AIM:To compare short-term outcomes after transanal total mesorectumectomy (Ta-TME) and laparoscopic (Lap-TME) procedure in 'difficult' patients.MATERIAL AND METHODS:Prospective nonrandomized trial included patients with confirmed middle-/low rectum adenocarcinoma T1-4aN0-2M0 for the period November 2013 - September 2016. We identified 20 out of 55 in TA-TME and 14 out of 54 patients in Lap-TME group as those of 'difficult' subgroup: male, BMI ≥25 кг/м2, previous chemoradiotherapy (CRT).RESULTS:Time of surgery, blood loss, conversions rate, postoperative morbidity and length of hospital-stay were similar in both groups. Hardware anastomoses were more frequent in TA-TME compared with LAP-TME group (78.9% vs. 50%, p=0.086). Specimen quality was more favorable in TA-TME group: Grade I 10% in Ta-TME group vs. 28.6% in Lap-TME group; 'positive' CRM 5% vs. 14.3%, р=0.365. Within-group analysis did not reveal any differences between 'difficult' and 'typical' patients by surgical and pathomorphological characteristics in TA-TME group in contrast to Lap-TME group. Median of follow-up was 24.6 (IR 10.6-40.2) and 23.8 (IR 12.1-39.9) months for TA-TME and Lap-TME groups, respectively. Local recurrence occurred in 1 (1.8%) 'difficult' patient after Ta-TME. Distant metastases were observed in 1 (1.8%) patient of Ta-TME and 2 (3.7%) patients of Lap-TME group. Actuarial 3-years reccurence-free survival was 95.7% for Ta-TME and 93.9% for Lap-TME group, respectively (p=0.923).CONCLUSION:TA-TME is advisable for 'difficult' patients. Further multicenter randomized trials are necessary to specify the effectiveness of TA-TME in these patients.

Objective: to analyze short-term and long-term outcomes of surgical, combination, and comprehensive treatment in patients with metastatic rectal cancer.Materials and methods. We performed a retrospective analysis of prospectively collected data on the outcomes of rectal cancer patients receiving surgical, combination (surgery + chemotherapy), or comprehensive (chemoradiotherapy + surgery + chemotherapy) treatment in the Department of Proctology at the N.N. Blokhin National Medical Research Center of Oncology, Ministry of Health of Russia, between 1999 and 2015. We assessed overall survival, frequency of postoperative complications, postoperative death rates and frequency of complications associated with chemoradiotherapy.Results. The study included 366patients that were divided into 3 groups according to the treatment strategy. The 2-year survival rate was 83 % in group 3 (comprehensive treatment) vs 40 % in groups 1 and 2. Median survival was 43 months in group 3 compared to 18 and 14 months in groups 2 and 1 respectively. The number of postoperative complications was 19 %, 13.4 %, and 15.1 % in groups 1, 2 and 3 respectively. There was one postoperative death (1.1 %) in group 3.Conclusion. Comprehensive treatment significantly improves overall survival of rectal cancer patients without increasing the risk of postoperative complications.

Objective: comparative analysis of specific perioperative features and pathological characteristics of the removed sample after laparoscopic total mesorectumectomy (Lap-TME) and transanal total mesorectumectomy (Ta-TME).Materials and methods. A prospective non-randomized controlled study was carried out from November 2013 until September 2016. Patients with сТ1–4aN0–2M0 cancer of low- or medium-ampullar section of rectum were enrolled.Results. 55 and 54 patients were included in the Ta-TME and Lap-TME groups respectively. Duration of surgery was 285 min (Ta-TME group) and 260 min (Lap-TME group); median volume of blood loss was less than 100 ml; duration of hospital stay after surgery was 7 days in both groups. 1 (1.8 %) patient from Ta-TME group and 3 (5.6 %) patients from the control group had conversion to open surgery (р = 0.223). Transanal removal of the sample was done in 53.7 % of the cases in Ta-TME group and 25.5 % of the cases in Lap-TME group (p = 0.008). Complications were registered in 27,3 and 24,1 % of the patients respectively (р = 0,436). 90.9 % of the patients from Ta-TME group had Grade 2–3 quality of mesorectumectomy, while in Lap-TME group this parameter was 85.2 % (p = 0.266). Circumferential resection margin damage was observed in 7.3 % of cases from Ta-TME group and 9.3 % of cases from Lap-TME group (p = 0.488).Conclusion. Ta-TME does not worsen short-term oncological results. Further randomized studies are required to identify those patients who would benefit from bottoms up mesorectumectomy.

The clinical observation demonstrates a successful surgical treatment of a 61-year-old female patient K. (body mass index 38.4) diagnosed with locally advanced sigmoid colon cancer protruded into the bladder and uterus (сT4bN2M0) with formation of a colovesical fistula. The patient underwent surgical treatment in the form of laparoscopic resection of the sigmoid colon and supralevator anterior pelvic exenteration with formation of a Bricker conduit. Intraoperative blood loss was 200 ml. Postoperative period was smooth, with fast track rehabilitation; the patient was discharged on day 9. Considering cancer stage, the patient received XELOX as adjuvant chemotherapy for 6 months after the surgery. During a year of follow-up, no signs of disease progression were evident. The patient is fully socially rehabilitated.

AIM To evaluate and compare intraoperative features, early surgical outcomes, quality of excised specimen after laparoscopic and transanal total mesorectal excision (LA-TME and TA-TME). MATERIAL AND METHODS Prospective randomized study included 45 patients with confirmed rectal adenocarcinoma (cT2-4N0-2M0) since October 2013. LA-TME and TA-TME groups consisted of 23 and 22 patients respectively. Inclusion criteria were patients with primary-operable rectal cancer and satisfactory response after neoadjuvant chemo- and radiotherapy. Both groups were comparable in stages of cancer, age and body mass index (BMI). Median length from anal edge was 6.5 cm and 7 cm in TA-TME and LA-TME groups respectively. There was significantly greater number of patients after chemo- and radiotherapy in TA-TME group (86% vs. 48%, p=0.006). RESULTS Surgery time was 305 and 320 minutes in LA-TME and TA-TME groups recpectively, median blood loss -- less than 100 ml. Mean hospital-stay was 8.0 days in both groups. Each group had 1 conversion including laparoscopic procedure in TA-TME group. Transanal extraction of specimen was performed in 86% vs. 48% in TA-TME and LA-TME groups respectively (p=0.021). Complications (Clavien-Dindo sclale) were observed in 27% and 26% in TA-TME and LA-TME groups respectively without statistically significance. Complications IIIb, IVb and V degrees were not diagnosed in TA-TME group. Also in this group «good», «satisfactory» and «unsatisfactory» quality of TME was obtained in 68%, 14% and 18% of cases. At the same time in LA-TME group these values were 74%, 9% and 17% respectively (p=0.859). One of operated patients had «positive» lateral edge (TA-TME). Median distal edge of resection was 21 mm and 23 mm in TA-TME and LA-TME groups respectively. CONCLUSION Preliminary data show comparable early outcomes after transanal and laparoscopic techniques. Laparotomy and associated compications are avoided in case of transanal extraction of specimen. Further researches are necessary to study functional and long-term results.

A clinical case of a sigmoid cancer patient with solitary lung metastasis is discussed in this article. Use of minimally invasive surgical technologies allowed to perform a simultaneous combined surgery on abdominal and thoracic cavities and improve rehabilitation time and time to systemic chemotherapy initiation. In presented clinical case patient was comorbid with stage III obesity, which was considered as a contraindication to laparoscopic surgery for a long time.

The article describes statistics, issues of diagnosis and treatment of rare type of tumors gastrointestinal stromal tumor. Presented case report of the patient with this tumor in low rectum, which was treated with sphincter saving operation. Also shows the possibility of postoperative morphological diagnosis.