Organ-preserving Treatment Research Articles

Conservative surgical treatment of uterine fibroids in women of childbearing age

Uterine fibroids are benign gynecologic tumors, and women aged between 30 to 50 years are known to have a high incidence of uterine fibroids. A growing number of pharmacotherapies and minimally invasive organ-preserving treatments have been designed and conducted over the past few years. However, there has not been any therapeutic drugs exhibiting an ideal therapeutic effect and low recurrence rate, such that the surgical treatment continues to be primarily employed in the actual clinical treatment. In general, surgical treatment has been performed as the organ- and fertility-preserving hysteroscopic or laparoscopic resections of the fibroids. Minimally invasive surgical equipment (e.g., hysteroscopy, traditional porous laparoscopy, trans-umbilical laparoscopy, transvaginal laparoscopy, as well as robot-assisted laparoscopy) has been extensively applied to clinical treatment. Compared with traditional laparotomy, minimally invasive surgical equipment is characterized by minimally invasive surgery, high efficiency and safety. As medical technology has been leaping forward, interventional therapy and radiofrequency ablation can also be employed for treating uterine fibroids. In accordance with the research progress worldwide, the current situation, limitations, and advantages of the treatment of uterine fibroids in patients with fertility requirements are reviewed in this study.

Modern approaches to minimally invasive, organ-preserving treatment for esophageal rupture in patient with achalasia (clinical case)

Modern approaches to minimally invasive, organ-preserving treatment for esophageal rupture in patient with achalasia (clinical case)

Functional and oncological results of endolaryngeal laser resections of squamous-cell carcinomas of the voice box

Introduction. Treatment with the initial stage of the disease causes a high need for the use of organ-preserving treatment methods, which are actively developing and improving. One of the modern and promising methods is endolaryngeal resection of the larynx.Aim. To evaluate oncological effectiveness and functional results of endolaryngeal laser resections in cancers of the voice box.Materials and methods. The study included 139 patients with squamous-cell carcinoma of the voice box between the ages of 26 and 81 years who received treatment at the Department of Head and Neck Oncology of the federal medicalBiological Agency of the Russian federation between 2015 and 2020. All patients underwent standard examination to diagnose oncological diseases and were diagnosed in accordance with the Tumor, Node and metastasis (TNm) international system. In 90 (64.7 %) of 139 patients, squamous-cell laryngeal cancer T1N0m0 was diagnosed, in 49 (35.3 %) patients – T2N0m0. All patients underwent surgical treatment in the form of endolaryngeal laser resection according to the plan developed during an oncological council.Results. After endolaryngeal laser resections, 3-year recurrence-free survival for cancer of the voice box, stages т1 and т2, was 92 and 84.2 % respectively. Temporary disruption of separating function of the larynx in patients with stage T2N0m0 was observed in 6.1 % cases, decreased vocal function in 100 % of cases, granuloma formation in the postoperative period in 19.4 % of cases, formation of a scar narrowing the laryngeal lumen in 4.3 % of cases.Conclusion. High 3-year recurrence-free survival as well as small percentage of postoperative complications and severe functional abnormalities show high effectiveness of endolaryngeal laser resections in treatment of cancer of the voice box and recommend this technique for active use in daily practice of head and neck tumor specialists.

ЭХОГРАФИЧЕСКАЯ ОЦЕНКА ЛОКАЛЬНЫХ ИЗМЕНЕНИЙ ПРИ ЗАКРЫТОЙ ТРАВМЕ ПОЧЕК У ДЕТЕЙ

The aim of the investigation was to present the results of dynamic ultrasound examination of the evolution of local changes accompanying kidney injury in comparison with the studied manifestations of pathomorphogenesis of renal injury. Dynamic ultrasound examination of 216 patients aged 2 to 16 years with kidney injury of varying severity was performed. The obtained data were compared with the results of X-ray examinations, intraoperative findings and pathomorphological conclusions. It was showed that polymorphic changes accompanying a renal injury can be differentiated based on the identification of specific morphodynamic stereotypes – permanent evolving signs that accompany, in particular: bruising (contusion) of the kidney, tissue integrity disorders, hemorrhagic manifestations, intra-organ vascular obstruction and acute post-traumatic inflammation. Each of the presented stereotypes is comparable with the corresponding manifestations of pathomorphogenesis of traumatic damage to the renal tissue. Conclusion. Echographic data, clearly correlated with changes in the morphological substrate, determine the ultrasound semiotics of kidney injury. This allows us to identify and predict the development of each stereotype in a timely manner, with the selection of the dominant (clinically most significant) at the time of the study, which in due time can be used for a rational choice of organ-preserving treatment tactics.

Assessment of Quality of Life in Rectal Cancer with Organ-Preservation Treatment: Are We There yet?

Rectal cancer is a common cancer and shows an increased incidence with older age. Although the gold standard treatment is surgical excision, minimally invasive approaches are increasingly used and organ preservation is becoming a reasonable approach. The conservative treatment approach includes local excision, external beam radiotherapy and brachytherapy. However, these all carry a risk of side-effects. It is crucial to provide patients with information to quantify the improvement or detriment in quality of life with their cancer treatment. This can only be done with patient-reported outcome measures (PROMs) as tools within current and future trials. Colorectal cancer has numerous publications with specific PROMs. However, PROMs reporting in rectal cancer is more sparse; PROMs are generally extrapolated from colorectal cancer. Rectal PROMs trials hold small population samples and PROMs as an end point is scarce. We present a review of recent literature based on the PROMs reporting of quality of life for rectal cancer patients and introduce the CITRuS trial as an innovative feasibility study related to electronic PROMs data collection.

Quality-of-life outcomes in older patients with early-stage rectal cancer receiving organ-preserving treatment with hypofractionated short-course radiotherapy followed by transanal endoscopic microsurgery (TREC): non-randomised registry of patients unsuitable for total mesorectal excision

Older patients with early-stage rectal cancer are under-represented in clinical trials and, therefore, little high-quality data are available to guide treatment in this patient population. The TREC trial was a randomised, open-label feasibility study conducted at 21 centres across the UK that compared organ preservation through short-course radiotherapy (SCRT; 25 Gy in five fractions) plus transanal endoscopic microsurgery (TEM) with standard total mesorectal excision in adults with stage T1-2 rectal adenocarcinoma (maximum diameter ≤30 mm) and no lymph node involvement or metastasis. TREC incorporated a non-randomised registry offering organ preservation to patients who were considered unsuitable for total mesorectal excision by the local colorectal cancer multidisciplinary team. Organ preservation was achieved in 56 (92%) of 61 non-randomised registry patients with local recurrence-free survival of 91% (95% CI 84-99) at 3 years. Here, we report acute and long-term patient-reported outcomes from this non-randomised registry group. Patients considered by the local colorectal cancer multidisciplinary team to be at high risk of complications from total mesorectal excision on the basis of frailty, comorbidities, and older age were included in a non-randomised registry to receive organ-preserving treatment. These patients were invited to complete questionnaires on patient-reported outcomes (the European Organisation for Research and Treatment of Cancer Quality of Life [EORTC-QLQ] questionnaire core module [QLQ-C30] and colorectal cancer module [QLQ-CR29], the Colorectal Functional Outcome [COREFO] questionnaire, and EuroQol-5 Dimensions-3 Level [EQ-5D-3L]) at baseline and at months 3, 6, 12, 24, and 36 postoperatively. To aid interpretation, data from patients in the non-randomised registry were compared with data from those patients in the TREC trial who had been randomly assigned to organ-preserving therapy, and an additional reference cohort of aged-matched controls from the UK general population. This study is registered with the ISRCTN registry, ISRCTN14422743, and is closed. Between July 21, 2011, and July 15, 2015, 88 patients were enrolled onto the TREC study to undergo organ preservation, of whom 27 (31%) were randomly allocated to organ-preserving therapy and 61 (69%) were added to the non-randomised registry for organ-preserving therapy. Non-randomised patients were older than randomised patients (median age 74 years [IQR 67-80] vs 65 years [61-71]). Organ-preserving treatment was well tolerated among patients in the non-randomised registry, with mild worsening of fatigue; quality of life; physical, social, and role functioning; and bowel function 3 months postoperatively compared with baseline values. By 6-12 months, most scores had returned to baseline values, and were indistinguishable from data from the reference cohort. Only mild symptoms of faecal incontinence and urgency, equivalent to less than one episode per week, persisted at 36 months among patients in both groups. The SCRT and TEM organ-preservation approach was well tolerated in older and frailer patients, showed good rates of organ preservation, and was associated with low rates of acute and long-term toxicity, with minimal effects on quality of life and functional status. Our findings support the adoption of this approach for patients considered to be at high risk from radical surgery. Cancer Research UK.

Outcomes of organ preservation treatment in advanced laryngeal carcinoma: A retrospective analysis from a single institution.

Chemoradiation is the standard treatment for patients with locally advanced laryngeal carcinoma with intact cartilage and functional larynx. The aim of this retrospective study was to assess overall survival (OS) and disease-free survival (DFS) of patients with locally advanced (stage III and stage IV) squamous cell carcinoma of the larynx who have been treated with definitive radical radiotherapy (RT) with or without chemotherapy in a tertiary cancer center in India between January 1, 2006 and December 31, 2015. Data were collected using structured proforma. The patients were treated with RT alone, induction chemotherapy (IC) followed by RT, concurrent chemoradiation therapy (CCRT) or IC followed by CCRT. Response assessment was conducted at 3-4 months post-treatment. Patient-, tumor- and treatment-related factors were documented and were associated with DFS and OS. Survival curves were generated using the Kaplan-Meier method and the statistical significance of survival curves was assessed using the log-rank test. Prognostic factors were assessed using the Cox proportional hazards regression model. A total of 630 patients were included in the present study. The most common age group at presentation was 50-70 years (n=477; 75.7%) and 95.4% (n=601) patients were male. The most common stage at presentation was stage III (n=367, 58.1%). The median follow-up period for the entire group of was 59 months (range, 2-175 months). A complete response after treatment was seen in 549 patients (87.1%). Salvage surgery was performed for 11 patients with residual disease. A total of 134 patients (21.3%) had developed locoregional and distant relapses, and salvage surgery was performed for 31 out of 102 patients with locoregional relapse. The 5-year OS was 48.7% and the 5-year DFS was 45.7%. The stage-wise OS rates were 58.9, 34.9 and 30.4% (P=0.001) and the stage-wise DFS rates were 56.3, 32.0 and 21.7 (P=0.001) for stage III, IVa and IVb, respectively. Results from the present study demonstrated the feasibility of delivery of chemoradiation protocols with good results in a developing country.

Cryotherapy of retinoblastoma: 13-year experience

Introduction. Cryotherapy (CT) is one of the main methods of small retinoblastoma (Rb) treatment and remains the “gold standard” for the treatment of small tumors of pre-equatorial localization, however, the number of studies in the literature on this problem is small, and they are represented only by single studies.Purpose of the study – to evaluate long-term results of CT of Rb.Materials and methods. During the period from 2008 to 2021 CT was performed in 87 children (98 eyes, 169 tumors) with Rb. 49 (56 %) patients were boys, 38 (44 %) were girls. The average age at the time of treatment was 22 months (from 0 to 73 months). Bilateral RB was observed in 70 (80 %) patients, unilateral – in 17 (20 %). In 19 (22 %) cases, CT was performed on a single eye. A total of 169 tumors were treated by CT. Most of the treated tumors (138 foci, 82 %) had pre-equatorial localization (35 tumors – on the mid periphery and 103 tumors – on the far periphery of the fundus). 31 (18 %) tumors located postequatorially. The mean tumor thickness was 1.2 (from 0.4 to 2.9) mm, the mean basal diameter was 2.2 (from 0.9 to 4.9) mm.In the vast majority of cases (n = 78, 87 %), CT was performed with an incision of the conjunctiva and separation of the tenon capsule in the projection of the tumor, then a double application with an exposure of 60 seconds was carried out according to the “classic” technology (“freeze–thaw”). In 13 % of cases (n = 9), CT was performed transconjunctivally without a conjunctival incision. In all cases, carbon dioxide (–78 ºC) was used as a refrigerant.Results. Complete tumor regression after CT was achieved in 63 % of cases (106 tumors), of which in 91 % of cases (96 tumors) – after one CT session, in 8 % (9 tumors) – after 2 sessions, in one (1 %) case– after 4 CT sessions. In 10 % of cases (17 tumors) an incomplete regression was observed and subsequent transpupillary laser thermotherapy was performed. In 27 % of cases (43 tumors), continued tumor growth or recurrence of the tumor was detected, and therefore other methods of local treatment were used (brachytherapy, laser thermotherapy, intra-arterial and intravitreal chemotherapy). As a result of organ-preserving treatment, 90 (92 %) eyes were preserved, 8 (8 %) eyes were enucleated.Complications after CT included vitreous hemorrhage in 3 (3 %) patients, preretinal hemorrhage in 7 (8 %) cases, subretinal hemorrhage in 2 %, local retinal detachment in 2 %, one (1 %) case of retinal tear, and vitreoretinal traction in 2 (2 %) patients. The mean follow-up time after CT was 44 months (from 4 to 121 months).Conclusion. CT still takes an important place in Rb local treatment, especially in the treatment of small tumors of peripheral localization. However, long-term results have shown that one session of CT is often not enough to achieve complete tumor regression and it requires either repeated use of CT or application of other local methods, mostly transpupillary laser thermotherapy. However, the use of CT is especially relevant in the treatment of small tumors of pre-equatorial localization, which are resistant to thermotherapy, especially in cases of a tumor height more than 1 mm and basal diameter more than 2 mm, which are too large and inconvenient for thermotherapy of peripheral Rb.

Clinical Experience with Organ-Preserving Surgery in Placenta Accreta

Introduction. A higher number of repeated cesarean sections determine a higher risk of placental ingrowth into the scar area of the uterus. The absence of current clinical guidelines in this field necessitates the need for development of various methods for organ-preserving surgery in placenta accreta, which preserve a woman’s reproductive function, as well as reduce risks for future pregnancies and childbirth.Materials and methods. The paper presents the successful clinical experience of organ-preserving surgical treatment of placental ingrowth, excluding the stage of fundal cesarean section (Perinatal Center, Noyabrsk, Yamalo-Nenets Autonomous District).Case description. The paper describes two clinical cases of successful organ-preserving surgical treatment of placental ingrowth with preservation of reproductive function and provision of a more favorable prognosis for subsequent reproductive plans due to excluding formation of two scars on the uterus in different localizations.Results and discussion. Early dissection of adhesions in order to provide access to the surgical site is crucial and reduces the blood loss after fetal extraction and the risk of intraoperative complications such as bladder, ureteric and intestinal injury. Temporary compression hemostasis via performing endovascular temporary balloon occlusion of the infrarenal aorta, or via temporary turnstile hemostasis using a Foley catheter, allows for organpreserving surgery that excludes the formation of two scars on the uterus in different localizations without increasing the amount of blood loss.Conclusion. Surgical tactics in organ-preserving treatment of placental ingrowth excludes the stage of fundal cesarean section, and involves the cesarean section at the border of the uterine-placental hernia and the body of the uterus with subsequent metroplasty. The surgery performed demonstrate the optimal result – a relatively low blood loss, a short duration of the operation and, above all, more favorable prognosis for subsequent reproduction.

Organ Preservation in Rectal Cancer: An Overview of the Dutch Perspective and Recent Developments

Although current guidelines on rectal cancer treatment often recommend rectal resection with or without neoadjuvant (chemo)radiotherapy, there is growing interest in organ-preserving treatment approaches among patients and clinicians in the Netherlands. Currently, multiple ongoing studies are investigating the value of different non-operative treatment modalities to improve tumour response rates and increase the chance of successful organ preservation. Papillon contact X-ray brachytherapy is a promising treatment modality to improve the chance of organ preservation, which seems especially relevant for elderly and frail patients unable or refusing to undergo total mesorectal excision surgery. The elderly and frail patient with rectal cancer poses a significant challenge and warrants a thorough multidisciplinary approach to provide the most optimal organ-preserving treatment. In this overview, an insight into the Dutch perspectives and developments within the field of organ preservation and the set-up of a Papillon facility to complete the spectrum of organ-preserving treatment options in a tertiary referral centre for rectal cancer treatment has been provided.

An innovative approach in the treatment of nodular adenomyosis

Introduction. The necessity to improve methods of adenomyosis treatment is determined not only by its high prevalence, which reaches 40 % among women of reproductive age, but also by its association with infertility of unclear genesis. The disease significantly reduces the quality of life. Objective. To optimize reproductive outcomes after surgical treatment of nodular adenomyosis and to prevent the disease recurrence. Materials and Methods. A cohort prospective comparative study examined the efficacy of therapy with dienogestam after laparoscopic removal of adenomyosis nodules with temporary uterine artery occlusion and temporary balloon occlusion of the internal iliac arteries. The study included 25 women who underwent organ-preserving treatment for nodular adenomyosis from January 1, 2020 to January 1, 2022. Inclusion criteria: age 22–45 years, mean 32 ± 4.5; organ preserving treatment for nodular adenomyosis, no contraindications to hormone therapy, informed voluntary consent of the patient to participate in the study. Results. The use of Dientogest at a dose of 2 mg/day in a continuous regimen for 6 months after surgical treatment for nodular adenomyosis was shown to transform the intensity of pain syndrome to insignificant, the absence of recurrent disease for 24 months of follow-up. Conclusions. The comprehensive treatment of nodular adenomyosis, which included laparoscopic removal of the nodule and the drug therapy with dienogestam, permitted the achievement of reproductive function in 40% of the patients. The choice of the treatment method for nodular adenomyosis depends primarily on the reproductive plans of the patient, the size and location of the adenomyosis nodules, and its long-term results depend on the comprehensive antiretroviral therapy.

Tumour-stroma ratio to predict pathological response to neo-adjuvant treatment in rectal cancer

IntroductionManagement of rectal cancer has advanced, with an increasing use of neoadjuvant chemoradiotherapy (nCRT). This opens options for organ preserving treatment for those with a major response to nCRT. However, the degree of clinical response, based on MRI and post-treatment biopsies, only poorly matches the degree of actual pathological response. In order to select patients with major pathological response without surgical resection, it is of importance to define tumour markers predicting the degree of pathological response to nCRT. The intra-tumoural tumour-stroma ratio (TSR) might be this marker. MethodsTSR in pre-treatment biopsies was estimated according to the method described by van Pelt et al. The degree of pathological response was assessed on the tumour resection according to tumour regression grading (TRG) by Mandard. The primary endpoint of this study was the difference in pathological response to nCRT between TSR-high and TSR-low groups. ResultsWe found that 26.2% of patients with major response was classified as TSR-high, while 73.8% of patients were classified as TSR-low. A high TSR in pre-treatment biopsies was associated with a lower chance of major-response to nCRT (OR = 0.37, 95%CI; 0.19–0.73), p = 0.004), independent of tumour stage and time between nCRT and surgery. ConclusionIn rectal cancer, TSR in pre-treatment biopsies predicts pathologic response to nCRT, with a high TSR bringing twice the risk of poor to no response compared to low TSR. In future, assessment of TSR may fulfil a role in a therapeutic algorithm identifying patients who will or will not respond to nCRT prior to treatment initiation.

Organ preservation treatment for locally advanced cancer of larynx or hypopharynx in the IMRT era

Organ preservation treatment for locally advanced cancer of larynx or hypopharynx in the IMRT era

1031 Survival Outcomes for Larynx-Preserving Therapy Compared to Total Laryngectomy in Advanced Laryngeal Tumour: A North-East of Scotland Cohort

Abstract Aim Advanced laryngeal tumours (stage III and IV) management remains uncertain. This study aims to investigate whether choice of organ-preservation treatment (radiotherapy or radiochemotherapy) or surgical intervention (total laryngectomy with/without adjuvant therapy) affects survival in the North-east of Scotland cohort. Method Laryngeal cancer data was prospectively collected and maintained at a tertiary care centre at NHS Grampian Scotland. This data was retrospectively analysed for overall and disease specific survival. Death from laryngeal cancer was recorded from death certificates. Statistical analysis with Cox regression was used to estimate hazard ratios for sex, smoking status, age, staging, tumour site, and treatment choice in the advanced laryngeal cancer cohort. Results A total of 311 laryngeal cancer patients were identified. 49 patients were stage III and of which 35 (71%) received organ-preserving treatment and 14(29%) underwent total laryngectomy. The corresponding numbers for 65 stage IV patients were 13 (20%) and 52 (80%) respectively. On cox regression for overall survival, reduced survival was associated (p<0.05) with choice of organ preservation and stage IV disease, fully adjusted HRs (95%CI) were 2.57 (1.42–4.66) and 3.00(1.08–8.34) respectively. For disease specific survival, no variables were found to be significant. Median follow up time from date of diagnosis to death was 1.56 years. Conclusions Organ preserving intervention was associated with a worsened overall survival in the advanced laryngeal cancer cohort. This study suggests that primary surgical intervention remains a key element in the treatment of advanced laryngeal cancer and future bigger cohort studies may be needed to evaluate this relationship.

Long-term survival of uveal melanoma patients with respect to clinical, hemodynamic and morphological characteristics of the tumor

Purpose. Evaluation of long-term results of uveal melanoma (UM) treatment in patients depending on clinical, hemodynamic and morphological parameters of the tumor. Material and methods. Long-term results of treatment were analyzed in 394 UM patients aged 17 to 82 (mean age 53.1 ± 13.2). The median follow-up was 56 months. Group A (n = 242, organ-preserving treatment) consisted of patients with a tumor height of 5.0 ± 1.8 mm and base diameter of 12.7 ± 2.9 mm. Group B (n = 152, enucleation) included patients with 8.3 ± 2.8 mm tumor height and 15.2 ± 4.1 mm base diameter. Overall survival and disease-dependent survival were determined. Results. The cumulative 3-, 5-, and 7-year survival rates of patients with choroidal melanoma were 91.6 ± 1.7, 84.0 ± 2.5, 74.0 ± 3.8 % , and those with ciliochoroidal melanoma were 84.2 ± 5.6, 79.9 ± 5.8, and 53.0 ± 14.7 %, respectively (p = 0.048). In group A, the 5-year survival rates of patients with mushroom-shaped and irregular forms were 80.6 ± 5.9 and 74.6 ± 10.9 %, respectively, and 96.0 ± 2.0 % for dome-shaped UM. The worst 5-year survival rates were shown by patients with tumor stabilization, and the best ones, by patients with complete tumor resorption (x2 = 6.880, p = 0.008). Patients with post-radiation optical neuropathy (n = 193) had better 5-year survival rates (90.3 ± 2.9 %) than patients (n = 49) without neuropathy (77.5 ± 8.0 %). In group B, cumulative 1-year survival was 95.2 ± 1.9 %, 2-year survival, 89.2 ± 2.8 % , 3-year survival, 84.9 ± 2.9 % , 4-year survival, 81.8 ± 3.6 %, 5-year survival, 77.5 ± 4.0 % , 6-year survival, 67.9 ± 4.8 % , and 7-year survival was 64.7 ± 5.2 %. In epithelioid-cell, mixed-cell, and spindle-cell types of UM, the 5-year survival rates were 46.3 ± 12.0, 70.7 ± 8.0 %, and 84.8 ± 5.4 %, respectively (x2 = 11.571, p = 0.004). The 5-year survival rate of patients with extrascleral growth was 56.0 ± 10.4 % and without extrascleral growth it was 81.7 ± 4.0 %. Conclusion. In organ-preserving treatment, the combination of prognostic factors allows us to stratify the patients based on the risk of early metastasis, which allows for personalized dynamic monitoring, taking into account the vital prognosis of a particular patient.

Voice rehabilitation with voice prosthesis: Long term results, complications and risk factors

ObjectivesDespite the advances in surgical and non-surgical organ preservation treatments, total laryngectomy (TL) remains the most effective treatment in advanced larynx cancer and as salvage procedure in chemoradiation failure.One of the most devastating sequel after TL is loss of voice. Voice prosthesis (VP) is currently the preferred choice for voice rehabilitation. The purpose of this study is to identify VP complications, its lifespan and factors that influence the longevity of the VP. MethodsWe performed a retrospective study at a Tertiary University Hospital. Medical records of patients that underwent total laryngectomy, between January 1st of 2008 and 31st of December of 2017 were analyzed. ResultsOf the 84 patients that underwent laryngectomy, 60 had VP. The average age at the time of surgery 60.2 years old and there was a male preponderance (57:3).The mean lifespan of the prosthesis was 7.53 months. Leakage through the prosthesis was the most common reason for replacement of the prosthesis, followed by leakage around the prosthesis.Follow up time and manual suture were associated with prosthesis replacement. There was no significant relationship between the staging, tumor location or adjuvant radiotherapy and number of prosthesis replacement or its lifespan. ConclusionsRehabilitation after TL is of major importance to improve quality of life after surgery. Tracheoesophageal puncture with voice prosthesis is a safe procedure for vocal rehabilitation and was performed in the majority of patients in our study.Follow-up time and type of suture were the main determinants of the lifespan of the prosthesis.

Prognostic value of lymphovascular invasion in patients with muscle-invasive bladder cancer

Background. Bladder cancer ranks 9 in prevalence among malignancies and 2 among malignant tumors of the human urogenital tract. Removal of the bladder together with a tumor significantly reduces the quality of patients’ life and contributes to the emergence of postoperative complications that can lead to the patient’s death during the first year after the surgery. Along with radical methods of removing muscleinvasive bladder cancer (MIBC), organ-sparing operations can be performed, which can be an effective alternative to radical cystectomy. Purpose of study was to compare the results of treatment of MIBC with presence of lymphovascular invasion (LVI) in the primary tumor in two groups: after radical cystectomy with ileocystoneoplasty and partial cystectomy (PC) with adjuvant chemotherapy. Materials and methods. Depending on the method of treatment, patients were divided into 2 groups. The 1st group included 46 (42,4%) patients who underwent PC with adjuvant chemotherapy; 2nd group – 63 (57,6%) patients after radical cystectomy with ileocystoneoplasty or ureterocutaneostomy. Patient selection criteria for bladder preservation were generally recommended. Overall survival, cancer-specific and recurrencefree survival rates were evaluated according to the method of Kaplan–Meier. The median age of patients in the 1st group was 55 (48–65 years), in the 2nd – 60 (55–71 years). Results. The obtained data show that during 5-year follow-up period, the oncological results of the treatment of 2 groups have no significant difference, but taking into account significantly better quality of life of patients who underwent organ-preserving treatment, it is possible to claim that the use of bimodal therapy of MIBC in selectively chosen patients is justified. LVI was an independent predictor of both disease recurrence and cancer-specific survival rates. Patients who received complex therapy in presented studies demonstrated satisfactory cancer-specific and overall survival rates. Conclusions. The use of organ-preserving treatment with adjuvant chemotherapy in patients with MIBC and positive LVI allows the oncological results, which are comparable to radical cystectomy, to be achieved. Taking into consideration significant advantages of organ-preserving treatment compared with radical cystectomy with various methods of urine derivation, the proposed treatment strategy is an appropriate alternative to radical cystectomy.

Primary Total Laryngectomy versus Organ Preservation for Locally Advanced T3/T4a Laryngeal Cancer.

Organ preservation (OP) treatment for advanced laryngeal cancer has increased compared to primary total laryngectomy. Our study compares oncologic and functional outcomes between these approaches. Retrospective cohort study. Single tertiary care institution. Retrospective review of patients receiving primary total laryngectomy or OP for laryngeal cancer between 1/1/2000 and 12/31/2018. A total of 118 patients received primary total laryngectomy and 119 received OP. Overall survival was similar between total laryngectomy and OP. When stratified by T stage, disease-free survival was worse among T3 patients receiving OP versus total laryngectomy. In T3 patients, 28 OP patients experienced local recurrence (28.9%) compared to 3 total laryngectomy patients (7.1%; p < 0.01). In total, 20 OP patients with local recurrence received salvage surgery. These patients had similar overall survival to patients who underwent initial total laryngectomy (TL). About 14 OP patients with local recurrence did not receive salvage surgery. About 89 (75.4%) TL patients achieved normal diet as compared to 64 (53.8%) OP patients (p < 0.001). In TL patients, 106 (89.8%) received primary or secondary tracheoesophageal-prosthesis, 82 (77.4%) of whom achieved completely understandable speech. There was no difference in survival by treatment in T4 patients, possibly because of strict patient selection. However, disease-free survival was worse in T3 patients receiving OP, likely due to a high local recurrence rate. Approximately 40% of patients with local recurrence were not eligible for salvage laryngectomy. TL patients had comparable swallowing and speech outcomes with OP patients. 3 Laryngoscope, 133:1122-1131, 2023.

Curative chemoradiation for low rectal cancer: Primary clinical outcomes from a multicenter phase II trial.

LBA3514 Background: Organ preserving treatment strategies based on chemoradiotherapy may spare rectal cancer patients of major surgery and stoma. We suggest substantially improved tumor control by increasing the radiotherapy dose, without significant increase in the rate of late effects. We designed a prospective phase II trial to test high-dose radiotherapy of low rectal cancer for organ preservation in a multicenter setting. Methods: We enrolled patients with localized T1-3 N0-1 M0 rectal cancer within 6 cm from the anal verge and in performance status 0-2. Any N1-nodes had to be at the level of the tumor and included in the primary tumor-volume. Radiotherapy consisted of 62 Gy to the tumor and 50.4 Gy to the regional lymph nodes, delivered in 28 fractions using intensity modulated radiation therapy and daily image guidance. Capecitabine 825 mg/m2 BID. Patients with clinical complete response (cCR) 6–12 weeks after end of treatment were allocated to follow-up. Surgery was offered only in case of residual cancer or later re-growth. The primary endpoint was the proportion of patients with locoregional tumor control after two years by chemoradiation alone. Secondary endpoints included long-term side effects (CTCAE grading), cCR, rate of distant metastases, and overall survival. Results: Three Danish centers enrolled 107 patients between 2015 and 2019. Baseline classifications were T1/T2/T3 and N1 in 15%/54%/31% and 29%, respectively. The median age was 71 years and 64% were male. 92 (86.0%) had cCR and were allocated to observation. Four patients drew consent or died leaving 103 observed for at least 2 years. 23 had regrowth after cCR, five of whom had organ preserving transanal endoscopic microsurgery, 15 other curative surgery, and three palliation. 63 had no locoregional regrowth. Thus 61% (63/103) of patients with 2 years of follow-up had locoregional tumor control with chemoradiation alone. The actuarial estimate of locoregional control at 2 years from start of observation was 73.8% (95%CI 63.2-81.8). Calculated from time of enrollment, metastasis-free and overall survival at 30 months was 85.4% (95%CI 76.5-91.1) and 94.8% (95%CI 87.8-97.8). In the 63 patients with complete response at 2 years, ‘Low Anterior Resection Syndrome-score’ was None=37%, Minor=28%, and Major=35%. The most severe toxicity was erectile dysfunction grade 3 (n=3), grade 2 (n=4), grade 1 (n=6), and grade 0 (n=26). Grade 2 diarrhea, constipation, fecal incontinence, rectal bleeding and decreased libido were each reported in one case, while urinary frequency grade 2 was seen in four patients. Conclusions: The vast majority of patients with low rectal cancer can be cured by modern radiotherapy 62 Gy in 28 fractions with excellent patient-reported outcomes, toxicity, tumor control, and survival. The treatment is feasible in a multicenter setting. We suggest this approach as a standard of care option. Clinical trial information: NCT02438839.

Minimally Invasive Treatment of Benign Thyroid Nodules

Background. Nodular goitre is the commonest pathology of thyroid gland. According to published evidence, the endemic prevalence of iodine deficiency varies within 19–76 % population. The high rates and lack of symptoms at progressive nodules growth warrant the development of effective organ-preserving treatments. Imaging techniques for local precision targeting of individual lesions enable maximum-preserving interventions at thyroid tissue. Today’s world experience of percutaneous ethanol sclerotherapy and radiofrequency ablation is adequate. However, there exist no clear indications for sclerotherapy and radiofrequency ablation, and their consecutive use has not been assessed.Materials and methods. We analyse minimally invasive organ-preserving treatments of benign thyroid nodules (ethanol sclerotherapy, RFA) in 63 patients at the outpatient and general surgery units of BSMU Clinic and MEGI Medical Centre, Ufa, during February 2019 — December 2020.Results and discussion. Ethanol sclerotherapy was highly effective in 46.5 % patients, as evident from discontinued nodule’s blood supply in CDI and B-mode ultrasound, which remained stable in 10.5 % and restored after 3–4 weeks in 25 % patients. Sclerotherapy in colloid goitre was efficient only in 37.5 % patients. Ethanol sclerotherapy was RFA-followed in 25.4 % patients. RFA was favoured at a low-effective sclerotherapy providing for a weak positive dynamics of nodule size, local parietal blood flow preservation and intranodular vessels recanalisation at re-examination.Conclusion. Sclerotherapy was high-effective in cystic nodules. Radiofrequency ablation can be considered most adequate for treating solid nodules. RFA-followed sclerotherapy is a rational choice in treatment of large cystic nodules (&gt;5 cm3 ).