This review focuses on the practical aspects of prevention and treatment of fungal infections in surgical patients. It covers epidemiology and risk factors for invasive candidiasis, updates on the etiological structure of fungal infections in patients in critical conditions, and provides the information on drug sensitivity of Candida species. The authors discuss the limitations of cultural and non-cultural diagnostic methods used in invasive candidiasis, emphasizing the importance of analyzing the existing risk factors in combination with a comprehensive assessment of clinical and laboratory data for timely initiation of adequate antifungal therapy. The review provides a brief description of currently available antimicotics, including polyenes, triazoles, and echinocandins. It also describes the benefits of anidulafungin, which does not interact with other drugs and has no negative effect on the liver and kidney. The article also covers indications for antifungal agents in surgical intensive care units in accordance with international and Russian guidelines. A cohort of patients with abdominal diseases requiring preventive and empirical treatment with antimicotics is described. In additions to that, the manuscript contains a rationale for the use of echinocandins in targeted therapy of invasive candidiasis.

Objective: to assess the frequency of liver resections in patients with metastatic colon cancer and isolated non-resectable liver metastases receiving FOLFOXIRI.

Materials and methods. In this single-center non-randomized prospective study, we assessed the frequency of liver resections. According to the statistical hypothesis, the frequency of R0-resections in patients with metastatic colon cancer receiving FOLFOXIRI is between 11 % and 33 % (mean 20 %); to increase it up to 50 % in patients with isolated metastatic lesions in the liver, we had to recruit 20 patients (with β = 0.9 and a = 0.05). We enrolled 20 patients with potentially resectable metastases and 22 patients with non-resectable metastases. The primary endpoint was the frequency of R0 liver resections; secondary endpoints included objective response rate, progression-free survival, overall survival, and tolerability of therapy. Patients receiving targeted therapy (according to the tumor mutation status) were also included in the study.

Results. Objective response was observed in 32 out of 42 patients (76 %) (in 17 out of 20 participants (85 %) with potentially resectable metastases), whereas progressive disease was registered in 2 patients (5 %). Radical resection of organs affected by metastasis was performed in 19 out of 42 patients (45 %): 15 out of 20 (75 %) in the group with potentially resectable metastases and 4 out of 22 (18 %) in the group with non-resectable metastasis (р <0.01). At a median follow-up of 11 months (range: 1–32 months), median progression-free survival was 10 months (95 % confidence interval (CI) 8.9–11.1), while median length of life was 34 months (95 % CI 21.3–46.7). Median overall survival was 34 months in patients that had undergone metastasectomy vs 19 months in patients that had no metastasectomy (hazard ratio 0.7; 95 % CI 0.01–0.70; p = 0.02).

Conclusions. FOLFOXIRI increased the frequency of metastasectomy in patients with potentially resectable liver metastases from colon cancer, which was associated with a pronounced increase in the length of life. 

Objective: to analyze intraoperative and postoperative complications in patients who underwent combination surgeries for advanced ovarian cancer.

Materials and methods. This retrospective study included patients that underwent primary or interval cytoreductive combination surgeries for advanced (grade III–IV) ovarian cancer at N. N. Blokhin National Medical Research Center of Oncology, Ministry of Health of Russia between 2000 and 2017.

Results. We analyzed medical records of 144 patients with grade III–IV ovarian cancer who underwent combination surgery at some stage of their treatment. Almost two-thirds of patients (64.8 %) had complete or optimal volume of surgery. Intraoperative complications were registered in 7 % of patients (n = 10), while postoperative complications were observed in 38.2 % of cases (n = 55). The postoperative death rate was 0.7 % (n = 1).

Conclusions. Higher frequency of complete and optimal cytoreduction, as well as acceptable level of intra- and postoperative complications confirm the need for combination surgeries in patients with advanced ovarian cancer. Aggressive surgical tactics should be used only in specialized cancer hospitals with the involvement of a multidisciplinary team that includes cancer surgeons and anesthesiologists in order to improve both short-term and long-term treatment outcomes in patients with advanced ovarian cancer.

Objective: to analyze functional surgical outcomes in patients with distal rectal cancer and their quality of life at different time-points postoperatively.

Materials and methods. This retrospective study included all patients with rectal cancer that underwent either abdominoanal resection of the rectum (with their sigmoid colon brought down into the anal canal) or low intraabdominal resection of the rectum with the formation of a mechanical coloanal anastomosis in Irkutsk Regional Oncology Dispensary between 1999 and 2012. Study participants were divided into two groups: the experimental group included patients who had low intraabdominal resection of the rectum, whereas the control group consisted of patients who had abdominoanal resection of the rectum. We evaluated 5-year survival and patients' quality of life (using the Wexner and FIQL scales).

Results. One year postoperatively, 17 patients (25 %) from the control group had unsatisfactory sphincter function (Wexner score 11–20). Sixty-three patients from the control group (95 %) reported fecal incontinence of varying severity. In the experimental group, 40 patients out of 88 (45 %) that survived during the first year had normal sphincter function. The remaining patients had solid stool incontinence or inability to retain feces for a long time (Wexner score <10).

Conclusions. Low resections of the rectum ensured better functional outcomes and patients' quality of life than abdominoanal resections of the rectum did. 

This article presents the experience of surgical management of pancreatic and colon metastases from kidney cancer, detected 10 years after nephrectomy. Atypical resection of the pancreas combined with right-sided hemicolectomy was performed. The postoperative period turned out uneventful. Histological examination showed that lesions of pancreas and colon were metastases from a clear renal cell carcinoma. Disease progression was noted 2 years after surgery. The patient received appropriate treatment and was alive for 14 years after surgery.

This article demonstrates the experience of successful treatment of a patient with locally advanced rectal cancer, who received a combined treatment with a non-standard course of chemoradiotherapy in hypofractionation mode according to a prolonged program. After the end of a course of chemoradiation received the complete clinical response of the tumor.