Background. Radiofrequency ablation (RFA) of pancreatic NET up to 20 mm in size under endosonographic control (EUS) may become the method of choice in the treatment of this group of patients, as well as an option for analgesia in patients with locally advanced forms of pancreatic cancer.
Aim. Describe the RFA – EUS technique, evaluate the safety and efficacy of the RFA – EUS method in the treatment of NET of the pancreas, up to 2.0 cm in diameter, and ablation of the celiac plexus in a cohort of patients with locally advanced forms of pancreatic cancer in order to relieve pain.
Materials and Methods. In a prospective ongoing observational study conducted at the FSBI “N. N. Blokhin national Medical Research Center of Oncology” of the Ministry of Health of Russia from September 2022 to June 2023, data of 10 patients with resectable NET and unresectable malignant neoplasms of the pancreas were analyzed. The main method of treatment in 100 % of cases was RFA – EUS, performed for the first time in Russia. All patients at the first stage underwent esophagogastroduodenoscopy (EGDS) and endosonographic study with fine needle aspiration biopsy (EUS-TAB) to verify the diagnosis. At the second stage, all patients underwent RFA – EUS. The main evaluated parameter in the group of patients with NET was the absence of residual tumor tissue after RFA – EUS, according to Endo-US and MRI, the nature of changes in the pancreatic tissue after RFA was additionally assessed – fibrous or necrotic changes in the area of RFA – EUS. The main parameter evaluated in the group of patients with unresectable pancreatic cancer was the absence of pain within 8 weeks. and complete withdrawal from opioid analgesics 3–5 days after RFA – EUS.
Results. According to the results of a morphological study, the diagnosis of pancreatic NET was confirmed in 7 (70 %) patients, adenocarcinoma – in 3 (30 %). Technical success, defined as a complete endosonographic and radiological response 3 months after the intervention in the group of patients with pancreatic NET (n = 7; 70 %) and complete withdrawal of opioid analgesics at 3–5 days, with the preservation of the analgesic effect for 8 weeks. after RFA – EUS, was achieved in 100 % of cases (n = 3; 30 %). Return to opioid analgesics after 3 months RFA – EUS in the group of patients with adenocarcinoma of the pancreas (n = 3; 30 %) was noted in 20 % of cases (n = 2), which required re-intervention, in 10 % (n = 1) – it was not possible to estimate the duration of the analgesic effect due to the death of the patient 2 months after RFA – EUS, the median follow-up was 6 months.
Conclusion. The results of the study are the first experience of using RFA – EUS in the treatment of malignant neoplasms of the pancreas. EUS-guided RFA is an effective, minimally invasive and safe treatment for pancreatic NET, up to 2.0 cm in diameter, as well as an analgesic option for advanced pancreatic cancer. To determine the indications, contraindications and effectiveness of RFA in the radical and symptomatic treatment of malignant neoplasms of the pancreas, it is necessary to conduct large prospective multicenter studies.

The aim of the study was to conduct a comparative analysis of clinical and morphological data of patients of different age groups after emergency resection interventions for complicated colon cancer.
Materials and methods. The retrospective cohort study included 227 patients who underwent emergency operations for complicated colon cancer during the period from September 2016 to December 2022. Two groups of patients were selected: group 1 – under 60 years old, group 2–60 years old and older. In the 2nd group, 2 subgroups were selected: patients aged between 60 to 74 years and patients between 75 years and older. The primary point of the study was assessment of postoperative complications according to the Clavien–Dindo classification within 30 days after surgery. The secondary point was study of oncological adequacy of the operation.
Results. The study included 128 (56.4 %) women and 99 (43.6 %) men. The median age was 66 years. Forty seven (20.7 %) patients were included in the group of persons younger than 60 years; 180 (79.3 %) patients were included in the group 60 years and older. There were no differences between the groups by gender and tumor localization. Tumor perforation was more often recorded in group 2 (23.3 % and 4.3 %, p = 0.017). High comorbidity was also more often observed in group 2 (46.8 % and 100 %, p = 0.023). In group 2, the physical status mostly corresponded to ASA grade 3 and 4 (p = 0.031). The difference between the groups by T-status was revealed: in group 1, there were more cases of T2-T3 (76.6 % vs. 46.7 %), and in group 2 – of T4 (53.3 % vs. 23.4 %), p = 0.034. Most patients in group 1 had the pN2 status (68.1 %), however, the pN1 status prevailed in the 2^nd group (70 %). There were more oncologically inadequate operations in group 2: 54 (30 %) compared with group 1–2 (4.3 %) (p = 0.004). The main factors influencing the radicality of the performed operation were the type of urgent complication – tumor perforation (odds ratio (OR) 1.81, 95 % CI 1.43–3.96, p = 0.002); type of surgery (the Hartmann type surgery) (OR 1.62, 95 % CI 1.22–3.83, p <0.001); age OR 0.76, 95 % CI 0.54–1.33, p = 0.004); comorbidity (OR 0.61, 95 % CI 0.43–1.28, p = 0.02); physical status of patients according to ASA classification grade 3–4 at admission (OR 0.52, 95 % CI 0.30–1.49, p = 0.002); tumor localization (OR 0.43, 95 % CI 0.28–1.15, p = 0.011).
Conclusion. Emergency operations for complicated colon cancer are characterized by a high risk of serious postoperative complications, especially in elderly and senile patients. In patients younger than 60 years of age, the malignant tumors are often characterized by more aggressive course with damage to regional lymph nodes (N2 status).

Introduction. Colorectal cancer (CRC) is one of those cancer types which have many worldwide organized screening programs. Those screening programs help to reduce colorectal cancer morbidity and mortality.
Aim. To evaluate the results of screening colonoscopy with simultaneous removal of benign epithelial formations on an outpatient basis using “cold” methods, as well as its effectiveness in the prevention of CRC.
Materials and methods. A retrospective analysis of the results of colonoscopy in outpatient conditions performed at the N. I. Pirogov Government City Clinic (Orenburg) for the period 2018–2021 was performed. The study included indicators of screening colonoscopy performed in asymptomatic patients. The main evaluated parameters are: the type of polyp according to the Paris classification, the results of histological examination, the frequency of complications, as well as the quality indicators of colonoscopy (preparation according to the Boston scale, the time of removal of the device, adenoma detection rate (ADR), polyp detection rate (PDR)).
Results. A total of 4,588 screening colonoscopies were performed, frequency of adenomas detection – 35,3 %, 1,041 neoplasms were removed (of which 456 (44 %) neoplasms were removed with biopsy forceps, 585 (56 %) neoplasms were removed with a cold loop as a single block). In 622 (59,7 %) cases, the macroscopic form of neoplasms is type 0–IIa, in 326 (31.3 %) – type 0–Is, in 93 (9 %) – type IIa + IIc. According to the results of histological examination, the sessile type of structure was diagnosed in 158 (15.2 %) cases, non – sessile – in 883 (84.8 %). In 276 (26.5 %) cases, were detected adenomas with micro-foci of adenocarcinoma (tumor in situ). During the study period (2018–2021), one complication (0.09 %) of outpatient polypectomy by the “cold” method was observed. This complication was manifested by automatically stopped bleeding.
Conclusion. Screening colonoscopy is one of the most effective diagnostic methods to detect CRC in asymptomatic patients. The “cold” polypectomy method has an important role in the prevention of CRC, as it is a safe procedure which can be performed on an outpatient basis.

With an increase in the frequency of publication of clinical observations with synchronous neoplasms of different histological types, experience is accumulating in the diagnosis and treatment of this cohort of patients. new clinical guidelines and strategies for the treatment of patients with primary multiple neoplasms of the gastrointestinal tract are being developed. A significant number of identified cases of the development of minimally invasive laparoscopic and robotic surgical interventions for primary multiple neoplasms of the gastrointestinal tract, as well as an increasing number of studies demonstrating the integrity and safety of performing minimally invasive endoscopic intraluminal aids in small mesenchymal tumors. The clinical observation presents the data of patient 82 years old with benign schwannoma and adenocarcinoma of the transverse colon.

Non-organ cysts of mesothelial origin are one of the groups of cystic neoplasms with rare and difficult-to-diagnose pathology of the abdominal cavity and retroperitoneal space. Today, the etiological factors remain the subject of interdisciplinary discussions, their clinical manifestations are non-specific, and their differential diagnosis is diverse. Often, these neoplasms become accidentally detected during surgical interventions or during routine diagnostic examinations. Currently, there are no uniform standards or recommendations to treat such diseases, however, according to literature sources, there is a consensus that mesothelial cysts of the retroperitoneal space and abdominal cavity should be completely removed within healthy tissues. Today, modern medical achievements and accumulated long-term experience allow us to successfully diagnose and perform radical treatment for any localization of such neoplasms. We present our own experience from the clinical practice of successful surgical treatment of non-organ cysts of mesothelial origin.

Until recently, the prognosis of patients with advanced endometrial cancer remained disappointing despite the standard treatment methods. None of the drugs in the arsenal of oncologists-chemotherapists provided long-term disease control and long-term survival of patients who received standard platinum-containing first-line chemotherapy. It is obvious that the poor results of treatment in patients with advanced endometrial cancer required a change in treatment approaches and indicated the need to develop more effective treatment regimens. A deeper understanding of the mechanisms of carcinogenesis, the emergence of new molecular classification of endometrial cancer and division of treatment approaches depending on the tumor biological potential has led to significant breakthrough in the treatment of advanced endometrial cancer. One of the most significant achievements is discovery of the function of microsatellite instability (MSI) and disorders in the repair system of unpaired bases of deoxyribonucleic acid (MMR) as a predictor of high efficient immunotherapy – a new direction of systemic drug therapy for the advanced endometrial cancer. The paper presents a clinical case of successful treatment of MSI-h / dMMR-positive advanced endometrial cancer using pembrolizumab as a second-line therapy (in the presence of refractoriness to standard platinum-based chemotherapy of the 1st line) in a mono mode with a complete radiological response of the tumor to treatment.

Background. Splenosis, or heterotopic autotransplantation of spleen tissue, is a benign disease, occurring in patient after splenectomy. This formation demands correct differential diagnosis because it is often diagnosed as a tumor. Main methods of splenosis diagnosis are ultrasound inspection, CT, MRI, but detailed anamnesis is also important to set the correct diagnosis. The clinical case in this report is aimed to show importance of timely and correct diagnosis which will allow to avoid unnecessary invasive diagnostic procedures, late diagnosis and decreasing of medical assistance quality.
Clinical case. patient 61 y. o. is suspected on a tumor in left iliac region. He noted the trauma after falling on a back. The inspection was performed: CT of iliac region showed formation in the small intestines. Splenectomy was carried out 20 years ago. The patient is set to the clinical medical center “Medicinsky gorod” to a surgeon-oncologist. physical examination and laboratory analysis showed no pathological changes. CT of abdominal organs showed formation with regular edges. MRI of pelvic organs with contrast agent showed formation accumulating contrast irregularly. Control CT of abdominal organs showed no increasing of formation size.
Conclusion. Abdominal splenosis is a benign disease, occurring after spleen tissue implantation in the abdominal cavity after spleen trauma or splenectomy. Splenosis course is usually asymptomatic and it is often diagnoses as a peritoneal canceromatosis mistakenly. Splenosis has to be included in the differential diagnosis in patients with trauma or splenectomy in anamnesis.