Organ-preserving Surgery Research Articles

Torsion of the uterine appendages in a 12-year-old girl

Introduction. The uterine appendage torsion (UAT) is an urgent pathology accompanied by a painful abdominal syndrome and requiring urgent diagnostic and therapeutic measures. In childhood, UAT develops mainly due to organic causes and due to the specific location of internal organs in children. The literature data on organ-preserving surgeries in the long-lasting UAT is very controversial and dubious. There are no objective criteria for assessing ovarian viability after detorsion what impacts the selection of surgical intervention tactics - unjustified adnexectomy may be performed.Clinical case. Girl P., 12 years old, was admitted to the hospital with a clinical picture of long-lasting torsion of the uterus appendages. Right uterine appendages were detorsed. The child was under observation. In two years, laparoscopic appendectomy was performed for chronic appendicitis. When examining pelvic organs, the right ovary was found reduced in size compared to the left one; there were no macroscopically visible changes; single follicles were visualized in it; the fallopian tube was not changed.Conclusion. A painful sensation before surgery indicates that the uterus appendages are viable; if there is no abdominal pain, necrosis of the ovary and fallopian tube may be suspected. A surgical tactics is chosen on making a comprehensive analysis of clinical and instrumental findings.

Psychological and Aesthetic Outcomes in Breast Cancer Patients.

Background:Patients who undergo breast cancer treatment require psychosocial and aesthetic rehabilitation. Advantages of breast reconstruction in-patient rehabilitation are well known. Oncoplastic organ-preserving surgery offers aesthetically better results, yet is often considered less safe than more radical procedures. We compared the aesthetic and psychological outcomes in patients undergoing breast reconstruction and oncoplastic breast cancer treatment.Methods:In total, 1130 patients who received either breast reconstruction or oncoplastic breast cancer surgery were included in the study. Patients were classified into two groups. Group 1 included 510 patients who received breast reconstruction surgery. Group 2 included 620 patients who received oncoplastic surgery. The following aspects were compared between the two groups: demographics, tumor progression, and immunohistochemical aspects, complications, hospitalization stay, and psychological and aesthetic outcomes.Results:Patients in the oncoplastic group showed statistically significant higher psychosocial and aesthetic outcomes, as well as lower incidence of complications, revision rate, disease progression, and recurrence. The majority of oncoplastic patients were treated in early stages of breast cancer.Conclusion:Offering superior treatment results, oncoplastic organ-preserving surgery should be favored in patients with earlier stages of cancer progression.

The clinicopathologic and operative characteristics of patients with small nonfunctioning pancreatic neuroendocrine tumors.

Incidentally detected, small nonfunctioning pancreatic neuroendocrine tumors (NF-PNETs) are increasingly diagnosed on imaging modalities. This retrospective investigation evaluated the clinicopathologic characteristics and perioperative and oncologic outcomes in patients with small NF-PNETs undergoing curative resection. The medical records of 444 patients who underwent pancreatic resection for NF-PNETs at a single, large-volume institution between January 2000 and December 2018 were retrospectively reviewed. Patients were divided into those with small (≤2cm) and large (>2cm) tumors based on the largest tumor diameter on preoperative computed tomography (CT). Outcomes were also evaluated in subgroups of patients with small NF-PNET who did and did not undergo lymphadenectomy. Of the 444 patients with NF-PNETs, 195 (43.9%) had small (≤2cm) and 249 (56.1%) had large (>2cm) NF-PNETs. The rate of parenchyma-preserving surgery (14.4% vs. 7.2%, p=0.014) and the ratio of spleen preservation for left-sided pancreatectomy (65.6% vs. 38.3%, p < 0.001) were higher in the small NF-PNET group. Size on CT >2cm (p < 0.001, hazard ratio [HR]: 5.836, 95% confidence interval [CI]: 2.474-13.769), presence of perineural invasion (p < 0.001, HR: 3.025, 95% CI: 1.640-5.577), World Health Organization (WHO) Grade 2 (p=0.007, HR: 2.861, 95% CI: 1.325-6.176), and WHO Grade 3 (p < 0.001, HR: 11.537, 95% CI: 5.282-25.199) were independent predictors of disease-free survival (DFS). DFS did not differ significantly in patients with small NF-PNETs who did and did not undergo lymphadenectomy (p=0.886). Assessment of long-term oncologic outcomes suggests that surgical resection may cure small NF-PNETs. Minimally invasive surgery and organ-preserving surgery are acceptable treatment options for select patients with small NF-PNETs. The effect on survival outcomes of lymph node dissection for small NF-PNETs remains unclear.

Organ-conserving operations in breast cancer: indication, contraindication and recurens

Organ-сonserving operations in breast cancer include performing extended sectoral resections with regional lymphadenectomy. In the case of these interventions, immediate histological examination of the safe margins and subareolar area will be mandatory. Overly economical tactics are associated with the risk of breast cancer recurrence. Organ-preserving breast cancer surgeries, supplemented with radiation therapy, are a safe alternative to mastectomy with the correct selection of patients with early forms.

Development of Incidence and Surgical Treatment of Penile Cancer in Germany from 2006 to 2016: Potential Implications for Future Management

BackgroundPenile cancer is a rare disease and surgical treatment often entails a significant impact on quality of life. The aim of this study was to analyze trends in surgical treatment patterns in Germany.MethodsWe analyzed data from the nationwide German hospital billing database and the German cancer registry from 2006 to 2016. All penile cancer cases with penile surgery or lymph node dissection (LND) were included. We also analyzed the distribution of cases, extent of surgery, and length of hospital stay, stratified for annual caseload. The geographical distribution of centers for 2016 was presented.ResultsDuring the investigated timespan, tumor incidences increased from 748 to 971 (p = 0.001). We identified 11,353 penile surgery cases, increasing from 886 to 1196 (p < 0.001), and 5173 cases of LND, increasing from 332 to 590 (p < 0.001). Cases of partial amputation increased from 45.8 to 53.8% (p < 0.001), while total amputation remained stable at 11.2%. Caseload in high-volume hospitals increased from 9.0 to 18.8% for penile surgery (p < 0.001) and from 0 to 13.1% for LND (p < 0.001). The increase in LND caseload was caused by an increase in inguinal LND, from 297 to 505 (p < 0.001), with increasing sentinel LND, from 14.2 to 21.9% (p = 0.098). The assessment of geographical distribution of cases in Germany revealed extensive areas without sufficient coverage by experienced centers.ConclusionsWe saw consistent increases in penile surgery and LND, with a growing number of cases in high-volume hospitals, and, accordingly, an increase in tumor incidence. The increasing use of inguinal LND and organ-preserving surgery reflect the adaptation of current guidelines; however, geographical distribution of experienced centers could be improved.

Surgical treatment of patients with nodular toxic goiter

Nodular toxic goiter (NTG) accounts for 7.3 % to 10.0 % of the goiter population. There are difficulties in the preoperative differential diagnosis between NTG and other thyroid diseases. There is also controversy about the benefits of resection surgery over thyroidectomy in patients with NTG. The aim of the study: a comparative assessment of the diagnosis and treatment results of patients with NTG in the early and late postoperative periods after resection surgery and thyroidectomy. Materials and methods. The study enrolled 51 patients with NTG. The mean age of patients in the group was 51.7 ± 12.9 years. Results. Bilateral multinodular lesions prevailed – 34 (66.7 %) patients. Free T3 level was measured only in 15 (29.4 %) patients, 7 (46.7 %) of them had elevated T3 level. 15 (29.4 %) patients underwent hemithyroidectomy including the isthmus, 2 (3.9 %) had subtotal resection, 34 (66.7 %) patients underwent thyroidectomy. Conclusions. Multinodular bilateral thyroid lesions dominated the structure of NTG – 34 (66.7 %) patients who underwent thyroidectomy. Uninodular and multinodular unilateral pathology was diagnosed only in 17 (33.3 %) patients who underwent organ-preserving surgery. The measurements of free T3 level in patients with NTG allowed the diagnosis of T3-thyrotoxicosis in almost half of patients (46.7 %), which is a diagnostic criterion for detection of functional nodal autonomy. Following the organ-preserving surgery, 17 (33.3 %) patients with NTG required the use of hormone replacement therapy with levothyroxine at a mean dose of 25.0 (25.0; 50.0) mcg/day in the late postoperative period (&gt;1 year).

Techniques of reconstructive surgery. Experience in reconstructing postoperative defects in children with forearm bone sarcomas. Case series

Introduction. Osteosarcoma is an extremely malignant mesenchymal, highly differentiated tumor from bone tissue, proceeding aggressively, characterized by the rapid development of distant metastases. Ewing's sarcoma is not less complex disease, which can be explained by its biological characteristics, including aggressive course, a tendency to develop early hematogenous metastases and frequent relapses. The aim of the study – checking the possibility of complications, the level of restoration of functions according to the Toronto Extremity Salvage Score (TESS) and Musculoskeletal Tumor Society (МSTS) scales after endoprosthesis, and the installation of a spacer. Materials and methods. We analyzed clinical cases of 7 children aged 8 to 15 years, who received treatment at the N.N. Blokhin National Medical Research Center of Oncology, оf the Ministry of Health of Russia in the period 2013–2019. Osteosarcoma was diagnosed in 4 patients, and Ewing’s sarcoma in 3 patients. They underwent organ-preserving surgical treatment of the upper limb in one of three ways – endoprosthesis, placement of a spacer, and replacement with autologous bone on microvascular anastomoses. In the course of the study, a method was used to assess limb function according to the TESS and МSTS scales. Results. It was found that in the postoperative period in all patients, regardless of the applied method of organ-preserving surgery, the results varied within 1,4–1,5 on the TESS scale, and 91–95 % on the MSTS scale. Postoperative complications in the form of post-traumatic neuropathy and dislocation were identified in 4 patients. 1 patient had local recurrence, 1 patient was diagnosed for metastatic leisure of lung tissue. It should be noted that the condition of all patients is currently satisfactory, no lethal cases have been identified. Conclusion. We believe that the results of this study are promising. However, it is necessary to conduct a longer period of observation of patients and evaluate their 5-year survival.

Closed kidney injuries in children

MATERIALS AND METHODS: Within 20 yrs, 76 children aged 28 yrs with kidney trauma were under observation, and 35 of them had associated trauma. Clinical, instrumental, and radiological methods were used in the diagnosis.&#x0D; RESULTS: Of the 76 children with closed kidney trauma, 23 were diagnosed with kidney contusion, 14 with kidney injury with subcapsular hematoma, 16 with kidney injury with rupture of the capsule and perirenal urohematoma, 21 with kidney rupture and damage to the calyxpelvic system, and 2 with traumatic hydronephrotic kidney. Conservative treatment was carried out in 49 (64.4%) children and surgical treatment in 28 (25.6%). In the long term, 28 children with kidney injuries and treated conservatively were examined. Complications were found in nine children: pyeloectasia, deformation of the calyxpelvic system, pyelonephritis, and renal hypertension. Organ-preserving surgery was performed in 22 (28.9%) children and nephrectomy in 5 (6.6%) children. As long-term results: the function of the operated kidneys was satisfactory, some changes occurred in the calyxpelvic systems, and no data for pyelonephritis was found.&#x0D; CONCLUSION: Renal injuries with subcapsular rupture and perirenal urohematoma should be surgically treated to prevent severe long-term complications. In unclear cases, the choice can be a two-stage organ-preserving operation for the so-called crushing of the kidney.

CCTG CO.28 primary endpoint analysis: Neoadjuvant chemotherapy, excision and observation for early rectal cancer, the NEO trial.

3508 Background: CO.28 (NCT03259035) is a phase II study designed to determine if patients with cT1-T3a/bN0 rectal cancer can be treated with induction chemotherapy (FOLFOX/CAPOX) and organ-preserving surgery. Methods: Patients with MRI staged cT1-3a/bN0 tumors and no pathologic (p) high risk features received 6/4 cycles of FOLFOX/CAPOX, repeat sigmoidoscopy/pelvic MRI and subsequent Transanal Endoscopic Surgery (TES) in the absence of tumor progression. ypT0/T1N0 tumors were treated with observation while ypT2+ or ypN+ stage were recommended Total Mesorectal Excision (TME). The primary endpoint was protocol specified Organ Preservation Rate (psOPR = ypT0/T1N0, no p high risk features) and actual Organ Preservation Rate (aOPR = ypT0/T1N0 stage plus higher yp stage patients who declined TME surgery). The study would be considered negative with an psOPR of 50% or lower (H0) and as promising if it is 65% or higher (H1). Results: Between 08/2017 to 05/2020, 58 eligible patients were accrued in Canada and the United States, median age was 67 years, 71% male. All had well-moderately differentiated, non-mucinous rectal adenocarcinoma and median tumor height was 6 cm (range 0-18). Median follow-up was 15.4 months. Chemotherapy with FOLFOX (32) or CAPOX (26) was administered, 90% completed all planned cycles. A total of 56/58 (97%) proceeded to TES, while one patient was ineligible due to tumor progression (1.7%) and one declined. In the intention to treat analysis, the psOPR was 57% (95% CI 43-70%) while the aOPR was 79% (95% CI 67% to 89%) due to 13/23 declining recommended TME surgery. Of 10 patients who proceeded to recommended TME, a complete R0 TME was performed in 9/10, and no p residual carcinoma was found in 7/10. Crude loco-regional (LR) and distant recurrence rates were 3.5% (95% CI 0.4 to 12%) and 0%, respectively. A recurrence occurred in 1/13 patients who initially declined TME surgery. Conclusions: In select patients with early stage rectal cancer, three months of induction CAPOX/FOLFOX followed by TES resulted in a high OPR without the use of pelvic irradiation. The observed high rate of pathologic downstaging may point to high chemo-responsiveness in early rectal adenocarcinoma with no p high risk features. Further trials to evaluate this approach are justified and updated results will be presented. Clinical trial information: NCT03259035. [Table: see text]

Minimally invasive technologies for surgical treatment of kidney cancer

The OBJECTIVE was to analyze the developmental trends, possibilities and outcomes of applying minimally invasive technologies in surgical treatment for kidney cancer.METHODS AnD MATERIALS. The study included 368 surgeries for kidney tumors which were performed from 2012 to 2019. Partial nephrectomy (Pn) was performed in 228 (60.6 %) cases, radical nephrectomy (Rn) – in 148 (39.4 %) cases. Tumors of the stage cT1a detected in 148 (39.4 %), сТ1b – 145 (38.6 %), сT2a – 58 (15.4 %), сТ2b-cTxn1M1 – 25 (6.7 %) patients. Operations were performed using open (3.7 %), laparoscopic (50.3 %), robotic (46.0 %) approaches with assessment of surgical and oncological outcomes of treatment.RESULTS. The incidence rate of Pn in patients with kidney cancer at the stages cT1a, cT1b and cT2a was 89.9, 57.2 and 20.7 %. Rn was performed in all cases of tumor stage сТ2b-cTxn1M1. The frequency of Pn at the stages cT1a, cT1b and cT2a in 2019 exceeded 80 %. Minimally invasive technologies (MIT) for Pn was used in 98.3 %, for Rn – in 92.2 % of cases. The incidence rate of postoperative complications after Pn and Rn at stages сТ1а, сT1b, сТ2а was 14.3and 6.7, 16.9 and 3.2, 16.7 and 2.2 %, respectively. Complications after Rn at tumors of the stage cT2bcTxn1M1 occurred in 20.0 % of patients. Positive surgical margin (PSM) occurred after Pn for tumors of the stage cT1a in 0.7 % of cases; for cT1b – in 2.4 %; for cT2a and after Rn – was not determined.CONCLUSION. Our study demonstrates a steady tendency towards an increase in the number of MIT for kidney tumors, including when performing organ-preserving surgeries. Robot-assisted surgery allows to expand the indications to use a minimally MIT even in the most difficult clinical cases. The frequency of complications after RP compared with Rn is higher because the complexity of the operation increases, and these complications did not affect the outcome of treatment, taking into account the functional advantages provided for patients. The development and widespread introduction of minimally MIT into clinical practice is an evident and inevitable way to develop surgical treatment of kidney cancer.

Опыт выполнения органосохранных и реконструктивно-пластических операций при злокачественных опухолях молочной железы в КГБУЗ «Краевой клинический центр онкологии» в г. Хабаровске

The article presents the experience of the Oncology department No. 1 of the Regional Clinical Oncology Center in Khabarovsk in performing organ-preserving and reconstructive plastic surgeries for breast cancer in the period 2014–2019. An assessment was made of the incidence of local recurrence or distant progression of the disease, as well as risk factors for their occurrence

Uterine fibroids, laparoscopic surgery and morcellation: comparative analysis of the results of organ-preserving operations

Aim. To conduct a comparative analysis of the results of organ-preserving laparoscopic operations performed for uterine fibroids with the use of plastic containers for morcellation and without it.&#x0D; Materials and methods. We examined 57 patients with a diagnosis of uterine fibroids who were admitted to the Department of Innovative Oncology and Gynecology of the Kulakov National Medical Research Center for Obstetrics, Gynecology and Perinatology for organ-preserving surgical treatment. To achieve the goal of the study, the patients were divided into the following groups: the main group 29 patients who underwent laparoscopic myomectomy and morcellation of removed nodes using plastic containers. The control group consisted of 28 patients who underwent morcellation during laparoscopic myomectomy without the use of plastic containers.&#x0D; Results. The duration of laparoscopic operations performed using plastic containers main group was 85.6925.87 minutes. Laparoscopic conservative myomectomies, performed without the use of limiting systems, took a slightly longer amount of time control group 88.7530.36 minutes. There were no statistically significant differences, but in the second group, more prolonged sanitation of the abdominal cavity and removal of small fragments of myomatous nodes after morcellation outside the sacs were required. Autoinfusion was used in 6 (20.69%) patients in the main group, in 7 (25%) patients in the control group. Blood transfusion was not used in any case. Average blood loss was 120.6967.50 ml in the main group, 125.0099.54 ml in the control. The duration of hospitalization in the main group was 4.661.76 days, in the control group 5.793.62 days. In the main group, histological examination revealed leiomyoma in all cases, leiomyoma was detected in 96.4% (27 patients) of cases in the control group, and leiomyosarcoma in 1 patient (3.6%).&#x0D; Conclusion. In all groups of patients, there was a favorable course of the postoperative period, early activation of patients. In the group of laparoscopic operations, one patient (3.6%) after morcellation of the myomatous node without the use of a plastic container was found to have leiomyosarcoma. The use of plastic containers in our study did not increase the duration of operations and did not affect the volume of blood loss, the frequency of intra- and postoperative complications. In contrast, the operation time was slightly higher among patients who were operated without the use of containers. In all likelihood, this was due to the fact that the morcellation stage itself took longer, since it was required to extract small fragments of myomatous nodes, as well as thorough and prolonged sanitation of the abdominal cavity. It should be noted that the use of plastic containers, of course, requires the development of certain skills from the surgeon, taking less and less time in parallel with the learning curve. Of course, further studies are required to assess the risk of tumor spread in patients undergoing surgery using plastic containers, but preliminary data indicate that ablastic morcellation can and should be used in organ-preserving surgery for uterine myoma.

Clinical Impact of Organ-Preserving Surgery for Pancreatic Neuroendocrine Neoplasms: A Single-Center Experience.

Organ-preserving surgery (OPS) has been accepted for pancreatic neuroendocrine neoplasms, particularly for the management of small tumors. This study aimed to analyze the surgical outcome following this treatment at our institute, focusing on the perioperative factors and postoperative locoregional recurrence. We analyzed 71 consecutive patients with no synchronous liver metastasis. These patients were classified into 1 of 2 groups: the standard operation group (SOG, 41 patients) with prophylactic regional lymph node dissection and the organ-preserving surgery group (OPG, 30 patients). We performed OPS based on size criteria (tumor size <1.5 cm in nonfunctional pancreatic neuroendocrine neoplasms and <2 cm in insulinoma with no evident bulky lymph node swelling on preoperative imaging). The median follow-up periods were 37 months. The OPG included enucleation, partial resection, proximal parenchymal pancreatectomy, central pancreatectomy, spleen-preserving distal pancreatectomy, and Warshaw operation. The SOG included pancreatoduodenectomy and distal pancreatectomy, showing no statistically significant differences between the 2 groups in terms of operation time, hospitalization duration, and postoperative complications. Ten patients showed lymph node metastasis (25%) only in the SOG. There were no locoregional recurrent cases in the OPG. In selected patients, OPS may be effective based on the appropriate tumor size criteria.

Minimal access surgery for organ-sparing interventions with laser light in closed spleen injury: Advantages and disadvantages

Actuality . Surgical interventions in case of spleen injury are aimed to achieve a reliable hemostasis, but due to the morphological structure of the spleen suturing does not lead to this goal; therefore, in most cases, surgeries end with splenectomy. However, removal of the spleen causes postplenectomic hyposplenism, and it urges to search for other modalities alternative to splenectomy. Purpose . To assess the effectiveness of interventions with minimal access in the left hypochondrium for organ-sparing surgery (OSS) on the spleen with laser light application. Material and methods . Outcomes of surgical treatment in 126 patients with closed spleen injury were analyzed. Of the total number of patients, organ-preserving surgeries with laser light were performed in 59 (46.8%) cases; among them 36 (28.6%) patients were operated on with minimal access surgery, and in case of upper midline laparotomy – in 23 (18.2%) cases. Medilas fibertom 5100 laser device (DORNIER Ltd) with wavelength 1064 nm was used for the discussed organ-sparing surgeries. In all cases, surgeries were ended with drainage of the abdominal cavity. Results . As it has been found out, the most optimal technique for OSS in spleen injury is laparoscopy which allows not only to evaluate the volume of intra-abdominal blood loss, but also to define the nature of spleen injury and presence or absence of damage to other abdominal organs. The minimal approach for closed spleen injury has both advantages and disadvantages. The advantages are technical convenience in performing surgery on the spleen and possibility to apply laser technology for OSS. However, OSS with laser light on the spleen with closed injury is recommended if patient’s hemodynamics is stable, organ injury is isolated, OSS is technically possible and there is no any damage to vessels of the spleen hilus. A significant disadvantage of minimal access surgeries is inability to perform a thorough revision of abdominal organs what is compulsory in urgent cases. Conclusion . Minimal access surgery with high-level laser energy in closed spleen injury is possible only if spleen injury is isolated.

Organ preservation versus radical surgery for early-stage rectal cancer.

Organ preservation versus radical surgery for early-stage rectal cancer.

THE ROLE OF COMPLEX TREATMENT OF UTERINE FIBROIDS IN WOMEN WITH INFERTILITY AND RECOVERY OF THE REPRODUCTIVE FUNCTION

A nation’s reproductive health is an important medical and public indicator. A significant decrease in the birth rate has put Ukraine on the list of Top 8 European countries with the lowest birth rate.&#x0D; Uterine fibroids are one of the most widely spread gynecological diseases, which ranks the 2nd place after the inflammatory processes of the small pelvis organs and affects from 20 to 30% of women above 30 years. In 13.3 to 27% of cases, uterine fibroids are observed in the reproductive age. In recent years, there has been a steady increase in the number of young women affected by the tumor. Uterine fibroids remain a serious issue and are one of the main causes of miscarriage and infertility, especially in women above 30 years [1, 2, 3].&#x0D; The treatment of uterine fibroids remains a disputable issue. The slow development of the disease, without obvious clinical manifestations, has long been the reason for passive observation of patients, until the onset of symptoms requiring surgical treatment. The clinical manifestations of the disease, which are observed in every second patient affected by uterine fibroids, require a more active strategy of management of such patients. One of the factors impeding effective organ preservation treatment of fibroids is the lack of information about the mechanisms of the tumor development. As it is known, the progression of any tumor is directly dependent on it blood supply [4, 5].&#x0D; So far, radical treatment (hysterectomy) remains the main method of treatment of uterine fibroids and is applied in 75 - 83% of cases. However, such radicalism is not justified in the majority of patients as new treatment methods come into being, which inhibit tumor growth and lead to the regression of the disease symptoms. According to various authors, the percentage of fibroidectomy in the total number of surgeries is lower than 1%, which is unreasonably low. The main advantage of fibroidectomy is the preservation of fertility, the main disadvantage – is the high risk of disease recurrence – from 15 to 20% [6].&#x0D; There has been more and more debate recently about the issue of interrelation of uterine fibroids, the results of assisted reproductive technologies and embryo transfer. The improvement of results of ART after fibroidectomy encourages the broadening of indications for such surgeries in patients with symptomless fibroids. Drug therapy also makes it possible to preserve the reproductive function but, in contrast to surgical treatment, it does not mean the risk of intra- and postoperative complications. The combination of drug therapy and organ preservation surgeries reduces the risk of complications related to surgical treatment and contributes to the preservation of fertility. The use of complex rehabilitation measures with hormone therapy improves the results of surgical treatment, reduces the risk of recurrence of uterine fibroids and contributes to a more favorable postoperative course.&#x0D; At present, there are no clear criteria for managing patients after organ preservation surgeries on the uterus; at the outpatient stage, there are few effective approaches aimed at the recovery of fertility and the rehabilitation of such patients. Thus, the recovery and preservation of the reproductive function is one of the priorities in the development of medicine in Ukraine.

Разрыв матки после миомэктомии, произведенной вне беременности

Objective. To study the incidence and risk factors of uterine rupture (UR) in a scarred uterus after myomectomy during pregnancy and childbirth. Patients and methods. A retrospective analysis of UR after myomectomy during pregnancy and childbirth was carried out according to the study of 43 labor and delivery medical records of patients from various maternity hospitals in Moscow. Results. Uterine scar after myomectomy, especially when performed laparoscopically, in the presence of pronounced interstitial changes poses a significant threat to both the mother and the fetus. In 27 (62.8%) cases, UR occurred before childbirth in a full-term pregnancy. UR in a scarred uterus after myomectomy was characterized by untimely diagnosis and laparotomy in 8 (21.6%) patients, resulted in blood loss of 1,000-5,000 mL in 32 (74.4%) patients; adverse perinatal outcomes: out of 45 children (2 cases of twins), 11 (24.4%) died (2 with extremely low body weight), 4 (8.9%) born with severe asphyxia, 6 (13.3%) with moderate asphyxia, 10 (22.2%) with mild asphyxia. In 5 (11.6%) cases, UR was detected in the early postpartum period. Conclusion. UR in a scarred uterus after myomectomy is characterized by delayed diagnosis and underestimation of early symptoms. Laparotomy was performed when a rupture occurred, both for complete 32 (74.4%) and incomplete 11 (25.6%). Careful choice of surgical approach for myomectomy in patients planning pregnancy and timely assessment of the state of the uterine scar are recommended. In case of UR, organ preservation surgery is performed. Key words: myomectomy, uterine rupture, uterine scar after myomectomy

Intentional Watch &amp;amp; Wait or Organ Preservation Following Neoadjuvant Chemoradiotherapy Plus Consolidation Capeox for Mri-Defined Low-Risk Rectal Cancer: Findings from a Prospective Phase 2 Trial (PKUCH-R01 Trial, NCT02860234)

Background: Clinical T2 or early T3 rectal cancers can be managed by definitive rectal resection and achieve high clinical complete response (cCR) with chemoradiation, thereby facilitating an intentional watch-and-wait (W&W) or organ-preservation strategy. We assessed the efficacy of neoadjuvant chemoradiation plus consolidation CAPEOX in MRI-defined low-risk rectal cancer to ascertain the proportion of patients who can achieve cCR and receive a W&W or organ-preservation approach. Methods: This prospective, single-arm, phase 2 trial enrolled patients with cT2/T3a/T3b low-risk rectal cancers that were pre-staged by magnetic resonance imaging (MRI), after excluding patients with local or systemic high-risk factors, such as mesorectal fascia, extramural vessel invasion, or mucinous differentiation. All patients concurrently received chemoradiation, followed by four 3-week cycles of the CAPEOX regimen. Following reassessment by the multidisciplinary team, patients with cCR or near-cCR received W&W/organ-preservation surgery. The primary endpoint was the 3-year organ-preservation rate. Findings: Of the 64 participants, 58 completed the treatment, with 6·4% and 33·9% grade 3–4 toxicities in the radiotherapy and consolidation CAPEOX phases, respectively, during a median follow-up of 32·7 (interquartile range [IQR] 4·3–60·3) months. Initial cCR, near-cCR, and non-cCR occurred in 33 (51·5%), 13 (20·3%), and 18 (28·2%) patients, respectively. Of the 31 cCR and seven near-cCR cases managed by WW 8 and 20 patients received local excision and radical resection, respectively, including six of seven patients with local regrowth salvage. One patient died of postoperative complications. Lung metastasis occurred in one patient with W&W and one patient with local excision, with no local recurrence and an estimated 3-year organ-preservation rate of 68·8%. The estimated 3-year CSS, non-regrowth disease-free survival, and stoma-free survival were 95·8%, 93·8%, and 84·3%, respectively. Interpretation: Chemoradiotherapy with consolidation CAPEOX for MRI-defined low-risk rectal cancer achieves high cCR and organ-preservation rate. Intentional W&W might be a safe strategy for this patient subgroup. Trial Registration: This study is registered at ClinicalTrials.gov with the identifier NCT02860234. Funding: Supported by The Beijing Municipal Science & Technology Commission Capital Clinical Research Special Fund (Z151100004015105); National Natural Science Foundation of China (81773214); Beijing Hospitals Authority Clinical Medicine Development of Special Funding Support, code: (ZYLX202116) Declaration of Interest: None to declare. Ethical Approval: The protocol and the later amendments were approved by the ethics committee of Peking University Cancer Hospital on August 06, 2016 and on December 17, 2018, respectively.

Применение лучевой терапии в комбинированном лечении сарком мягких тканей конечностей с поражением длинных трубчатых костей

Soft tissue sarcomas (STS) are rare malignant tumors of mesenchymal origin. They account for about 1% of all malignant neoplasms. Haematogenous spread is the most common route of me-tastasis for STS and bone metastases occur in 9.4% of cases. When creating treatment plan for STS, it is necessary to consider a multimodal approach. Combination treatment can include pre-operative or postoperative radiation therapy (RT), chemotherapy (CT), and local hyperthermia (LHT). Surgery for STS should be radical. This paper presents 9 STS clinical cases and treatment outcomes in patients with secondary bone disease. Four patients underwent chemotherapy and surgery. Two patients received chemoradiotherapy (CRT) and surgery. Three patients received thermo-chemo-radiotherapy (TCHRT) followed by surgery. Accelerated fractionation radiotherapy was given using a single tumor dose of 3 Gy, twice a day with interval of 4 hours between ses-sions, 3 times a week to a total tumor dose (TTD) of 30 Gy (isoeffective TTD – 42 Gy, TDF – 69 Gy). Local hyperthermia for soft tissue tumor treatment was performed over 6 sessions: 2 ses-sions were combined with CHT courses before and after RT, and 4 sessions were combined with RT. The follow up period for 6 patients varied from 12 to 1.5 months, for 3 patients it varied from 6 to 8 months, for 1 patient it lasted 3 months and for 1 patient – 2 years. According to the RECIST criteria, more than half of the patients had tumor stabilization and 22% of patients had a partial response. Grade III-IV the rapeutic pathomorphosis was observed in 70% of patients after pre-operative combination treatment. The use of CT, CRT or TCHRT in combination treatment of STS with secondary bone disease enabled us to achieve a pronounced therapeutic pathomorphosis of tumors and to perform organ preservation surgery with endoprosthetic replacement.

Experience in using metroplasty using distal compression hemostasis for organ-preserving surgery at placenta accreta

Experience in using metroplasty using distal compression hemostasis for organ-preserving surgery at placenta accreta