Long-term Results Of Surgical Treatment Research Articles

Immediate and Long-Term Results of Treatment of Aneurysms of Ascending Aorta and Aortic Arch and Substantiation of Tactical Approaches to the Treatment Based on the Obtained Results

Acute aortic dissection is a formidable disease. Its prevalence increases due to the population aging, as well as wider awareness of physicians about this pathology.
 The aim. To analyze immediate and long-term results of surgical treatment of aneurysms of ascending aorta and aortic arch and to determine optimal methods of correction of these lesions in order to improve the results of surgical treatment.
 Materials and methods. This was a comparative analysis of immediate and long-term treatment outcomes in 419 patients with aneurysms of ascending aorta and aortic arch. A comparative analysis of the results of treatment of two groups of patients was performed: the comparison group of 157 people operated before 2013, and the main group of 262 patients operated since 2013 using modified methods of aortic surgery.
 Results. The study showed significant reduction in the left ventricular dilatation according to echocardiography and satisfactory postoperative course in patients of both groups. Patients with valve-sparing aortic prosthetics had better results than those who underwent valve replacement surgery. Hospital mortality decreased from 17.2% to 5.3%.
 Analysis of long-term results showed that supracoronary aortic prosthetics with aortic valve plasty and elimination of the intimal tear zone make it possible to carry out effective aortic reconstruction. Due to events in the long run, regular lifelong monitoring is required.
 The analysis also showed that individualized approach to the choice of surgical tactics for the correction of aortic insufficiency in patients with aortic root and ascending aortic pathology allows to achieve comparable results in the immediate and long-term follow-up. Despite the complexity of the applied correction methods, the developed methods of surgical treatment of ascending aortic aneurysm (AAA) and aortic arch aneurysm and methods of protection of brain and visceral organs allowed to keep hospital mortality and the number of complications at the same level corresponding to one of the best world results. This gives hope for a good result in the long-term follow-up.
 Conclusions. Aneurysm of ascending aorta and aortic arch is a formidable life-threatening disease, and its only non-alternative treatment option is surgery. The optimized approach to the treatment of patients in the main group allowed to obtain better immediate and long-term results of surgical treatment and reduce postoperative complications from 34.4% to 8.4% and hospital mortality from 17.2% to 5.3%. Comparative analysis of long-term results in the studied groups showed more encouraging indicators of quality of life and life expectancy in patients when using modified surgical techniques, protection of the brain and visceral organs. We hope to get a final assessment of these data in the further study of the condition of these patients in the long-term follow-up.

Influence of neodymium laser radiation on the frequency of recurrence and continued growth of extramedullary tumors

Objective. To assess the effect of neodymium laser radiation on the recurrence rate and continued growth of primary extramedullary tumors on the basis of clinical data obtained in the long-term follow-up period in operated patients with extramedullary tumors.Material and Methods. The long-term results of surgical treatment of two groups of patients (n = 412) with primary extramedullary tumors operated on from 1998 to 2014 were studied and systematized. Patients of comparison group (n = 277; 67.2 %) underwent removal of tumors using standard microsurgical techniques, and the neoplasms in patients of the study group (n = 135; 32.8 %) were removed with additionally used neodymium (Nd:YAG) laser.Results. The use of the developed laser technologies for the resection of extramedullary intracanal primary tumors made it possible to reliably reduce the relative number of recurrence and continued growth from 11.1 % to 1.2% compared with patients treated with standard surgery methods. The proportion of recurrences was 3.5 %, all of them were detected only in the group with the classical technique of tumor resection (p <0.01).Conclusion. The use of a neodymium laser as an additional technology to the classical microsurgical resection of extramedullary tumors is effective for the prevention of their recurrence and continued growth.

Ближайшие и отдаленные результаты хирургического лечения синдрома диабетической стопы и оценка качества жизни больных (обзор литературы)

В настоящее время при многих хронических заболеваниях все большее значение придается исследованию качества жизни (КЖ). Сахарный диабет (СД) в силу сложного режима контроля и лечения, а также многочисленных соматических проявлений (острых и хронических осложнений) оказывает выраженное воздействие на КЖ. КЖ, в свою очередь, оказывает значительное влияние на прогноз заболевания. В данном обзоре рассмотрены ближайшие и отдаленные результаты хирургического лечения синдрома диабетической стопы, определения КЖ и сходных понятий, освещены основные подходы к исследованию КЖ при СД, приведен перечень наиболее часто использующихся инструментов для оценки КЖ. Анализ публикаций показал, что до сих пор недостаточно проводилась системная проработка данной проблемы, не реализованы возможности современного уровня развития техники и информационных технологий для ее решения. Таким образом, несмотря на дальнейшее развитие сосудистой хирургии, многие вопросы, связанные с диагностикой и методами лечения больных с язвенно-некротическими поражениями нижних конечностей, остаются нерешенными. Качество диагностических и лечебных мероприятий по-прежнему зависит от профиля лечебного учреждения, наличия в нем отделения хирургии сосудов, субъективного отношения врачей к тем или иным методам лечения, их знаний и опыта в этой области. Наиболее эффективно решить данные проблемы и повысить качество диагностики, лечения и последующей жизни пациентов позволяет создание алгоритма, определяющего последовательность действий врачей при поступлении в стационар такого больного. Анализ литературы показал, что для более точной оценки ближайших и отдаленных результатов реконструктивных сосудистых операций у больных с диабетической ангиопатией необходимо использовать определение показателя КЖ и его параметров, что в дальнейшем позволяет выбрать наилучший способ оперативного лечения в каждом конкретном случае, а также выявить влияние хирургической операции или других видов лечения на психику пациента. По мнению некоторых авторов, имеющиеся классификации синдрома диабетической стопы неполно отражают клиническую картину осложнений, а следовательно, в большинстве случаев не определяют тактику лечения больных. Существуют различные мнения в отношении оперативно-хирургических приемов. Недостаточно полно и не всегда обоснованно описаны способы снижения послеоперационных осложнений, частота которых во многих клиниках превышает 30 %.

Laparoscopic vs. open resection of gastrointestinal stromal tumors (GISTs) from gastric origin: different approaches for different diseases.

Although minimally-invasive techniques are currently recognized as effective and validated treatment for small gastric gastrointestinal stromal tumors (GISTs), the role of laparoscopy is not yet established. The aim of this study was to evaluate the outcomes of laparoscopic treatment of gastric GISTs compared to the results obtained in a group of patients treated with conventional surgery. A retrospective analysis was performed, using a prospectively maintained comprehensive database of 100 patients treated for gastric GIST in the period from 2000 to 2015. Thirty-six patients were treated laparoscopically, and 64 patients underwent conventional surgery. The analyzed medical data included clinical and pathological features of removed tumors, perioperative parameters as well as short and long-term results of surgical treatment. Histopathological examination confirmed radical resections for all patients. No deaths were reported in the 90-day postoperative period. Patients in laparoscopic group had significantly shorter length of hospital stay (5.5 vs. 7 days, P<0.0001), fewer extended and combined surgical procedures (11.2% vs. 34.4% and 2.8% vs. 39%; P=0.02 and P<0.001, respectively), and a smaller tumor size compared to laparotomic group (3 vs. 6 cm, P<0.0001). The median postoperative follow-up for the entire study population was 42 months. During this period, 11 patients died and 4 of them developed a tumor recurrence. None of them was in the laparoscopic group. Laparoscopy in the treatment of gastric GISTs has unquestionable advantages, but its choice is strictly related to tumor features.

Effectiveness of Repair of Aortic Coarctation in Neonates: A Long-Term experience

To evaluate early and long-term results of surgical treatment of aortic coarctation (CoAo) in neonates. This is a retrospective clinical review of neonates with CoAo, who underwent surgery between 1995 and 2019. Data were retrieved from our institutional database, to identify preoperative and postoperative characteristics. Statistical analysis was performed by means of relative risk ratio and Cox and logistic multivariate analysis. 218 consecutive neonates (M/F: 129/89, median age 11 days, IQR 7–17 days) were included; 202 (92.7%) had a left thoracotomy; 178 underwent extended end-to-end anastomosis (EEEA, 81.6%). Hypoplastic aortic arch (HAA) was present in 102 patients (46.8%); complex cardiac anomalies in 85 (39%). Significant postoperative complications occurred in 20 (9.2%). Thirty-day mortality was 2.3% (most in complex types). At a median follow-up of 10.4 years (IQR 5.6–15.0 years; FU completeness 95.9%), there were 8 late deaths (3.7%), all associated to complex CoAo. Among 196 survivors, 177 (93.2%) were in NYHA class I; re-interventions on aortic arch occurred in 9.2% (2.0% were surgical). Freedom from mortality and re-intervention on aorta at 10 years were 94.3% and 96.7%, respectively. Surgical repair of CoAo in newborns without CPB in our series was safe and low-risk, with excellent early and late outcomes.

Long-term results of hip arthroplasty and determination of unfavorable risk factors for early development of osteonecrosis in patients with systemic lupus erythematosus

Aim of the study – to determine the risk factors for the early development of osteonecrosis and to analyze the results of surgical treatment of patients with systemic lupus erythematosus in the long term after total hip arthroplasty.Materials and methods. The study group included 42 patients with systemic lupus erythematosus (SLE) complicated by osteonecrosis (ON) of the femoral head, who underwent 59 total hip arthroplasty (THA) operations. Before surgery and 6–21 years after THA, in order to assess the long-term results of surgical treatment of patients, the following was assessed: activity of the underlying disease – according to the SLEDAI-2K (Systemic Lupus Erythematosus Disease Activity Index 2000); the severity of irreversible changes in internal organs – according to the SLICC/ACR index of damage (Systemic Lupus International Collaborating Clinics/American College of Rheumatology); the clinical and functional state of the hip joint – according to the HHS (Harris Hip Score); the intensity of pain syndrome – according to the visual analogue scale (VAS); quality of life (QOL) – using the SF-36 questionnaire. The concentration of antibodies to cardiolipin (aCL) of IgM and IgG isotypes was determined by enzyme-linked immunosorbent assay (normal range – 0.0–10.0 GPL for IgM, 0–7 MPL for IgG).Results. After 6–21 years of follow-up after THA, there was a statistically significant decrease in pain intensity according to VAS, improvement according to the HHS from 40.0±14.9 to 83.3±17.4 points, SLE activity according to the SLEDAI-2K from 0 to 20 points (median – 4 [4; 8] points) before surgery and from 0 to 41 points (median – 0 [0; 4] points) after a long period of observation. There was a pronounced statistically significant positive dynamics for all QOL indicators studied (p≤0.005 in all cases). The most significant changes were found on the scales RE (Role-Emotional), RP (Role-Physical Functioning) and BP (Bodily Pain). The early development of ON was associated with the degree of activity of the underlying disease, the cumulative dose of glucocorticoids, kidney damage and arthritis in the first year from the onset of SLE, as well as hematological disorders and the presence of aCL in the blood serum 3 years before the onset of ON. The total number of complications was 10.2%.Conclusion. Total hip arthroplasty in patients with systemic lupus erythematosus can achieve a statistically significant reduction in pain intensity, increase functional activity and improve their quality of life.

Clubfoot treatment in China before and after the advent of the Ponseti technique: a historical narrative review.

Congenital clubfoot (CF) was first described by Hippocrates in approximately 400 B.C. In ancient China, manipulations were widely used to correct CF, but the outcomes were frequently unsatisfactory with residual deformity even if corrective devices were used. The advent of aseptic surgery and anesthesia has favored the development of different surgical procedures to manage children with CF. Surgical treatment became extremely popular in China during the years 1960–1990 due to the good clinical foot appearance post-surgery. However, the poor mid- to long-term results of surgical treatment facilitated the return of conservative treatment, i.e., the Ponseti technique. Over the past decade, the Ponseti technique has become very popular in China. The Ponseti technique is essentially conservative and it is based on a good understanding of CF pathophysiology. Casts are changed once a week and Achilles tenotomy is performed if equinus persists at the end of treatment. Although highly successful on the short to mid-term, the Ponseti technique is not able to completely eradicate surgery, and recurrence is still possible. As the etiology of CF is still unclear, the first mission for doctors and researchers all over the world is to truly understand the pathogenesis of the deformity. Even though genetics seems to play an important role, successful gene therapy is still a distant goal. This narrative review aims to investigate the history of CF treatment in China, to describe its tortuous process and to potentially inspire new ideas to create new effective methods of treatment.

Outcomes after surgical resection of primary cardiac sarcomas

Aim. To assess the immediate and long-term results of surgical treatment of patients with primary cardiac sarcomas.Methods. In the period from 2013 to 2020, five patients (two men and three women) of different age groups (from 10 to 54 years old) with primary cardiac sarcomas various localisations had been operated at our hospital. In all the patients, the operation was performed from the median sternotomy with cardiopulmonary bypass, normothermia and crystalloid cardioplegia.Results. The average age of the patients was 32 ± 12 years. Two patients had leiomyosarcoma (of right atrium and pulmonary artery), two had angiosarcoma of the right atrium and one was diagnosed with pleomorphic left atrial sarcoma. Only in two patients, the lesion was limited to one chamber; in other cases, the tumour exhibited aggressive infiltrative growth and invasion into the inferior vena cava, myocardium of the left ventricle, contralateral cardiac chambers, pericardium and parietal pleura. Three patients underwent radical surgery with R0 resection, two others underwent cytoreductive surgery with R2 resection owing to the prevalence of the process and the technical impossibility of radical resection. We did not record any in-hospital mortality. Postoperative chemotherapy was administered to four patients. At follow up, (median 18.8 ± 11.7 month), one patient was alive (follow-up 35 months) and was undergoing chemotherapy owing to local recurrence of the disease. One patient with pulmonary leiomyosarcoma underwent re-operation because of local recurrence 1 year after the primary surgery. All the patients died because of disease progression. The average postoperative survival duration in those who died was 14.8 ± 8.1 month.Conclusion. Despite effective early results, long-term survival and tumour-free course were disappointing owing to the initial prevalence of the disease course, the complexity of surgical procedures and the impossibility of radical resection in two cases. However, a multimodality treatment of this pathology, including radical surgical resection of the tumour (R0) along with the modern neoadjuvant and adjuvant chemotherapy, and in some cases, radiotherapy, can improve the survival duration. Received 18 December 2020. Revised 4 March 2021. Accepted 10 March 2021. Funding: The study did not have sponsorship. Conflict of interest: Authors declare no conflict of interest.

Treatment Methods for Different Variations Syndrome Mirizzi

The number of patients with complicated forms of cholelithiasis of cholelithiasis is progressively growing. One of the complications of gallstone disease is Mirizzi syndrome (SM). The reason for the development of which is the spread of the inflammatory - destructive process from the gallbladder to the bile ducts with the formation of pressure ulcers in the common bile duct, as a result of which the formation of a cholecystobiliary fistula occurs, through which stones from the gallbladder enter the main bile ducts. The analysis of the surgical treatment of patients with cholelithiasis (GSD) treated in the UH NJSC "MUS" was carried out. There were 3842 patients in total, Patients were in the period from January 2012. to July 2018 The analysis revealed that of all these patients with gallstones, Mirizzi SM type III and IV syndrome was diagnosed in 25 (0.7%). In 14 (56%) patients with type III SM and type IV SM, 11 (44%). The main group consisted of 10 (40%) patients and 15 (60%) patients included in the control group. The main group completed: 1) In type III SM (only 4 (40%) patients). One patient underwent hepaticojejunostomy according to the clinic method (2017/0423.1). In 3 patients, cholecystohepaticocholedochoplasty was performed with U-shaped interrupted sutures on the drainage according to Vishnevsky (2017 / 0980.1); 2) In type IV SM (a total of 6 (60%) patients). 4 patients underwent hepaticojejunostomy according to the clinic method (2017/0423.1). In 2 patients, cholecystohepaticocholedochoplasty was performed with U-shaped interrupted sutures on the drainage according to Vishnevsky (2017 / 0980.1). The developed and tested methods of surgical treatment of Mirizzi syndrome of types III and IV make it possible to improve the immediate and long-term results of surgical treatment of patients with this pathology. These methods of surgical treatment allow preserving the physiology of the bile outflow without postoperative complications typical for traditional hepaticojejunostomy (incompetence of the anastomotic sutures, stricture of hepaticojejunostomy).

Лапароскопическая уретеропластика тубуляризированным буккальным графтом при протяженной облитерации дистального отдела мочеточника

Introduction. Reconstruction of the distal ureter after exposure to radiation energy on the pelvic organs remains an important problem in modern urology. The use of tissues of the own urinary tract in these cases is not always possible due to their deficiency in this category of patients, and the formation of an anastomosis by intestinal segments is often unjustified due to the high degree of trauma of enteroplastics. Materials and methods. To improve the immediate and long-term results of surgical treatment of extended strictures and obliterations of the distal ureter, we have developed a new method of its reconstruction – laparoscopic ureteroplasty of the distal ureter with tubularized buccal graft. This surgary was performed on a 36-year-old patient after extirpation of the uterus with appendages and the upper third of the vagina due to malignant neoplasm and several courses of radiation therapy. The length of the replaced ureteral defect was 6 cm. Results. The use of a tubularized buccal graft is an affordable alternative to these operations, and the laparoscopic technique allows one to achieve better anastomosis and reduce the number of postoperative complications. The immediate results of this operation are encouraging in terms of the possibility of its use in this category of patients. Conclusion. Laparoscopic ureteroplasty with tubularized buccal graft may be one of the promising options for the reconstruction of the distal ureter in case of its extended obliteration. The possibilities of this operation will be studied as experience is gained and as long-term postoperative observation of patients is observed.

Reconstruction of the Aortic Arc through Left Thoracotomy in Patients with Isolated Coarctation and Aortic Arch Hypoplasia

Background. The choice of surgical approach for the reconstruction of aortic arch hypoplasia is a rather controversial issue. Traditionally, left lateral thoracotomy is used to correct aortic coarctation with hypoplasia of one or more arc seg-ments. However, in recent years, more and more clinics have begun widespread use of median sternotomy for the surgical treatment of aortic arch hypoplasia. The purpose of the research was to analyze the immediate and long-term results of surgical treatment of isolated hypoplasia of the aortic arch in infants through left thoracotomy.&#x0D; Materials and methods. From 2010 to 2019, 159 infants with coarctation and hypoplasia of one or more segments of the aortic arch underwent reconstruction of the aortic arch at the National Amosov Institute of Cardiovascular Surgery of the NAMS of Ukraine and Ukrainian Children’s Cardiac Center. The study included only patients with biventricular physiology and subsequent biventricular correction. There were 108 male patients (68%) and 51 female patients (32%).&#x0D; The mean age of the patients was 2.4 ± 0.9 months, the mean body weight was 4.7 ± 2.0 kg. The main method of diagnosis, i.e. determining the defect and assessing the immediate and long-term results, was echocardiographic examination. The study group consisted of 155 patients (97.5%) in whom the reconstruction of the aortic arch was performed through left thoracotomy, in the remaining 4 patients (2.5%) the intervention was performed through median sternotomy.&#x0D; &#x0D; Results. In-hospital mortality was 0.6% (n = 1). The average time of the operation was 126 ± 40 minutes, the aortic cross-clamp time was 24.7 ± 5.1 minutes. The mean duration of mechanical ventilation after the surgery was 41 ± 15.9 hours.&#x0D; The mean follow-up period ranged from 1 month to 13 years. There were no deaths in the long-term period. Ten (6.4%) patients developed aortic arch restenosis in the postoperative period. In 8 patients, the narrowing was treated by endovascular dilatation. Two patients underwent repeated aortic arch repair using median sternotomy. There were no cases of compression of the trachea, main bronchi, neurological complications in the follow-up period.&#x0D; &#x0D; Conclusions. Reconstruction of the aortic arch hypoplasia through left thoracotomy is an effective and safe treatment option in infants associated with good immediate and long-term results. The study indicates that this surgical strategy can be used in most patients with hypoplasia of the isthmus and distal aortic arch.

Retrospective Analysis of Surgical Treatment Results of Postinfarction Ventricular Septal Rupture

Ventricular septal rupture (VSR) is the most dramatic complication of acute myocardial infarction (MI). It manifests itself most often in the first week after infarction, with the maximum fatal complications occurring on day 1 and day 3–5 after MI. Patients receiving conservative treatment mostly die of progressive heart failure within few hours or days. Even now, in the era of endovascular interventions, surgical treatment remains the gold standard for the treatment of this pa-thology. Our research is mainly aimed at studying the factors of operative mortality, describing our methods of treatment and analyzing the survival rate and long-term outcomes after surgical treatment of this pathology.&#x0D; We studied 90 patients with postinfarction VSR who underwent surgical intervention in 2002–2019. Twelve of them were operated at the Central Clinical Hospital in Baku, and 78 at the National Amosov Institute of Cardiovascular Surgery in Ukraine. The mean age of the patients was 59.9 ± 9.59 years, 65 (72.2%) were men and 25 (27.8 %) were women. Fifteen (16.6%) patients were smokers, 31 (34.4%) were diabetic, 70 (77.7%) patients had arterial hypertension, 62% of patients had NYHA class III heart failure with average ejection fraction of 43.9 ± 10.4%. According to the results of coronary angiography, single vessel stenosis of the coronary arteries was detected in 18 (20%), two-vessel lesion in 32 (35.5%), and three-vessel lesion in 40 (44.4%) patients. There were no patients with left main coronary artery (LMCA) stenosis.&#x0D; Long-term results of surgical treatment were followed for 1 to 8 years, on average in 18 (28.6%) patients. Within 1, 3 and 8 years 17, 12 and 2 patients were examined, respectively. Good results within 5 and 10 years after surgical treatment were observed in 87.5% and 64.3% patients, respectively.&#x0D; Repeated complaints in our group and those observed in the literature are associated with worsening of heart failure after venticulotomy and changes in the geometry of the left ventricle.&#x0D; Recurrence of heart failure and coronary symptoms within 3 years and after 3 to 8 years were observed in 6 (33.3%) and 3 (25%) patients, respectively. Repeated endovascular revascularization was performed in 5 patients. ICD was im-planted in 4 patients, and in 2 patients CRT-D was implanted within 4 years 2 months and 7 years, respectively.&#x0D; There were no hemorrhagic complications within 8 years. Four (22.2%) patients died in the long-term period, the cause of death was unknown.&#x0D; In intensive care department the treatment strategy suggested hemodynamic stabilization with the help of conserva-tive therapy and IABP.&#x0D; The patients who underwent surgery in ≥ 3 weeks after the diagnosis of postinfarction VSR survived within 30 days after surgery. Delayed planned recovery is stipulated by the formation of scar tissue in the myocardium, which enables to facilitate the technical aspects of recovery. The time of the operation depends mainly on hemodynamic status of the patient. Patients with cardiogenic shock should undergo immediate surgical treatment.

THE PROGNOSTIC SIGNIFICANCE OF MYXOID MATRIX IN RETROPERITONEAL WELL-DIFFERENTIATED LIPOSARCOMA

Objective: to assess the influence of the myxoid matrix in retroperitoneal well-differentiated liposarcoma(WDLPS ) on the long-term results of surgical treatment of patients.Material and Methods. The study included 111 patients with primary retroperitoneal WDLPS who underwent radical surgical treatment in Federal State Budgetary Institution «N.N. Blokhin National Medical Research Center of Oncology» of the Ministry of Health of the Russian Federation. Histological slides of all surgical specimens were reviewed by experienced pathologist and reclassified according to criteria of WHO (2013) for histological subtypes of the WDLPS . Patients were divided into groups depending on presence or absence of the myxoid matrix in WDLPS and enrolled in intergroup analysis of overall (OS ) and recurrence-free (RFS) survival.Results. OS was significantly worse in the group of patients with the myxoid matrix in the tumor (p=0.002; log-rank test). The median OS was 142 (95 % CI , 108, 176) months in the group without the myxoid matrix, and 84 (95 % CI , 29, 139) months in the group with the myxoid matrix. The 5-year survival rates were 79 % and 44 % in the groups without myxoid matrix and with myxoid matrix, respectively. RFS was also significantly worse in the group of patients with the myxoid matrix than in the group of patients without the myxoid matrix (p=0.006; log-rank test). The median RFS was 55 (95 % CI , 38, 72) months in the WDLPS group without the myxoid matrix, and 31 (95 % CI , 15, 47) months in the WDLPS group with the myxoid matrix. The 2-year RFS rates were 75 % and 44 % in the groups without the myxoid matrix and with the myxoid matrix, respectively.Conclusion. The results of the study demonstrated that the presence of the myxoid matrix in WDLPS was associated with poor prognosis. We believe that the presence of the myxoid matrix in WDLPS can serve as an effective morphological marker of a less favorable prognosis for retroperitoneal WLPS .

Quantitative assessment of preoperative risk factors for aggressive course of medullary thyroid carcinoma

Objectives: to study the long-term results of surgical treatment of patients with medullary thyroid carcinoma and evaluate the significance of prognostic factors. Materials and methods: the continuous retrospective study included 169 patients with histologically confirmed medullary cancer who were initially operated at the Northwestern Center for Endocrinology and Endocrine Surgery of the SPbSU University Clinic from 2010 to 2016. They were divided into prognostic groups according to the level and dynamics of postoperative calcitonin and clinical manifestations of the disease. Results: The study allowed to assess the effect of predictive factors on the risks of progression and recurrence in medullary thyroid cancer. Size of the primary tumor more than 2 cm significantly increases the risk of disease progression (OR=6,56 (0.52-17.96) p=0,00001495). Invasion of the thyroid capsule and metastases to regional lymph nodes are even more important prognostic value as OR=49,08 (10.72-224.89), p=0,00000011 и OR=30,63 (9,75-96,27), p&lt;0.0000001 respectively. Regional MTC metastases are a significant threat to the life of the patient. This fact is a fundamental difference with differentiated thyroid carcinoma were regional metastases do not affect the prognosis. This study failed to link the prognosis to the patient's age. As expected the level of basal calcitonin &gt;600 pg/ml affects the prognosis (OR=6,65 (2,53-17,59) p=0.01055). Its prognostic value is comparable to the size of the primary tumor and significantly less than the presence of regional and distant metastases. Conclusions: Unfavorable prognosis in 21 (12.4%) observed patients is associated not only with the presence of distant metastases, but also and independently with regional ones.

Анализ результатов хирургического лечения грыж шейного отдела позвоночника способом передней декомпрессии и межтеловой кейджевой стабилизации

The research objective is to study the results of surgical treatment of the cervical spine with anterior decompression and interbody cage stabilization. Material and methods. The analysis of immediate and long-term (from 12 months to 5 years) results of surgical treatment by the method of anterior intercorporal fusion of 57 patients with cervical spine diseases was performed. Results. The treatment results were evaluated by the data of clinical examination in accordance with the Odom criteria, and neurostatus — in accordance with the criteria proposed by the Japanese Orthopedic Association (JOA). Conclusions. The study of long-term results of surgical treatment of patients with cervical spine degenerative-dystrophic diseases using the ACDF method showed high efficiency, reliability and safety of anterior decompression and stabilization with titanium cages.

Collis gastroplasty in surgical treatment of hiatal hernia

To analyze the early and long-term postoperative outcomes after Collis gastroplasty in the treatment of patients with hiatal hernia complicated by gastroesophageal reflux disease and shortening of the esophagus. Postoperative outcomes after Collis gastroplasty were analyzed in 22 patients with hiatal hernia and shortening of the esophagus. The control group consisted of 166 patients after simple repair of hiatal hernia without Collis procedure. In case of Collis gastroplasty, surgery time was 185 (160-250) min. Intraoperative complications were observed in 3 (13.6%) patients, incidence of postoperative complications - 18.2%. There were no lethal outcomes in this group of patients. Mild functional dysphagia was observed in 2 (9.1%) patients. Length of hospital stay was 7.8±2.4 days. Mean follow-up was 34 (6-52) months. There were no anatomical recurrences. A relapse of gastroesophageal reflux was noted in 1 (4.6%) case. GERD-HRQL score was 4.8±2.2 points. Additional Collis gastroplasty did not affect the immediate and long-term results of surgical treatment in comparison with simple cruroraphy and fundoplication. Unreduced shortening of the esophagus may be followed by high incidence of recurrent hiatal hernia and GERD in long-term period. In case of shortening of the esophagus, surgery should include Collis gastroplasty. This effective and safe procedure does not impair treatment outcomes. Indications and optimal technique of Collis gastroplasty require clarification and further research.

Long-term results of surgical treatment in patients with high-risk localized prostate cancer

Long-term results of surgical treatment in patients with high-risk localized prostate cancer

Desarda technique as a valuable alternative for inguinal hernia patients refusing mesh implantation: long-term results fifteen years after a pure tissue repair in 198 patients

Aim: The aim of the study was to retrospectively analyze long-term results of surgical treatment of patients diagnosed with primary inguinal hernia up to 15 years after a Desarda pure tissue repair.

Long term results of the reproductive system after surgical correction of unilateral cryptorchidism

This article examines the long-term results of the reproductive system after surgical treatment of 86 patients with cryptorchidism. The data obtained confirm the feasibility of an earlier surgical correction of cryptorchidism in children. There are several options for the incorrect location of the testicles. The situation when the testicle did not descend on only one side occurs 5 times more often than the undescendedness of both testicles. The results obtained in the study of the long-term results of surgical treatment of cryptorchidism in children showed that the brought down testicle lags behind in development compared with the healthy one, this is especially noticeable in testicular hypoplasia.

Long-term results of surgical treatment for intrahepatic cholangiocarcinoma according to the tumor mutation status

Long-term results of surgical treatment for intrahepatic cholangiocarcinoma according to the tumor mutation status