Introduction. Pancreatic cancer is a disease with a severely unfavorable prognosis. In the majority of patients, tumors are initially unresectable. The most common complication of this pathology is chronic pain syndrome. The traditional method of its treatment is opioid analgesics. However, adverse effects of this treatment and negative effects on psychological and emotional state of the patients require the search for alternative methods of pain management, one of which is celiac plexus neurolysis.

Aim. To evaluate the effectiveness of celiac plexus neurolysis in patients with unresectable pancreatic cancer.

Materials and methods. The retrospective study included patients with unresectable pancreatic cancer complicated by chronic pain syndrome who underwent celiac plexus neurolysis between 2007 and 2010. The following parameters were evaluated: the effect of pain management according to the visual Analogue Scale (VAS), frequency in requirement for repeat neurolysis sessions, development of complications, as well as effectiveness and preservation of analgesic effect 8 weeks after the procedure (evaluated as preservation of significant difference compared to the baseline pain level per VAS). The quality of life of patients who underwent transcutaneous neurolysis was evaluated using the Russian version of the medical Outcomes Study-Short form-36 (MOS-Sf-36) questionnaire.

Results. The study included 12 patients. In 9 (75 %) patients, analgesic effect was observed after 1 neurolysis session. A repeat session was required for 3 (25 %) patients. Side effects of neurolysis were not observed in any of the patients. Evaluation of the quality of life was performed using the MOS-Sf-36 questionnaire. mean score of the general health scale prior to neurolysis was 41.6 ± 0.4; 1 month after the procedure it was significantly higher: 73.2 ± 0.6. On the men tal health scale, mean score after neurolysis increased from 34.8 ± 0.9 to 83.1 ± 0.9. Additionally, differences between values per the vAS scale before and after the procedure were statistically significant (р <0.01).

Conclusion. Our study confirmed the safety and effectiveness of different methods of neurolysis in treatment of chronic pain syndrome in patients with unresectable pancreatic cancer.

Background. microsatellite instability (MSI) is a prognostic marker of survival in many malignant diseases and show resistance to chemotherapy at early stages of colorectal cancer and show no benefits from chemotherapy at early stages of colorectal cancer. However, the role of MSI in resectable gastric cancer (GC) remains unknown.

Aim. To study the results of treatment of resectable gastric cancer with microsatellite instability.

Materials and methods. The study included 286 patients with resectable gC who received treatment at the N. N. Blokhin national medical Research Center of Oncology. All patients underwent PCR testing for MSI-H in 5 markers (BAT25, BAT26, NR21, NR24, NR27). Tumor regression grades (TRG) were evaluated according to the mandard tumour regression score, including disease-free survival and overall survival.

Results. MSI indicated in 27 cases (9.44 %) out of 286 resectable gastric cancer. In group patients who received only surgical treatment, 2-year disease-free survival in patients with MSI-H was 77.80 % versus 88.29 % in MSS patients (hazard ratio (HR) 1.82, 95 % confidence interval (CI) 0.37–8.82, p = 0.45), 2-year overall survival in patients with MSI-H was 88.90 % versus 95.36 % in MSS patients (HR 2.03, 95 % CI 0.20–19.8, p = 0.54). In patients who received perioperative chemotherapy, 28.57 % (4 / 14) had progression in MSI-H tumor versus 3.61 % (6 / 166) in MSS tumor (p <0.001). In group patients who received treatment combined with chemotherapy, 2-year disease-free survival in patients with MSI-H was 59.60 % versus 67.36 % (HR 1.96, CI 95 % 0.88–4.35, p = 0.09), 2-year overall survival in patients with MSI-H was 67.30 % versus 85.86 % in MSS patients (HR 1.86, 95 % CI 0.64–5.41, p = 0.25)

Conclusion. MSI-H is not a favorable prognosis factor in patients with resectable GC who are treated surgically combined with chemotherapy. The prevalence of progression in patients with MSI-H-status is higher than MSS-status with perioperative chemotherapy (FLOT / FOLFIRINOX).

Background. The gastritis-like form of primary non-Hodgkin’s lymphomas (NHL) of the stomach is the rarest macroscopic variant of malignant neoplasms of the stomach, endoscopically resembling inflammatory changes in the mucous membrane and, in single observations, polypoid and flatly elevated forms of neuroendocrine tumors (NET) of the stomach. Despite the great experience gained in the diagnosis and treatment of primary NHL of the stomach and NET of the stomach, in clinical practice there are examples that cause difficulties in the correct interpretation of the endoscopic picture and the timely diagnosis.

Aims. To analyze the data of a comprehensive endoscopic examination of patients with diagnoses of a gastritis-like form of primary NHL and NET of the stomach, and to identify the main differentially significant endoscopic criteria characteristic of each individual type of neoplasia.

Materials and methods. In a prospective study conducted at the FSBI “N.N. Blokhin national medical Research Center of Oncology” of the ministry of Health of Russia in the period from 2017 to 2022, data from endoscopic and morphological studies of 69 patients with gastritis-like malignancies were analyzed. All patients underwent a comprehensive endoscopic examination of the upper gastrointestinal tract – esophagogastroduodenoscopy using all clarifying examination methods (narrow-spectrum mode, examination in magnification mode, a combination of narrow-spectrum examination with magnification mode), accompanied by the taking of biopsy material for the purpose of morphological verification of the diagnosis, and endosonographic study.

Results. According to the results of a morphological study, the diagnosis of primary NHL of the stomach was confirmed in 38 patients (55.1 %), NET of the stomach – in 31 patients (44.9 %). A change in diagnosis based on the results of a morphological study occurred in 3 (4.3 %) of 69 (100 %) patients. The sensitivity and diagnostic accuracy of complex endoscopic examination were higher compared to endoscopic examination in white light mode, and amounted to 92.11, 95.65 and 13.16 %, 52.17 %, respectively.

Conclusion. for a correct assessment of the endoscopic picture, it is necessary to conduct a comprehensive endoscopic examination using all clarifying diagnostic methods, which shows greater sensitivity and specificity compared to examination in white light mode.

Introduction: Surgical site infections (SSI) are one of the key problems in surgical practice. Despite the achievements of modern medicine, ongoing preventive measures, the incidence of wound infection remains quite high. This is especially relevant for oncoplastic surgery, since in most cases the installation of foreign materials (expanders, implants, meshes) is required to achieve a satisfactory cosmetic result.

The purpose of the study: to identify the most common cause of infectious complications after reconstructive operations on the mammary gland using endoprostheses.

Materials and methods: In a retrospective review of 526 consecutive implant-based breast reconstructions at a single institution from June 2020 to June 2022 was conducted. The frequency of development of infectious complications was assessed, as well as the taxonomic structure of the main pathogens that were isolated in the department of oncomammology in 2020–2022.

Results: The incidence of infectious complications that led to the loss of the endoprosthesis during reconstructive surgery on the mammary gland was 6.7 %. The main causative agents of SSI leading to the loss of implants and the need for reoperations were Corynebacterium striatum (35.2 %) and Staphylococcus aureus (27.2 %). The spectrum of the most common pathogens that led to the loss of implants corresponded to the flora most often detected during bacterial culture in the department. The probability of implant loss was higher in the group of patients who underwent chemotherapy (14 of 197, 7.1 %) or chemoradiotherapy (14 of 188, 7.4 %) compared with patients who did not receive specific anticancer treatment (7 of 141, 4.9 %). However, taking patients who did not receive drug or radiation treatment as a reference group, statistical significance could not be achieved (p = 0.56 in the chemotherapy group and p = 0.49 in the chemoradiotherapy group).

Conclusions: Our own experience has shown that, despite the current preventive measures, the frequency of infectious complications remains quite high. In the etiological structure of SSI pathogens, microorganisms of the genera Staphylococcus and Corynebacterium predominate. The use of broad-spectrum antibiotics in perioperative prophylaxis did not guarantee the absence of SSI in the postoperative period. An analysis of the sensitivity of isolated pathogens to antibacterial drugs, an assessment of the effectiveness of various antibiotic regimens in the future may allow us to develop an optimal antibiotic prophylaxis scheme for infectious complications during breast reconstructive surgery, therefore, further prospective studies in this direction are needed.

Background. The need of neoadjuvant treatment for upper rectal cancer remains the object of discussion, which makes further study of this topic important.

Аim. To estimate the postoperative complications rate depending on the type of neoajuvant treatment.

Materials and methods. A retrospective cohort multicenter study, that analyzed data of medical records of patients with upper rectal cancer from the archive of N.N. Blokhin Cancer Research Center of the ministry of Health of Russia, Ryzhikh national medical Research Center of Coloproctology of the ministry of Health of Russia and Stavropol Regional Clinical Oncology Center for 2007–2020. Patients were devided into 3 groups: the group of radiotherapy (5*5 gy), the group of neoadjuvant chemotherapy (4 courses of XELOX before surgery) and the group of surgery. The main endpoint was the study of anastomotic leak rate. Also we estimated the postoperative complications rate III–Iv degree (Clavien– Dindo), the sphincter-preserving surgery rate, the stoma creation rate, the postoperative mortality.

Results. we included 110 patients in radiotherapy group, 188 patients in neoadjuvant chemotherapy group, 103 patients in surgery group. Study groups were comparable by sex, ASA status and histological grade. Postoperative grade III– Iv complications (in all cases were associated with anastomotic leak) developed in 8 (6.8 %) patients in neoadjuvant chemotherapy group versus 11 (10.0 %) patients in radiotherapy group (p = 0.379) and 12 (11.7 %) patients in surgery group (p = 0.208). There weren»t any significant differences in this parameter between the radiotherapy and the surgery group (p = 0.698). R0-resection was performed in 117 (99.2 %) patients in neoadjuvant chemotherapy group versus 107 (97.3 %) patients in radiotherapy group (p = 0.280) and 103 patients (100 %) in surgery group (p = 0.349). Radiotherapy and surgery groups didn’t differ significantly in R0-resection rate (p = 0.091). 1 patient (0.84 %) in neoadjuvant chemotherapy died before surgery, in other groups there weren’t any lethal outcomes (p = 0.283). Only the male sex, had a statistically significant effect on the anastomotic leak rate (risk ratio (HR) 2.875; 95 % confidence interval (CI) 1.24–6.63; p = 0.003).

Conclusions. A study of these case histories of patients with cancer of the upper ampullary rectum, conducted by us, showed that neoadjuvant treatment didn»t affect the postoperative complications rate.

The formation of intestinal stoma is performed during routine and emergency operations. This review provides a brief historical overview of the main stages of development of methods colo- and ileostomy. The article presents indications, as well as possible complications that may happen during operative treatment. It is occurred that there is little evidentiary material of colo- or ileostomy in evaluating complications that are associated with the various surgical methods of intestinal stoma formation. The purpose of this review is to summarize the current data on stoma formation and determine the method to use.

Background. The high frequency of frailty and sarcopenia in patients with cancer led to the development of «prehabilitation» concept. multimodal prehabilitation includes physical training, nutritional and psychological support before anticancer treatment.

Aim. we aim to present the results of treatment of a patient with frailty and severe sarcopenia who underwent a multimodal prehabilitation program before surgery for colorectal cancer.

Materials and methods. A 81-year-old woman with colon cancer was diagnosed with frailty and severe sarcopenia. The patient underwent a multimodal prehabilitation for 12 days prior to surgery, which included nutritional and psychological support as well as a supervised physical exercise program based on nordic walking.

Results. The patient gained weight. Also, she increased grip strength and gait speed. The postoperative period went uneventfully and the patient was discharged home 7 days after surgery.

Conclusions. multimodal prehabilitation is a potentially beneficial option in sarcopenic patients with frailty and colon cancer who need surgery.