Background: Anastomotic leak rates after colorectal surgery remain high. In most left-sided colon and rectal resection surgeries, a circular stapler is utilized to create the primary bowel anastomosis. However, it remains unclear whether a relationship between circular stapler technology and anastomotic leak in left-sided colorectal surgery exists. Methods: A post-hoc analysis was conducted using a prospectively collected data set of patients from the 2017 European Society of Coloproctology snapshot audit who underwent elective left-sided resection (left hemicolectomy, sigmoid colectomy, or rectal resection) with a manual circular stapled anastomosis. Rates of anastomotic leak and unplanned intensive care unit stay in association with manual circular stapling were assessed. Patient-, disease-, geographical-, and surgeon-related factors as well as stapler brand were explored using multivariable regression models to identify predictors of adverse outcomes. Results: Across 3305 procedures, 8.0% of patients had an anastomotic leak and 2.1% had an unplanned intensive care unit stay. Independent predictors of anastomotic leak were male sex, minimal-access surgery converted to open surgery, and anastomosis height C11 (lower third rectum) (all P < 0.050). Independent predictors of unplanned intensive care unit stay were minimal-access surgery converted to open surgery and American Society of Anesthesiologists grade IV (all P < 0.050). Stapler device brand was not a predictor of anastomotic leak or unplanned intensive care unit stay in multivariable regression analysis. There were no differences in rates of anastomotic leak and unplanned intensive care unit stay according to stapler head diameter, geographical region, or surgeon experience. Conclusion: In patients undergoing left-sided bowel anastomosis, choice of manual circular stapler, in terms of manufacturer or head diameter, is not associated with rates of anastomotic leak and unplanned intensive care unit stay.

Ulcerative colitis (UC) is an inflammatory bowel disease that mainly affects young people. Colorectal cancer (CRC) is one of the UC complications. This review considers the epidemiology, risk factors, diagnosis and screening, and drug prevention of CRC in UC. Various treatment options for dysplasia and CRC associated with UC are described. Taking into account the lack of literature to standardize colorectal cancer treatment approaches (especially rectal cancer) for UC, further studies are warranted to evaluate both oncological and functional treatment outcomes.

Resection of “difficult” polyps is associated with high risks of intra- and postoperative complications. About 10 % of polyps are not amenable to endoscopic resection due to technical difficulties. Routinely, for the treatment of big size laterally spread tumors and early tumor of bowel segmental resections is used, which had a significantly higher risks of postoperative complications development. Hybrid laparoendoscopic surgery included a combination of laparoscopic and endoscopic technologies becomes a great opportunity to local bowel resection. This surgical procedure is accompanied by a minimal risk frequency of postoperative complications and the length of stay. In the two clinical cases we demonstrate techniques of hybrid laparoendoscopic surgery for “difficult” endoscopically unresectable polyps of the colon.

For now days we don’t have any guidelines for the treatment of synchronous and metachronous tumors of the upper and lower gastrointestinal tract. In this case report, we are talking about optimal treatment strategy in a patient with early gastric cancer, a neuroendocrine tumor of the sigmoid colon, and a locally advanced rectal cancer. The patient underwent laparoscopic gastrectomy and endoscopic excision of the early neuroendocrine tumor of the sigmoid colon. View of the local advanced rectal cancer patient underwent combined preoperative “sandwich” treatment with 2 courses of chemotherapy before a long course of chemoradiotherapy and 2 courses of chemotherapy after. The treatment was well tolerated. Ten weeks later, the patient gets surgical procedure: laparoscopic low anterior resection with loop colostomy followed by adjuvant chemotherapy. At the end of chemotherapy colostomy closure was done. The minimally invasive surgical treatment is safe and feasible in patients with synchronous malignancies of upper and lower gastrointestinal tract. Fast track rehabilitation and minimal surgical trauma ensure timely delivery of chemotherapy.

Fecal DNA testing is a noninvasive method recommended by professional medical societies for colorectal cancer screening in individuals with intermediate risk of the disease. Adenamatous and serrated lesions, as well as cancer, lead to exfoliation of cells containing neoplastic altered DNA which, in turn, can be detected with sensitive testing methods aimed at specific genetic and epigenetic biomarkers. Mt-sDNA test approved by the United States Food and Drug Administration in 2014 showed sensitivity of 92 % for detection of colorectal cancer which is much higher than sensitivity of fecal immunochemical test (74 %).

Objective: To assess the impact of mesorectal excision for upper rectal cancer on long-term treatment results.Materials and methods. 227 patients with upper rectal cancer in the period between January 2004 and December 2014 were analyzed. The study included patients over 18 years of age with upper rectal cancer, stage T2-4N0-2M0. The patients were divided into 2 groups: partial mesorectal excision (PME) and total mesorectal excision (TME).Results. 226 (99.6 %) of 227 patients underwent surgical treatment. PME was performed in 199 (85.4 %) patients, TME in 27 (14.6 %) patients. TME was significantly more often performed in patients with preoperative treatment (р = 0.03). Operative time did not differ significantly between the two groups (TME - 186 minutes and PME - 168 minutes; р = 0.34). Postoperative complications were observed in 12.3 % of cases with no significant differences between the groups (TME - 14.3 %, PME - 12.1 %; р = 0.68). Anastomotic failure was noted in 7.1 % of cases, all in the PME group. Median follow-up was 57 months. The number of deaths was 29 (12.8 %), in the PME group - 27 (13.6 %), and in the TME group - 2 (7.4 %) (р = 0.61). Local recurrences developed in 4 (2.2 %) patients of the PME group and none in TME group. Distant metastases were diagnosed in 2 patients (8 %) of the TME group and 23 patients (12.1 %) of the PME group (р = 0.509). Overall 5-year survival in the TME group was 79.6 %, in the PME group - 86.3 % (р = 0.463), and 5-year disease-free survival was 79.3 % and 86 %, respectively (р = 0.521).Conclusion. Multivariate analysis showed that the volume of mesorectal excision did not affect the rate of disease recurrence and disease-free survival in both groups.

Immunotherapy has improved the results of treatment of patients with metastatic colorectal cancer. According to literature, the most cancericidal effect revealed in a microsatellite instability high (MSI-H) tumors. In our case, PD-1/PD-L1/PD-L2 inhibitors (nivolumab) treatment for locally advanced MSI-H colon carcinoma with liver metastasis in 44-year-old patient resulted in tumor regression, so that R0 surgical procedure became possible. Computed tomography scan and pathology report showed complete response, in primary and metastatic tumors. As a result, this allowed to improve the quality of patient’s life.

Seborrheic keratosis is the most common benign tumor of the epidermis. Rarely the tumor develops in the perineal area and quite rarely is large. For the Leser-Trelat syndrome these tumors is a marker of a malignant disease even before the symptoms are appeared, as well as a manifestation of the paraneoplastic process. In our case report, a giant perianal seborrheic keratoma was the reason for the clinical examination of the patient and stomach cancer was detected. As a result, we demonstrated a successful experience of surgical treatment of seborrheic keratoma of the perianal area and determined an algorithm for the treatment of stomach cancer.

The study objective was to evaluate the impact of medical hospital volume on short-term colorectal cancer treatment results.Materials and methods. The retrospective study included 93 patients with colorectal cancer operated on by one surgeon at two medical centers in Moscow from 2018 to 2020: 32 patients of the first group were operated in tertiary medical center (N.I. Pirogov National Medical and Surgical Center) and 61 of the second group – in regional low volume hospital (Centrosoyuz Hospital). The endpoints of the study were the short-term outcomes: surgery duration, blood loss, postoperative hospital stay, intra- and postoperative complications, lymph node harvested and the quality of specimen.Results. Surgery duration as well as blood loss in two groups were similar (258 min vs 240 min, p = 0.47 and 100 ml and 100 ml, p = 0.89, accordingly). Hospital stay after surgery was significantly less in the first group (9 days vs 16 days, p <0.01). The frequency of postoperative complications of type I–II according to the Clavien–Dindo classification was higher in the first group (6/8 vs 1/8, p <0.05) but reoperations performed more in the second group due to III Clavien–Dindo complications (2/8 vs 7/8, p = 0.012). Grade 2–3 rectal cancer specimen quality was 94.7 % vs 77.8 %, p = 0.13 and harvested lymph nodes >12 was 71.9 % vs 78.7 %, p = 0.485 in first and second group, respectively.Conclusion. Hospital volume does not affect rectal cancer specimen quality, surgery duration and blood loss, if the surgical interventions are performed by one experienced surgeon but associated with the incidence of postoperative complications and the length of stay.

Лапароскопическая правосторонняя гемиколэктомия для пациентов онкологического профиля признана целесообразной в плане радикальности и воспроизводимой в техническом аспекте. Как показывает анализ литературы, данный вид оперативного вмешательства используется и у пациентов с неопухолевыми заболеваниями правой половины ободочной кишки. Ключевое звено этой операции — способ мобилизации правой половины ободочной кишки, соответственно, его выбор является определяющим техническим приемом для оперирующего хирурга. В большинстве источников литературы на данную тему медиолатеральный способ мобилизации правой половины ободочной кишки представлен как стандартный. В данном обзоре представлен каудокраниальный способ мобилизации правой половины ободочной кишки с точки зрения оперативной техники в исполнении различных авторов, непосредственные и отдаленные результаты лечения пациентов, оперированных с использованием данного доступа.

Myeloma is an oncological disease characterized by uncontrolled formation of plasma cells in the bone marrow leading to destruction of bone tissue and accompanied by anemia and kidney failure. Morbidity is 1–2 % among all malignant tumors. Specific antitumor therapy in conjunction with bone marrow transplant allows to achieve satisfactory long-term outcomes. It should be noted that during therapy various complications are quite common, as well as exacerbation of concomitant pathology which can transform into a competitive disease at any moment. A clinical observation of treatment of a patient with myeloma and diverticulosis of the colon complicated by acute diverticulitis with paracolic infiltrate formation is presented.

Aim The Enhanced Recovery After Surgery (ERAS (R)) Society guidelines aim to standardize perioperative care in colorectal surgery via 25 principles. We aimed to assess the variation in uptake of these principles across an international network of colorectal units. Method An online survey was circulated amongst European Society of Coloproctology members in 2019-2020. For each ERAS principle, respondents were asked to score how frequently the principle was implemented in their hospital, from 1 ('rarely') to 4 ('always'). Respondents were also asked to recall whether practice had changed since 2017. Subgroup analyses based on hospital characteristics were conducted. Results Of hospitals approached, 58% responded to the survey (195/335), with 296 individual responses (multiple responses were received from some hospitals). The majority were European (163/195, 83.6%). Overall, respondents indicated they 'most often' or 'always' adhered to most individual ERAS principles (18/25, 72%). Variability in the uptake of principles was reported, with universal uptake of some principles (e.g., prophylactic antibiotics; early mobilization) and inconsistency from 'rarely' to 'always' in others (e.g., no nasogastric intubation; no preoperative fasting and carbohydrate drinks). In alignment with 2018 ERAS guideline updates, adherence to principles for prehabilitation, managing anaemia and postoperative nutrition appears to have increased since 2017. Conclusions Uptake of ERAS principles varied across hospitals, and not all 25 principles were equally adhered to. Whilst some principles exhibited a high level of acceptance, others had a wide variability in uptake indicative of controversy or barriers to uptake. Further research into specific principles is required to improve ERAS implementation.

Background. The study aims to compare the functional outcomes and quality of life in patients having variant rectal reconstruction procedures after low anterior resection for cancer.Materials and methods. A prospective randomised controlled trial enrolled 90 patients who underwent total mesorectumectomy with formation of J-pouch (J-P), side-to-end (STE) or end-to-end (ETE) anastomoses.Results and discussion. We analysed 22 J-P, 30 STE and 38 ETE patients. For technical reasons, 26.6 % J-Ps were remodelled to other anastomoses. The neorectal sensory threshold, first and permanent defecation urges and maximal tolerated volume were higher in J-P at months 3–6–12 postoperatively.Severe low anterior resection syndrome events at post-surgery month 6 were significantly more frequent in the ETE vs. J-P and STE cohorts (21, 0 and 3.3 %, respectively, p < 0.05). Stool frequency was significantly lower in J-P vs. STE and ETE at months 3–6–12. Wexner score was 3, 5, 6 at month 6 (p < 0.05) and 0, 1, 1 at month 12 for J-P, STE and ETE, respectively (p > 0.05). Evacuatory dysfunction was present at month 6 in 59.1 J-P, 33.3 STE and 21.1 % ETE.Quality of life (FIQL) in J-P and STE was significantly higher vs. ETE anastomoses in the Lifestyle (3.21, 3.22 and 3.03, respectively, p < 0.05) and Coping (3.29, 3.21 and 2.95, respectively, p < 0.05) scales to month 12 postoperatively.Conclusion. The J-pouch formation after low anterior resection ameliorates anal continence at months 3–6 post-surgery, reduces low anterior resection syndrome and improves quality of life (FIQL). The ease of implementation and irrelevance of evacuatory dysfunction in side-to-end anastomosis make it a superior choice over end-to-end surgery.

Inflammatory myofibroblastic tumors are a group of rare mesenchymal tumors which were considered by some authors to be benign; however, with accumulation of experience in treatment of these tumors their capability for invasive growth and metastasis was identified. The literature review showed a small number of clinical cases with intraabdominal forms of inflammatory myofibroblastic tumors. Mostly these are patients with tumors of the liver, upper gastrointestinal tract, pancreatobiliary area, small and large intestines. It should be noted that the literature review didn’t present any cases of isolated tumors of the greater omentum, hence we’ve decided to present a detailed description of a clinical observation of a female patient with rare ALK-positive inflammatory myofibroblastic tumor of the greater omentum.

The aim of the study was to compare functional results prior to and following neoadjuvant chemoradiation therapy.Materials and methods. An analysis of the functional results of a prospective clinical study was carried out. The study included 90 patients who underwent low anterior rectal resection for cancer of the lower or middle ampullar rectum with T1-4aN0-2M0 using various reconstruction methods.Results and discussion. Group A included 22 patients with J-shaped reservoirs; group B — 30 patients with side-to-end anastomoses; group C — 38 patients with end-to-end anastomoses. Out of the total study group (n = 90), 43 patients underwent neoadjuvant chemoradiotherapy vs. 47 patients without any preoperative treatment. No statistically significant difference was observed in the frequency of applied reconstructive techniques (р = 0.725) and the incidence of postoperative complications (p = 0.103) in the groups with and without neoadjuvant chemoradiotherapy. The baseline scores of the Wexner scale and the results of anorectal manometry in the comparison groups were comparable (p > 0.05). However, upon completion of neoadjuvant chemoradiotherapy and during the period from the moment of surgery up to 12 months after the closure of preventive intestinal stomas, the functional results were less satisfactory in the group of patients having received neoadjuvant chemoradiotherapy (n = 43) with regard to the comparison group (n = 47). Nevertheless, a statistically significant difference in the results was observed from the end of neoadjuvant chemoradiotherapy up to 3 months after closure of the stoma (p <0.05).Conclusions. Neoadjuvant chemoradiation therapy has a negative effect on the function of the anal sphincter, thus requiring concomitant therapy and physiotherapy both at the stages of neoadjuvant chemoradiotherapy and at long intervals after the main surgical stage.

The aim of the study was to compare functional results prior to and following neoadjuvant chemoradiation therapy. Materials and methods . An analysis of the functional results of a prospective clinical study was carried out. The study included 90 patients who underwent low anterior rectal resection for cancer of the lower or middle ampullar rectum with T1-4aN0-2M0 using various reconstruction methods. Results and discussion . Group A included 22 patients with J-shaped reservoirs; group B — 30 patients with side-to-end anastomoses; group C — 38 patients with end-to-end anastomoses. Out of the total study group (n = 90), 43 patients underwent neoadjuvant chemoradiotherapy vs. 47 patients without any preoperative treatment. No statistically significant difference was observed in the frequency of applied reconstructive techniques (р = 0.725) and the incidence of postoperative complications (p = 0.103) in the groups with and without neoadjuvant chemoradiotherapy. The baseline scores of the Wexner scale and the results of anorectal manometry in the comparison groups were comparable (p > 0.05). However, upon completion of neoadjuvant chemoradiotherapy and during the period from the moment of surgery up to 12 months after the closure of preventive intestinal stomas, the functional results were less satisfactory in the group of patients having received neoadjuvant chemoradiotherapy (n = 43) with regard to the comparison group (n =  47). Nevertheless, a statistically significant difference in the results was observed from the end of neoadjuvant chemoradiotherapy up to 3 months after closure of the stoma (p <0.05). Conclusions . Neoadjuvant chemoradiation therapy has a negative effect on the function of the anal sphincter, thus requiring concomitant therapy and physiotherapy both at the stages of neoadjuvant chemoradiotherapy and at long intervals after the main surgical stage.

OBJECTIVE To compare functional outcomes of various rectal reconstruction after total mesorectal excision. MATERIAL AND METHODS A prospective randomized trial included 90 patients with mid-to-low rectal carcinoma who underwent total mesorectal excision. RESULTS There were 22 patients after J-pouch surgery, 30 patients with side-to-end anastomoses and 38 patients with end-to-end anastomoses. Eight patients (26.6%) required conversion of J-P to E-E (7 patients) and S-E (1) anastomosis for technical reasons. Postoperative morbidity was similar (13.6, 16.7 and 34.2% in J-P, S-E and E-E groups, respectively, p=0.705). Sensory threshold, earliest and constant defecation urge and maximal tolerable volume were higher for J-P surgery within 3-6-12 months after surgery. Stool frequency was significantly lower after J-P surgery compared to S-E and E-E anastomoses within 3-6-12 months. Wexner scores were 3, 5, 6 after 6 months (p<0.05) and 0, 1, 1 after 12 months for J-P, S-E and E-E, respectively (p>0.05). Evacuation dysfunction was observed in 59.1% with J-P, 33.3% with S-E and 21.1% with E-E anastomoses in 6 months after stoma closure. CONCLUSION J-pouch reconstruction demonstrates higher neorectal volume that ensures reduced stool frequency up to 12 months after stoma closure. However, technical challenges of J-pouch surgery and evacuation dysfunction restrain application of this procedure in clinical practice.

Background: compare results of surgical and combined treatment of upper rectal cancer (URC) patients.

Lynch syndrome was synonymous with hereditary non-polyposis colorectal cancer for a long time, however, mapping of the DNA mismatch repair (MMR) genes has led to distinguish Lynch syndrome as an independent syndromic unit from a number of Lynch-like syndromes that phenotypically mimic with the most frequent hereditary variant of colon cancer but genetically representing quite a heterogeneous group. This article presents up to date clinical and genetic characteristics of Lynch syndrome and Lynch-like conditions.