АСПЕКТЫ НУТРИЦИОННОЙ ПОДДЕРЖКИ В РАМКАХ ПРОГРАММЫ УСКОРЕННОГО ВЫЗДОРОВЛЕНИЯ ПРИ ПЛАНОВЫХ ОНКОЛОГИЧЕСКИХ ОПЕРАЦИЯХ НА ТОЛСТОЙ КИШКЕ У ГЕРОНТОЛОГИЧЕСКИХ ПАЦИЕНТОВ

Goal: to develop and evaluate the efficiency of the tactics for peri-operative nutritional-metabolic therapy as a component of Fast Track programme (FTP) in elderly patients suffering from colon cancer and having planned surgery. Methods. Treatment outcomes were analyzed for 400 elderly patients with colon cancer divided into two groups: main group (prospective n = 170), who were treated complying with optimized FTP and nutritional-metabolic therapy and control group (retrospective, n = 230), who were managed in the traditional way. Peri-operative nutritional-metabolic therapy in the main group included detection of those initially suffering from protein-calorie deficiency basing on changes in body mass loss and body weight index, and provision of integral nutritional support for them. During pre-operative preparation period lasting from 10 to 14 days they were prescribed with residue-free diet additionally to which, depending on the volume of food consumed by sipping, they received liquid nutritional mixture (Impact® Oral, Nestle) with high protein (7.6 g per 100 ml) and calories (1.4 kcal in ml) content. Post-operative nutritional support included early (from the 1st day after the surgery) enteral feeding with use of standard multisubstrate nutritional mixtures with protein content of 40g/l (Isosource® Standard, Nestle) in order to prevent paresis of gastro-intestinal tract combined with early activation of patients. Results. Patients in the main group confidently earlier restored the protein pool and immune status, nasogastric tube was removed faster, the duration of stay in the intensive care department and hospital after the surgery was less, the severity of complications as per Clavien – Dindo classification was lower, and life quality and late treatment outcomes were better. Conclusions. Use of the offered tactics of peri-operative nutritional-metabolic therapy as a component of FTP allowed speeding up rehabilitation and enhancing surgical and oncological outcomes in the burdened elderly patients having planned surgery due to colon cancer. Цель: разработка и оценка эффективности тактики периоперационной нутритивно-метаболической терапии как компонента программы ускоренного выздоровления (ПУВ) у геронтологических больных раком толстой кишки при плановых хирургических вмешательствах. Методика. Проанализированы результаты лечения 400 геронтологических хирургических пациентов с диагнозом рака ободочной кишки, разделенных на две группы: основную (проспективную, n = 170), в которой лечение осуществляли с соблюдением оптимизированной ПУВ и нутритивно-метаболической терапии, и контрольную (ретроспективную, n= 230), ведение которой осуществляли традиционным способом. Периоперационная нутритивно-метаболическая терапия в основной группе заключалась в выявлении на основе оценки индекса массы тела в сочетании с динамикой потери массы тела пациентов, исходно имеющих белково-энергетическую недостаточность, и осуществлении их комплексной нутриционной поддержки. При предоперационной подготовке в период от 10 до 14 дней им назначали бесшлаковую диету, дополнительно к которой, в зависимости от объема съеденной пищи методом сипинга, назначали жидкую питательную смесь (Impact® Oral, Nestle) с высоким содержанием белка (7,6 г на 100 мл) и энергии (1,4 ккал в мл). Послеоперационная нутриционная поддержка заключалась в осуществлении раннего (с 1-х сут после операции) энтерального питания с использованием стандартных полисубстратных питательных смесей с содержанием белка 40 г/л (Isosource® Standard, Nestle) с целью профилактики пареза желудочно-кишечного тракта в сочетании с ранней активизацией больных. Результаты. У больных основной группы достоверно раньше восстанавливались белковый пул и иммунный статус, меньше было время стояния назогастрального зонда, пребывания в отделении интенсивной терапии и стационаре после операции, легче степень тяжесть осложнений по классификации Clavien – Dindo, лучше качество жизни и отдаленные результаты лечения. Выводы. Применение предложенной тактики периоперационной нутритивно-метаболической терапии как компонента ПУВ позволило ускорить реабилитацию и улучшить хирургические и онкологические результаты лечения отягощенных геронтологических пациентов при плановых операциях по поводу рака толстой кишки.

Многоэтапное хирургическое лечение первично-множественного синхронного рака толстой кишки у больного старческого возраста: клиническое наблюдение

А clinical case of successful multistage surgical treatment of elderly patient with primary synchronous colon cancer is presented. Locallyadvanced tumor are in ascending colon, the secod tumor are in sigmoid colon. The treatment realized in two stages after assessment by multidisciplinary team based on decision of council of physicians consist of oncologist, anaesthesiologist, therapeutist and neurologist. First stage include an ileotransversal bypass. After the complex rehabilitation during one month in aggregate with pre-operative council of physicians second stage are simultaneous radical right hemicolectomy with abdominal wall resection and sigmoidectomy with abdominal wall defect plastic by own tissues. Staged surgical treatment allowed to perform radical resection of the giant malignant neoplasm of the colon with good clinicasl result.Представлен клинический случай успешного многоэтапного хирургического лечения пациента старческого возраста с первично-множественным синхронным раком ободочной кишки. Местно-распространенная опухоль локализовалась в восходящей ободочной кишке, еще одна – в сигмовидной кишке. Лечение проводилось в 2 этапа после оценки мультидисциплинарной командой на основании решения консилиума в составе онколога, анестезиолога, терапевта и невролога. На 1-м этапе был наложен обходной илеотрансверзоанастомоз. После проведения комплексной реабилитации в течение месяца в сочетании с предоперационной подготовкой была выполнена симультанная операция в объеме радикальной правосторонней гемиколэктомии (с резекцией передней брюшной стенки) и резекции сигмовидной кишки, а также пластика дефекта передней брюшной стенки местными тканями (2-й этап). Этапное хирургическое лечение в сочетании с мультидисциплинарным подходом позволило выполнить радикальное удаление гигантского злокачественного новообразования толстой кишки с хорошим клиническим результатом

Characteristics of Early-Onset vs Late-Onset Colorectal Cancer: A Review.

The incidence of early-onset colorectal cancer (younger than 50 years) is rising globally, the reasons for which are unclear. It appears to represent a unique disease process with different clinical, pathological, and molecular characteristics compared with late-onset colorectal cancer. Data on oncological outcomes are limited, and sensitivity to conventional neoadjuvant and adjuvant therapy regimens appear to be unknown. The purpose of this review is to summarize the available literature on early-onset colorectal cancer. Within the next decade, it is estimated that 1 in 10 colon cancers and 1 in 4 rectal cancers will be diagnosed in adults younger than 50 years. Potential risk factors include a Westernized diet, obesity, antibiotic usage, and alterations in the gut microbiome. Although genetic predisposition plays a role, most cases are sporadic. The full spectrum of germline and somatic sequence variations implicated remains unknown. Younger patients typically present with descending colonic or rectal cancer, advanced disease stage, and unfavorable histopathological features. Despite being more likely to receive neoadjuvant and adjuvant therapy, patients with early-onset disease demonstrate comparable oncological outcomes with their older counterparts. The clinicopathological features, underlying molecular profiles, and drivers of early-onset colorectal cancer differ from those of late-onset disease. Standardized, age-specific preventive, screening, diagnostic, and therapeutic strategies are required to optimize outcomes

Post-Operative Functional Outcomes in Early Age Onset Rectal Cancer

Background: Impairment of bowel, urogenital and fertility-related function in patients treated for rectal cancer is common. While the rate of rectal cancer in the young (<50 years) is rising, there is little data on functional outcomes in this group. Methods: The REACCT international collaborative database was reviewed and data on eligible patients analysed. Inclusion criteria comprised patients with a histologically confirmed rectal cancer, <50 years of age at time of diagnosis and with documented follow-up including functional outcomes. Results: A total of 1428 (n=1428) patients met the eligibility criteria and were included in the final analysis. Metastatic disease was present at diagnosis in 13%. Of these, 40% received neoadjuvant therapy and 50% adjuvant chemotherapy. The incidence of post-operative major morbidity was 10%. A defunctioning stoma was placed for 621 patients (43%); 534 of these proceeded to elective restoration of bowel continuity. The median follow-up time was 42 months. Of this cohort, a total of 415 (29%) reported persistent impairment of functional outcomes, the most frequent of which was bowel dysfunction (16%), followed by bladder dysfunction (7%), sexual dysfunction (4.5%) and infertility (1%). Conclusion: A substantial proportion of patients with early-onset rectal cancer who undergo surgery report persistent impairment of functional status. Patients should be involved in the discussion regarding their treatment options and potential impact on quality of life. Functional outcomes should be routinely recorded as part of follow up alongside oncological parameters

NUTRITIONAL SUPPORT ASPECTS WITH FAST TRACK PROGRAMME IN PLANNED SURGERIES FOR COLON CANCER IN ELDERLY PATIENTS

Goal: to develop and evaluate the efficiency of the tactics for peri-operative nutritional-metabolic therapy as a component of Fast Track programme (FTP) in elderly patients suffering from colon cancer and having planned surgery. Methods. Treatment outcomes were analyzed for 400 elderly patients with colon cancer divided into two groups: main group (prospective n = 170), who were treated complying with optimized FTP and nutritional-metabolic therapy and control group (retrospective, n = 230), who were managed in the traditional way. Peri-operative nutritional-metabolic therapy in the main group included detection of those initially suffering from protein-calorie deficiency basing on changes in body mass loss and body weight index, and provision of integral nutritional support for them. During pre-operative preparation period lasting from 10 to 14 days they were prescribed with residue-free diet additionally to which, depending on the volume of food consumed by sipping, they received liquid nutritional mixture (Impact® Oral, Nestle) with high protein (7.6 g per 100 ml) and calories (1.4 kcal in ml) content. Post-operative nutritional support included early (from the 1st day after the surgery) enteral feeding with use of standard multisubstrate nutritional mixtures with protein content of 40g/l (Isosource® Standard, Nestle) in order to prevent paresis of gastro-intestinal tract combined with early activation of patients. Results. Patients in the main group confidently earlier restored the protein pool and immune status, nasogastric tube was removed faster, the duration of stay in the intensive care department and hospital after the surgery was less, the severity of complications as per Clavien – Dindo classification was lower, and life quality and late treatment outcomes were better. Conclusions. Use of the offered tactics of peri-operative nutritional-metabolic therapy as a component of FTP allowed speeding up rehabilitation and enhancing surgical and oncological outcomes in the burdened elderly patients having planned surgery due to colon cancer

RESULTS OF ENHANCED RECOVERY PROTOCOL IN GERONTOLOGICAL PATIENS WITH COLON CANCER

The study evaluated the results of introduction of enhanced recovery protocol in elderly and senile patients who underwent planned colon cancer surgery. The largest rate of colon cancer was noted in elderly and senile patients in Russia and majority of countries. These patients had an increased rate of complications, hospital stay and mortality compared with young patients. The authors proposed the enhanced recovery protocol for gerontological patients based on clinical data and literature analysis. The protocol implementation decreased the number and severity of complications, shortened the postoperative patient day and improved the quality of life of the patients

Multistage surgical treatment of elderly patient with multiple colon cancer: case report

А clinical case of successful multistage surgical treatment of elderly patient with primary synchronous colon cancer is presented. Locallyadvanced tumor are in ascending colon, the secod tumor are in sigmoid colon. The treatment realized in two stages after assessment by multidisciplinary team based on decision of council of physicians consist of oncologist, anaesthesiologist, therapeutist and neurologist. First stage include an ileotransversal bypass. After the complex rehabilitation during one month in aggregate with pre-operative council of physicians second stage are simultaneous radical right hemicolectomy with abdominal wall resection and sigmoidectomy with abdominal wall defect plastic by own tissues. Staged surgical treatment allowed to perform radical resection of the giant malignant neoplasm of the colon with good clinicasl result

INFLUENCE OF NUTRITIVE SUPPORT ON SURGERY OUTCOMES IN ELDERLY PATIENTS WITH COLON CANCER

The article presents the results of surgery outcomes in 127 elderly patients with colon cancer. The patients were divided into two groups: the main group (prospective, n=52) and control group (retrospective, n=75). The combined preoperative nutritive status assessment by BMI and a prognostic hypotrophy index were used. It included the optimization of nutritive support on all stages and an early tube removal, an enteral feeding during postoperative period. It was stated, that it significantly reduced the level of complications, period of intensive care unit stay on 2 days and a hospital stay on 4 days in main group. All the patients of the main group improved the quality of life during 7 days (EORTC QIQ CR29). Proposed nutritive support program allowed improvement of the quality of life and positive treatment outcomes in elderly patients with colon cancer

Post-Operative Functional Outcomes in Early Age Onset Rectal Cancer

BackgroundImpairment of bowel, urogenital and fertility-related function in patients treated for rectal cancer is common. While the rate of rectal cancer in the young (<50 years) is rising, there is little data on functional outcomes in this group.MethodsThe REACCT international collaborative database was reviewed and data on eligible patients analysed. Inclusion criteria comprised patients with a histologically confirmed rectal cancer, <50 years of age at time of diagnosis and with documented follow-up including functional outcomes.ResultsA total of 1428 (n=1428) patients met the eligibility criteria and were included in the final analysis. Metastatic disease was present at diagnosis in 13%. Of these, 40% received neoadjuvant therapy and 50% adjuvant chemotherapy. The incidence of post-operative major morbidity was 10%. A defunctioning stoma was placed for 621 patients (43%); 534 of these proceeded to elective restoration of bowel continuity. The median follow-up time was 42 months. Of this cohort, a total of 415 (29%) reported persistent impairment of functional outcomes, the most frequent of which was bowel dysfunction (16%), followed by bladder dysfunction (7%), sexual dysfunction (4.5%) and infertility (1%).ConclusionA substantial proportion of patients with early-onset rectal cancer who undergo surgery report persistent impairment of functional status. Patients should be involved in the discussion regarding their treatment options and potential impact on quality of life. Functional outcomes should be routinely recorded as part of follow up alongside oncological parameters