Introductio n. 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.

Currently, with duodenal tumor lesion (duodenum), the possibility of performing economical operations that significantly improve the immediate results and quality of life of patients is increasingly being considered as an alternative to gastropancreatoduodenal resection. using the example of clinical observation, the article presents a new type of economical surgical intervention – duodenectomy with preservation of the peripapillary flap. The operation was performed in a patient with cancer of the resected stomach with a low spread of the tumor along the wall of the duodenum. At the control examination 9 months after the operation, the patient’s condition is satisfactory, without signs of impaired biliodynamics and passage of food through the intestinal tube. The proposed method differs from the existing prototype (papilloservative duodenectomy) by preserving the peripapillary flap of the duodenal wall.The insertion into the jejunum of not the fater papilla, but the surrounding wall of the duodenum eliminates its deformation and violation of patency and provides greater reliability of the formed suture, and the preservation of the small duodenal papilla with an additional pancreatic duct of Santorini can help reduce the frequency of postoperative pancreatitis and pancreonecrosis. In addition to cases of low lesions of the duodenum in gastric cancer, the method can be used in patients with non-epithelial and neuroendocrine tumors, as well as in secondary tumor invasion of the duodenum from the outside. The criterion limiting the performance of this type of operation is the distance from the edge of the tumor to the fater papilla less than 2.0–2.5 cm.Duodenectomy with preservation of the peripapillary flap can be considered as a way to improve the safety and quality of life in the surgical treatment of patients with a tumor lesion of the duodenum.

OBJECTIVE:To evaluate the early outcomes of radical surgical treatment of patients with resectable periampullary tumors and previous acute pancreatitis (AP).MATERIAL AND METHODS:A retrospective analysis included 9 patients. AP was diagnosed in all patients at different times of preoperative period (post-manipulative AP in 7 cases, alcoholic AP in 2 cases). Pancreaticoduodenectomy was performed in 5 patients, total pancreatectomy (TP) - in 4 patients.RESULTS:Severe postoperative complications occurred in 3 patients after pancreaticoduodenectomy. There were no complications after TP. All complications after pancreaticoduodenectomy were associated with a pancreatic stump that required urgent surgical interventions. Three patients died from surgical complications. All postoperative deaths were observed after pancreaticoduodenectomy.CONCLUSION:TP may be a safer surgical option compared to pancreaticoduodenectomy in patients with resectable periampiullary tumors and preoperative AP.

Представлен анализ публикаций, посвященных результатам повторных циторедуктивных операций при раке яичников, и собственный опыт выполнения данных вмешательств. Обсуждаются показания к выполнению повторных циторедуктивных операций и их результаты, прогностические модели, позволяющие оценить возможность выполнения полной повторной циторедукции. По данным ретроспективных исследований, повторные циторедуктивные операции увеличивают продолжительность жизни части больных с рецидивами рака яичников. Результаты единственного завершенного рандомизированного исследования неоднозначны. Критериями отбора кандидатов для этих вмешательств являются платино-чувствительный рецидив, наличие перспектив для дальнейшей химиотерапии, наличие одной или нескольких рецидивных опухолей. Повторная циторедуктивная операция целесообразна только при удалении всех макроскопически определяемых опухолей.

AIM:To present early and remote surgical outcomes in patients with locally-advanced right-sided colonic cancer, invasion of pancreatic head and/or duodenal wall.MATERIAL AND METHODS:Early and remote surgical outcomes were analyzed in 27 patients who underwent gastropancreatoduodenectomy combined with right-sided hemicolectomy (ileotransversostomy extirpation) for locally-advanced right-sided colonic cancer.RESULTS:Mean time of surgery was 300 (240-460) minutes, intraoperative blood loss - 2000 (500-7200) ml. Postoperative complications were observed in 15 (55.6%) patients. 3 (11.1%) patients died in early postoperative period. Overall 1-, 3- and 5-year survival was 92.7%, 48% and 36,5% respectively. Median was 33 months.CONCLUSION:Advanced combined surgery for locally-advanced right-sided colonic cancer, invasion of pancreatic head and/or duodenal wall is associated with acceptable incidence of postoperative complications, early and long-term mortality.

Aim: To investigate the impact of time of performance of delayed orchiectomy on overall survival of patients with advanced germ cell tumors of testicle who didn’t undergo surgery before starting of treatment. Materials and methods: From 1986 to 2010 in the department of clinical pharmacology and chemotherapy 71 (4,8%) of 1486 patients underwent delayed orchiectomy. During the first course of chemotherapy (1st group) 39 (55%) patients underwent surgery, 21 (29,6%) patients - during 2nd -4th courses (2nd group), after the ending of chemotherapy – 11 (15,5%) patients (3rd group). Results: Final histological investigation of the specimens revealed viable germ cell tumor in 25 (64,1%) patients in the 1st  group, in 10 (47,7%) patients in the 2nd group and no viable tumor in the 3rd group. Conclusion: Performance of orchiectomy simultaneously with the removal of the other sites of the tumor after chemotherapy doesn’t impair survival.

Aim: To investigate the impact of time of performance of delayed orchiectomy on overall survival of patients with advanced germ cell tumors of testicle who didn't undergo surgery before starting of treatment. Materials and methods: From 1986 to 2010 in the department of clinical pharmacology and chemotherapy 71 (4,8%) of 1486 patients underwent delayed orchiectomy. During the first course of chemotherapy (1st group) 39 (55%) patients underwent surgery, 21 (29,6%) patients - during 2nd -4th courses (2nd group), after the ending of chemotherapy – 11 (15,5%) patients (3rd group). Results: Final histological investigation of the specimens revealed viable germ cell tumor in 25 (64,1%) patients in the 1st group, in 10 (47,7%) patients in the 2nd group and no viable tumor in the 3rd group. Conclusion: Performance of orchiectomy simultaneously with the removal of the other sites of the tumor after chemotherapy doesn't impair survival.

The results of treatment were studied in 95 patients with local recurrences of uterine sarcomas, who had been treated at the N.N. Blokhin Russian Cancer Research Center in 1972 to 2010. Two patient groups were comparatively analyzed after surgical and conservative (chemo- and radiotherapy) treatments. Overall survival was found to be significantly higher in the group of patients who had undergone surgical treatment.

The results of treatment were studied in 95 patients with local recurrences of uterine sarcomas, who had been treated at the N.N. Blokhin Russian Cancer Research Center in 1972 to 2010. Two patient groups were comparatively analyzed after surgical and conservative (chemo- and radiotherapy) treatments. Overall survival was found to be significantly higher in the group of patients who had undergone surgical treatment.

The first stage in the treatment of disseminated germinogenic ovarian tumours (HOT) is induction chemotherapy in accordance with the IGCCCG prognosis group. Dynamic observation is indicated in case of incomplete induction in patients with seminoma excepting those with PET-positive residual tumours bigger than 3 cm to whom second-line chemotherapy or retroperitoneal lymphadenectomy is indicated. Ablation of residual tumour of any localization is indicated to patients with disseminated non-seminoma HOT (NHOT), incomplete induction, and negative level of tumour markers. The necessity of adjuvant chemotherapy in case of a viable malignant HOT in the removed tissues remains debatable. Refractory and recurring HOT are usually treated with a combination of fosfamide and vinblastine. Residual tumours need to be removed after salvation chemotherapy. Surgical treatment is the preferred option for the management of late NHOT relapses.

Data of 5 patients, who required resection and prosthetics of abdominal aorta during radical excision of malignant retroperitoneal lesions, were analyzed. Therefore, 2 patients demonstrated retroperitoneal lymph node metastases of nonseminoma hermonogenous tumour, 1 patient had colorectal liver and lymph node metastases, another had ovarian tumor, and the rest--leiomyosarcoma of the aorta. Tubular Gore-tex aortic prostheses were used. Radical tumor excision provided absence of local recurrence in all patients. Only one patient showed further progression of the tumor as liver metastases. Thus, such an aggressive surgical approach could be appropriate in carefully selected group of patients.

As high as 40% of patients have locally advanced pelvic tumors without distant metastases and many of them have previously undergone radical treatment. The only possible treatment for these patients is combined and expanded surgery.Subjects and methods: In 1996 to 2004, a total of 38 patients with locally advanced pelvic tumors involving the bladder underwent different types of evisceration at the Department of Radiosurgery, Russian Cancer Research Center. There were internal fistulas in 18 cases. Total evisceration was performed in 4 (10.5%) patients, subtotal supralevator evisceration in 25 (65.8%), subtotal infralevator evisceration in 3 (7.9%), and frontal evisceration in 6 (15.8%) patients. Thirty-one (81.6%) patients underwent ureteral reconstruction without ureterostomy; normal stool restored in 35 (92.1%) patients.Results: One (2.6%) patient died intraoperatively. Twenty-eight patients had postoperative complications that needed resurgery in 12 cases. Three patients with the single-stage ileal orthitopic bladder reported that they had a fair urinary retention. One patient complained about nocturnal urinary incontinence. Stool retention was fair in all cases.Conclusion: Careful selection of patients, comprehensive preoperative preparation, and improved surgical performance will reduce the incidence of postoperative complications.

The experience of CRC in the treatment of advanced germ cell tumors is reported. The analysis of factors influencing prognosis and treatment tactics is carried out. Contemporary conception of advanced germ cell tumors treatment implies the initial use of platinum based chemotherapy. After completion of chemotherapy, surgical removal of residual tumor (retroperitoneal and mediastinal lymph nodes, lung and liver metastases) carries diagnostic and curative means. Such approach allows curing 50-90% of patients depending on prognostic factors. Results of induction chemotherapy for relapses of germ cell tumors are presented separately. Treatment of this condition comprises chemotherapy with inclusion of ifosfamid or taxanes with following cytoreductive surgery. This modality allows long term remission in the fourth of patients with relapse of germ cell tumors.

The experience of CRC in the treatment of advanced germ cell tumors is reported. The analysis of factors influencing prognosis and treatment tactics is carried out. Contemporary conception of advanced germ cell tumors treatment implies the initial use of platinum based chemotherapy. After completion of chemotherapy, surgical removal of residual tumor (retroperitoneal and mediastinal lymph nodes, lung and liver metastases) carries diagnostic and curative means. Such approach allows curing 50-90% of patients depending on prognostic factors. Results of induction chemotherapy for relapses of germ cell tumors are presented separately. Treatment of this condition comprises chemotherapy with inclusion of ifosfamid or taxanes with following cytoreductive surgery. This modality allows long term remission in the fourth of patients with relapse of germ cell tumors.

The paper summarizes CRC experience in the treatment of patients with advanced germ cell tumors using up-to-date chemotherapy regimens. Therapy of 600 patients is analyzed with respect to several clinical factors such as tumor histology, location of the primary and metastases, levels of tumor markers. Postchemotherapy cytoreduction surgery is demonstrated to be of much importance since definitive operations improve significantly the prognosis irrespective of residual tumor morphology. The paper also overviews results of treatment for recurrent disease.