[Combined surgical operations for locally spread cancer of the rectum and female genital organs with ablation of remote metastases].

The article presents data of 148 combined cytoreductive operations (with ablation of remote metastases) in patients with widespread rectal cancer (in 83 patients) and female genital organs (in 65 patients). The immediate and long-term results suggest that such operations are justifiable in multitype hospitals.

[Testosterone production by tumor tissue in partial androgen deficiency in aged men (PADAM)].

The aim of the study was examination of cause-effect relationships between PADAM, extragonadal production of androgens and high proliferative activity in aged men. The study group included 15 patients aged between 53 and 79 years with prostatic cancer (n = 5), urinary bladder cancer (n = 5) and cancer of the rectum (n = 5). Control samples of tissues of the prostatic gland, urinary bladder and rectum were obtained from dead bodies of men at the age between 18 and 29 years killed in the accidents at the age from 18 to 29 years. Testosterone levels in the tissues of peritumor zone of the prostate, in tumor tissue of patients with cancer of the prostate, urinary bladder and the rectum were higher than in blood serum. In prostatic cancer, testosterone in the tumor tissue was higher than in the tissues of prostatic peritumor zone. The values of Histochemical score AR of the peritumor zone in prostatic cancer patients were higher than those of the control group. It was detected that ER, PR, bcl-2, Ki-67 and p53 in prostatic tissue of young controls were absent while in patients with prostatic cancer these factors were expressed in the peritumor zone. In cancer of the urinary bladder, peritumor zone showed expression of PR, bcl-2, Ki-67 and p53, while no such expression was in the controls. ER, bcl-2, Ki-67 and p53 were registered in the peritumor zone of patients with cancer of the rectum but the controls had neither ER, bcl-2 nor p53 while Ki-67 expression in rectal cancer was higher than in the controls. The results of the study suggest that testosterone production by some tumors and tissues of the peritumor zone accompanied with high proliferative activity and dysregulation of the cell cycle is secondary to PADAM. These changes arise to compensate testicular deficiency and are manifestations of metabolic syndrome (X-syndrome). In this situation immune system fails to utilize all atypical cells.

[Changes in the expression of receptors of steroid hormones in the development of partial androgen deficiency of aging men (PADAM)].

This work is devoted to the vital topic of the influence of partial androgen deficiency of aging men (PADAM) on the development of cells with androgen receptors. The results obtained in this study suggest a conclusion that the production of testosterone by some tumors and tissues of the peritumorous zone, which is accompanied by increased proliferative activity and disturbance of the regulation of the cell cycle, is caused by PADAM. The given changes are directed at compensating for testicular deficiency (in particular at overcoming the androgen-dependent stage of development of androgen-sensitive cells). These changes are a partial manifestation of metabolic syndrome (X-syndrome). The atypical cells, which unavoidably develop during metabolic syndrome, are dealt with by means of the immune system, whose capabilities become less and less adequate in the given circumstances.

[Survival of patients with distant metastases of colon cancer after different extent of surgery]. / Pokazateli vyzhivaemosti bol'nykh rakom obodochnoi kishki s otdalënnymi metastazami posle operatsii razlichnogo ob''ëma.

The results of a retrospective non-randomized pair-controlled investigation are discussed. The data on a patient of cytoreductive surgery and another one operated on for symptoms only (control) were compared. Both subjects had to have comparable most important prognostic characteristics, such as gender, age, primary tumor localization and the number and pattern of distant metastases. The study included 34 patients. The surgery group comprised 19 patients (female--13, male--6). Total cytoreductive surgery (5) used standard removal of primary tumor and marginal resection of a segment of the liver (4), or excision of the right lobe (1). Partial surgery (14) involved removal of primary tumor alone. Controls (female--10, male--5) were operated on for symptoms (proctotoreusis--12, shunt--3). No systemic antitumor therapy was given. Concomitant pathology, its absence as well as postoperative complications were excluded from consideration. Median survival in control was 5.2 mo, total or partial surgery--13.5 mo (p = 0.00083). In a longer perspective, it was 27.0 mo for total surgery and 12.6 mo--partial (p = 0.00295), while after partial surgery it was longer than for symptomatic treatment--5.2 mo (p = 0.0029). No correlation was established between survival, on the one hand, and gender, age or primary tumor localization, on the other (p(0.005). However, a relationship was found between survival and extent of excision (p = 0.01737).

[Differential diagnosis and surgical treatment of colorectal nonepithelial tumors]. / Differentsial'naia diagnostika i khirurgicheskoe lechenie pri kolorektal'nykh neépitelial'nykh opukholiakh.

An analysis of results of the examination and treatment of 92 patients with nonepithelial colorectal tumors has shown that the correct diagnosis can be made in 82% of the cases on the basis of using complex X-ray, ultrasonic and endoscopic methods. Of decisive significance in determination of the tumor tissue character is the morphological investigation. Extensive surgical interventions were performed due to suspected malignization on 21 patients with benign nonepithelial tumors. In other cases (n = 49) the organ-saving operations were fulfilled. The decision between the volumes of the surgery for malignant nonepithelial tumors (n = 24) was not difficult in most cases and depended on the spread of the oncological process. The 5-year survival in this group of patients was 57%. No recurrences were noted after ablation of benign tumors.

[Effectiveness of combined resection and exenteration of the pelvic organs as part of the comprehensive treatment of extensive malignancies of the rectum and female genitals]. / Effektivnost' kombinirovannykh rezektsii i ékzenteratsii organov malogo taza kak étapa kompleksnogo lecheniia rasprostranennykh opukholei priamoi kishki i zhenskikh genitalii.

The results of the surgical treatment of 865 patients with extended malignancies of the rectum and female genitals are presented. Combined resection and exenteration of organs of the small pelvis (both radical and palliative to ensure cytoreduction of tumor) were carried out in 695 cases (palliative surgery for symptoms--170). The number of resections and sphincter-saving operations has increased while the lethality rates have dropped in recent years. Three-year survival after combined radical surgery for rectal cancer was 59.1%; five-year survival--49% (palliation with removal of distant metastases--26.0 and 14.8%; without removal--24.2 and 0%, respectively; palliative surgery for symptoms--2.3 and 0%, respectively). In cases of palliative surgery for cytoreduction of tumor of the female genitals, 3- and 5-year survival after removal of all distant foci was 66.2 and 54.1%; partial cytoreduction--42.2 and 28.8%, and surgery for symptoms--13.8 and 13.8%, respectively. Cytoreduction improved both the chances and efficacy of adjuvant radio- and chemotherapy. It is suggested that surgery be included as a component of complex treatment of malignancies; combined cytoreduction is fully justified even if its effect is merely palliative.

[Intestinal obstruction in disseminated malignant tumors of the female genitalia: the surgical procedure and combined operations]. / Kishechnaia neprokhodimost' pri rasprostranennykh zlokachestvennykh opukholiakh zhenskikh polovykh organov: khirurgicheskaia taktika i kombinirovannye operatsii.

Results of surgical treatment of 103 patients are presented who had spread malignant tumors of the female genitalia with the involvement of different segments of the intestine and urinary tract, and damaged intestinal passage. Combined operations were performed on 57 patients (55.3%), palliative--46 patients (44.7%) 54 patients were operated on urgently. For the last 10 years resectability has been increased 8.5 times owing to active surgical policy. Immediate lethality after combined operations was 10.5%. Cumulative indices of 3- and 5-year survival were 66% and 53.3% respectively. Lethality and 5-year survival after palliative operations were 30.4% and 13.8% respectively. Combined operations for cancer of female genitalia (both primary and recurrent ones and metastases) are quite reasonable in order to provide the optimum volume of cytoreduction and perform chemo- and radiation treatment.

[Laparoscopic surgery in colorectal tumors]. / Laparoskopicheskaia khirurgiia pri opukholiakh priamoi i obodochnoi kishki.

The authors describe their first experience with using less invasive laparoscopic methods in patients with tumors of the rectum and the colon. Twelve operative interventions were performed. The method and technique of endovideosurgical operations on the colon are described. The intraoperative and postoperative complications are analyzed. The authors not rich experience with performing laparoscopic interventions on the colon shows the necessity of stepwise and thorough mastering the method and of using strictly individual indications for such operations.

[Extensive hepatic resections and reconstruction of bile ducts in patients with tumors and parasitic cysts]. / Obshirnye rezektsii pecheni i rekonstruktsiia zhelchevyvodiashchikh putei pri opukholiakh i parazitarnykh kistakh.

The short-term and end results of hemihepatoectomies (36) associated with malignant (31) and benign (2) hepatic tumors and parasitic cysts (3) are presented (total right-side hemihepatectomy-7, subtotal-9, left-side hemihepatectomy-15, extended left-side hemihepatectomy-5). In 14 cases, due to considerable invasion of tumor from other sites or because of distant metastases, the liver was resected alongside with removal of primary tumor. In such patients, gastric extirpation was carried out simultaneously with resection of the esophagus and pancreas (4), colon and rectum (8) and gastropancreatoduodenal area (1). Liver resection was associated with surgical correction of biliary tracts (6). Post-operative lethality was 11.1%. The end results are quite satisfactory: out of 27 patients treated for primary (10) and secondary (17) hepatic malignancies, 15 survived 2 years, 8-4 years and more; there are 10 survivors at the time of reporting.

[Current principles and methods of radical therapy for locally extensive esophageal and gastroesophageal cancer]. / Sovremennye printsipy i metody radikal'nogo lecheniia mectorasprostranennogo raka pishchevoda i kardioèzofageal'noi zony.

The results of radical surgical and combined treatment of 124 cases of esophageal and cardioesphageal tumors are presented. Extensive local disease (stage III, T2-4N0-2M0) was diagnosed in 113 patients (91.1%). Esophagoectomy with transmediastinal esophagogastroplasty and cervical esophagostomy proved most useful for esophageal tumor, while extensive surgery after Lewis in combination with extirpation or proximal resection of the stomach--for proximal gastric disease involving the esophagus. Combined surgery with resection of adjacent organs was carried out in 50%. Post-operative mortality rates were reduced to 7.1% due to application of effective surgical, anesthetic and intensive care procedures. The 3-year survival rate was 26.5%. Prognosis improved significantly when radiation was used prior to dissection of lymph nodes.

[Clinical introduction and results of simultaneous resection and repair in esophageal cancer]. / Rezul'taty odnomomentnykh rezektsii i èzofagoplastiki pri rake pishchevoda na ètapakh klinicheskogo vnedreniia.

The data on 80 cases of radical resection and extirpation of the esophagus for intrathoracic tumors entailing esophagogastroplasty are discussed. Esophageal extirpation with resection of the proximal part of the stomach, sufficient lymphadenectomy, simultaneous transmedianal esophagogastroplasty and formation of cervical esophago-gastrostomy proved the most radical. The 3-year complication and mortality rates were 20.0 and 5.0%, respectively. The procedure yields the best functional results, too. It is understood that the long and tortuous process of development of a new surgical procedure inevitably involves frequent postoperative complications, which, however, can be effectively treated if measures are taken to improve surgical technique and intensive care standards. The end-results still leave much to be desired--the 3-year survival rate was 24.0, 5 years--8.0%.

[Experimental tests and clinical trials of the biologically active food additive Fibromed]. / Eksperimental'naia i klinicheskaia aprobatsiia biologicheski aktivnoi dobavki k pishche Fibromed.

A biologically active food additive--Fibromed--has been tested experimentally and clinically. The additive made from wheat bran by the Reacon Company contains no less than 40% of dietary fibre (cellulose, hemicellulose and lignin). Its effect on multi-organ carcinogenesis induced by N-methyl-N-nitrosourea (MNU) and lipid metabolism was tested in rats. Tumors were induced by combined intramammary injections and intrarectal infusions of the agent. Fibromed was fed (20% by weight) during post-initiation period. It effectively inhibited the development of mammary and colonic tumors and reduced serum-blood cholesterol, triglycerides and beta-lipoproteids. The influence of Fibromed treatment on stool during early post-operative period was studied in surgical cases of colorectal cancer. When administered in a dose of 60 g, daily, starting from days 4-5, Fibromed restored intestinal function 36 hr earlier than in controls. Fibromed should be recommended for prevention of breast and colonic tumors, lipid metabolism disorders and rehabilitation of patients who underwent surgery for colorectal cancer.