Introduction. Despite the wide introduction of the principles of total mesorectumectomy and effective schemes of neoadjuvant chemoradiotherapy, the development of local recurrences of tumors of the rectum and female reproductive system remains a complex and unsolved surgical problem. The lack of a unified classification and algorithms for choosing the optimal volume of surgery are one of the reasons for unsatisfactory results of treatment of this group of diseases.The aim. To standardize the choice of surgery volume based on the proposed unified classification.Materials and Methods. The experience of surgical treatment of 108 patients with pelvic organ tumor recurrence (pOTR) is summarized in the article. Inclusion criteria: age 18 years and older, confirmation of the diagnosis of tumor recurrence of rectum, uterine body, cervix, ovaries by radiation methods of examination and histologically if the tumor was available for biopsy, the primary tumor was surgically removed with achievement of negative peripheral resection margin (R0), signed informed consent. Inclusion criteria: health status according to the Eastern Cooperative Oncology group (ECOg) 2 or more; distant visceral metastases and/or carcinomatosis of the peritoneum and pleura were diagnosed; complicated course of the tumor process was detected, which did not allow performing a planned surgical intervention.Results. According to the location of the primary tumor, the distribution was as follows: 66 patients with rectal cancer, 12 with cervical, 9 with uterine body and 21 with ovarian cancer. The sex distribution was as follows: 38 (35.1 %) – males and 70 (64.8 %) females. The median age was 63.0 (53.0; 70.0) years. The ECOg overall status was: 0 points in 44 (66.7 %) patients and 1 point in 64 (59.3 %) patients. The median duration of relapse-free period was 15.25 (6.2; 19.6) months. On the basis of the analysis of the nature and type of local tumor spreading, a classification was developed, distinguishing 8 types of recurrence: anterior-upper, anterior-lower, central, lower, posterior-upper, posterior-lower, lateral-left and lateral-right. The characteristics of the entire cohort of patients were analyzed to determine the extent of surgery appropriate for a particular type of recurrence or their combinations.

Objective: to evaluate alleles distribution of single nucleotide polymorphism 118A>G of μ1-opioid receptor (OPRM1) gene in patients with renal neoplasm and benign diseases.Materials and methods. 100 consecutive patients after renal surgeries retrospectively divided into groups with neoplasm (n = 29) and benign diseases (n = 71).Results. The incidence of renal neoplasm was much higher in homozygous 118A patients than in AG + GG group (36.4 % vs. 14.7 %; p = 0.035).Conclusion. Single nucleotide polymorphism 118A>G OPRM1 gene may be of value in genesis of renal neoplasm.

Background. In recent years, we observe technological and scientific growth in the field of medicine. It makes revise of existing ideas about certain pathological conditions. Such a serious complication of radiation treatment as fistulas of the pelvic organs is not excluded. All available classification of the post radiation fistulas of pelvic organs or consider them in the total mass of fistulas, specifying only the cause of occurrence, or even fall into the category of “others”. Moreover, the existing classifications do not reflect the medical tactics needed in each particular case. The study objective is to develop classification of radiation-induced fistulas of the lower pelvis which would assist with selection of the optimal treatment tactics. Materials and methods. This study analyzed the results of the examination and treatment of 82 cases of post-radiation pelvic fistula. Results and conclusion. Treatment of patients according to the proposed classification allowed to attain stable recovery in 92 % of cases.

Background. In recent years, we observe technological and scientific growth in the field of medicine. It makes revise of existing ideas about certain pathological conditions. Such a serious complication of radiation treatment as fistulas of the pelvic organs is not excluded. All available classification of the post radiation fistulas of pelvic organs or consider them in the total mass of fistulas, specifying only the cause of occurrence, or even fall into the category of "others". Moreover, the existing classifications do not reflect the medical tactics needed in each particular case. The study objective is to develop classification of radiation-induced fistulas of the lower pelvis which would assist with selection of the optimal treatment tactics. Materials and methods. This study analyzed the results of the examination and treatment of 82 cases of post-radiation pelvic fistula. Results and conclusion. Treatment of patients according to the proposed classification allowed to attain stable recovery in 92 % of cases.

The objective. To assess the effect of spinal analgesia on the oxygen status and the level of myocardial damage markers in patients with colorectal cancer operated by laparoscopic access. Subjects and methods. 60 patients with colorectal cancer operated under general anesthesia with laparoscopic access were divided into two groups. In group 1 (n=30) intraoperative analgesia was performed with fentanyl. In Group 2 (n=30) before the induction of general anesthesia was performed an intrathecal administration of 10.0-12.5 mg of bupivacaine and 200 mcg of morphine. In case of decreasing an MAP 65 mm Hg.V. a continue infusion of noradrenaline was began. The frequency of administration and the average dose of noradrenalin were estimated, as well as the levels of lactate, pH, BE, ScvO2, highly specific cardiac troponin I (hs-cTnI ) and NT-proBNP in the central venous blood. Results. The frequency of noradrenalin administration in group 2 was significantly higher compared to group 1 56.7% versus 26.7% (HR=2.1; 95% CI 0.86-4.16; p=0.036). Noradrenalin dose, the levels of lactate, pH, BE, ScvO2, hs-cTnI and NT-proBNP levels did not differ significantly in both groups at all stages of research. Conclusion. Spinal analgesia increases the frequency of noradrenalin administration but does not affect the oxygen status and the level of myocardial damage markers in patients with colorectal cancer operated by laparoscopic access.

The objective: to assess the efficiency of spinal analgesia as a part of anaesthesiologic support in laparoscopic colon surgeries within fast track programs. Subjects and methods: 60 patients who had laparoscopic colon surgeries within fast track programs were divided into 2 groups. In Group 1 ( n = 30), peri-operative analgesia was provided through intrathecal administration of 10.0–12.5 mg of bupivacaine and 200 mcg of morphine. In Group 2 ( n = 30), the systemic multi-modal analgesia was provided (nonsteroidal anti-inflammatory drugs, opioids). Results. The maximum intensity of pain at rest within 24 hours after surgery was assessed as 2 (2−3) scores as per the digital rating scale in Group 1 and 5 (4−6) scores in Group 2 ( p < 0.0001). The intensity of pain by the first verticalisation made 3 (2−5) scores in Group 1 and 6 (6−7) scores in Group 2 ( p < 0.0001). Intra-operative consumption of phentanyl, frequency of post-operative nausea, vomit and need for extra pain relief were much lower in Group 1. Conclusion. Intrathecal administration of 10.0−12.5 mg of bupivacaine and 200 mcg of morphine as a part of anaesthesiologic support in laparoscopic colon surgeries provides effective peri-operative analgesia and promotes the implementation of fast track programs in this type of interventions.

This article presents a clinical observation of the treatment of recurrent invasive urothelial cancer of the upper urinary tract using surgical and chemotherapy treatments. During the treatment, surgical treatment and 2 chemotherapy lines were performed. The patient was under strict dynamic control, during which diagnostic procedures were carried out, which allowed time to identify the progression of the underlying disease and prescribe timely treatment of identifi ed relapses.At the first stage, the patient underwent surgical radical treatment to remove the primary tumor focus localized in the lower third of the right ureter. At the control examination a local relapse was revealed. The 1st line of chemotherapy was prescribed and performed, against which the full effect of the treatment was noted. But in the future, the progression of the disease was revealed, which required the 2nd line of chemotherapy with preliminary surgical removal of a local relapse.

This work presents the results of performing intraoperative photodynamic therapy (IOPDT) on 22 patients with recurrent pelvic tumors(cervical cancer – in 18 patients, cancer of the corpus uteri – in 3 patients, cancer of the anal canal – in 1 patient). Prior to the PDT procedure, the patients were injected with photolon photosensitizer (PS) at a dose of 1.0–1.1 mg/kg. After the injection of PS, local fluorescence spectroscopy of tumor lesions was performed to determine the accumulation of drug in various areas of tumors and healthy tissue. Intraoperative laser irradiation was carried out 3–5 hours after the photolon injection with light at 662 nm wavelength using "Latus-2" laser device with a power density of 140 mW/cm2and the density of light energy of 40–60 J/cm2, the number of irradiation fields was 3–5 depending on the anatomical features.The follow-up period after surgical treatment combined with PDT was from 6 to 24 months. Analyzing the immediate results of the treatment, there were no undesirable events or increase in the number of postoperative complications compared to patients treated without IOPDT. Were registered: transient increase in ALT and AST levels – in 5 patients (13.6%), reduction of oxygenation during anesthesia – in 20 (90.9%), transient fevers in the postoperative period – in 7 (31.8%).It was noted that IOPDT with photolon drug, while slightly extending the time of the operation, is well tolerated by patients and does not lead to an increase in the number of early postoperative complications or the length of hospitalization.

45 Гастроинтестинальная стромальная опухоль (GIST) является редкой опухолью пищеварительной системы. Частота выявления GIST варьирует от 0,1 до 3% среди всех гастроинтестинальных злокачественных опухолей. В России ежегодно регистрируется 2000—2500 случаев GIST различной локализации. Одинаково часто болеют как мужчины, так и женщины. В 50% случаев GIST диагностируют на поздних стадиях развития в связи с отсутствием специфических симптомов и трудностью гистологической верификации опухоли. GIST относится к мезенхимальным опухолям. Развитие GIST происходит из клеток Кахаля, расположенных в интерстициальных нервных сплетениях и отвечающих за моторику ЖКТ. В большинстве случаев развитие GIST связано с мутациями протоонкогена с-KIT (70—85% мутаций), наиболее часто в экзонах 11 (75%), 9 (15%), 13 и 17 (2—5%) и в 5% случаев с мутацией в экзонах 18, 12 и 14 гена PDGFRα, кодирующего тирозинкиназный рецептор тромбоцитарного фактора роста [1—5]. В 10—15% встречается дикий тип GIST. Эти особенности необходимо учитывать при назначении ингибитора тирозинкиназ (иматиниба мезилат). Наиболее чувствительны к этому препарату опухоли с мутацией в экзонах 11 и 13 гена с-KIT, менее чувствительны при мутации в 9 экзоне гена с-KIT и нечувствительны при мутации в 18 экзоне гена PDGFRα. При диком типе GIST эффект от иматиниба мезилата наблюдается в 40% случаев (табл. 1) [1, 2, 6]. В подавляющем большинстве случаев GIST встречаются как солитарные опухоли различной локализации. GIST первично-множественной локализации встречается крайне редко (менее 1%) либо спорадически — как первично-множественная GIST без семейного опухолевого анамнеза, либо является проявлением наследственных синдромов. В зависимости от молекулярно-генетичеdoi: 10.17116/onkolog20176245-50

ДИФФЕРЕНЦИАЛЬНАЯ ДИАГНОСТИКА ОПУХОЛЕЙ ТАЗА У ЖЕНЩИН: ДВА МРТ НАБЛЮДЕНИЯ РЕДКИХ ЭКСТРАГЕНИТАЛЬНЫХ ТАЗОВЫХ ОБРАЗОВАНИЙБерезовская Т

Objective. To evaluate the effect of preserving proximal and distal segments of the prostatic urethra on functional and oncological outcomes retropubic prostatectomy.Patients and methods. 97 men who underwent radical prostatectomy were divided into two groups. The first group (n = 49) included patients with complete retention of the bladder neck and prostatic urethra segments followed urethro- urethral anastomosis. The control group (n = 48) included patients who have not been saved the bladder neck. Continence control produced by the method of monitoring the daily amount of urine in the pad.Social aspects and quality of life was assessed using conventional questionnaire. Radical surgery was evaluated by «negative surgical margin».Results. Within 1, 3, 6 and 12 months after surgery the average loss of urine control patients with respect to patients of the study group was 741.3 g vs. 218.3 g, 56.9 g and 16.5 g, 48.7 g, against 8.5 g and 35.6 g from 3.3 g, respectively (for each comparison, p < 0.05). The indicator of the quality of life of the patients of the first group on all end points was significantly higher than those of the second group. There were no significant differences betweenthe frequency of «positive margins» in patients in the control group and the group with a fully preserved bladder neck (5.8 % vs. 5.4 %, p = 0.65).Conclusions. Preservation of the bladder neck and proximal and distal segments of the prostatic urethra during radical prostatectomy significantly improved urinary function, and can achieve full satisfaction of quality of life in these patients compared with patients in the control group, subject to the necessary oncologic outcomes.

Results of treatment of 143 patients who underwent cystprostatectomy or anterior pelvic exenteration. A comparative analysis of two groups of patients whose operation ended with the traditional drainage through the anterior abdominal wall (n = 71), and bilateral perineal drainage (n = 72). Bilateral perineal drainage after operations on the pelvic organs, accompanied by cystectomy and extended lymphadenectomy in conjunction with the restoration of the peritoneum lateral pelvic walls, improves postoperative recovery of intestinal peristalsis, promotes an earlier reduction in the intensity of pain and morbidity in the early postoperative period. Installation is simple perineal drainage performed and safe procedure. We recommend bilateral perineal drainage after operations on the pelvic organs, accompanied by cystectomy and extended lymphadenectomy.

The data of 60 patients with metastatic kidney cancer involving the vertebrae who had undergone different-volume surgery were retrospectively analyzed. The role of surgical volume was assessed. In patients with solitary spinal metastases, their radical removal was found to lead to better quality of life and longer survival. Puncture vertebroplasty with bone cement in patients with spinal metastatic involvement permits one to avoid traumatic fixing operations, without reducing the median survival at the same time.

Analyzed the surgical treatment of 154 patients with locally advanced pelvic tumors that required resection of the bladder or its complete removal. 67 (43.5 %) patients had colorectal cancer. In 53 (34.4 %) cases of cervical cancer in 21 (13.7 %) - ovarian cancer, 8 (5.2 %) uterine cancer, in 5 (3.2 %) - a cancer of the vagina. In 41 (26.6 %) patients operation was accompanied by resection of the bladder, 113 (73.4 %) cases, the volume of surgery was pelvic exenteration.Proposed surgical classification of locally advanced pelvic tumors and secondary destruction of the bladder with locally advanced tumors. Describes the criteria of choosing the optimal amount of intervention at different propagation of the tumor and the degree of involvement of the bladder. The perspective of large interventions to improve the results of treatment of patients with tumors of the pelvic localization.

An analysis of surgical treatment of 154 patients with locally advanced and recurrent malignant tumors of the pelvic organs with secondary lesions of the bladder was performed. Described surgical technique used for resection and reconstructive stages of surgery. In 73.4 % of the volume of the intervention was complete or anterior pelvic exenteration. Morbidity after operations was 30.5 %, postoperative mortality — 7.8 %. The perspective of large-scale interventions to improve outcomes of patients with tumors of the pelvic localization is marked.

Background. How to derive urine is stemmed from removal of the bladder and from the necessity of its disengaging from the process of urination. Most surgeons prefer to do incontinent urine derivation in elderly and senile patients.Subjects and methods. In 2007 to 2009, the Leningrad Regional Oncology Dispensary treated 103 patients with diseases requiring the bladder be removed. All these patients underwent cystectomy as an independent operation or one of the surgical stages, followed by incontinent urine derivation described by Bricker. The patients were divided into 2 groups: 1) Bricker-type end-to-side ureteroileal anastomosis; 2) Wallace-type one. Group 1 comprised 50 patients: 37 (74 %) women and 13 (26 %) men; Group 2 included 53 patients: 48 (90.6 %) women and 5 (9.6 %) men. These were elderly and senile patients aged 60 to 79 years (mean age 65 ± 3.71).Results. In Group 1, 36 (72 %) patients were preoperatively diagnosed as having hydroureteronephrosis (HUN). Of them, 23 (64%) patients underwent preoperative percutaneous puncture nephrostomy (PPN). In Group 2, HUN was diagnosed in 43 (81 %) patients; of them 27 (63 %) had PPN. Complications and resurgeries were more common in Group 1 (p < 0.001). In Group 2, there were a larger number of cases of incompetence of the ureteroileal anastomosis. This complication required no surgical correction, but a longer drainage standing.Conclusion. The Bricker operation is the safest urine derivation in elderly and senile patients after surgery involving cystectomy. Wallacetype ureteroileal anastomosis during the Bricker operation is accompanied by a considerable reduction in the number of early and late postoperative complications and resurgeries. Wallace-type ureteroileal anastomosis is considered the method of choice in cancer patients.