ОСЛОЖНЕНИЯ НА ЭТАПЕ НЕОАДЪЮВАНТНОЙ ТЕРАПИИ РАКА ГОЛОВКИ ПОДЖЕЛУДОЧНОЙ ЖЕЛЕЗЫ

Aim: to study complications of preoperative chemoembolization of the gastroduodenal artery and external beam radiation therapy in patients with pancreatic head cancer.Material and Methods. Sixty patients underwent chemoembolization of the gastroduodenal artery and external beam radiation therapy. Femoral artery angiography was performed using the Seldinger’s technique. Lipiodol 5–7 ml and gemcitabine 400 mg/m2 were used for transarterial chemoembolization. Radiation therapy was given at a total dose of 50 Gy (2 Gy/fraction, 5 times a week, over 5 weeks) using AGAT -R apparatus.Results. Complications after chemoembolization of the gastroduodenal artery were observed in 18.3 % of patients: abdominal pain in 3.3 % of patients; pain and nausea in 3.3 %; pain, nausea and fever in 6.7 %; pain, nausea and increased blood amylase in 1.7 %; pain, nausea and fever, blood amylase in 1.7 %; nausea, fever and blood amylase in 1.7 %. Radiation-induced injuries were observed in 23.3 % of patients: erythema in 18.3 %, grade 1 leukopenia in 1.7% and grade 2 leukopenia in 3.3 %.Conclusion. Complications of neoadjuvant therapy in terms of frequency and severity were consistent with literature data, were manageable with conservative treatment, and did not increase the duration of the preoperative period.Цель исследования – изучить частоту осложнений предоперационного этапа (химиоэмболизация желудочно-двенадцатиперстнокишечной артерии и дистанционная лучевая терапия) комбинированного лечения больных раком головки поджелудочной железы.Материал и методы. В предоперационном периоде 60 пациентам проведены химиоэмболизация желудочно-двенадцатиперстнокишечной артерии и дистанционная лучевая терапия. Для проведения ангиографии применяли чрезбедренную катетеризацию по Сельдингеру. Вводили химиоэмболизат – липиодол 5–7 мл и гемцитабин 400 мг/м2. Лучевую терапию проводили на аппарате АГАТ-Р классическим фракционированием в РОД 2 Гр 5 раз в неделю до СОД 50 Гр на протяжении 5 нед.Результаты. При выполнении химиоэмболизации желудочно-двенадцатиперстнокишечной артерии в 18,3 % случаев возникли осложнения: в 3,3 % диагностирована боль в животе, в 3,3 % – боль и тошнота, в 6,7 % – боль, тошнота и повышение температуры тела, в 1,7 % – боль, тошнота и повышение амилазы крови, в 1,7 % – боль, тошнота и повышение температуры тела, амилазы крови, в 1,7 % – тошнота, повышение температуры тела и амилазы крови. При проведении дистанционной лучевой терапии в 23,3 % возникли лучевые повреждения: эритема I степени – в 18,3 % случаев, лейкопения I степени – в 1,7 %, лейкопения II степени – в 3,3 % наблюдений.Заключение. Осложнения неоадъювантной терапии больных раком головки поджелудочной железы по частоте и тяжести соответствуют литературным данным, купируются консервативными мероприятиями, не увеличивая продолжительности предоперационного периода комбинированного лечения

Liver metastases in patients with curatively treated colorectal cancer

Background. The problem of the development of liver metastases in colorectal cancer patients previously treated with curative intent surgery remains little studied. Identification of significant factors affecting the occurrence of metachronous metastasis contributes to a more accurate prediction of recurrence in this group of patients. material and methods. In our study we analyzed the incidence of liver metastases and prognostic factors in 116 colorectal cancer patients previously treated with curative intent at Irkutsk Regional Cancer Center between 2006 and 2017. The patients received combined modality treatment including neoadjuvant radiotherapy or chemoradiotherapy for localized and locally advanced rectal cancer, radical surgery and adjuvant chemotherapy. After curative treatment, 96 patients had no evidence of distant liver metastases, and 20 patients developed distant metastases. results. The incidence of liver metastases was 17 %. In most patients, metastases occurred 16.5 months after completion of curative treatment, reaching peak incidence at 12–18 months. Prognostic factors of colorectal liver metastases in colorectal cancer patients previously treated with curative intent surgery were: the stage of the tumor, tumor growth in the parirectal/mesocolic fatty tissue, and no previous preoperative chemoradiotherapy and adjuvant chemotherapy. conclusion. For early detection of liver metastases, the carcinoembryonic antigen (CEA) measurements, contrast-enhanced abdominal multislice CT, and ultrasound-guided liver biopsy were recommended to perform every 3 months in the postoperative period

COMPLICATIONS OF NEOADYAVANT THERAPY FOR CANCER OF THE HEAD OF THE PANCREAS

Aim: to study complications of preoperative chemoembolization of the gastroduodenal artery and external beam radiation therapy in patients with pancreatic head cancer.Material and Methods. Sixty patients underwent chemoembolization of the gastroduodenal artery and external beam radiation therapy. Femoral artery angiography was performed using the Seldinger’s technique. Lipiodol 5–7 ml and gemcitabine 400 mg/m2 were used for transarterial chemoembolization. Radiation therapy was given at a total dose of 50 Gy (2 Gy/fraction, 5 times a week, over 5 weeks) using AGAT -R apparatus.Results. Complications after chemoembolization of the gastroduodenal artery were observed in 18.3 % of patients: abdominal pain in 3.3 % of patients; pain and nausea in 3.3 %; pain, nausea and fever in 6.7 %; pain, nausea and increased blood amylase in 1.7 %; pain, nausea and fever, blood amylase in 1.7 %; nausea, fever and blood amylase in 1.7 %. Radiation-induced injuries were observed in 23.3 % of patients: erythema in 18.3 %, grade 1 leukopenia in 1.7% and grade 2 leukopenia in 3.3 %.Conclusion. Complications of neoadjuvant therapy in terms of frequency and severity were consistent with literature data, were manageable with conservative treatment, and did not increase the duration of the preoperative period

Autotransplantation of the kidney in surgery of retroperitoneal sarcomas

The paper presents the analysis of 5 clinical cases that demonstrate the potential of using organ-saving technologies in surgery of locally advanced retroperitoneal sarcomas. The clinical example shows step by step the technique of organ-preserving surgical intervention: an extended tumour nephrectomy followed by the extracorporeal precise dissection of the kidney from the tumor bulk with inducing a reversible pharmaco-cold ischemia and the isolated kidney autotransplantation into a heterotopic position with regard to intraoperative rapid cytology monitoring results. The article describes the characteristics of anesthesia, the early postoperative period, subsequent rehabilitation, and prophylactic medical screening of this group of patients