Malignant tumors have long occupied a special place in medicine and many researchers in different areas focused their attention on these disorders. Particular attention should be paid to gastrointestinal tumors with colon cancer being the most common among them. Moreover, the incidence of colon cancer is constantly growing. Despite the extensive experience in surgical treatment for colon cancer, we are still in search for new optimal methods that can increase overall and relapse-free survival without increasing the incidence of intra- and post-operative complications that are always associated with the volume of surgery. Recently, there has been a stable trend towards organ-sparing techniques. Segmental resections have become widely used in patients with localized cancer of the left colon and are now considered as an alternative to traditional left hemicolectomy. These two techniques demonstrated no significant differences in long-term outcomes. Then segmental resections became widely used in patients with localized tumors of the right colon and middle third of the transverse colon. These surgeries demonstrated their efficacy and good long-term outcomes. As for caecal cancer, the literature on this subject is too scant to make any conclusions about the rationality and feasibility of ileocecal resections. This implies that the utility of the method and its potential implications should be evaluated in further studies, including prospective ones that will compare both short-term and long-term outcomes. This literature review analyzes anatomical and physiological characteristics of right and left colon tumors, outlines generally accepted standards of lymphadenectomy, and summarizes the information on novel surgical techniques for colorectal cancer.

The article presents a clinical case of a prolonged course of gastrointestinal ulcer disease, followed by dysphagia. During the examination, severe hyperparathyroidism was revealed, which subsequently prompted a diagnostic search for a parathyroid adenoma, which is the cause of hyperathyroidism in 8085% of cases. With instrumental methods of research, the cause of the main complaint is dysphagia, a formation in the posterior upper mediastinum up to 5 cm, compressing the esophagus. With transoesophageal aspiration biopsy (EUS-TYPE). The cytological picture is similar to the thyroid epithelium with part of the oncocytic differentiation. In an immunological study, lavage for parathyroid hormone showed high expression. Scintigraphy with Tc-99m pertechnetate revealed the exact topic of the formation of the parathyroid gland in the posterior mediastinum an atypical location. Surgical treatment was performed in the amount of thoracoscopic removal of the mediastinal tumor. The radical nature of the surgical intervention was confirmed by laboratory. Serum PTH levels decreased significantly. Upon receipt of the morphological conclusion, reliable data on malignant damage to the parathyroid gland were obtained. Subsequent treatment of the patient consisted in the correction of severe hypercalcemia in the postoperative period by prescribing denosumab, which led to the stabilization of the patients condition.

Представлен клинический случай длительного течения язвенной болезни желудочно-кишечного тракта с последующим проявлением дисфагии. В ходе обследования у пациента выявлен тяжелый гиперпаратиреоз, что натолкнуло на диагностический поиск аденомы околощитовидной железы, которая является причиной гиперпатиреоза в 80–85% случаев. Инструментальными методами исследования выявлено, что причиной основной жалобы – дисфагии – явилось образование в заднем верхнем средостении до 5 см, сдавливающее пищевод. При транспищеводной аспирационной биопсии: цитологическая картина, сходная с тиреоидным эпителием с частью онкоцитарной дифференцировки. При иммунологическом исследовании смыва на паратиреоидный гормон выявлена высокая экспрессия исследуемого показателя. Сцинтиграфия с 99m Тс-пертехнетатом выявила точную топику образования околощитовидной железы в заднем средостении – атипичное расположение. Проведено хирургическое лечение в объеме торакоскопического удаления опухоли средостения. Радикальность оперативного вмешательства подтверждена лабораторно. Уровень паратиреоидного гормона в сыворотке крови значительно снизился. При морфологическом заключении получены достоверные данные о злокачественном поражении околощитовидной железы. Последующее лечение пациента заключалось в коррекции тяжелой гиперкальциемии в послеоперационном периоде путем назначения деносумаба, что привело к стабилизации состояния.

The article presents a rare case report about the use of thoracoscopic transdiaphragmatic approach to resection of a solitary segment VIII metastasis in the liver (1.5 × 1.2 cm). Taking into account the difficulty of laparoscopic resection of postero ‑superior segments of the liver, a decision was made to refrain from laparotomy and to perform a safe minimally invasive surgery using an approach, which is rare at the current stage. The article also presents the analysis of published literature and discussion of a non‑ standard approach in this clinical case.

Введение. Детекция диссеминированных опухолевых клеток (ДОК) при солидных опухолях является важной составляющей оценки прогноза заболевания. Поражение костного мозга наблюдается часто. Существуют данные, указывающие на важную роль субпопуляций лимфоцитов костного мозга в процессах гематогенного метастазирования. Цель. Оценить частоту поражения костного мозга у больных немелкоклеточным раком легкого (НМРЛ) на основании обнаружения ДОК методом проточной цитометрии, а также их влияние на популяции лимфоцитов костного мозга. Материалы и методы. Исследовали 62 образца костного мозга больных с верифицированным диагнозом НМРЛ: аденокарцинома (33), плоскоклеточный рак (27), другие виды (2). Методы: морфологический, многоцветная проточная цитометрия. Изучены ДОК, популяции лимфоцитов CD3, CD4, CD8, CD19/CD20, CD16, CD27. Сбор и анализ: FACS Canto II, США, программа Kaluza Analysis v2.1. Результаты. В костном мозге ДОК (EPCAM+CD45-) были обнаружены у 43,5% пациентов c НМРЛ (в качестве порогового значения приняли 1 клетку на 10 млн миелокариоцитов). Наличие ДОК не коррелировало с размером опухоли, статусом лимфоузлов, стадией опухолевого процесса. ДОК чаще наблюдались при более дифференцированных опухолях ( р =0,023). Выявлено достоверное повышение уровня субпопуляций CD16+CD4-NK-клеток ( р =0,002), CD27+CD3+Т-клеток ( р =0,015) при поражении костного мозга. Заключение. Установлена возможность детекции ДОК в костном мозге больных НМРЛ, у 43,5% больных НМРЛ в костном мозге выявлены ДОК, при этом их наличие установлено даже при локализованном опухолевом процессе. Более частое поражение костного мозга наблюдалось при высокодифференцированных опухолях. Выявлена взаимосвязь между ДОК и костномозговыми популяциями лимфоцитов: субпопуляции CD16+CD4-, CD27+CD3+.

Introduction.Detection of disseminated tumor cells (DTC) in solid tumors is an important component of the assessment of disease prognosis. Bone marrow damage is common. There is evidence indicating an important role for bone marrow lymphocyte subpopulations in hematogenous metastasis. Aim.To evaluate the frequency of bone marrow damage in patients with non-small cell lung cancer (NSCLC) based on the detection of DTC by flow cytometry, as well as their effect on the population of bone marrow lymphocytes. Materials and methods.62 bone marrow samples of patients with a verified diagnosis of NSCLC: adenocarcinoma (33), squamous cell carcinoma (27), other types (2). Methods: morphological, multicolor flow cytometry. Studied DTC, lymphocyte populations CD3, CD4, CD8, CD19, CD20, CD16, CD27. Collection and analysis: FACS Canto II, USA, Kaluza Analysis v2.1. Results.In bone marrow, DTC (EPCAM+CD45-) were found in 43.5% of patients with NSCLC (1 cell per 10 million myelocariоcytes was taken as the threshold value). The presence of DTC did not correlate with the size of the tumor, the status of the lymph nodes, and the stage of the tumor process. DTC was more often observed in more differentiated tumors (p=0.023). A significant increase in the level of subpopulations of CD16+CD4-NK-cells (p=0.002), CD27+CD3+T-cells (p=0.015) with bone marrow damage was revealed. Conclusion.The possibility of detecting DTC in the bone marrow of patients with NSCLC was established, in 43.5% of patients with NSCLC in the bone marrow DTC was detected, and their presence was established even with a localized tumor process. More frequent bone marrow damage was observed with well-differentiated tumors. The relationship between DTC and bone marrow lymphocyte populations was revealed: subpopulations of CD16+CD4-, CD27+CD3+.

The article presents a rare case report about the use of thoracoscopic transdiaphragmatic approach to resection of a solitary segment VIII metastasis in the liver (1.5 × 1.2 cm). Taking into account the difficulty of laparoscopic resection of postero ‑superior segments of the liver, a decision was made to refrain from laparotomy and to perform a safe minimally invasive surgery using an approach, which is rare at the current stage. The article also presents the analysis of published literature and discussion of a non‑ standard approach in this clinical case.

The training module was developed by the staff of the department under the leadership of the head. Department of Academician of RAS, Professor I.V. Poddubnoy and Rector of FSBEI DPO RMANPO of the Ministry of Health of Russia, Corr. RAS, Professor D.A. Sychev.

Учебный модуль разработан коллективом кафедры под руководством зав. кафедрой академика РАН, профессора И.В. Поддубной и ректора ФГБОУ ДПО РМАНПО Минздрава России, чл.-кор. РАН, профессора Д.А. Сычева.

The aim of this study was to evaluate the effect of the chemoradiation therapy on the incidence of postoperative complications and mortality rate in patients with locally advanced tumors of the thoracic esophagus. The study included men and women over 18 with histologically verified squamous cell carcinoma of the thoracic esophagus with TNM stage cT3-4aN0-3M0. Patients were divided into two groups: patients in a main group (n=26) received a complex treatment, patients in a second group (n=30) undergoing only surgical treatment. The first stage of treatment was performed for all 26 patients and included 2 courses of preoperative chemotherapy, followed by a chemoradiation therapy with a 44–46 Gy with weekly injections of chemotherapy. Surgical procedure (R0) was performed for 24 patients (92.3 %) in the main group and for 26 (86.6 %) in a second group. Therapeutic complications were developed in 17 (65 %) patients in a first group, while in a second group this rate was in 18 (60 %) patients from 30. The incidence of surgical complications was slightly higher in a group of patients received a complex treatment – 7 (26.92 %) patients. In the surgical group such complications was  noted in 6 (20 %) patients. The only death in an early postoperative period was in 1 (3.84 %) patient from the main group. The cause was sepsis and the development of multiple organic failure. There were no lethal outcomes in a surgical group. Estimating the incidence of complications, it should be noted that the use of chemoradiation therapy in the neoadjuvant regimen does not significantly affect the course of the postoperative period. The mortality rate was slightly higher in in the group of patients received complex treatment. At the same time, improvement of the ostoperative period and a reduction of mortality rate in group of patients undergoing complex treatment is possible due to  optimization of preoperative preparation, postoperative management and competent selection of patients.

Introduction: Nowadays the stereotactic radiotherapy (SRT) of clinical stage I-II lung cancer patients is the choice of the treatment modality for functionally inoperable patients. It shows safety and high efficiency in achieving local control. Though there is a range of unsolved issues connected with the prediction of the treatment efficiency and frequency of complications, an integration of new technologies in the planning and treatment process allows widening the search of the predictive factors. Material and methods. Since 2014, 39 patients (17 T1N0M0 patients, 22 T2N0M0 patients) with clinical stage I-IIa lung cancer have undergone SRT. The majority of patients (35) have been recognized as functionally inoperable due to the concurrent broncho-pulmonary pathology, 4 conditionally operable patients have refused an operation. 11 patients had the primary multiple tumors in their anamneses. 36 patients had a peripheral tumor. The options for the fractionation were: 10 Gy × 5 fractions (n = 26) and 7 Gy × 8 fractions (n = 13) - BED = 100 Gy. Results. The median follow-up was 26 months (range: 3-38 months). The 2-year local control was 94%. The isolated local recurrences were not registered. Overall and 2-year recurrence-free survival rate was 84% (95% CI, 70-99) and 83.2% (95% CI: 70.5-99) respectively. During the first year, 4 patients (10%) had the locoregional and distant progression and 3 of them died. 7 patients had experienced pulmonary toxicity of grade 2 or more. One patient with central tumor died from pulmonary hemorrhage (toxicity of grade 5). Grade 3 chest pain was observed in 2 patients, one of them had a rib fracture. One-factor analysis, revealed a reliable influence of the fractionation regimen (р = 0.04) and, close to reliability, the initial SUVmax level (р = 0.07) on the prognosis. A reliable relationship between the radiation toxicity level and dosimetric radiation index (V10, V5, MLD) was not registered. There was a tendency to reliable correlation with the total lung capacity indices (р = 0.058). Conclusions. A search for additional treatment efficiency and toxicity predictors of SRT treatment should include modern approaches to planning and delivery. The total dose delivery regimen and initial tumor SUVmax can be predictive efficiency factors, while the pulmonary tissue volume can be a predictive toxicity factor.

At the present time, a small group of patients with oligometastases (who have a solitary metastatic lesion in another organ along with the primary tumour of the lung) is differentiated among the patients with metastatic lung cancer. A total of 14 patients of the study citied in this article underwent a comprehensive treatment of oligometastatic non-small cell lung cancer (ONSCLC), which included systemic therapy and local influence on solitary metastasis. The median overall survival for this group was 20 months (16.0–32.6, CI 95%). The 1-year and 2-year overall survival rates accounted for 84.5 and 65.7%, respectively. The findings of the study demonstrate the possibilities of an aggressive approach to the treatment of patients with ONLDLC.

Background: Thymomas are very rare malignances, with an estimated incidence of 0.15 cases per 100.000. Metastases of Thymoma are usually involved the pleura, pericardium or diaphragm, whereas the probability of extrathoracic metastases are extremely low. Success in the treatment of thymomas mainly depends on the radicalism of the performed operation. Materials and methods: Since 2008 33 Thoracoscopic Thymectomies were performed in the thoracic department of the N.N.Blokhin Russian Cancer Research Center. The right-sided approach was in 23 (69,7%) patients, 7 (21,2%) operated on the left and 3 (9,1%) patients had combined approach. We include 26 patients with similar characteristics of the primary tumor operated from sternotomy approach to compare direct and long-term results of surgical treatment. Results: Thoracoscopic approach in comparison with sternotomy in surgical treatment of non-invasive Thymomas significantly reduces the incidence of postoperative therapeutic complications (p < 0.01). There was a decrease in the frequency of postoperative surgical complications (p = 0.08). Conclusion: Thoracoscopic thymectomy in comparison with thymectomy from open surgical approach contributes to a significant decrease in the length of patients' stay in the intensive care unit and hospital, and the duration of analgesia with narcotic analgesics in the postoperative period. All of the above factors contribute to shorter periods of functional recovery of patients and a full return to a normal lifestyle.

At the present time, a small group of patients with oligometastases (who have a solitary metastatic lesion in another organ along with the primary tumour of the lung) is differentiated among the patients with metastatic lung cancer. A total of 14 patients of the study citied in this article underwent a comprehensive treatment of oligometastatic non-small cell lung cancer (ONSCLC), which included systemic therapy and local influence on solitary metastasis. The median overall survival for this group was 20 months (16.0–32.6, CI 95%). The 1-year and 2-year overall survival rates accounted for 84.5 and 65.7%, respectively. The findings of the study demonstrate the possibilities of an aggressive approach to the treatment of patients with ONLDLC.

BACKGROUND:A lot of clinics worldwide in recent years recommend the use of minimally invasive surgical procedures in the early stages of lung cancer claiming that this technique helps reduce the number of postoperative complications, shortens the period of social rehabilitation of patients, without significantly affecting the long-term results of treatment. In this study we evaluate immediate and long-term results of surgical treatment of patients with early stages of non-small cell lung cancer (NSCLC) after video-assisted thoracoscopic lobectomy (VATS) with mediastinal lymph node dissection. MATERIALS AND METHODS:Since 2008 317 patients with T1-2N0M0 NSCLC over 20 (median age was 65.3 ± 2.5) years underwent VATS with mediastinal lymphadenectomy. Total number of men was 186 (58.7%), women - 131 (41.3%). Histologically verified adenocarcinoma was in 278 (87, 7%), Squamous cell carcinoma in 39 (12.3%). A group of patients who underwent thoracotomy lobectomy (n = 189) was taken to compare immediate and long-term results. Median age in this group was 66.5 ± 1.7. Total number of men was 115, women - 74. Histologically verified adenocarcinoma was in 154 (82.4%), Squamous cell carcinoma in 35 (17.6%). RESULTS:Conversion to thoracotomy during VATS was in 14.3% of surgeries. There was no postoperative mortality in VATS group, whereas in open surgeries this happened in 2.6%. The 3 and 5-year overall survival (OS) rate was 94.0% and 94.0% in the VATS group respectively, 83.0% and 78.0% in the thoracotomy group for clinical stage T1N0M0 NSCLC (p = 0.04554). CONCLUSION:Considering the results of our research and the literature review we made sure that VATS lobectomy with mediastinal lymph node dissection is an alternative procedure to open approaches: it is much safer, reduce the frequency of post-operative complications and the rehabilitation period. We believe that complete VATS lobectomy with mediastinal lymph node dissection must be taken as a standard in surgical treatment of patients with early stages of non-small cell lung cancer.

Surgical treatment of metastatic colorectal cancer in lungs is a relatively new trend of modern oncology. In this connection, still there are no clearly formulated criteria for patient selection for this type of intervention, approaches to repeated resections and scope of the surgical operation in case of multiple lesions. Established key prognostic factors include lesion of intrathoracic lymph nodes, timing of the development of metastatic disease, baseline level of carcinoembryonic antigen, number of foci and the volume of metastatic lesion, stage of the disease. Options for surgical access include lateral thoracotomy, sternotomy, thoracoscopy and thoracoscopy combined with additional minithoracotomy.If a patient has a single peripheral metastatic lesions, physician should prefer thoracoscopic operations. One of their advantages include minimum development of adhesions and possibility of subsequent re-thoracoscopy. Resection of pulmonary metastases from colorectal cancer (R0 resection rate) allows to achieve persistent healing of the tumor process in a significant number of patients.

Surgical treatment of metastatic colorectal cancer in lungs is a relatively new trend of modern oncology. In this connection, still there are no clearly formulated criteria for patient selection for this type of intervention, approaches to repeated resections and scope of the surgical operation in case of multiple lesions. Established key prognostic factors include lesion of intrathoracic lymph nodes, timing of the development of metastatic disease, baseline level of carcinoembryonic antigen, number of foci and the volume of metastatic lesion, stage of the disease. Options for surgical access include lateral thoracotomy, sternotomy, thoracoscopy and thoracoscopy combined with additional minithoracotomy. If a patient has a single peripheral metastatic lesions, physician should prefer thoracoscopic operations. One of their advantages include minimum development of adhesions and possibility of subsequent re-thoracoscopy. Resection of pulmonary metastases from colorectal cancer (R0 resection rate) allows to achieve persistent healing of the tumor process in a significant number of patients.

The paper describes a clinical case of successful treatment in a female patient with disseminated rectal cancer by minimally invasive technologies that could perform one-stage simultaneous intervention into the rectum and lung, which promoted rapid patient rehabilitation and reduced systemic chemotherapy initiation time.