The article is devoted to some issues of perioperative nutritional support of patients with colorectal cancer. This group is usually characterized by high proportion of patients with nutritional disorders and impossibility of quick return to usual good nutrition in the early postoperative period. Timely administration of medical nutrition reduces the risks of postoperative complications and death among these patients. Enteral support is associated with lower risk of postoperative complications and should be used in most of the patients. 

Objective: to evaluate the results of “watch and wait” approach for rectal cancer patients with complete clinical response after neoadjuvant chemoradiotherapy (CRT) followed by consolidation chemotherapy.

Materials and methods. Between 2013 and 2016, 130 patients who were diagnosed with stage T2N0–1M0–T3(CRM+)–4N0–2M0 middle and low rectal cancer were treated by CRT (single dose 2 Gy to a total dose 50–54 Gy with concominant capecitabine 850 mg/m2 /day of radiotherapy) with consolidation chemotherapy (CapOx) (capecitabine 2000 mg/m2 14 days and oxaliplatin 130 mg/m2 intravenous once in 3 weeks).

Results. 21 patient showed complete clinical response. During the time of observation (median 14.6 month) all patients alive without signs of recurrence and progression.

Conclusion. Preliminary results showed that organ saving treatment for rectal cancer patients with a complete clinical response is oncologically safe when followed by strict selection criteria and active follow-up, including endoscopy and magnetic resonance imagin. Future investigation is needed to justify this statement. Probability of complete response is higher for early stages of rectal cancer. 

Objectives: to assess the feasibility of a combination of the intensity-modulated radiation therapy (IMRT) with a triplet chemotherapy with paclitaxel, capecitabine, and mitomycin C in the treatment of patients with anal cancer, and to evaluate the toxicity of the proposed treatment regimen.

Materials and methods. All patients included in the study had stage I–IIIB anal cancer. All patients underwent IMRT radiotherapy 52–58 Gy (the dosage is calculated according T symbol) by 1.8 to 2.2 Gy fractions daily. The proposed chemotherapy scheme includes mitomycin C 10 mg/m2 on day 1, paclitaxel 45 mg/m2 on days 3, 10, 17, 24, 31, capecitabine 625 mg/m2 during radiotherapy. A complete response to treatment after 26 weeks, and the compliance to the study protocol were the primary end points of the study.

Results. The study included 38 patients. Among patients stage I anal cancer occurred in 1 (2.6 %) case, II – in 5 (13.2 %), IIIA – 15 (39.5 %) and IIIB – in 17 (44.7 %). A significant deviation from the protocol reported in 6 (15.8 %) patients, in 11 (28.9 %) patients a slight alteration from the treatment was documented, and 21 (55.3 %) patients completed the treatment of chemoradiotherapy with full compliance to the study protocol. The high profile of toxicity (grade III–IV) was recorded in 23 (60.5 %) patients. An incomplete clinical response at 26 weeks after treatment was reported in 5 (13.2 %) patients, one whom continued watchful waiting and achieved complete response at 9 months posttreatment. Median followup was 27 months. 1 patient developed a local recurrence 1 year posttreatment.

Conclusions. The proposed triplet chemotherapy regimen using IMRT is feasible and has acceptable toxicity. For further assess the continuous research is needed. 

Objective: to evaluate efficacy and safety of the short-course radiotherapy combined with capecitabine chemotherapy, intracavitary hyperthermia and delayed surgical treatment as neoadjuvant therapy of rectal cancer

Materials and methods. Patients with T2–3N0–2M0 newly diagnosed rectal cancer were included. All patients received short-course radiotherapy with total dose of 25 Gy in several fractions of 5 Gy each, along with capecitabine and metronidazole therapy and local hyperthermia. Capecitabine (1000 mg/m2 ) was administrated twice daily on days 1–14. Local hyperthermia (41–45 °С, 60 min) was applied on days 3–5. Metronidazole (10 g/m2 per rectum) was given on days 3 and 5. Patients underwent surgical treatment not earlier than 4 weeks after neoadjuvant therapy completion. The primary endpoint of the study was assessment of pathologic complete response rate. Secondary endpoints included evaluation of neoadjuvant treatment toxicity, tumor regression, surgical treatment results and oncological results.

Results. 81 patients were enrolled. 10 of them (12.3 %) were found to have grade III toxicity, 1 (1.2 %) – grade IV toxicity. Sphincter preservation surgery was carried out in 78 (96.3 %) patients. Postoperative mortality was 0 %. Postoperative complications were registered in 11 (13.8 %) cases. Pathologic complete responses (pCR) were observed in 16 (19.8 %) patients. Median follow-up time was 40.9 months. Distant metastases developed in 10 (12.3 %) patients. Three-year overall survival rate was 97 %, three-year relapse-free survival rate was 85 %.

Conclusion. Short-course radiotherapy combined with chemotherapy, radiomodificators and delayed surgical treatment is a safe method for rectal cancer treatment; its results are comparable with the results of prolonged chemoradiotherapy course in terms of tumor regression frequency. 

Objective: to improve the results of treatment of patients with colorectal cancer complicated by acute bowel obstruction and diastatic rupture.

Materials and methods. Retrospective analysis of treatment outcomes of patients with complicated colorectal cancer, treated at the Clinic of Hospital Surgery of theI.I.MechnikovNorth-WestStateMedicalUniversity from 1986 till 2015.

Results. Of the 1206 patients with colorectal cancer complicated by intestinal patency violation injury breach of intestinal, decompensated violation intestinal patency (ABO) was detected in 245 (20.3 %) cases. The main principle of treatment of colonic obstruction in cancer was the intention for the simultaneous elimination of obstruction and the radical removal of the tumor. Radical surgery was performed in 152 (62 %) of 245 cases with ABO. In case of right-sided colon tumors generally colon resection with anastomosis formation were performed, in case of left-sided tumors colon resection in the majority ended with the terminal colostomy formation. Palliative operations were performed to 93 (37.9 %) patients. Postoperative complications were detected in 51 (20.8 %) cases. The death rate was 11.8 %. The mortality after radical surgical operations was 6.6 %. Diastatic rupture was diagnosed in 15 (1.2 %) patients. Subtotal colectomy with the formation or anastamosis was performed to 3 patients, operation ended with ileostomy formation – in 9 cases.

Conclusion. In case of the left-side cancer of colon, complicated by АВО, a radical surgical operation with colostomy formation is beneficial. In the case of colorectal cancer, complicated by the diastatic rupture the operation of choice is subtotal colectomy. 

The article considers the possibility of sphincter sparing surgery in patients with negative risk factors, such as localization in low third and lesion of lateral lymph nodes. Combined treatment and improved surgical approach allowed to achieve positive oncological and functional results. The discussion provides an analysis of the publications devoted to various approaches to the treatment of low rectal cancer with extended pelvic lymph node dissection and neoadjuvant chemoradiotherapy. 

A new approach to combined treatment of patients with colorectal cancer with synchronous distant liver metastases is discussed in the article. The approach is based on simultaneous surgical treatment of the colon using laparoscopic method and via open liver resection. This hybrid technology allows to reduce the frequency of postoperative complications, minimize the duration of in-patient care, therefore decreasing time until drugs administration as well as treatment costs, ensuring early start of combined treatment. The description of clinical observations demonstrated the benefits of this method implementation.