[Fast track recovery protocols for extended pelvic surgery]. / Protokoly uskorennogo vyzdorovleniya pri rasshirenno-kombinirovannykh operatsiyakh na organakh malogo taza.

OBJECTIVE: To compare the immediate results of extended pelvic surgery before and after introduction of standardized fast track surgery (FTS) protocol into routine clinical practice. MATERIAL AND METHODS: The study included 111 patients with pelvic tumors who underwent extended pelvic surgery. The control group included 59 patients whose perioperative management implied traditional approaches (2018-2019), the main group - 52 patients with FTS protocol (2020-2021). Age, BMI and ECOG status were similar. In the main group, females (90.4% vs. 74.6%; p=0.046), patients with recurrent (46.2% vs. 22.0%; p=0.009) and complicated tumors (26.9% vs. 11.9%; p=0.054) prevailed. Obstructive resection without anastomosis was less common in the main group (28.8% vs. 47.5%; p=0.068). RESULTS: Surgery time was higher (319±125 min vs. 236±79 min, p<0.001) in the main group, but blood loss (238±154 ml vs. 282±150 ml, p=0.029) and incidence of blood transfusions (23.1% vs. 42.4%, p=0.043) were lower. Moreover, complications (36.6% vs. 54.3%; p=0.086), mild complications (Clavien-Dindo class I-II) (11.6% vs. 28.8%; p=0.034) and local infectious complications (19.2% vs. 42.4%; p=0.009) were less common in the main group. Two patients died in the control group due to sepsis following colonic anastomosis and bladder suture failure, respectively. Postoperative hospital-stay was similar (14±9.1 days vs. 14.4±9 days; p=0.89). CONCLUSION: FTS protocol is possible and safe in patients with locally advanced and recurrent malignant pelvic tumors. This approach reduces blood loss, the number of blood transfusions and risk of postoperative infections.

[C-reactive protein as early predictor of anastomotic leakage after surgery for colorectal cancer. Systematic review and meta-analysis]. / S-reaktivnyi belok kak rannii marker nesostoyatel'nosti shvov tolstokishechnogo anastomoza posle rezektsii tolstoi kishki po povodu raka. Sistematicheskii obzor i metaanaliz.

OBJECTIVE: Systematic review and meta-analysis of data on C-reactive protein (CRP) as a predictor of anastomotic leakage (AL) after surgery for colorectal cancer. MATERIAL AND METHODS: Literature searching was performed in Medline, Elibrary, Scopus, Web of Science databases. Literature request consisted of keywords «CRP¼, «colorectal surgery¼, «anastomotic leakage¼ for the period 2008-2018. Meta-analysis included 2 manuscripts for the second postoperative day, 7 articles for the third postoperative day and 6 articles for the fourth postoperative day. ROC-analysis was made to determine optimal prognostic values. RESULTS: ROC-curve for the second postoperative day - AUC 0.758; optimal CRP value - 154 mg/l (sensitivity 70.1%, specificity 55.6%), 95% confidence interval 0.698-0.819. ROC-curve for the third postoperative day - AUC 0.715; optimal CRP value - 144.5 mg/l (sensitivity 79.1% specificity 60.3%), 95% confidence interval 0.68-0.75. ROC-curve for the fourth postoperative day - AUC 0.767; optimal CRP value - 122.91 mg/l (sensitivity 72.3% specificity 60%), 95% confidence interval 0.73-0.804. CONCLUSION: Increased CRP is an early predictor of AL after surgery for colorectal cancer. CRP level ≥144.5 mg/l on the third postoperative day can predict AL (sensitivity 79%, specificity 60%).

[Application of the standardized protocol for fast track recovery after lung cancer surgery]. / Rezul'taty primeneniia standartizovannogo protokola uskorennogo vyzdorovleniia posle onkologicheskikh operatsii na legkom.

OBJECTIVE: To assess standardized protocol for fast track recovery after lung cancer surgery. MATERIAL AND METHODS: There were 201 patients. Patients underwent VATS lung resection, VATS lobectomy and various open resections of lungs. Patients had either primary lung cancer or metastatic lung lesion with indications for surgical treatment. Management of patients was divided into 3 periods: preoperative, intraoperative and postoperative. The protocol of fast track recovery was developed considering literature data and own experience. Requirements of this protocol were applied in perioperative management. RESULTS: Application of the protocol was successful in all patients. Minimum number of complications (6%) and length of postoperative hospital-stay of 4 days were observed after VATS resection of lung. VATS lobectomy was followed by complication rate 25% and postoperative hospital-stay of 6 days. In the group of open resections these values were 29% and 7 days.

[Thoracoscopic pulmonary resection for metastatic lesion without pleural drainage: initial experience]. / Torakoskopicheskie rezektsii legkogo pri metastaticheskom porazhenii bez ustanovki plevral'nogo drenazha: nachal'nyi opyt.

AIM: To analyze the possibility of thoracoscopic pulmonary resection for metastatic lesion without pleural drainage. MATERIAL AND METHODS: There were 10 patients aged 53.8 years. Most of patients had solitary lung injury within 3 cm from the visceral pleura on the average. Surgical treatment was performed in standard fashion: hardware atypical pulmonary resection within healthy tissues. Pleural cavity was drained with 24 Fr tube. After that lung was inflated under visual control. Since wounds were closured residual air was evacuated by active aspiration and drainage tube was removed. Control chest X-ray was performed in 2 hours and 1 day after surgery. RESULTS: The technique was successful in all patients. Mean surgery time was 52 minutes. There was no blood loss in all patients. Pneumo- and/or hydrothorax were absent according to control chest X-ray in postoperative period. Mean length of postoperative hospital-stay was 3 days (median 2 days). There were no cases of repeated hospitalization.

Russian consensus on exo- and endocrine pancreatic insufficiency after surgical treatment.

The Russian consensus on exo- and endocrine pancreatic insufficiency after surgical treatment was prepared on the initiative of the Russian "Pancreatic Club" on the Delphi method. His goal was to clarify and consolidate the opinions of specialists on the most relevant issues of diagnosis and treatment of exo- and endocrine insufficiency after surgical interventions on the pancreas. An interdisciplinary approach is provided by the participation of leading gastroenterologists and surgeons.

[Accelerated postoperative rehabilitation in patients undergoing pancreatoduodenectomy]. / Uskorennaia posleoperatsionnaia reabilitatsiia patsientov, perenesshikh pankreatoduodenal'nuiu rezektsiiu.

AIM: To assess safety and clinical-economic effectiveness of complex postoperative rehabilitation after pancreatoduodenectomy. MATERIAL AND METHODS: 73 patients were included in the study. Main group consisted of 39 patients who underwent accelerated postoperative rehabilitation that was developed in our clinic. In the control group of 34 patients this protocol was not applied. The main components of rehabilitation were multicomponent analgesia, early enteral nutrition, physical rehabilitation by using of exercise therapy and physiotherapy. RESULTS: There were no significant differences in the incidence of postoperative complications and mortality (58.8% and 74.3%; p=0.213, 5.8% and 7.7%; p=0.678, respectively). Median of postoperative hospital-stay in the study group was 13 days (9; 16), in the control group - 15 days (9; 24). An estimated economic effect in the study group was 558 764, 84 rubles. CONCLUSION: Accelerated postoperative rehabilitation after pancreatoduodenectomy is safe and does not lead to increased number of postoperative complications and mortality. Developed protocol has clinical advantages and is cost-effective.

[A change in the expression of membrane-associated proteins and cytoplasmic actin isoforms in the progression of human colon tumors]. / Izmenenie ékspressii membranoassotsiirovannykh belkov i tsitoplazmaticheskikh izoform aktina pri progressirovanii opukholei tolstoi kishki cheloveka.

Tumor progression is a complex process that also involves the restructuring of the actin cytoskeleton and the weakening of intercellular adhesive contacts due to the tumor cells that pass through the epithelial-mesenchymal transition (EMT). AIM: Тo identify correlations between clinical features, risk of progression and/or recurrence of human colon adenocarcinomas (CAC), and EMT-related tumor markers. MATERIAL AND METHODS: Descending colon and sigmoid colon adenocarcinoma samples were examined immunohistochemically. Formalin-fixed paraffin-embedded tissue sections were incubated with antigen-specific antibodies, then secondary antibodies labeled with fluorochromes, and the fluorescence intensity of microscopy images was analyzed. RESULTS: The cells of a tumor compared to those of intact colon tissue showed a weak staining of E-cadherin in the cell-cell contact areas. The reduced membrane staining and nuclear localization of ß-catenin were detected in moderately (G2) and poorly (G3) differentiated tumors. There were substantially decreased ß-actin levels in almost all tumor samples and increased γ-actin ones, mainly in the samples belonging to stage IV disease. CONCLUSION: A correlation was found between stage, tumor differentiation grade, risk for relapse or progression of disease, and the impaired expression of different EMT markers: total or partial loss of E-cadherin expression, ß-catenin reorganization in cell-cell contacts, and a change in the ratio of cytoplasmic actin isoforms in the late stages of CAC development. We believe that these molecular markers may have a prognostic potential.

[Radical oncological stomach, liver and pancreatic surgery in patients over 80 years old]. / Radikal'nye onkologicheskie vmeshatel'stva na zheludke, pecheni i podzheludochnoi zheleze u patsientov v vozraste 80 let i starshe.

AIM: To analyze the results of radical surgery for upper GI cancer in patients ≥80 years old. MATERIAL AND METHODS: For the period November 2010 - June 2015 there were 14 radical operations in elderly (≥80 years) patients with gastric, liver and pancreatic tumors. There were 4 Whipple procedures, 4 total and 2 distal gastrectomies, 1 total pancreatectomy as well as a central liver resection, one laparoscopic 5 segment resection and one 2, 3, 7 segment resection. We analyzed blood loss, duration of surgery, 90-day mortality, morbidity (Dindo-Clavien scoring), length of hospital-stay. RESULTS: Blood loss ranged from 0 to 1500 ml, mean duration of surgery - from 150 to 560 min. There was one case of in-hospital mortality: one patient after a Whipple procedure died in 17 days after surgery due to massive arrosive bleeding. Complications developed in 8 patients, 3 of them required reoperation. Mean hospital-stay was 15±6 (8-29) days. CONCLUSION: Advanced upper GI surgery for cancer is feasible in octagenarians and does not lead to inappropriate mortality and morbidity. Comprehensive preoperative examination alongside with enhanced recovery protocol are prerequisites for this type of surgery.

[Experience of transaxillary endoscopic thyroid surgery]. / Opyt endoskopicheskikh transaksillyarnykh vmeshatel'stv na shchitovidnoi zheleze.

AIM: To compare the outcomes after open and endoscopic interventions on thyroid gland. MATERIAL AND METHODS: We have retrospectively analyzed 158 interventions on thyroid gland for the period March 2014 - January 2016. Herewith, 21 interventions were performed endoscopically with transaxillary removal of specimen. RESULTS: The study was designed in 2 groups - main (endoscopic surgery) and control (open surgery). There were 2 complications in the main group: intraoperative injury of cricoid cartilage by harmonic scalpel and unilateral subcutaneous emphysema of the neck and face. In the control group one patient had transient hypocalcemia. CONCLUSION: Endoscopic thyroid surgery is technically feasible in certain patients, adequate technical equipment and sufficient experience of surgical team.

Radical surgical treatment of elderly patients with gastric cancer.

To analyze the early results of radical surgery for gastric cancer in patients > 75 years. In the period between Jan. 2013 and June 2015 there were 25 radical operations in elderly (≥ 75 years) patients with gastric cancer. The following outcomes are presented: bloodloss, duration of surgery, mortality and morbidiy according to Dindo-Clavien classification, length of stay. There were 12 total and 13 distal gastrectomies, including 8 laparoscopic procedures (2 - total laparoscopic gastrectomies), all with D2 lymph node dissection. Mean bloodloss constituted 50±64 ml (0-300 ml), mean duration of surgery 220±70 min (140-360 min). There was no in-hospital mortality, but one patient died 2 weeks after discharge because of an unclear intraluminal bleeding. Mild complications (Dindo-Clavien I-II) were found in 6 patients, severe in 11 patients. In 6 patients repeated laparotomies were necessary. Mean length-of-stay constituted 13±17 (5-63) days. Radical gastric cancer surgery in the elderly patients is feasible. A prerequisite is a thorough pre-operative examination. This type of surgery shall be practiced in highly specialized centers after detailled control of patients' comorbidity.

[No-touch pancreatectomy and radical antegrade modular pancreatosplenectomy: a systematic review]. / Beskontaktnaia tekhnika pankreatoduodenal'noi rezektsii i radikal'naia antegradnaia modul'naia distal'naia rezektsiia podzheludochnoi zhelezy: sistematicheskii obzor.

AIM: To summarize the data of 'no-touch isolation technique' (NIT) for pancreatoduodenectomy and radical antegrade modular pancreato-splenectomy (RAMPS) for pancreatic malignancies. MATERIAL AND METHODS: We looked through Pubmed and Cochrane databases for scientific papers published from January 2000 until September 2014. RESULTS: Eight studies were included. There were 7 retrospective cohort studies and one randomized controlled trial (RCT). Mean operation time and blood loss were 267 min (198-386 min) and 132 ml (331-744 ml) respectively. Mean morbidity rate was 35% (17-58%). There was no 30-day mortality. Mean incidence of R0-resection varied from 50% to 97% with average value 84%. Median survival was reported in 3 studies (17, 18 and 26 months). Five-year actuarial overall survival was reported in 4 studies (31, 36, 40 and 53%). CONCLUSION: Positive results of NIT and RAMPS might justify further evaluation of the method in pancreatic cancer. Prospective randomized controlled trials needs to be done to demonstrate the oncological value of this novel surgical technique.

[Experience of 100 transthoracic needle biopsies of the lung under CT navigation].

The aim of this study was to investigate and analyze the results of transthoracic needle biopsy of lung tumors under CT navigation. There were carried out more than 100 transthoracic needle biopsies of lung tumors. The analysis of immediate results of the applicability of this technique was performed. The average period of hospitalization after the puncture was 1.4 days (1-7). A number of pneumothorax that required drain- ing the pleural cavity was 8. The median of duration of drain- ing the pleural cavity was 6 of 8 patients (5-6.5) days. More severe complications and deaths were not. The histological conclusion was obtained in 100% of cases, in 72 patients the diagnosis of a malignant lung tumor was firstly verified, 12 cases showed a false-negative result. Diagnosis of lung cancer was excluded in 16 patients. The sensitivity of the method was 86%, specificity - 100% and accuracy - 88%. Therefore transthoracic needle biopsy of lung tumors with minimal risk to the patient allows receiving the morphological verification of peripheral lung tumors.