Quality of Life of Elderly and Senile Patients with Hormone Receptor Positive Breast Cancer Using Primary Endocrine Therapy

Introduction. Elderly and senile patients are a special category of patients and standard methods in breast cancer treatment are not suitable due to the frequent presence of serious comorbidities and personal preferences and concerns about treatment options. Аn available treatment option for these patients with hormone-receptor positive breast cancer may be the primary endocrine therapy (PET).The objective was to assess the quality of life of patients treated by PET or surgical treatment with adjuvant endocrine therapy (ET) and identifying the reasons of choosing a conservative treatment strategy.Methods and materials. Our study included 65–89-year-old patients with hormone-receptor positive breast cancer with stages I–II, some of whom received only endocrine therapy (ET) (n=20), and others are prescribed adjuvant ET after surgical treatment (n=20). Quality of life was assessed by analyzing the EORTC QLQ C-30 and QLQ-BR23 questionnaires filled in by patients at different stages of treatment. An analysis of outpatient records was carried out to identify the reasons for choosing a conservative treatment strategy.Results. The choice of conservative treatment strategy was justified by the presence of a serious concomitant pathology in 65 % of cases. Performing breast surgery was associated with a decline in the quality of life in the postoperative period.Conclusions. PET is an alternative treatment option for some of the elderly patients with hormone-receptor positive breast cancer, since it has similar results in overall survival compared to standard complex treatment (surgery + adjuvant ET), but also does not make the quality of life worst during treatment

The score system of assessing the risk of anastomosis leakage in colorectal operations

The results of treatment of 1510 patients who were operated in clinics of hospital surgery named. V. A. Oppel of North-Western State Medical University n.a. 1.1. Mechnikov and Alexander hospital during the period from 1999 till 2015 were analyzed. Complications occurred in 154 (10,2%) cases: 87 male (56.5 %) and 67 women (43.5 %). Method of statistical analysis — random sampling, 140 patients were selected. The patients were divided into 2 groups: basic group and control group. The main group (70 persons) consisted of patients with complicated postoperative period and the control group (70 persons) with a favorable course of the postoperative period. The patients were performed colon resections due to the colorectal cancer of different differentiation - 95% and due to other diseases in 5% of cases. By comparison the main and control groups were assessed predictors of complications. On the basis of the data obtained by analogy with the scale of insolvency colonic anastomosis Colon Leakage Score developed by Dekker T. 2010, was created a point system to assess the development of insolvency anastomosis In colorectal operations, which helps to solve the issue of formation of preventive stoma.Изучены результаты лечения 1510 пациентов, оперированных в клиниках госпитальной хирургии им. В А Оппеля СЗГМУ им. И.И. Мечникова и Александровской больницы в период с 1999 по 2015 годы. Осложнения развились у 154 (10,2%) пациентов: 87 мужчин (56,5%) и 67 женщин (43,5%). Методом статистического анализа—случайная выборка было отобрано 140 человек. Пациенты были разделены на 2 группы: основная и контрольная. Основную группу (70 человек) составили пациенты, с осложнённым течением послеоперационного периода и контрольную группу (70 человек) с благоприятным течением послеоперационного периода. Больные были оперированы на толстой кишке по поводу колоректального рака, различной степени дифференцировки - 95% и 5% по поводу иных заболеваний. Методом сравнения основной и контрольной группы были оценены предикторы развития осложнений. На основании полученных данных по аналогии со шкалой несостоятельности толстокишечного анастомоза Colon Leakage Score разработанной Dekker Т. 2010, была создана балльная система оценки риска несостоятельности анастомоза при колоректальных операциях, которая помогает решить вопрос формирования превентивной стомы

The use of minimally invasive techniques in the treatment of colorectal cancer metastases in the liver (review)

In this paper there is a review of available minimally invasive methods of local treatment of colorectal liver metastases, according to the modem domestic and foreign literature, including: ablative techniques (such as radiofrequency ablation, laser thermoablation, cryoablation), stereotactic radiotherapy, and endovascular techniques ( chemoinfusion, chemoembolization, radioembolization). Comparative description of individual treatment methods with surgical technique and with each other.В статье выполнен обзор по данным современной отечественной и зарубежной литературы существующих малоинвазивных методов локального воздействия на метастазы колоректального рака в печени, включающих: абляционные методики (такие как радиочастотная абляция, лазерная термоабляция, криоабляция), стереотаксическую лучевую терапию, а также рентгенэндоваскулярные методики (химиоинфузия, химиоэмболизация, радиоэмболизация). Проведена сравнительная характеристика отдельных методов лечения с хирургическим методом и между собой

Comparative analysis of existing prognostic scales of cytoreductive operations on liver metastases of colorectal cancer

In the article there is an overview of existing prognostic scales for cytoreductive operations on liver metastases of colorectal cancer in the liver to improve patient selection for surgery, according to the modern domestic and foreign literature.В статье выполнен обзор по данным современной отечественной и зарубежной литературы существующих прогностических шкал циторедуктивных операций на печени по поводу метастазов колоректального рака в печени для улучшения отбора пациентов на хирургическое лечение

The role of human papillomavirus in laryngeal cancer and recurrent respiratory papillomatosis: epidemiological and clinical aspects

In the recent decade, the number of laryngeal cancer cases increased worldwide by 23 %. Currently, laryngeal cancer morbidity and associated mortality do not show statistically significant trends toward a decrease. The main risk factors for laryngeal carcinoma are smoking, alcohol consumption, human papilloma virus (HPV) infection, recurrent respiratory papillomatosis, and genetic predisposition.Aim. To evaluate the incidence and role of HPV in etiology and clinical course of laryngeal cancer and recurrent respiratory papillomatosis.Analysis of the available literature sources published in the Medline, Pubmed, and eLibrary databases was performed. The review is based on 59 of 584 identified scientific studies. Frequency of HPV detection in laryngeal cancer tumor tissue varies and is associated with the studied country’s geographical location. The incidence of these viruses in tumor tissue varies between 2.7 and 62.6 %. Genotype 16 human papilloma virus is more common in women between the ages of 31 and 40 years and is mostly located near the glottic aperture. Genotype 6 and 11 human papilloma viruses promote development of recurrent respiratory papillomatosis of the larynx and are detected in 0–87.5 % of cases. It is noted that in patients with HPV-positive neoplasms of the larynx, better response to radiation therapy and higher survival rates are observed compared to patients without the virus. In countries where national programs of vaccination against HPV infection have been implemented, a significant decrease in the incidence of recurrent respiratory papillomatosis is observed.The incidence of HPV in laryngeal cancer and recurrent respiratory papillomatosis varies. The role of these viruses in carcinogenesis has not yet been fully understood. Clinical course of HPV-associated laryngeal carcinoma is more favorable than HPV-free laryngeal carcinoma, however, this statement requires further confirmation. Evaluation of the results of programs of vaccination against HPV and their effect on recurrent respiratory papillomatosis and laryngeal cancer morbidity is important

Percutaneous cystolithotripsy for patients with benign prostatic hyperplasia

Introduction. According to the literature, 5.0% of patients with urolithiasis are characterized by the presence of stones in the bladder. The issue of bladder stones for patients with benign prostatic hyperplasia remains relevant and requires further improvement of approaches to surgical treatment.Purpose of the study. To evaluate the safety and efficacy of energy-diverse percutaneous cystolithotripsy (and placement of a cystostomy catheter) in comparison with transurethral cystolithotripsy.Materials and methods. A retrospective analysis of 56 cases in patients (aged 54-82 years) with bladder stones was carried out. All patients were treated in the Urology Clinic of the Mechnikov North-Western State Medical University from 2019 to 2021. Two groups were formed: group I — 26 (46.4%) patients who underwent percutaneous cystolithotripsy, group II — 30 (53.6%) patients underwent transurethral cystolithotripsy. The duration of surgery, intraoperative and postoperative complications were assessed.Results. On average, the duration of surgery for the percutaneous approach was shorter than for transurethral access (35 vs 44 min). The stone-free rate in the case of the percutaneous approach was 100.0%, while in transurethral cystolithotripsy the stone-free rate was 90.0%. In the early postoperative period, in groups I and II, gross hematuria was observed for 2 (7.6%) and 4 (13.3%) patients, respectively. In the late postoperative period, 2 patients from group II had a urethral stricture.Conclusions. Percutaneous cystolithotripsy is a minimally invasive method of stone fragmentation, characterized by a minimal risk of intra- and postoperative complications

Comparison of the effectiveness of intraoperative radiotherapy with external beam radiotherapy in patients with early breast cancer

Background. Breast cancer is the most common cancer in women. The main treatment for breast cancer includes surgery, chemotherapy, radiation therapy, and hormone therapy. The role of radiation therapy in the management of breast cancer continues to evolve. Radiation therapy is currently being de-escalated to include the use of intraoperative radiotherapy (IORT) and adjuvant endocrine therapy. Purpose of the study: to compare the efficacy of IORT with that of external beam radiotherapy (EBRT) in the treatment of early breast cancer. Material and Methods. A retrospective study of 559 patients with early breast cancer was conducted in Clinical Oncology Center of Saint Petersburg. The main treatment group included 273 patients who underwent breast-conserving surgery with IORT and sentinel lymph node biopsy. The control group included 286 patients who underwent breast-conserving surgery with sentinel lymph node biopsy and EBRT. Results. For all patients, the median follow-up time was 59.1 months (interquartile range: 43.7 to 80.7), the minimum follow-up period was 0.6 months, and the maximum follow-up period was 110.4 months. Recurrence occurred in 18 (6.6 %) patients of the main group and in 8 (2.8 %) patients of the control group. A statistically significant association of biological subtype with survival outcomes was found (p=0.02). The hazard ratio for Luminal B of 1.88 (95 % CI 1.02, 3.46) corresponded to a 65 % chance of an earlier onset of a negative outcome. The hazard ratio for triple-negative breast cancer of 3.01 (95 % CI 1.53, 5.95) corresponded to a 75 % chance of an earlier negative outcome. In the main treatment group, 11 (4 %) patients developed disease progression, and 2 of them died of multiple organ failure. In the control group, disease progression was observed in 18 (6.3 %) patients, 6 of whom died. However, the analysis of overall survival using the Kaplan–Meier curve showed a statistically non-significant log-rank p-value (0.73). The 3-year survival rates were 100 % (100 – 100) in the treatment group and 98.2 % (96.7 – 99.8) in the control group. The 5-yaer survival rates were 99.3 % (97.9 – 100) in the treatment group and 97.8 % (96.2 – 99.6) in the control group. These results showed advantage of IORT over EBRT. Conclusions. Intraoperative radiotherapy is a safe and effective alternative to external beam radiotherapy for early breast cancer

Выявление факторов риска регионарного метастазирования дифференцированного рака щитовидной железы

Diagnostic difficulties of regional metastases, especially lesion of the central neck, is the main problem with choosing the type of surgical intervention for patients with differentiated thyroid cancer diagnosis. The frequency of differentiated thyroid cancer regional metastasis to the neck lymph nodes is about 60 %. This article includes the search and identification of risk factors of differentiated thyroid cancer regional metastases, as well as a review of the literature on this problem. We have analyzed the results of surgical treatment of patients with papillary thyroid cancer of Stage I–III (T1–4aN0–1bM0) who underwent surgical treatment at the St. Petersburg State Healthcare Institution «City Clinical Oncology Center» in 2018–2019. As a result of the study, the data revealed a relationship between regional metastases and intrathyroid vascular invasion of the primary tumor (p < 0.05), while multifocality, extrathyroid extension and the incidence of BRAF mutation have not demonstrated this correlation (p > 0.05). After the surgical treatment we should focus on the presence of vascular invasion and, if it is detected, perform final thyroidectomy and central lymph node dissection with subsequent radioiodine therapy.Трудность диагностики регионарных метастазов, особенно при поражении центрального уровня шеи, представляет основную проблему выбора объема хирургического вмешательства у пациентов с диагнозом дифференцированного рака щитовидной железы (РЩЖ). Частота регионарного метастазирования дифференцированного РЩЖ в лимфатические узлы шеи составляет в среднем 60 %. В статье описан процесс поиска факторов риска регионарного метастазирования дифференцированного рака щитовидной железы, а также дан обзор литературы по данной проблеме. Были проанализированы результаты хирургического лечения пациентов с морфологическим диагнозом папиллярного РЩЖ I–III стадии T1–4aN0–1bM0, которым было проведено хирургическое лечение в СПБ ГБУЗ «Городской клинический онкологический диспансер» Минздрава России в период с 2018 по 2019 гг. Согласно полученным в результате исследования данным выявлена связь регионального метастазирования с интратиреоидной сосудистой инвазией первичной опухоли (p < 0,05), тогда как многофокусность, экcтратиреоидное распространение и наличие BRAF-мутации данной корреляции не продемонстрировали (p > 0,05). После выполненного хирургического лечения у пациентов с дифференцированным РЩЖ при оценке послеоперационного гистологического материала следует акцентировать внимание на наличии интратиреоидной сосудистой инвазии первичной опухоли и при её обнаружении расширять объём лечения и выполнять завершающую тиреоидэктомию с лимфодиссекцией и последующей радиойодтерапией

Extensive penile skin necrosis after surgery for Peyronie's disease

The clinical case represents the surgical correction of postoperative complications in a patient with Peyronie's disease. The patient underwent flap corporoplasty using an autovein. The late postoperative period in the patient was complicated by extensive necrosis of the penile skin, which required repeated surgery as follows. The first stage of surgical treatment was performed by excision of necrotic tissues of the penile skin. Within 10 days of the postoperative period, chymotrypsin with an ointment containing dioxomethyltetrahydropyrimidine with chloramphenicol was applied to the penile wound surface to prepare the wound for subsequent skin autotransplantation. Further, within 5 days, the polymeric drainage sorbent «Aseptisorb DT» was applied to the wound surface until the wound was cleansed and granulation tissue was formed. The second stage of the surgical treatment performed penile skin replacement plasty with a free perforated skin graft taken from the patient's femoral surface

Spontaneous rupture of the renal pyelocaliceal system

Spontaneous rupture of the renal pyelocalyceal system (PCS) is a rare condition that can be challenging to diagnose. Unlike traumatic injuries, this condition is not easily identified based on clinical symptoms, anamnesis, or physical examination findings. However, in most cases, PCS rupture is a result of underlying medical conditions. Surgical intervention for ruptured PCS should aim to immediately drain the kidney and the retroperitoneal area. This report aims to illustrate a clinical case involving treatment of a patient with spontaneously ruptured PCS