi SVCh-gipertermiei v komplekse lecheniia rasprostranennykh form raka priamoi kishki.

The results of treatment of diffuse forms of rectal cancer with the use of a preoperative course of endolymphatic polychemotherapy (fluorouracil and platidiam) and local SHF-hyperthermia are presented. The most pronounced effect of treatment was noted in patients with metastases to the regional lymph nodes. The method suggested is effective in treatment of all the types of adenocarcinoma. All the patients survived for 2 years.

[Multiple primary malignant neoplasms of the large intestine]. / Pervichno-mnozhestvennye zlokachestvennye novoobrazovaniia tolstoi kishki.

Of the 3182 patients with malignant tumors of the large intestine, in 140 (4.4%), the primary multiple malignant neoplasms were revealed: in 59 (42.1%) of them--the synchronous, in 81 (57.9%)--the metachronous ones. Surgical treatment was performed in 137 (97.9%) patients, including the radical treatment--115 (83.9%). The postoperative lethality was 7.3%. 75.3% of the patients are alive for five years, 21.3%--for ten years.

[Combined surgical interventions in disseminated forms of rectal cancer]. / Kombinirovannye operativnye vmeshatel'stva pri rasprostranennykh formakh raka priamoi kishki.

Combined operative interventions were performed in 375 (14.6%) out of the 2564 patients operated on radically. In 10 patients, evisceration of the pelvic organs was performed. At the preoperative period, 60% of the patients received the intensive irradiation. Among the postoperative complications, the purulent-inflammatory, urologic and cardiovascular ones were the most frequent. The five-year survival after the combined operations was 45.4%, and with preoperative irradiation--60.4%. The recurrences were noted in 23.9 and 5.6% of the patients, respectively.

[Conservative surgery in the initial forms of cancer, malignant adenomas and villous tumors of the rectum]. / Ekonomnye operatsii pri nachal'nykh formakh raka, malignizirovannykh adenomakh i vorsinchatykh opukholiakh priamoi kishki.

The results of sparing transanal operations performed in 519 patients with the early forms of cancer, malignant adenomas and villous tumors of the rectum are presented. On the basis of studying the five- and ten-year survival, it is shown that local sparing operations provide stable and prolonged cure of the patients. The dependence between recurrence of adenomas, peculiarities of their macro- and microscopic structure has been traced.

[Peculiarities of diagnosis and treatment of initial forms of rectal cancer]. / Osobennosti diagnostiki i lecheniia nachal'nykh form raka priamoi kishki.

Of 3185 patients, the stage I rectal cancer was diagnosed in 220 (6.9%), stage II--in 156 (4.9%), stage III--in 1948 (61.2%), stage IV--in 861 (27.0%). The causes of late diagnosis were the following: asymptomatic course of the disease (74.2%), delayed taking the medical advice, incomplete (without rectal inspection) examination of the patients. The sphincter-preserving operations were performed in 86.3% of the patients. The 5-year survival of patients in stage I was (97.6 +/- 2.5)%, in stage II--(75.7 +/- 4.1)%.

[Nonspecific active stimulation of the immune system in the combined treatment of rectal cancer]. / Nespetsificheskaia aktivnaia stimuliatsiia immunnoi sistemy v kompleksnom lechenii raka priamoi kishki.

Results of investigations on the efficacy of splenin as an immunomodulator in the complex treatment of 70 patients with cancer of the rectum revealed its favourable effect on the T- and B-systems of immunity. It was found that immunotherapy effected favourably the immunological properties of the body and this was also supported by clinical data. This makes it possible to recommend splenin as in immunomodulator in the complex treatment of patients with cancer of the rectum.

[Future trends in increasing the efficacy of surgical and combination treatment of cancer of the rectum]. / Perspektivnye napravleniia povysheniia éffektivnosti khirurgicheskogoi kombinirovannogo lecheniia raka priamoi kishki.

The analysis of the results of surgical and combined treatment of 2785 patients with rectal cancer was carried out. Radical operative interventions were performed in 2226 (80%) patients. The postoperative lethality was 8%. Before the operation, the intensive irradiation was performed in 959 patients. The five-year survival of patients in stage I cancer was 97.6%, in stage IV--22.7%, the duration of life--117.8 and 37.1 mos., respectively. The use of preoperative irradiation reduces the incidence of cancer recurrences 1.5-2 fold.

[Means of improving the efficacy of the treatment of cancer of the rectum (experience in the surgical and combination treatment of 3185 patients)]. / Puti povysheniia éffektivnosti lecheniia raka priamoi kishki (opyt khirurgicheskogo i kombinirovannogo lecheniia 3185 bol'nykh).

The analysis of the results of surgical and combined treatment of 3185 patients with rectal cancer was carried out. Of these patients, 88.2% were operated on at the stages III and IV of the disease. Radical operative interventions were performed in 2564 (80.5%) patients. The postoperative lethality was 8.1%. Sphincter-preserving operations comprised 53%. The combined treatment with the use of preoperative intensive irradiation was performed in 1174 patients and resulted in 2-fold decrease in the incidence of recurrences. The five-year survival of patients after surgical treatment was 60.1%, after combined--75.4%.

[Clinico-morphologic aspects of the combined treatment of locally disseminated cancer of the rectum]. / Kliniko-morfologicheskie aspekty kombinirovannoto lecheniia mestno-rasprostranennogo raka priamoi kishki.

In 1174 patients, the pathomorphosis of rectal cancer conditioned by the combined treatment with preoperative irradiation was studied. Preoperative radiotherapy caused considerable disorders in the morphologic structure of a tumour. The survival of patients and incidence of tumour recurrences, depending on the pronouncement of morphologic changes after radiotherapy, were studied. The use of radiation modifiers in combination with radiotherapy facilitated more pronounced damage to the tumour.

[Pelvic exenteration as a means of improving the resectability of advanced cancer of the rectum]. / Evistseratsiia taza kak sposob povyshehiia rezektabel'nosti raka priamoi kishki.

The paper discusses the results of treatment of 10 male patients who underwent pelvic evisceration for advanced rectal cancer. Surgical technique is described. In 9 cases, an isolated ileocecal "urinary bladder" was formed; in 1 patient urine was passed into a small intestine segment. The involvement of the urinary bladder and/or the prostate were observed in 6 patients. One patient died shortly after surgery, three--within the first 12 months and another 2--during the second year. Four cases have survived over 5 years, 3 of them surviving over 10 years.