SURGICAL TREATMENT OF PATIENTS WITH EXTRAORGANIC TUMORS OF THE PELVIC LOCALIZATION WITH INVASION OF THE ILIAC VESSELS

The aim of our study was to determine the indications for expanding the scope of operations in patients with pelvic extraorgan local formations. Materials and methods. The results of surgical treatment of 7 patients with nonorgan tumors of the pelvic localization, who underwent resection on the main vessels in connection with their involvement in the tumor process, are presented. Results and discussion. A total of 7 interventions were performed on the iliac arteries — 2 resections with an end-to-end anastomosis and 5 prostheses (one case — the aorta resection with reconstruction with a bifurcation prosthesis). Patients with pelvic extraorgan tumors are a special cohort of patients, due to the presence of several organs in a narrow space, which inevitably causes them to fit snugly to the tumor. Locally advanced tumor process in extraorganic tumors involving the main vessels of the pelvis and adjacent organs is not a reason to refuse surgery, and despite the complications, repeated recurrences and previous operations, are well tolerated by patients. This is especially important due to the lack of a real alternative to surgical treatment of this group of patients. Conclusions. Surgical intervention in the treatment of pelvic inorganic tumors involving the main vessels is the only radical method of treatment. Invasion of the main arterial and venous vessels is not a contraindication to surgery in patients with pelvic tumors. Combined angioplastic interventions allow to achieve a long without recurrent period even after cytoreductive operations.

LOCALLY-ADVANCED SIGMOID CANCER WITH CARCINOMATOSIS AND MULTIPAY RECURRENCES. 15 YEARS OF OBSERVATION

Peritoneal carcinomatosis is a major reason for treatment failure. However, combination of «aggressive» surgical approach with chemotherapy allows achieving good results. In this clinical case, a locally advanced tumor was presented with large carcinomatous node in anomentum. Cytoreductive surgery with a complete cytoreduction in combination with intra-abdominal chemotherapy prevented generalization of carcinomatosis. Subsequently, the patient underwent three surgeries for repeated local recurrence of colon cancer. A 15-year period of observation of the patient suggests that this approach is promising, which significantly increases the length of patients life expectancy.

TREATMENT OF PATIENTS WITH COMPLICATIONS OF COLON CANCER IN CONDITIONS OF MULTIFIELD GERONTOLOGICAL HOSPITAL

The article analyzes treatment results of 482 patients of elderly and senile age with complicated colon cancer forms who were in the hospital for war veterans at the period from 2008 to 2014. The more frequent complication of colon cancer was an acute intestinal obstruction (76,8%). Peritumorous inflammation with abscess formation was noted in 13,5% cases, hemorrhage - in 5,6% tumor perforation - in 4,1% cases. The operations were performed by conventional methods and using endovideosurgical technologies in case of complication of colon cancer. Laparoscopic operations had less volume of intraoperative hemorrhage, lower rate of postoperative complications and reduction of the level of postoperative lethality. The rate of lethality was 31,18% after conventional operations and it consisted of 1,81% after laparoscopic surgery. Total postoperative lethality was 24,5%. The maximal level of postoperative lethality was noted in cases of colon cancer complications and it had an ultimate rate (100%) in cases of perforation of locally advanced tumor.

Prediction of Locally Advanced Urothelial Carcinoma of the Bladder Using Clinical Parameters before Radical Cystectomy - A Prospective Multicenter Study

Introduction: We aimed at developing and validating a pre-cystectomy nomogram for the prediction of locally advanced urothelial carcinoma of the bladder (UCB) using clinicopathological parameters. Materials and Methods: Multicenter data from 337 patients who underwent radical cystectomy (RC) for UCB were prospectively collected and eligible for final analysis. Univariate and multivariate logistic regression models were applied to identify significant predictors of locally advanced tumor stage (pT3/4 and/or pN+) at RC. Internal validation was performed by bootstrapping. The decision curve analysis (DCA) was done to evaluate the clinical value. Results: The distribution of tumor stages pT3/4, pN+ and pT3/4 and/or pN+ at RC was 44.2, 27.6 and 50.4%, respectively. Age (odds ratio (OR) 0.980; p < 0.001), advanced clinical tumor stage (cT3 vs. cTa, cTis, cT1; OR 3.367; p < 0.001), presence of hydronephrosis (OR 1.844; p = 0.043) and advanced tumor stage T3 and/or N+ at CT imaging (OR 4.378; p < 0.001) were independent predictors for pT3/4 and/or pN+ tumor stage. The predictive accuracy of our nomogram for pT3/4 and/or pN+ at RC was 77.5%. DCA for predicting pT3/4 and/or pN+ at RC showed a clinical net benefit across all probability thresholds. Conclusion: We developed a nomogram for the prediction of locally advanced tumor stage pT3/4 and/or pN+ before RC using established clinicopathological parameters.

Thymoma: From Chemotherapy to Targeted Therapy

Overview: Thymic malignancies are rare epithelial tumors that may be aggressive and difficult to treat. Thymomas are frequently eligible for upfront surgical resection. However, nearly 30% of patients present with locally advanced tumor at time of diagnosis, and chemotherapy is then used to reduce the tumor burden—possibly allowing subsequent surgery and/or radiotherapy. Metastatic and recurrent thymic malignancies may be similarly treated with chemotherapy. More recently, the molecular characterization of thymoma led to the identification of potentially druggable targets, laying the foundation to implement personalized medicine for patients.