Rectal cancer (lecture)

The lecture deals with the issues of classification, etiology, diagnostics and treatment of rectal cancer

SHORT-TERM RESULTS OF SIMULTANEOUS SURGERIES AT METASTATIC COLORECTAL CANCER

We compared the main group of patients (64 persons) underwent colon resection and liver resection, radiofrequency ablation of metastases in the liver and portal vein chemoembolization with the control group (62 persons) with the operation on the colon without intervention on the liver. The blood loss during surgery in the main group was 696.1 ± 226.3 ml and in the control group - 473.3 ± 245.9 ml (p = 0.000008). When performing hemihepatectomy blood loss during surgery was 802.9 ± 208.5 ml, and performing other liver resections - 575 ± 182.2 ml (p = 0.00005). Duration of hospital stay after the surgery in the study group was 16.8 ± 5.1 days and in the control group -14.0 ± 4.1 days (p = 0,001). Duration of hospital stay after the surgery was higher in the patients after hemihepatectomy, compared to the patients who received smaller volume liver resection -19.7 ± 3.9 versus 13.4 ± 3.8 days (p = 0,005). Postoperative complications were more frequent in the patients of the main group -18 (28.1 %) vs 10 (16.1 %). However, increasing the proportion of complications in the patients with simultaneous treatment of complications associated with the summation operations on the colon and liver operations. Performing liver resection is an independent factor contributing to the prolongation of operative time and blood loss, which increases the frequency of postoperative complications and increases duration of the patient's stay in the hospital

Remote sensing of potential aircraft icing areas

Remote sensing technique of detection of potential aircraft icing areas based on temperature profile measurements, using meteorological temperature profiler, and the data of the Airfield Measuring and Information System (AMIS-RF), was proposed, theoretically described and experimentally validated during the field project in 2012 - 2013 in the Tomsk Bogashevo Airport. Spatial areas of potential aircraft icing were determined using the RAP algorithm and Godske formula. The equations for the reconstruction of profiles of relative humidity and dew point using data from AMIS-RF are given. Actual data on the aircraft icing for the Tomsk Bogashevo Airport on 11 October 2012 and 17 March 2013 are presented in this paper. The RAP algorithm and Godske formula show similar results for the location of spatial areas of potential icing. Though, the results obtained using the RAP algorithm are closer to the actual data on the icing known from aircraft crew reports

Using WRF mesoscale model to restore temperature profile in atmosphere boundary layer in Tomsk

In the paper, the possible use of a WRF mesoscale model for the detailed restoring of a temperature profile in the atmosphere boundary layer (ABL) during winter anticyclone is studied. The correctness of air temperature modeling as well as the possible use of a WRF model for predicting a vertical temperature distribution was show

Особенности IPO как инвестиционного инструмента производственного предприятия

У статті розглянуто особливості проведення публічного розміщення акцій (IPO) виробничими підприємствами, законодавчий механізм проведення IPO в Україні. Особливу увагу приділено дослідженню переваг проведення первинного публічного розміщення акцій в Україні та за її межами. Досліджено стримуючі фактори розвитку ринку IPO, виявлення яких дозволить підвищити інтерес вітчизняних компаній до розвитку цього напрямку інвестиційної діяльності.The article discusses the features of the public offering (IPO) production enterprises, the legislative mechanism of the IPO in Ukraine. Particular attention is paid to research the benefits of the IPO in Ukraine and abroad. Studied constraints of market development IPO, which will improve the detection of interest in domestic companies to develop this area of investment activity.В статье рассмотрены особенности проведения публичного размещения акций (IPO) производственными предприятиями, законодательный механизм проведения IPO в Украине. Особое внимание уделено исследованию преимуществ первичного публичного размещения акций в Украине и за ее пределами. Исследованы сдерживающие факторы развития рынка IPO, выявление которых позволит повысить интерес отечественных компаний в этом направлении инвестиционной деятельности

Pseudomembranous colitis complicated by toxic megacolon in oncological patients

In recent years, information on the increase in the incidence of  infection associated with Clostridioides difficile (CDI) has appeared in the literature. It is known that C. difficile which causes pseudomembranous colitis (PMC) most often affects debilitated patients who receive treatment for the main pathology for a long time. That is why PMC is most common in cancer patients receiving long-term and aggressive anticancer treatment, which is often accompanied by the use of several courses of antibiotics. The result of the irrational use of antibiotics, incorrect PMC therapy may be the  formation of toxic megacolon, intestinal perforation, sepsis, which in turn is fraught with a fatal outcome. It is this state of affairs that aroused our interest in the study of this topic. The steady increase in the incidence of Clostridioides difficile infection makes it particularly relevant to study CDI problem in relation to cancer patients, since they most often have a wide range of risk factors for developing clostridial infection. The article presents an overview of domestic and foreign sources describing this pathology, discusses epidemiology, pathogenesis, clinical picture and current understanding of the CDI treatment. At the end of the review, we present a case of successful treatment of pseudomembranous colitis after stoma closure, which was complicated by the development of toxic megacolon. Colproctectomy was performed as part of the complex treatment of this pathology. The patient received respiratory, renal replacement, hepatoprotective, antibiotic and antifungal therapy and other treatments

Combination of chemoembolization with hepatic resection and methods of local destruction in complex treatment of colorectal cancer

The aim of the study was to prove the efficacy of the treatment regimen for patients with colorectal cancer with metastatic liver involvement. The regimen included a combination of colon and liver resection, methods of local destruction and chemotherapy. There were 126 patients with colon cancer and metastases in the liver involved in the study. All tumors were adenocarcinomas of the intestinal type. Metastases in the liver affected both lobes of the liver. In the main group (64 patients), resection of the large intestine and liver resection were carried out. During the operation, radiofrequency ablation of the remaining metastases and chemoembolization of the portal vein were performed. In the postoperative period, systemic chemotherapy and chemoembolization of the hepatic artery were prescribed. In the control group (62 patients), surgery was performed on the large intestine and systemic chemotherapy was performed. Complications of the operation occurred in 18 patients (28.1 %) in the main group and 10 in patients (16.1 %) in the control group (p = 0.004). Median disease-free survival in the main group was 9.01 months, in the control group - 5.01 months (p = 0.001). Median overall survival in the main group was 13.8 months, in the control group - 9.8 months (p = 0.004). One-year overall survival in the main group was 60.93 %, in the control group - 41.93 %, two-year in the main group -17.18 %, in the control group - 6.45 %. In the control group, there were no three years survivals, and in the main group, the three-year overall survival was 4.68 %

TREATMENT OUTCOMES OF COLORECTAL CANCER WITH BILATERAL LIVER METASTASES

The purpose of the research: to develop an effective treatment regimen for patients with synchronous liver metastases from colorectal cancer. Material and methods. The study included 126 patients with colon cancer and synchronous liver metastases. The patients were divided into two groups. Group I consisted of 64 patients, who underwent resection of the colon and hepatic resection with radiofrequency ablation of metastases in the remaining portion of the liver and portal vein chemoembolization. Then, they received 4 courses of systemic chemotherapy followed by hepatic artery chemoembolization. Group II (the control group) consisted of 62 patients, who underwent resection of the colon without hepatic resection. Systemic chemotherapy was administered 3‑4 weeks after resection of the colon. Results. Postoperative complications occurred in 18 (28.1 %) patients of Group I and in 10 (16.1 %) patients of Group II. Six patients died (4 patients in Group I and 2 patients in Group II). Of the 18 postoperative complications occurred in Group I, 9 were related to hepatic resection. The median progression-free survival time was 9.0 months in Group I patients and 5.0 months in Group II patients, p=0.001. The median overall survival time was 13.8 months and 9.8 months in patients of Group I and Group II, respectively (p=0.004). Conclusion. Treatment options used for Group I patients resulted in improved survival rates

ЛАПАРОСКОПИЧЕСКАЯ ГАСТРЭКТОМИЯ С ЕЮНОГАСТРОПЛАСТИКОЙ

The arm of the research. To develop a way to perform the laparoscopic total gastrectomy with jejunal interposition (Longmire’s procedure).Material and methods. The study presents the technology of laparoscopic total gastrectomy with a lymph node dissection D1α and jejunal interposition. After removal of the gaster with the tumor through a mini-laparotomy (2 inch), the jejunum was cut approximately45 cm distally to the ligament of Treitz. A circular stapler was used to perform an esophago-jejunostomy with Roux-en-Y reconstruction using a standard technology. The second stage is forming a segment of the small intestine for jejunal interposition. The third stage is entering the head of the circular stapling apparatus into the stump of the duodenum on a probe retrogradely through the afferent loop of the small intestine. The fourth stage is stapled anastomosis between a free segment of the jejunum and the duodenum with the circular stapler. The procedure is finalized with hand-sewn anastomosis between the afferent and efferent loops of the small intestine.Results. The presented technology was used to perform surgery on one patient. The increase in operative time did not lead to increased intraoperative blood loss and longer post-operative bed-days. After 1 year the patient shows no evidence of a tumor progression, manifestations of reflux esophagitis, and dumping syndrome. Conclusion. The proposed technology allows laparoscopic total gastrectomy with jejunal interposition via a mini-invasive technology. Цель исследования – разработать способ выполнения лапароскопической гастрэктомии с сохранением пассажа по ДПК путём пластики сегментом тонкой кишки без формирования резервуара.Материал и методы. Представлена технология лапароскопической гастрэктомии с лимфодиссекцией Д1α и пластикой желудка сегментом тонкой кишки с включением в пассаж двенадцатиперстной кишки без формирования резервуара. Производится лапароскопическая гастрэктомия. После удаления препарата через минидоступ первым этапом накладывается циркулярным аппаратом эзофагоэнтероанастомоз на Ру-петле по стандартной технологии. Вторым этапом формируется интерпонируемый сегмент тонкой кишки из Рупетли. Третьим этапом в культю двенадцатиперстной кишки вводится головка циркулярного сшивающего аппарата ретроградно на зонде через приводящую петлю тонкой кишки. Четвёртым этапом накладывается аппаратный еюнодуоденоанастомоз между сегментом тонкой кишки и двенадцатиперстной кишкой. Операция завершается наложением анастомоза между приводящей и отводящей петлями тонкой кишки.Результаты. По описанной технологии прооперирован один пациент. Увеличение времени операции не привело к увеличению интраоперационной кровопотери и удлинению послеоперационного койко-дня. Через 1 год у больного нет признаков опухолевого прогрессирования, проявлений рефлюкс-эзофагита и демпинг-синдрома.Заключение. Предлагаемая схема лапароскопической гастрэктомии позволяет выполнить операцию с еюногастропластикой по мини-инвазивной технологии.

РЕЗУЛЬТАТЫ КОМПЛЕКСНОГО ЛЕЧЕНИЯ КОЛОРЕКТАЛЬНОГО РАКА С БИЛАТЕРАЛЬНЫМ МЕТАСТАТИЧЕСКИМ ПОРАЖЕНИЕМ ПЕЧЕНИ

The purpose of the research: to develop an effective treatment regimen for patients with synchronous liver metastases from colorectal cancer. Material and methods. The study included 126 patients with colon cancer and synchronous liver metastases. The patients were divided into two groups. Group I consisted of 64 patients, who underwent resection of the colon and hepatic resection with radiofrequency ablation of metastases in the remaining portion of the liver and portal vein chemoembolization. Then, they received 4 courses of systemic chemotherapy followed by hepatic artery chemoembolization. Group II (the control group) consisted of 62 patients, who underwent resection of the colon without hepatic resection. Systemic chemotherapy was administered 3‑4 weeks after resection of the colon. Results. Postoperative complications occurred in 18 (28.1 %) patients of Group I and in 10 (16.1 %) patients of Group II. Six patients died (4 patients in Group I and 2 patients in Group II). Of the 18 postoperative complications occurred in Group I, 9 were related to hepatic resection. The median progression-free survival time was 9.0 months in Group I patients and 5.0 months in Group II patients, p=0.001. The median overall survival time was 13.8 months and 9.8 months in patients of Group I and Group II, respectively (p=0.004). Conclusion. Treatment options used for Group I patients resulted in improved survival rates.Цель исследования – разработать эффективную схему лечения пациентов с синхронными метастазами в печени при колоректальном раке. Материал и методы. В исследование включено 126 пациентов, страдающих раком толстой кишки с синхронными метастазами в печени. В основную группу вошли 64 пациента, которым проводились резекция толстой кишки и резекция печени с радиочастотной абляцией метастазов в остающейся части печени и химиоэмболизацией воротной вены, потом им назначали 4 курса системной химиотерапии, после которой выполняли химиоэмболизацию печеночной артерии. В контрольную группу вошли 62 пациента, которым выполняли резекцию толстой кишки без вмешательства на печень, а через 3–4 нед начинали системную химиотерапию. результаты. Послеоперационные осложнения возникли у 18 (28,1 %) пациентов основной и 10 (16,1 %) пациентов контрольной группы. В ходе исследования умерло 6 пациентов, из них 4 – в основной группе, 2 – в контрольной. Из 18 послеоперационных осложнений в основной группе 9 были связаны с резекцией печени. Медиана выживаемости без признаков прогрессирования в основной группе составила 9,01 мес, в контрольной группе – 5,01 мес (p=0,001). Медиана общей выживаемости в основной группе составила 13,8 мес, в контрольной группе – 9,8 мес (p=0,004). Заключение. Использованная в основной группе больных схема комплексного лечения позволяет улучшить показатели выживаемости.