Immediate results of surgical treatment of patients with malignant tumors of the biliopancreatoduodenal region

Objective. To improve the immediate results of surgical treatment for lung cancer in elderly and senile patients, by identifying the features of the postoperative course. Subjects and methods. In the period from January 2012 to October 2022, a total of 520 older age group patients with lung cancer were operated in the Tomsk Region, among whom 436 (83.85%) patients were aged 60 to 75 years inclusive; the remaining 84 (16.15%) patients were within the age range of 76 to 85 years, which characterized their age as senile. At the time of hospitalization, 492 (94.62%) patients had one or more concomitant diseases, of whom 238 (45.77%) patients required preoperative correction. Surgical treatment options included extended lobectomy using a variety of techniques involving angioplasty and/or bronchoplasty, and pneumonectomy. The immediate results were assessed using the Thoracic Morbidity and Mortality System. Results. In the group of patients aged 60—75-year, adverse postoperative events were recorded in 22.25% of cases with a mortality rate of 3.9%. The patients older than 75 years had a complication rate of 70.24% and a mortality rate of 9.52%. Of these, there was a preponderance of serious complications associated with insufficient aerostasis and the presence of residual cavities, which led to additional or repeated drainage. Among the critical complications, there were most commonly different types of cardiac arrhythmias that resulted in death in 2.12% of the patients. The highest mortality rates were recorded in patients after pneumonectomy and in those with incompetence of the bronchial stump. Conclusion. Lung cancer patients of this age periodization have a pronounced comorbidity that determines the features of their perioperative management and the specificity of complications. Lobar resections and lung parenchyma-sparing surgical interventions make it possible to achieve optimal immediate results of surgical treatment for lung cancer.

The aim of the study: is to analyze the immediate results of surgical treatment of high-and intermediate-risk PE in a group of elderly and senile patients. Material and methods. The study included 43 patients operated on for high-and intermediate-risk pulmonary embolism between 2008 and 2019. In the general group of patients, the number of women prevailed and amounted to 67.4%. The average age was 65.4 ± 4.23 years old. The Miller index in the general group was 29.1 ± 1.42. The Geneva Index was 8.4 ± 1.12. The average pressure in the pulmonary artery at the time of operation was 54 ± 1.4 mm Hg, and the peak pressure was 68 ± 3.43 mm Hg. Results. 5 patients died at the hospital stage. Thus, the hospital survival rate of patients was 88.4%. Among nonlethal complications, cardiovascular and respiratory failure prevailed. According to the statement, the calculated pressure gradient in the pulmonary artery was 29.0 ± 3.1 mm Hg. Conclusion. Surgical treatment is a highly eff ective and reliable method of treatment in the group of older patients.

To study the immediate results of surgical treatment of patients with perforative gastroduodenal ulcer. It was analyzed immediate results of surgical treatment of 646 patients with perforative gastroduodenal ulcer. Ulcer suturing predominated as surgical technique (358 patients, 55.5%), in other observations there were different types of vagotomy (215 cases, 33.3%), partial gastrectomy in 73 (11.2%) patients. In early postoperative period 36 (5.62%)patients died, incidence of complications was 6.2%. Following aspects effect on choice of surgical techbique including laoarotomy or minimally invasive approach, conventional suturing, vagotomy, partial gastrectomy: 1. presence of shock or unstable hemodynamics; 2. life-threating comorbidities (ASA class 3 and higher); 3. degree of abdominal bacterial contamination; 4. pre-hospital duration of disease; 5. dimension and type of ulcer; 6. ulcerative history or intraoperative evidence of chronic ulcer. Implementation or absolute predominance of surgery of the same type (suturing of perforative ulcer) leads to great number of poor long-term results (up to 60-70%) and requires repeated interventions.

Objective. To estimate immediate results of surgical treatment of peripheral cholangiocarcinoma in elderly and senile patients.
 Materials and methods. In 2004-2018 yrs period in the Department of Transplantation and Surgery of the Liver of the Shalimov National Institute of Surgery and Transplantology 84 patients, suffering peripheral cholangiocarcinoma, were radically operated: 31 (36.9%) patients older than 60 yrs (the main Group), and 53 (63.1%) patients, younger than 60 yrs (control Group).
 Results. Postoperative clinically significant (IIIa-IV degree in accordance to classification of Clavien-Dindo) complications during 90-days of postoperative period were noted in 29.1% patients of the main Group and in 32.1% patients of a control Group (p=0.262), postoperative hepatic insufficiency, in accordance to The International Study Group of Liver Surgery criteria, - in 16.1 and 22.6% accordingly (p=0.473); reoperation was performed in 9.6 and 9.4% patients, accordingly (p=0.973). The causes of postoperative lethality in 2 patients of the main Group were an acute myocardial infarction (1) and an acute pulmonary thromboembolism (1).
 Conclusion. Hepatic resection is characterized by satisfactory immediate results of treatment of peripheral cholangiocarcinoma in elderly and senile patients, if performed in highly-specialized multidisciplinary centre and thorough selection of patients.

The increased worldwide interest in performing coronary artery bypass grafting operations on a beating heart has made the question of the results of these operations in patients with low contractility of the left ventricular myocardium belonging to the high-risk category urgent. The aim of our study was a comparative assessment of the immediate results of surgical treatment of patients with reduced (LVEF <45%) and normal myocardial contractility, operated under MIRM conditions. Materials and methods. A comparative analysis of the immediate results of surgical treatment of 302 patients with coronary artery disease who underwent beating heart bypass surgery was carried out. Most of the patients were men (81.3%). The average age of the general group was 59.2 ± 7.4 years. The patients were divided into two groups - patients with LVEF less than 45% - 49 patients (16%) and patients with LVEF more than 45% - 253 people (84%). Results. Despite the fact that for a number of clinical indicators (concomitant diseases), we obtained a statistically significant difference - arterial hypertension, BCA lesion, mean LVEF, according to the main hemodynamic criteria, such as - unstable angina pectoris, middle class according to CCS and NYHA, the number of women in group, lesion of the trunk of the LCA and multivessel coronary artery disease, we did not reveal statistically significant differences between our groups. Nevertheless, the initial degree of operational risk according to EuroSCORE II was significantly higher in the first group of patients - with a low left ventricular ejection fraction. Conclusions. Our results of a comparative assessment of two groups of patients - with reduced LV ejection fraction (less than 45%) and with normal contractile ability, who underwent minimally invasive myocardial revascularization, showed the high efficiency of this type of surgical treatment.

Purpose.To improve the immediate results of surgical treatment of endogenous hypercorticism throughoptimizing the perioperative management of patients using accelerated rehabilitation protocols.Materials and methods.A randomized prospective study of 53 patients with a body mass index 35 kg/m2 was carried out. In the control group (n=27), TIVA based on propofol was used with postoperative analgesia by systemic administration of opioids. In the accelerated rehabilitation protocol group (n=26), we used anesthesia based on low-flow inhalation of desflurane with sympatholytic mixture infusion in intra- and postoperative periods, multimodal postoperative analgesia, and use of accelerated rehabilitation protocol in the perioperative period. The time of patients' achievement of BIS90 index, time of extubation, time of achievement of 10 points by the Aldrete scale and 0 points by the Bidway test, duration of stay in the in-patient hospital, number of postoperative complications were assessed. Effectiveness of analgesia was evaluated by the time of the first analgesia requirement, consumption of narcotic analgesic, VAS and Verbal Descriptor scale.Results.The study revealed that the time of awakening and reaching 10 points by the Aldrete scale in patients of group 2 was significantly shorter than in group 1: 3 (2; 6) and 6.5 (3.5; 9) min respectively (P=0.046). They had fewer postoperative complications, shorter hospitalization time — 58 (39; 71) hours compared to the control group with 74.5 (58.5; 87) hours (P=0.032).Conclusion.Perioperative management of obese patients after retroperitoneal video endoscopic adrenalectomy with the use of accelerated rehabilitation protocols contributed to earlier mobilization, reduction of the number of complications in the early postoperative period, reduction of the duration of stay in the in-patient hospital, which together facilitates improving the immediate results of surgical treatment of endogenous hypercorticism.

Objective. To evaluate and compare the immediate results of surgical treatment of aneurysms and dissection of the ascending aorta by the classic Bentall technique with anastomosis according to Cabrol and as modified by N. Kouchoukos. Material and Methods. We analyzed 189 patients who underwent aortic valve and ascending aorta prosthesis by Bentall-de Bono technique (n = 135) and in Kouchoukos modification (n = 49). Exclusion criteria: repeated operations, one-stage interventions on the aortic arch, heart valves, coronary bypass surgery. The mean age of patients in the first group (Bentall – de Bono technique) was 46±14.5 (14L – 73g); in the second group (Kouchoukos modification) – 50.18±12.8 (23-72 years). Both groups were predominantly male, 110 (84.6%) in the first group and 40 (81.6%) in the second group. Patients with ascending aortic aneurysm, 110 (81.4%) / 41 (83.6%); acute aortic dissection, 10 (7.6%) / 5 (10.2%); and chronic aortic dissection, 15 (11.1%) / 3 (6.1%), predominated in both groups. Etiology – CHD (bicuspid aortic valve) predominated in both groups, 53 (40.45%) / 28 (57.1%); atherosclerosis, 45 (33.3%) / 11 (22.4%); connective tissue dysplasias, 34 (17.7%) / 9 (11.4%); syphilitic aortitis, 2 (1.48%)/ 1 (2%). Both groups had severe circulatory insufficiency (NYHA FC III to IV) – 109 (83.2%) / 39 (79.5%). Mean diameter of the ascending aorta was 58.6±13.2 mm / 54.4±9.84 mm. Mean EuroScore- 6.5±4.1 (0.96–23.8) / 6.14±4.01 (1.28–14.95). The groups were not statistically significantly different on these factors (p>0.05). Results: hospital mortality was not statistically significantly different between the groups, with 4 patients (3%) in group 1, mean Euroscore among those who died was 8.2±4.14, and 1 (2.8%) in group 2. IR time was statistically significantly higher in group 1 and amounted to 188.8±44.3 /161.1±60.2 min, respectively; aortic constriction in both groups was not statistically different – 115.27±33.9 / 117.2±54.8 min. Rethoracotomy due to bleeding in the first group was performed in 5 patients (3.8%). In all cases during revision the source of bleeding was not determined. The reason for rethoracotomy in two patients in the second group was bleeding from the left coronary anastomosis area and bleeding from soft tissues. Intraoperative blood loss in group 1 was 745.8 ml, in group 2 – 822±452 ml. The average stay in ORIT was 1.6±2.48 / 1.13±2.44 days. Duration of hospitalization – 10.9±4.28/11.5±3.3 days. The groups were not statistically different according to these parameters. Conclusions: both techniques are optimal and have comparable immediate results of surgical treatment of aneurysms and dissection of the ascending aorta.

To study the immediate results of surgical treatment of advanced age patients with non-small cell lung cancer (NSCLC). We included 190 elderly and senile patients with NSCLC who underwent surgery at the thoracic department of the Tomsk Regional Clinical Hospital in 2010-2018. There were 149 men and 41 women. Cancer stage I was observed in 67 (35%) cases, stage II - 49 (26%) patients, stage III - 69 (37%) patients, stage IV - 5 (2%) patients. Squamous cell cancer was diagnosed in 94 patients, adenocarcinoma - 78 patients, large cell lung cancer - 18 patients. Paraneoplastic inflammatory complications occurred in 26% of patients, concomitant diseases - in 99% of patients. The research included anatomic lung resection with systematic mediastinal lymph node dissection and the absence of tumor at the resection line. There were 118 lobectomies and 47 pneumonectomies. In 74 cases, combined procedures were carried out. Lobectomy with pulmonary artery resection was performed in 18 patients, lobectomy with bronchial resection - in 10 cases. Twenty-five patients underwent video-assisted lobectomy. An acceptable morbidity and mortality allow you to expand the indications for radical surgery in geriatric patients with NSCLC. However, we must establish strict indications for pneumonectomy. Bronchial and angioplastic lobectomy may be an alternative to pneumonectomy in NSCLC patients.

Objective. To improve the immediate results of surgical treatment of colorectal cancer, using more effective prophylaxis of morbidity. Маterials and methods. The treatment efficacy of the Program of complex prophylaxis of postoperative complications in colorectal surgery, elaborated in the Clinic was studied up, using comparative analysis of the morbidity, occurred in 1253 patients, radically operated for cancer recti. In 2005 - 2010 yrs, when some elements of the elaborated Program have begun introduced into clinical practice, 361 patients were operated on (Group I). In 2011 - 2017 yrs, when the Program for prophylaxis of postoperative complications was applied in full volume, 892 patients, presenting the main group (Group II) were operated on. Results. Сomparative analysis of the elaborated program for complex prophylaxis of postoperative complications and of the «fast track» concept have shown several essential differences between them. Introduction of the Program elaborated into clinical practice have improved the immediate results of surgical treatment of cancer recti due to essential lowering of rate of different morbidities from 14.9 tо 9.2% and mortality - from 3.0 tо 1.8%. Conclusion. The Program for complex prophylaxis of postoperative complications in colorectal surgery, elaborated in the Clinic, guarantees the results improvement while surgical treatment of cancer recti and may be recommended for wide clinical application.

Aim: to evaluate the perioperative results of robot-assisted surgery for rectal cancer in a group of high-risk patients and the influence of surgical risk factors (obesity, male gender, neoadjuvant chemoradiotherapy (CRT), as well as the tumor localization within 8 cm of the anal verge). Patients and Methods: the retrospective study included 223 cases of patients (48.43% men, 51.57% women) with rectal cancer who underwent robot-assisted surgery in the period from 2015 to 2021. Patients had a high surgical risk and were included in the study in the presence of one of the following factors: body mass index (BMI) ≥30 kg/m2, male gender, preoperative CRT, tumor localization within 8 cm of the anal verge. In this study, the relationship of BMI, CRT, age and gender of patients with parameters such as 30-day postoperative mortality, the number of postoperative complications according to the Clavien — Dindo classification, conversion rate, volume of intraoperative blood loss, duration of surgery, quality of total mesorectumectomy (TME), number of removed lymph nodes, frequency of lesions of the circular and distal edges of resection was evaluated. Correlations of stages T and N, tumor localization, ASA index and the presence of operations in the anamnesis with the above parameters were also checked in order to exclude their influence on the studied phenomena. Results: correlations of risk factors with the surgery time were revealed using the Spearman's rank-order correlation: surgery time — gender: correlation coefficient (ρ) 0.25, p<0.001; surgery time — BMI: ρ=0.23, p=0.001; surgery time — CRT: ρ=0.17, p<0.01; surgery time — Z-line: ρ=0.27, p=0.003. The correlation of circumferential resection margin (CRM) quality with the Z-line ( ρ=0.26, p=0.011) was also revealed. Conclusion: when performing robot-assisted surgery for malignant rectal tumors, there was no effect of surgical risk factors (male gender, obesity (BMI ≥30 kg/m2), CRT) on the conversion rate, as well as on the immediate results of surgical treatment. Despite this, the complexity of such surgeries in patients of this category undoubtedly increases, which is noted in an increase in the time spent on them. KEYWORDS: robot-assisted surgery, rectal cancer, oncology, risk factors, surgical treatment, colorectal cancer. FOR CITATION: Moiseev M.E., Gladyshev D.V., Kovalenko S.A. et al. Effect of surgical risk factors on the immediate results of robot-assisted surgery for rectal cancer. Russian Medical Inquiry. 2023;7(4):191–195 (in Russ.). DOI: 10.32364/2587-6821-2023-7-4-191-195.

Aim. To improve the immediate results of surgical treatment of injuries, and diseases of the liver and biliary tract through the rational use of minimally invasive technologies. Material and methods. Over the past 18 years, 6548 surgical interventions on the liver and biliary tract were performed. Postoperative intra-abdominal complications were observed in 643 (9.8 %) patients. At the same time, in 420 (6.4 %) cases, various options for repeated surgical interventions were used. Results. In 46 (23.4 %) cases, patients of the main group underwent laparoscopic cholecystectomy with endoscopic papillosphincterotomy (n = 10). In 5 (2.5 %) cases, percutaneous transhepatic cholangiography was performed to stop obstructive jaundice. Traditional surgical interventions with the formation of various variants of biliodegistic anastomoses were performed in 103 (52.5 %) patients. Postoperative complications in the main group were 23.0 %, and mortality was 9.6 %, while in the control group of patients, these figures were 36.0% and 19.3%, respectively. Conclusion. In the treatment of early postoperative intra-abdominal complications after surgical interventions on the liver and biliary tract, minimally invasive technology per indication is certainly considered the method of choice.

To date, the issues of surgical treatment of malignant cardiac tumors (MCT) remain relevant and are of particular interest to cardiac surgeons. Hospital mortality of this group of patients is extremely high (20–30%). Finding ways to reduce early postoperative mortality remains an extremely important task of oncocardiac surgery. The aim. To analyze the causes of early postoperative mortality based on the data of many years of experience in the surgical treatment of MCT and to propose methods for the prevention of early postoperative complications with the improvement of the immediate results of operations. Materials and methods. From 1970 to 01.01.2021, National Amosov Institute of Cardiovascular Surgery has provided surgical treatment of 67 patients with malignant tumors of the heart which amounted to 7.1% of the total number of observed patients with cardiac tumors (949). Of the 67 patients with MCT, 57 (84.9%) were operated using artificial circulation, three operations (4.6%) were emergency. Hospital mortality was 19.4% (13 patients). Results. Microscopic examination of the removed tumors revealed the presence of necrosis zones, their mechanical damage leads to significant intoxication of the patient. To prevent tumor intoxication (cause of postoperative mortality) in the operative and postoperative periods, new methods of combating such a factor of hospital mortality were used, which helped to improve the results of treatment of MCT. Hospital mortality reduced from 33.3% (1970–2001) to 5.5% (last 10 years), as a result of use these measures. Conclusions. Destruction of the tumor during surgery with artificial circulation leads to the entry of a significant number of tumor cells and toxins into the bloodstream, causing tumor intoxication. Improvement of the immediate results of surgical treatment of MCT depends on their timely diagnosis, which allows for adequate surgery with radical removal of the tumor and the use of detoxification measures, significantly reducing surgical mortality.

Currently, surgical intervention is the gold standard treatment of thymus tumors. Radical removal of the thymus gland in a single block, including the tumor, adjacent lymph nodes, and surrounding tissue of the anterior mediastinum, is a prerequisite for achieving satisfactory immediate and long-term results. The need for maximum thymectomy together with anterior mediastinal fiber is attributed to the fact that, along with other long-term survival factors (stage of tumor progression and histological subtype of the tumor), 4550% of deaths in the long-term follow-up period are due to the recurrence of thymoma and 1520% are caused by a progressive course of myasthenia gravis. The results of domestic and foreign studies on the implementation of thymectomy from various surgical approaches are analyzed. These include traditional thoracotomy and sternotomy, video-assisted and robot-assisted interventions, and combined operative accesses. The data presented are based on systematic reviews, retrospective cohort studies, clinical cases, and experimental studies using text databases PubMed, Google Scholar, and eLibrary.ru. The clinical characteristics of each operative access are given with an emphasis on technical features and advantages and disadvantages of thymectomy. The immediate results of surgical treatment of patients with thymus gland neoplasms are presented. Additional methods of visualization and physical preparation of anterior mediastinal tissues are described separately, which help increase the safety and effectiveness of surgical intervention. Currently, low-traumatic video-assisted surgical interventions are widely used in thoracic surgery, gradually replacing traditional open operations. Nevertheless, the variety of proposed options for surgical access, lack of clear indications and contraindications to various interventions on the thymus gland, and discrepancies in the use of various terms determine the need to develop a modern classification of surgical accesses for performing thymectomy. Taking into account world literature data and our own experience, a classification of operative accesses for performing thymectomy is proposed.

Background.Immediate postoperative complications in the surgical treatment of autoimmune thyroiditis range from 8.5 to 15.0% of the total number of operated patients.
 Aim.Improving the results of surgical treatment of patients with autoimmune thyroiditis through the introduction of advanced surgical techniques and the use of CO2 laser in surgical interventions.
 Material and methods.The immediate postoperative results of surgical treatment of patients with autoimmune thyroiditis at the clinical base of the Scientific Center for Surgery named after M.A.Topchibashev for 20152021 were studied. The analysis was carried out in two groups with the inclusion of data from 207operated patients aged 27 to 73years, mostly patients with hypertrophic form of AIT. There were 183(88.4%) women and 24(11.6%) men. The first group consisted of 96(46.4%) patients who underwent an advanced surgical technique using a CO2 laser. The second group included 111(53.6%) patients who underwent surgery using traditional methods. The immediate postoperative specific complications (paresis of the larynx and hypoparathyroidism) and the results of surgical treatment of patients in two groups were compared. To test the statistical significance of differences, nonparametric Pearson's 2 and Student's t tests were used. Differences were considered statistically significant at p0.050.
 Results.The number of patients with complications among the patients of the first group was 3(3.1%), among the patients of the second group 16(14.4%) (2=7.870, p=0.006). The greatest number of complications was noted in patients with large goiter and recurrence of the disease in those previously operated on for autoimmune thyroiditis. The proposed method using a CO2 laser in the surgical treatment of patients with autoimmune thyroiditis can reduce the incidence of laryngeal paresis (2=4.057, p=0.044), hypoparathyroidism (2=4.381, p=0.037) and mortality (2=3.840, p=0.050), reduce the duration of hospital stay by 22% from 9.6 to 7.4days (t=2.588, p=0.007).
 Conclusion.The use of advanced surgical techniques, the performance of the operation in an adequate volume and the use of a CO2 laser made it possible to reduce the number of postoperative complications and improve the results of treatment of patients with autoimmune thyroiditis.

In gynecological practice, due attention is paid to increasing the efficiency of institutions and organizations for surgical treatment of patients, in particular, rational use of hospital beds, reducing the economic cost of operations and rehabilitation of patients, reducing the time of hospitalization and incapacity for work, besides the above, the expediency of expanding the scope of surgical intervention is also increasing.
 The aim of the study is to prove the economic feasibility of combined single-stage surgical interventions in gynecological patients.Materials and Methods. The study was based on a retrospective analysis of the immediate results of surgical treatment of 50 women with uterine myoma operated on using combined (hystero-, laparo-) access and intracorporeal continuous suturing of the node bed (an innovative proposal) in the Scientific and Research Center SIS RPCPCM SAD. The results were in comparison with the same number of patients who underwent isolated operations of laparoscopy and hysteroscopy.
 Study results and discussion. As a result of the calculations, it was established that the total economic effect of the treatment using a combined one-stage operation was 8765.37 hryvnias per patient. This confirms the economic feasibility of this type of surgery compared to the two isolated ones.
 Conclusions. The results of the study indicate the economic feasibility of performing a combined one-stage hysteroscopy and laparoscopy for uterine myoma.