The development of new treatment options gradually brings metastatic colon cancer closer to a chronic disease that can last for years. One of such options is trifluridine / tipiracil (FTD / TPI, TAS-102), a new chemotherapeutic agent, which has already been registered in more than 60 countries. It increases patients’ survival and has an acceptable toxicity profile (adverse events primarily include hematological complications). This literature review aims to cover various aspects related to this new drug, including its pharmacokinetics, maximum tole rated dose, possibility of its use in patients with liver disorders, results of its simultaneous use with targeted therapy, comparison with other therapeutic approaches in patients with chemorefractory metastatic rectal cancer, etc.

Background. Video-assisted anal fistula treatment (VAAFT) is a new minimally invasive sphincter-sparing technology.

Objective: to describe technical characteristics of VAAFT and evaluate short-term outcomes.

Materials and methods. We used a specialized surgical video system (VAAFT®; Karl Storz) for the treatment of complex high rectal fistulas. This technology allows a surgeon to use a special fistuloscope to perform visual examination of the fistula, find its internal opening, and detect secondary fistula passages and inflows. In addition to visual inspection, it is possible to simultaneously conduct a cytological brush through the working channel of the endoscope in order to clear the fistula from detritus and desquamate lining mucosa, and then perform fistula ablation using a monopolar electrode. The internal opening of the fistula can be either closed by a flap or sutured using a linear stapling device or closed using an endoscopic clip with additional sealing of the suture line with biological glue.

Results. Between September 2017 and August 2019, a total of 112 patients underwent VAAFT® surgeries. Ninety-three patients (83 %) were followed up for 6 months postoperatively. We observed no significant complications during the follow-up period. The majority of study participants (85 %) did not experience severe pain (>2–4 points on a visual-analog scale) in the early postoperative period. Primary healing was achieved in 98 patients (87.5 %) within 2–3 months. Eighty-nine individuals (79.5 %) were followed up for more than 1 year. Rectal fistula healing within 1 year after VAAFT® surgery was observed in 82 % of patients.

Conclusions. The main advantage of the VAAFT® technique is the combination of the diagnostic stage for fistula visualization and identification of the internal opening with the possibility of simultaneous surgical treatment.

Objective: comparative assessment of long-term oncological results of laparoscopic extralevator and traditional abdominal-perineal resection (APR).

Materials and methods. The analysis of immediate and long-term oncological results of treatment of 92 patients who underwent traditional laparoscopic and extralevator APR for low rectal cancer. Inclusion criteria were tumors of the lower ampullar rectum, excluding the performance of sphincter-sparing surgical interventions, and patients’ age up to 75 years. Exclusion criteria: distant metastases, histologically confirmed squamous cell carcinoma. Analysis of immediate and long-term results was carried out.

Results. The main group included patients who underwent extralevator APR (n = 62), patients in the control group (n = 30) underwent traditional APR. There were no significant differences in the type of neoadjuvant and adjuvant treatment in the comparison groups (p >0.05). In the group of patients operated on in the volume of extralevator APR, 42 received neoadjuvant chemoradiotherapy versus 19 patients in the group of traditional APR, there was no statistically significant difference (p = 0.21). In the extralevator APR group, perineal plastic surgery was performed significantly more often than in the traditional APR group (p = 0.001). When evaluating the immediate results, there was a statistically significant difference in the total number of complications between the study groups, such complications as bladder dysfunction following after surgery, inflammatory pelvic disease in the perineal wound, perineal hernia occurred significantly more often in the traditional APR group than in the extralevator APR group (p >0.05). In terms of overall and disease-free survival, the groups differed statistically significantly: 5-year overall survival in the main group was 90 % versus 62.5 % in the control group (p = 0.03), 5-year disease-free survival in the main group was 98.5 % versus 65 % in the control group, respectively (p = 0.01).

Conclusions. Extralevator APR of the rectum is the most radical surgical intervention than with the traditional APR technique due to the lower risk of a positive circumferention resection margin, therefore, reducing the incidence of local recurrence, and as a result, improving overall and disease-free survival rates compared to the traditional technique.

Objective: to evaluate the efficacy of combination therapy in patients with stage сT3N0M0 and сT2–3N1–2M0 distal rectal cancer during a short course of neoadjuvant thermoradiotherapy compared to radiotherapy or surgical treatment alone.

Materials and methods. A total of 166 patients received 3 sessions of local microwave hyperthermia (LMH) at a temperature of 43–45 °C for 60 minutes during a short course of radiotherapy (LMH + CT); 138 patients received combination treatment (CT) using preoperative radiotherapy alone; 197 patients received surgical treatment (ST) only.

Results. In patients receiving LMH + CT, overall incidence of complications was 38.6 % and did not significantly differ from that in patients receiving ST (p = 0.8464) and CT (p = 0.5383). We observed no significant differences in the severity of postoperative complications (according to the Clavien–Dindo classification) between the three groups of study participants treated using different regimens. The incidence of relapses was 6 % in the LMH + CT group vs 17.3 % in the ST group (p <0.0011) and 10.9 % in the CT group (p = 0.1258). Relapse-free survival rates were significantly higher in patients receiving LMH + CT than in patients who had ST alone: 59.4 % vs 51 % (p = 0.04). Difference in relapse-free survival between the CT and ST groups was not significant (56.5 % vs 51 %, respectively, p = 0.07). The frequency of therapeutic pathomorphosis was significantly higher (p <0.00001) in the LMH + CT group than in the CT group (14.9 % and 1.5 %, respectively).

Conclusions. LMH has a universal radiosensitizing potential that can increase tumor radiosensitivity and improve treatment outcomes.

Objective: a retrospective analysis of association of the tumor stage of stromal cell ovarian tumors with the frequency of recurrence and development of metastases in lymph nodes.

Materials and methods. 473 patients with stromal cell ovarian tumors with various histological types were examined, and long-term treatment results were evaluated.

Results. The highest recurrence rate (more than 80 %) was observed in stages II, III and IV. The frequency of development of metastases in the lymph nodes was highest in patients with stromal cell ovarian tumors of III–IV stages (50 %); however, in more than 40 % of cases of metastases in the lymph nodes was developed in patients with stromal cell ovarian tumors of IА, IВ, IС stages. The remaining 10 % of cases were in patients with stromal cell ovarian tumors of II stage. In patients with I stage without lymphadenectomy, metastases in the lymph nodes was developed in 21 % cases.

Conclusions. The high frequency of lymph node metastasis in patients with stromal cell ovarian tumors is a risk factor, which had to be evaluated to develop surgical treatment tactics.

The aim of this literature review was to a highlight the basic concepts of artificial intelligence in medicine, focusing on the application of this area of technological development in changes of surgery. PubMed and Google searches were performed using the key words “artificial intelligence”, “surgery”. Further references were obtained by cross-referencing the key articles.

The integration of artificial intelligence into surgical practice will take place in the field of education, storage and processing of medical data and the speed of implementation will be in direct proportion to the cost of labor and the need for “transparency” of statistical data.

The preferred method in detection and staging of chronic radiation proctitis is colonoscopy. Moreover, endoscopy is used widely in treating patients with this disease. The main goal of endoscopic techniques is hemostasis and elimination of vascular transformations. This includes formalin application, band ligation, various types of laser irradiation, bipolar coagulation and cryotherapy. However, these methods are associated with relatively high risk of complications, whereas argon plasma coagulation and radiofrequency ablation are effective, relatively safe techniques for chronic radiation proctitis and well tolerated by patients.

Combination of neoadjuvant chemoradiotherapy with subsequent total mesorectum excision and 6-months of adjuvant chemotherapy remains a standard approach to treatment of locally advanced rectal cancer (T3 or T4 and / or N1–3; M0) for more than 15 years, which is reflected in practical guidelines of most leading oncological societies. However, recent data suggests possibilities of more individualized treatment conceptions with a potential of further improvement of long-term therapy outcomes and patient’s quality of life. In this paper we present review of results of clinical trials which investigated new approaches to treatment of locally advanced rectal cancer.

Transrectal ultrasound (TRUS) is inexpensive and simple method for examining the rectum and surrounding tissues. In particular it is used to preoperatively assess stage, in patients with rectal cancer. By using TRUS is possible to analyze the neoplasm extent, depth of tumor invasion into the layers of the colon wall, the mesorectal lymph node involvement and the circumferential resection margin. This method is comparable to an expensive magnetic resonance imaging scan, and if done correctly could even exceed it. The correct diagnosis, especially in the early stages of the disease, plays an important role in choosing surgical treatment in future. However, to interpret the results, you must be familiar with the anatomy of the rectum and anal canal, as well as follow the simple rules for the preparation and implementation of TRUS. If you follow all the rules, you can answer the question about the possibility of performing organ-preserving surgery and compliance with cancer radicalism.