First-line therapy for metastatic colon cancer is most important for a patient. Its median time to progression constitutes the bulk of the patient’s survival. Clearly, it is necessary to choose the most effective combinations of targeted drugs and chemotherapy regimens. The choice of therapy for patients with colon cancer is governed by both the clinical characteristics of the disease and the molecular changes of a tumor. In recent literature, there has been a great deal of evidence for the use of targeted drugs in different clinical situations; the results of comparative trials of different treatment combinations have been published. This all determines the reconsideration of the choice of a treatment regimen in patients with metastatic colon cancer; it is the topic of the present review.

Background. Although minimally invasive surgery has undoubted advantages, the proportion of endovideosurgical interventions in the treatment of patients with colorectal cancer (CRC) remains insignificant and indications for their application have not been defined until the present time. The authors describe their experience with laparoscopic CRC surgery.

Objective and methods. 132 endovideosurgical interventions and 143 open surgeries for рТ2–4N0–2М0–1а CRC were performed for 25 months of surgical practice. The above patient groups were assessed for body index, patient age, comorbidity severity (CR-ROSSUM scale), T index, number of lymph nodes removed, blood loss, operation time, and complication rate and pattern. The learning curve was studied from the duration of each type of laparoscopic surgery.

Results. No significant differences were found between the groups in the ratio of surgery types, the number of lymph nodes removed, and the rate of complications. More significant blood loss and a larger number of postoperative wound infections were seen in the patients who had been operated on through open access with the significantly shorter duration of open surgery. All the types of laparoscopic surgery for CRC are characterized by a marked learning curve, except for those for rectal resection with total mesorectumectomy.

Conclusion. Laparoscopic surgery for CRC compares well with routine surgery. The principles of laparoscopic resections should be employed in CRC and open surgery. It is possible and necessary to more extensively use endovideosurgical techniques.

Introduction. Microcirculation plays an important role in early postoperative period in colorectal cancer patients. At the same time the question connected with studying of rheological properties of blood as one of microcirculation indicators in literature it studied insufficiently.

Materials and methods. We studied rheological properties of blood in 30 patients operated for bowel obstruction caused by right colon cancer. 17 (56,7 %) patients were male, 13 (43,3 %) – female. Average age was 57 ± 3 years. Time from the moment of manifestation of the first clinical signs before admission to a hospital and the beginnings of carrying out medical and diagnostic actions was 12 ± 0,5 h. The stage of a disease was T3N0–1M0. The group of comparison consisted of 20 healthy volunteers of the same age. Changes of a rheology of blood were measured by means of the accounting of viscosity of blood, change of an index of deformation and aggregation of erythrocytes. Studying of viscosity of blood was carried out by means of the rotational viscometer at shift speeds: 200; 100; 150; 50 and 20 MPas. Measures were conducted at the time of receipt, on the first, third, fifth, seventh and tenth postoperative day.

Results. In patients with bowel impassability at the time of receipt the increase in indicators of viscosity of blood is noted at all speeds of the shift, analyzed indicators increase by the third postoperative day, decrease on the seventh and are partially restored for the tenth postoperative days. Complications developed in 16,6 % of cases, in all cases – pneumonia. By comparison of the obtained laboratory data to a clinical picture it is established that complications developed on 3–5th postoperative days.

Purpose. To conduct retrospective analysis of treatment results of combined first line therapy of metastatic colorectal cancer with bevacizumab with further bevacizumab maintenance and second line treatment with or without bevacizumab use in Kirov regional clinical oncology dispensary.

Materials and methods. The study was conducted in Kirov regional clinical oncology dispensary from 2008 until 2014. 35 patients treated with combined first line therapy including bevacizumab with further bevacizumab maintenance and second line treatment with or without bevacizumab were retrospectively evaluated. Overall response was evaluated using RECIST ver. 1.1 criteria. Long term outcomes – progression free and overall survival were evaluated. Treatment safety was evaluated using NCI CTCAE.

Results. There were no complete remissions in second line bevacizumab treatment, partial remissions were detected for 4 (22.2 %) patients, stable disease for 14 (77.8 %). Median progression free survival in both groups was comparable 9.1 and 10.4 months respectively. Patients treated with bevacizumab in first and second lines of treatment had 8.2 months survival benefit (p > 0.05).

Conclusions. Combined first line therapy of metastatic colorectal cancer with bevacizumab with further bevacizumab maintenance and second line treatment with bevacizumab improves overall survival on 8.2 months in comparison with patients who stopped bevacizumab treatment after first disease progression.

The article describes statistics, issues of diagnosis and treatment of rare type of tumors – gastrointestinal stromal tumor. Presented case report of the patient with this tumor in low rectum, which was treated with sphincter saving operation. Also shows the possibility of postoperative morphological diagnosis.