Objective: to evaluate safety and efficacy of robot-assisted extralevatory abdominoperineal extirpation of the rectum with transabdominal levator transеction in a patient in lithotomy position.Materials and methods. Within this study, we analyzed clinical observations of several patients who underwent robot-assisted extralevatory abdominoperineal extirpation of the rectum with transabdominal levator transеction at lithotomy position, conducted in the Saint Petersburg City Hospital No 40 during 2015–2016. We assessed the main intraoperative characteristics, postoperative complications, and pathological features of removed organs.Results and discussion. We analyzed the data on 5 patients. All of them underwent R0 resection. The number of resected lymph nodes varied from 15 to 21. Maximum blood loss was 100 ml. The duration of surgery was between 150–210 min. One patient had a postoperative complication – intrapelvic bleeding in the early postoperative period.Conclusion. The use of the described surgical method allowed to perform R0 resections in all patients without losing the advantages of minimally invasive surgery, including small blood loss, early recovery of peristalsis, and rapid rehabilitation of the patients.

We have analyzed both Russian and foreign publications devoted to tactics of surgical treatment of complicated colorectal cancer. We carried out a comparative analysis of different surgical tactics. There is a significant increase in the number of emergency colorectal cancer surgeries performed in non-specialized surgical hospitals; postoperative mortality rates remain high, long-term treatment results are still poor. These facts suggest that the problem of colorectal cancer treatment is far from being resolved and requires particular attention.

In 1998, oncologists got a brand new antitumor drug – irinotecan. It’s been already 18 years since its approval for second-line polychemotherapy of metastatic colorectal cancer. Indications for irinotecan use were significantly expanded since that time; it is now used in combination with other therapeutic agents for first- or second-line treatment of metastatic colorectal cancer, in combination with targeted drugs or separately; there are some studies assessing the use of irinotecan in neoadjuvant therapy. The article describes the history and modern schemes of irinotecan administration in treatment of colorectal cancer.

Background . During the last years several trials emerged demonstrating high tumour heterogeneity, including those on colorectal cancer. Objective. These findings made us initiate a meta-analysis of trials dedicated to this question. Materials and methods. We searched PubMed database, ASCO and ESMO abstracts for publications presented until August 2016. Studies which compared concordance of KRAS, NRAS, BRAF and PIK3CA mutations between primary tumour and metastases of colorectal cancer and which included more than 10 patients were included in meta-analysis. Meta-analysis was performed using Review Manager (RevMan), version 5.3. Results. Statistically significant differences were observed in KRAS (5 %; RR 0.95; 95 % CI 0.92–0.98; р = 0.003), PIK3CA (7 %; RR 0.93; 95 % CI 0.86–0.99; р = 0.04) mutational status, but not BRAF and NRAS. We observed no significant publication-associated systematic errors. KRAS discordance was significantly higher between primary tumour and lymph node metastases – 13.2 % (р = 0.036). Conclusions. A possibility of KRAS discordance between primary tumour and colorectal cancer metastases was demonstrated. Considering a small number of patients with discordance it is necessary to distinguish a high-risk discordance group, which will require an additional mutational analysis of metastatic nodes tissue.

Objective : comparative analysis of specific perioperative features and pathological characteristics of the removed sample after laparoscopic total mesorectumectomy (Lap-TME) and transanal total mesorectumectomy (Ta-TME). Materials and methods . A prospective non-randomized controlled study was carried out from November 2013 until September 2016. Patients with сТ1–4aN0–2M0 cancer of low- or medium-ampullar section of rectum were enrolled. Results . 55 and 54 patients were included in the Ta-TME and Lap-TME groups respectively. Duration of surgery was 285 min (Ta-TME group) and 260 min (Lap-TME group); median volume of blood loss was less than 100 ml; duration of hospital stay after surgery was 7 days in both groups. 1 (1.8 %) patient from Ta-TME group and 3 (5.6 %) patients from the control group had conversion to open surgery (р = 0.223). Transanal removal of the sample was done in 53.7 % of the cases in Ta-TME group and 25.5 % of the cases in Lap-TME group (p = 0.008). Complications were registered in 27,3 and 24,1 % of the patients respectively (р = 0,436). 90.9 % of the patients from Ta-TME group had Grade 2–3 quality of mesorectumectomy, while in Lap-TME group this parameter was 85.2 % (p = 0.266). Circumferential resection margin damage was observed in 7.3 % of cases from Ta-TME group and 9.3 % of cases from Lap-TME group (p = 0.488). Conclusion . Ta-TME does not worsen short-term oncological results. Further randomized studies are required to identify those patients who would benefit from bottoms up mesorectumectomy.

Background. Colorectal cancer is highly prevalent in Russia, especially among the elderly patients. We analyzed the influence of age on anxiety level and cognitive function on patients with colorectal cancer.Materials and methods. In the period 2012–2015 we analyzed pre-operatively the level of anxiety (HADS scale) and cognitive disfunction (MoCA test) in 244 patients who underwent radical colorectal resection.Results. Patients younger than 60 constituted 34 %, 60–74 years – 31 %, 75 years and older – 35 %. We were able to show a correlation between age and anxiety level according to HADS. The same trend was found according to MoCA test.Conclusion. Oncopsychologist shall develop individualized treatment plan according to anxiety and cognitive levels in patients with colorectal cancer.

Background. The paper presents our own experience of using a waterjet dissector ERBEJET2® in the course of surgical interventions for colorectal cancer. This experience is unique for Russia.Materials and methods. Waterjet dissection method associated with total mesorectumectomy was used by us in 20 patients suffering from rectal cancer. An average age of patients was 59.2 ± 13.9 years. In all the patients surgeries were performed for adenogenic colorectal cancer, morphologically verified at the preoperative stage. Resected preparations were studied on morphological level. For comparison, two control groups of 20 patients were selected, in which the rectum mobilization was performed by using monopolar coagulator and harmonic scalpel. The studied groups were matched by gender, age, location and the tumor extent. All the surgeries were performed by one surgical team.Results. Results of the study demonstrated advantages of waterjet dissection when performing total mesorectumectomy due to a minimum depth of tissue damage on the lateral margin of resection.Conclusion. Waterjet dissectors have taken their place in the extensive list of tools used when performing surgical interventions for colorectal cancer, that allows to expect an improvement of functional and oncological results of the surgical treatment.

The term “liquid biopsy” describes the study of various tumor derivatives (circulating tumor DNA, circulating tumor cells, tumor RNA, tumor proteins) in the blood plasma. Results of liquid biopsy provide real-time information on the molecular pathologies and morphological features throughout the whole tumor mass and allow to estimate evolutionary changes of tumor mass in the dynamics, heterogeneity of mass formation and effectiveness of the therapy. Despite the impressive perspective of this method in the diagnosis, monitoring of disease, there is a number of problems for the implementation of liquid biopsy for various cancer pathologies. In this literature review, we focus on the role of circulating DNA as a source of information about the tumor in patients with colon cancer.

This article displays the results of successful combined treatment of patient with recurrence of rectal carcinoma with use of preoperative chemotherapy followed by infralevator pelvic exenteration and primary reconstruction of pelvic floor using xenotransplant “Kollost”.