Objective: to evaluate tolerability and efficacy of maintenance treatment in the absence of progression after 16 weeks of first-line therapy in patients with unresectable metastatic colon cancer.

Materials and methods. We have analyzed medical case histories of patients with metastatic colorectal cancer who underwent treatment in the department of clinical pharmacology and chemotherapy of N. N. Blokhin Russian Cancer Research Center from 2007 to 2015 years. Inclusion criteria were the following: 16–24 weeks of first-line chemotherapy with no signs of progression and the inability to perform metastasectomy. Progression-free survival was the main criterion for effectiveness in our study.

Results. 160 (44.5 %) of 359 treated patients met the inclusion criteria. 102 (63.7 %) patients were followed up, while the other 58 (36.3 % – comparison group) patients underwent maintenance chemotherapy. Grade I–II toxic reactions and grade III complications associated with first-line chemotherapy were insignificantly more common in the group of patients left on maintenance chemotherapy: 72.4 % and 37.9 % versus 57.8 % and 24.5 % in the comparison group, p = 0.07 and p = 0.07 respectively. The frequency of grade I–II toxic reactions and grade III complications in the second-line treatment did not differ between treatment groups (p = 0.9 and p = 0.8). The median of progression-free survival in observation group and comparison group was 4, and 6 months (odds ratio (OR) 0.6; p = 0.009), and life expectancy – 23 and 31 months (OR 0.75; p = 0.1), respectively. Statistically significant differences between groups with respect to achieving the objective response and/or normalization of carcinoembryonic antigen level were revealed: median of progression-free survival was 13 (n = 26 of 57; 45.6 %) and 4 months (n = 31 of 57, 54.4 %), respectively (HR 0.38; p = 0.002), median of life expectancy – 34 months versus 26 months (OR 0.37; p = 0.3).

Conclusions. Carrying out maintenance therapy is associated with increased incidence of grade III complications during the first-line treatment, but does not affect the tolerability of the second-line treatment. Supportive chemotherapy with fluoropyrimidines remains to be the most effective in patients with favorable prognostic factors such as normalization of carcinoembryonic antigen and/or achievement of the objective response on the background of first-line chemotherapy.

Objective: explore the use of enhanced recovery after surgery (ERAS) in the treatment of patients with colorectal cancer, evaluate its efficacy and safety.

Materials and methods. Prospective, single-site, randomized study for the implementation of enhanced recovery after surgery in patients with colorectal cancer has been conducted from October 2014 till the present time. All patients after laparoscopic surgeries undergo treatment according to ERAS protocol, patients after open surgeries are randomized (1:1) in groups of the standard treatment or treatment according to ERAS protocol. The study included patients with localized and locally disseminated colorectal cancer aged from 18 to 75 years, ECOG score ≤ 2. The primary evaluated parameters were the following: the number of postoperative complications (according to Clavien– Dindo classification), postoperative hospital days, incidence of complications and mortality in the 30-day period, timing of activation.

Results. Up to date, the study includes 105 patients: laparoscopic group – 51 patients, open-surgery group of patients treated by ERAS protocol – 27 patients, open-surgery group of patients with the standard post-op treatment – 26 patients. Complications requiring emergency surgery for anastomotic leak (p = 0.159) developed in 3.7 % of patients with the standard post-op treatment and in 3.9 % of patients after laparoscopic surgery, while 1 patient required repeat hospitalization. The total number of complications was significantly lower in opensurgery group of patients treated by ERAS protocol compared with the standard post-op treatment (p = 0.021). However, there were no differences between laparoscopic and open-surgery group with the standard post-op treatment (p = 0.159). An average hospitalization stay in patients with the standard post-op treatment was equal to 10 days compared to 7 days in patients treated by ERAS protocol (p = 0.067) and 6 days after laparoscopic surgery (p = 0.001). No cases of 30 days mortality have been reported in all the groups.

Conclusion. The use of ERAS protocol in our study allowed to reduce hospitalization time and provided an early activation of patients. There was a tendency towards the reduction in the number of postoperative complications. However, the resulted data is to be confirmed in a larger study.

Introduction. Standardized protocols for perioperative management of patients are increasingly used in colorectal surgery. We compared the results of right-sided hemicolectomy in elderly patients before and after implementation of this protocol.

Materials and methods. The results of a prospective database of the department of surgical oncology of Treatment and Rehabilitation Center for 2009–2016 years were analyzed. A comparative analysis of 86 case of elective right-sided hemicolectomy was performed in patients aged 60 years and over as a part of standardized protocol for perioperative management of patients, and 34 similar surgeries carried out earlier without compliance with the protocol. Clinically, there was no significant differences between groups.

Results. In the study group we revealed statistically significant decrease in the number of sever (grade III–V by Clavien–Dindo) postoperative complications and mortality from 33 % to 13 % and from 12 % to 1 %, respectively. Also, despite the fact that surgical operations in the test group were carried out by less experienced surgeons, introduction of the unified surgical technique reduced median duration of the surgery from 185 to 165 minutes.

Conclusion. Introduction of the standardized protocol for perioperative management of elderly and old patients, that need right-sided hemicolectomy, reduces the number of complications and lethal cases.

Objective: to assess ERP implementation results in patients with colon cancer and to reveal correlation between compliance of ERP protocol and efficacy of perioperative care.

Materials and methods. 124 patients were included in the study. Main group consisted of 62 patients with ERP, others were controls. ERP compliance was assessed using original formula which considers number of accomplished elements of the Protocol and quality of performance of each element.

Results. No significant difference between the groups in morbidity was obtained (1.6 % in main group vs 9.8 % controls; р = 0.06). Minor dependence in self-care was obtained in 90.5 % at third post-op day in main group vs 58.0 % in controls (p < 0.0001). Postoperative hospital stay was lower in main group (4.7 ± 0.1 vs 9.0 ± 0.6 days; p < 0.0001). Total hospital stay was lower in main group as well (7.2 ± 0.1 vs 14.1 ± 0.7 days; р < 0.0001). No mortality and readmissions occurred. ERP compliance rate was 80.0 % (56.9–93.3 %). Рostoperative hospital stay in patients with high protocol compliance (≥ 80 %) was significantly shorter then in patients with low protocol compliance (< 80 %): 4.3 ± 0.2 vs 5.1 ± 0.2; р = 0,005).

Conclusion. ERP is effective and safe method of postoperative care in patients after colon resection and the effectiveness of the treatment correlates with protocol compliance rate resulted in shorter hospital stay.

Objective: improve the results of treatment of patients with metastatic cancer of liver by reducing the risk of post-resection liver failure based on the assessment of liver functional reserve.

Materials and methods. The study included 2 independent samples of patients underwent surgery for liver metastases in the department of abdominal oncology at the P. A. Herzen Moscow Oncological Research Institute. Group 1 included 47 patients: in addition to the standard treatment algorithm they underwent 13C methacetin breath test and dynamic scintigraphy of liver in the preoperative stage. Patients from the group 2 (n = 30) underwent standard clinical and laboratory examination, without preoperative evaluation of liver functional reserves; the level of total bilirubin, albumin and prothrombin time showed no decrease in liver function. Post-resection liver failure was established based on 50/50 criterion when evaluated on the 5th postoperative day.

Results. The analysis of operational characteristics of functional tests showed absolute sensitivity of 13C methacetin breath test (SE ≥ 100 %) and negative predictive value (–VP ≥ 100 %) in case of integrated application of 2 diagnostic methods. An incidence of post-resection acute liver failure in the study group was significantly 2.2-fold lower than in the control group – 10.6 % and 23.3 %, respectively (p < 0.001).

Conclusion. Combination of preoperative dynamic scintigraphy of liver with 13C methacetin breath test allows to perform comprehensive assessment of liver functional reserves, and it can greatly improve preoperative assessment and postoperative results of anatomic resections in patients with liver metastases.

Background. Сomparative assessment of long-term oncologic outcomes of surgical and combined treatment of patients with upper rectal cancer.

Materials and methods. Patients aged > 18 with histologycally verified upper T1–4N0–2M0 rectal cancer were included. In group A patients received neoadjuvant chemoradiotherapy 25 Gy in 5 Gy fractions with capecitabine 850 mg/m2 bid per os on radiation days and surgery. In group B patients received surgery alone.

Results. From january 2004 to december 2014, we selected 227 archival cases of patients with upper rectal cancer. Group A was 103 patients (45.4 %) in group B – 123 (54.6 %). We traced long-term results of treatment in 217 (96.6 %) patients. In the group A was 98 (95.1 %) patients, in the group B – 119 (96.7 %) patients. Local recurrence occurred in group A – 1 (1.2 %) patient, in group B – 3 (2.5 %) patients (p = 0.413). The frequency of distant metastases developed in group A in 10 (10.2 %) patients and in group B – 15 (12.6 %) patients (p = 0.581). Overall survival in group A was 90.6 %, and the disease-free survival – 89.6 %, in group B – 82.8 % and 81.9 %, respectively (p = 0.46).

Conclusions. Surgical treatment of patients with upper rectal cancer stage I–III, in compliance with all oncological principles is justified.

Toxic megacolon complicating pseudomembranous colitis is a very rare condition that confirms by a few reports. In our case report probably described a case after extraperitoneal preventive colostomy closure toxic megacolon was developed with fatal final.