ORIGINAL REPORTS
Selected squamous-cell anal carcinoma (SCAC) patients are initially presented with large pararectal lymph node metastases.
The aim of this study was to investigate safety, efficacy and long-term outcome of chemoradiotherapy in this patient group.
Materials and methods. SCAC patients, initially referred with gastrointestinal stromal tumors, rectal cancer diagnosis or patients with regional metastatic lymph nodes more than twice the size of the primary tumour were included in this retrospective analysis. Previous treatment, diagnostic and clinical mistakes of primary care specialists, short- and long-term outcome of chemoradiotherapy were analyzed.
Results. 6 patients were included. Primary tumour size varied between 0.5 and 6.5 cm (median – 1.7 cm), metastatic lymph node size varied between 4.2 and 7.4 cm (median – 6.4 cm). All patients received radical doses of chemoradiation. All patients developed grade 3 toxicities, 2 patients developed grade 4 toxicities. Median followup was 15.5 months. 5 out of 6 patients had persistent complete clinical response. 1 patient died of disease progression (incomplete response and metachronous distant metastases).
Conclusion. SCAC patients with large regional lymph node metastases have equal prognosis with the rest of the patient group of adequate treatment was carried out.
Background. The urgency of the problem with training specialists in laparoscopic techniques is due to the wide introduction of minimally invasive technologies into surgical practice. Previously untrained, a surgeon runs considerable difficulties with the coordination of movements and the use of tools, which may lead to both the longer life of surgical aids and damage to the viscera and vascular structures in a patient. Many factors influence the level of manual skills in the audience at the beginning of training, which further affect its duration and hence cost.
Objective. To evaluate the effect of initial level of basic manual skills for the duration of the study.
Materials and methods. The investigation enrolled 255 listeners: medical students, interns, residents, and practicing surgeons. Manual skills as single successive performance of exercises 1 (peg transfers) and 2 (cutting a circle) in an endotrainer box were tested before training. The correlation of the results of testing for the rate of formation of basic laparoscopic skills was then analyzed.
Results. According to the results of the testing, only 20 % of the physicians showed a result of less than 110 s and were ready for being further taught in intracorporeal suturing techniques. The authors consider that all students and interns/residents and most physicians must start their training in laparoscopic technique from a series of basic exercises. The analysis revealed a correlation between the results of doing exercises 1 and 2 and the number of their repetitions to achieve the needed level (r = 0.66).
Conclusion. The single performance of peg transfers and cutting a circle exercises before training could objectively measure the performance of laparoscopic skills, define an individual plan, and optimize the costs of the training.
The issue of sphincter preservation when low rectal cancer (rectal adenocarcinoma 0–6 сm from marge anal) remains topical.
Objective: to increase the number of sphincter preservation operations in patients with low rectal cancer.
Materials and methods. We analyzed data on 110 patients with low rectal cancer randomized into 3 groups: in the 1st group surgery was performed following 0–3 days after the end of short-term radiotherapy (RT) 25 Gy. In the 2nd group the interval before surgery after the identical RT was 42 ± 3 days. In the 3rd group, in 2 cycles of capecitabine chemotherapy were performed starting on the 1st day of RT.
Results. pCR was observed obly in 2nd and 3rd group: in 16.6 % patients in the 2nd group, and 12.8 % in the study group. The sphincter preservation rate was 40.0 % in the 1st control group, 70.0 % in the 2nd group and 77.0 % in the 3rd group. The postoperative complications rate was 37.5 % in the 1st group, 26.6 % in the 2nd group and 17.9 % in the 3rd group.
Conclusions. Preoperative chemoradiotherapy may increase sphincter preservation rate without increase in the number of postoperative complications.
Background. The aim of this study was to compare short and long-term outcomes after neoadjuvant short-course chemoradiotherapy with capecitabine ot tegafur for operable rectal cancer.
Materials and methods. Patients with histologycally verified Т3N0M0, Т2–3N1–2M0 rectal cancer, who underwent 5 × 5 Gy neoadjuvant radiotherapy with local 41–45 °C hyperthermia on days 3–5 and metronidazole 10 g/m2 per rectum days 3, 5 were randomized to receive capecitabine 1000 mg/m2 bid per os days 1–14 or tegafur 400 mg/m2 bid per os days 1–21. Toxicity, tumor regression, sphincter preservation rate and long-term outcomes were analyzed.
Results. During 2011–2013 26 patients were included in the tegafur group and 30 – in capecitabine group. Overall toxicity was 50 % in the tegafur arm and 36.7 % in the capecitabine arm (p = 0.42), grade III–IV toxicity (diarrhoea was the most common grade 3+ event) was observed in 23.1 % and 6.7 % (p = 0.13) patients accordingly. Grade III–IV tumor regression was observed in 34.6 % patients, who received tegafur and 53.3 % (p = 0.12) patients who received capecitabine. Sphincter-sparing surgery was performed in 84.6 % and 100 % (p = 0.04) patients who received tegafur and capecitabine accordingly. Median follow-up was 31.6 and 32.2 months accordingly. 3-year overall survival in capecitabine and tegafur arms was 95.4 and 82.1 % (р = 0.13), 3-year disease-free survival – 91 and 74 % (р = 0.029).
Conclusions. Both fluorpyrimidines demonstrated comparable short-term outcomes with a tendency to better results in the capecitabine arm.
Background. Choosing a primary radical resection in treatment of large bowel obstruction, often oncologically justified by necessity to remove the obstructive tumor at the first stage. However, indicators of radicalism of this approach is not enough reflected in trials.
Materials and methods. In prospective comparative trial in period from December 2012 till April 2014 of treatment outcomes and specimens of 70 patients, whom mobilization of the mesocolon were performed in medial to lateral direction and traditional way.
Results. The average number of lymph nodes, complications of I, II and V level did not differ significantly. The median vascular tie length improved from 42 to 115 mm for right colon cancer and from 30 to 65 mm for left colon cancer.
Conclusions. Benefits of the primary radical treatment for large bowel obstruction versus delayed surgery remains controversial. However, at the first case, the choice should be given to the medial-lateral approach, which allows to achieve best tissue morphometry and improving of treatment outcomes.
Objective: to assess the immediate results of surgical interventions for colorectal cancer complicated by perforation.
Materials and methods. The immediate results of surgical treatment were retrospectively analyzed in 56 patients with colorectal cancer complicated by perforated colon cancer, who had been treated at Smolensk surgical hospitals in 2001 to 2013. Patients with diastatic perforation of the colon in the presence of decompensated obturation intestinal obstruction of tumor genesis were not included into this investigation.
Results. The immediate results of uni- and multistage surgical interventions were analyzed in relation to the extent of peritonitis and the stage of colon cancer. More satisfactory immediate results were observed after multistage surgical treatment. Following these interventions, a fatal outcome of disseminated peritonitis in the presence of performed colorectal cancer was recorded in 8 (53.3 %) cases whereas after symptomatic surgery there were 11 (67.8 %) deaths. A fatal outcome was noted in 1 case (7.7 %) after multistage surgery.
Discussion. The results of surgical treatment in the patients with perforated colorectal cancer are directly related to the degree of peritonitis and the choice of surgical tactics.
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