Preoperative Staging Research Articles

Assessment of Oncosurgical and Functional Outcomes in Patients undergoing Glossectomy for Advanced Carcinoma Tongue: A Cross-sectional Study at a Tertiary Cancer Care Centre in Northern India

Introduction: Tongue carcinoma presents a global oncological challenge due to its aggressive nature and late-stage diagnosis. Glossectomy, a key surgical procedure for advanced cases, significantly affects both cancer control and essential functions such as speech and swallowing. Aim: To analyse the impact of different glossectomy types on oncological and functional outcomes in patients with advanced carcinoma of the tongue. Materials and Methods: A cross-sectional study was conducted in the Department of Surgical Oncology, Cancer Research Institute, Himalayan Institute of Medical Sciences, Swami Rama Himalayan University, Uttarakhand, India over a one-year period from September 1, 2022, to August 31, 2023. The study included 47 patients with squamous cell carcinoma of the oral and posterior tongue who underwent glossectomy. Oncological outcomes (mortality and hospital stay) and functional outcomes (swallowing, speech, dysphagia, and Quality of Life (QoL)) were assessed. The questionnaires used were the EORTC Core Quality of Life questionnaire (EORTC QLQ-C30), EORTC questionnaire for the assessment of QoL in head and neck cancer patients (EORTC QLQ-H&N35), M.D. Anderson Dysphagia Inventory (MDADI), and Speech Handicap Index (SHI). Follow-up was conducted at the 6th week to assess changes in the functional aspects compared to the baseline scores. Data were entered into Microsoft Excel, and the analysis was performed using Statistical Packages for Social Sciences (SPSS) software version 25.0. The data were analysed using the Wilcoxon Signed Rank test. A p-value of <0.05 was considered statistically significant. Results: The study comprised 37 (78.72%) males and 10 (21.28%) females, with a mean age of 47.77±12.6 years. Preoperative staging indicated that 22 (46.81%) patients had T2N0 stage, 16 (34.04%) patients had T3, and 9 (19.15%) patients had T4a disease. Among the patients, 14 (29.79%) underwent partial glossectomy, 27 (57.45%) underwent hemiglossectomy, and 3 (6.38%) underwent subtotal glossectomy, and 3 (6.38%) underwent total glossectomy. The mean duration of hospital stay was 10.09±2.87 days. There were no instances of mortality or tumour recurrence at the 6th week. Regarding the functional outcomes, compared to baseline, at the 6th week, there was a significant decrease in EORTC QLQ-H&N35 median scores from 6.94 to 1.73 (p=0.005), but no significant change in the mean EORTC QLQ-C30 (90±8.22 versus (vs) 89.72±8.52, p=0.368), mean MDADI (4.51±1.2 vs 4.43±1.19, p=0.585), and mean SHI (15.81±25.76 vs 13.43±26.19, p=0.052). Conclusion: It can be inferred that glossectomy for advanced carcinoma of the tongue leads to a significant improvement in symptoms; however, the overall Quality of Life (QoL) and functions of the tongue such as swallowing and speech remain comparable to pre-surgery levels.

FEATURES OF THE DIAGNOSIS AND TREATMENT OF PATIENTS WITH SMALL TUMORS OF THE THYROID GLAND

Summary. Aim: to identify the causes of diagnostic errors at the preoperative stage in patients with thyroid nodules measuring < 1.0 cm. Object and methods: the study consists of retrospective and prospective research based on the analysis of examination results of 4509 patients with focal lesions of the thyroid gland. All patients underwent a comprehensive examination (ultrasound, fineneedle aspiration biopsy + cytological examination) in 872 patients with nodules of the thyroid gland measuring < 1.0 cm. The data of histopathological, cytological, and ultrasound findings were compared, and the accuracy, sensitivity, and specificity of ultrasound (US) and fineneedle aspiration biopsy (FNAB) under US control in the diagnosis of thyroid nodules with a diameter < 1.0 cm, including microcarcinoma, were evaluated. Results: out of 1003 cases of thyroid nodules, a correct preoperative US conclusion was formulated in 838 cases (83.6%) relative to postoperative histological examination, incorrect interpretation of the ultrasound image was noted in 165 cases (16.5%), with false-positive results in 85 cases (8.5%) and false-negative results in 80 (8.0%). The sensitivity of US for thyroid nodules measuring < 1 cm was 73.9%, and specificity was 82%. In 159 cases (94.6%) out of 168 patients with verified thyroid nodules, cytological examination data (papillary, follicular, or medullary thyroid carcinoma) corresponded to histological findings. The sensitivity of FNAB for thyroid nodules in less than centimeter sizes was 89.7%, and the specificity for benign less than centimeter thyroid nodules was 83.4%. Conclusions: ultrasound remains the standard for visualizing thyroid nodules, so clear criteria for their assessment will significantly reduce the number of nodules requiring biopsy and help clinicians improve the accuracy of treatment recommendations.

The role of immunohistochemical examination in the differential diagnosis of atypical tumors and carcinomas of parathyroid glands

Studying the role of IHC analysis in the differential diagnosis of APT and PC. The study included 44 patients with morphologic diagnosis of the APT established after surgical treatment for primary hyperparathyroidism on the basis of Endocrinology Research Centre during 2018-2023. All cases underwent IHC examination with evaluation of CD31/CD34 and parathormone (PTH) expression for identification of vascular invasion, Ki-67, parafibromin. According to the results of IHC analysis in 8/44 patients (18.2%) the diagnosis of APT was revised in favor of the PC: in 7 of them vascular invasion was detected; in 1 patient the additional series of slices in the surrounding fatty tissue revealed foci of tumor growth, confirmed by positive reaction with antibodies to PTH. According to IHC results, the material was divided into 2 groups: APT and PC. There were no differences in clinical and morphological characteristics, Ki-67% level and parafibromin expression between the groups. Assessment of clinical and laboratory-instrumental data at the preoperative stage does not allow differentiating APT from PC. In case of APT diagnosis and detection of suspicious morphological features, it is necessary to perform IHC examination to exclude PC.

ПСИХОЛОГИЧЕСКОЕ СОПРОВОЖДЕНИЕ ПОДРОСТКА, БОЛЬНОГО ТУБЕРКУЛЕЗОМ ОРГАНОВ ДЫХАНИЯ, НА ЭТАПЕ ХИРУРГИЧЕСКОГО ЛЕЧЕНИЯ

High stressogenicity of surgical treatment, especially in phthisiopediatrics, preconditions the necessity of both psychological preparation of patients at the pre-operative stage and psychological assistance at the early and late post-operative stages. The article represents a clinical observation demonstrating effectiveness of psychological support to a teenager experiencing high stress load, personal anxiety, destructive reactions, insufficient social skills required for interactions with surrounding people at the stage of surgical treatment. Psychological assistance enabled to achieve improvement and stabilization of the emotional state of the girl, increase motivation for recovery, cope emotional disadaptation, stimulate personal development, obtain skills of constructive reactions and interpersonal interactions.

Applications of Artificial Intelligence in Cataract Surgery: A Review.

Cataract surgery is one of the most performed procedures worldwide, and cataracts are rising in prevalence in our aging population. With the increasing utilization of artificial intelligence (AI) in the medical field, we aimed to understand the extent of present AI applications in ophthalmic microsurgery, specifically cataract surgery. We conducted a literature search on PubMed and Google Scholar using keywords related to the application of AI in cataract surgery and included relevant articles published since 2010 in our review. The literature search yielded information on AI mechanisms such as machine learning (ML), deep learning (DL), and convolutional neural networks (CNN) as they are being incorporated into pre-operative, intraoperative, and post-operative stages of cataract surgery. AI is currently integrated in the pre-operative stage of cataract surgery to calculate intraocular lens (IOL) power and diagnose cataracts with slit-lamp microscopy and retinal imaging. During the intraoperative stage, AI has been applied to risk calculation, tracking surgical workflow, multimodal imaging data analysis, and instrument location via the use of "smart instruments". AI is also involved in predicting post-operative complications, such as posterior capsular opacification and intraocular lens dislocation, and organizing follow-up patient care. Challenges such as limited imaging dataset availability, unstandardized deep learning analysis metrics, and lack of generalizability to novel datasets currently present obstacles to the enhanced application of AI in cataract surgery. Upon addressing these barriers in upcoming research, AI stands to improve cataract screening accessibility, junior physician training, and identification of surgical complications through future applications of AI in cataract surgery.

Anesthetic management of glycogen storage disease type 1b during liver transplantation: a case report

The glycogen storage disease type 1b is a rare metabolic disease caused by the glucose 6-phosphate transporter disorder. This study presents a 10-year-old female patient with growth retardation, neutropenia and inflammatory bowel disease, severe hypoglycemia attacks before and during the surgery, and hepatocellular carcinoma who underwent liver transplantation. A multidisciplinary approach from the preoperative preparation stage is essential in addition to intraoperative intervention for hypoglycemia and lactic acidosis in the anesthetic management of these patients.

Взаимосвязь колебаний уровней окситоцина в крови и слюне с когнитивными нарушениями у пациента с ишемической болезнью сердца до и после аортокоронарного шунтирования

Aim. To assess the dynamics of cognitive status and oxytocin levels in biological fluids (blood and saliva), as well as their relationship before and after coronary artery bypass surgery. Key points. According to the literature, postoperative cognitive dysfunction occurs in patients after coronary artery bypass grafting. The reasons for its development are factors that influence the preoperative, operational and postoperative stages. Timely diagnosis of cognitive deficit is extremely important, since the more pronounced the cognitive impairment, the less opportunities there are to provide assistance to patients. In this clinical observation, special attention is paid to oxytocin as a biomarker of degenerative brain lesions. Conclusion. We identified the development of postoperative cognitive dysfunction in a patient who did not have such disorders before surgery. There is a direct relationship between the state of cognitive functions and the level of oxytocin in the blood and saliva. Taking into account the data obtained, we propose to consider oxytocin as a biomarker of vascular cognitive disorders. Keywords: coronary heart disease, coronary artery bypass grafting, cognitive status, oxytocin, postoperative cognitive dysfunction.

Laparoscopic Radical Prostatectomy: Assessing the Impact of Residency Training on Early Surgical Experience.

Transferring the intricate laparoscopic radical prostatectomy (LRP) technique poses a considerable challenge for novice surgeons. Fellowship programs, typically lasting three to twelve months, remain the primary avenue for acquiring laparoscopic skills. This study proposes that residency-based laparoscopy training confers distinct advantages over fellowship programs during the initial stages of LRP. The study analyzed retrospectively collected data and operation videos from the first and second sets of fifty operations (Group 1 and Group 2) out of a total of 553 performed by the "fellow" surgeon between August 2009 and December 2022, and the first fifty operations by the "resident" surgeon from January 2022 to June 2023. Parameters examined included patient demographics, preoperative prostate-specific antigen (PSA) levels, grades, stages, operation durations, complications, postoperative outcomes, and short-term (6-month) oncological and functional results. No statistically significant differences were observed in prostate volume, age, body mass index, or PSA levels between Groups 2 and 3 or 1 and 3 (p > 0.05). Nevertheless, Group 3 exhibited significantly more International Society of Urological Pathology grade 3 and 4 cases than Group 1 (p = 0.004) and Group 2 (p = 0.006). Additionally, Group 3 had a shorter anastomosis time (AT) (25 min vs. 35 min, p < 0.001) and reduced estimated blood loss (EBL) (275 mL vs. 385 mL, p = 0.008) compared to Group 1. No significant differences were found among the groups regarding intraoperative complications, nerve sparing, or lymph node dissection rates. While Group 2's anastomosis time was comparable to that of Group 3 (24 min vs. 25 min, p = 0.144), it demonstrated a significantly shorter insufflation duration (150 min vs. 170 min, p < 0.001). Functional outcomes, including continence and erectile function at six months, showed no significant differences across the groups. This study underscores the potential benefits of integrating LRP training into a surgeon's residency, particularly in the early stages of their learning curve (LC), by reducing anastomosis and operation times and EBL in the first fifty cases. Initial findings suggest that implementing modular training in residency programs could enhance LRP proficiency, benefiting both surgeons and patients.

Comparison of skeletal stability with rigid and wire fixation in patients who have undergone Le Fort I and Anterior Segmental Maxillary Osteotomy

ABSTRACT Background: Maxillary superior repositioning is widely regarded as the most stable procedure in orthognathic surgery, requiring minimal instruments for stabilization. Rigid fixation is considered the ideal method for long-term stability, leading to improved anatomic structures, enhanced recovery of bite forces, and better bite function. Objective: To compare the skeletal stability following Le Fort I and anterior maxillary osteotomy with wire osteosynthesis and rigid fixation. Materials and Methods: A total of 16 patients, including one male and 15 females, underwent Le Fort I and anterior segmental maxillary osteotomy along with fixation using either wire osteosynthesis or rigid fixation for correction of vertical and anteroposterior maxillary excess. Patients were assessed at preoperative, 1-week postoperative, and 6-month postoperative stages using a lateral cephalogram to evaluate skeletal stability. Results: The wire osteosynthesis group showed significant differences in posterior maxillary vertical measurements compared to the rigid fixation group. However, there was no significant difference in anterior vertical and anteroposterior skeletal measurements between the two groups. Conclusion: Wire osteosynthesis is a stable form of fixation for superior repositioning with segmentation of the maxilla for correction of vertical and antero-posterior excess.

Analysis of therapeutic effects of congenital kyphosis in children due to anterior vertebral bone bridges.

To investigate the choice of treatment options and long-term orthopedic results of congenital kyphosis in children due to anterior vertebral bone bridges. The clinical data of children with congenital kyphosis due to anterior vertebral bridges treated at our center from May 2005 to May 2020 were retrospectively analyzed. We evaluated the clinical features of the deformity, the choice of treatment plan, the change in the Cobb angle of the kyphosis and the improvement of the sagittal trunk deviation before and after treatment and at the final follow-up visit by means of pre-treatment and post-treatment imaging, physical examination and analysis of the case data. A total of 35 children were included. Clinical follow-up was conducted on a cohort of 5 children, all of whom presented with type Ⅱ congenital kyphosis caused by less than three thoracic anterior bone bridges. The study findings revealed no noteworthy advancement in segmental kyphosis, thoracic kyphosis, lumbar lordosis, and sagittal vertical axis during the final follow-up assessment (p > 0.05). In a cohort of 30 pediatric patients who underwent surgical intervention, segmental kyphosis was corrected, with a decrease from an average angle of (40.1 ± 20.5)° to (15.6 ± 9.5)°. Furthermore, significant improvements were noted in segmental kyphosis, thoracic kyphosis, lumbar lordosis, and sagittal vertical axis at the postoperative stage compared to the preoperative stage (p < 0.05). Notably, improvements in thoracic kyphosis and lumbar lordosis persisted at the final follow-up visit compared to postoperative (p < 0.05). Type Ⅱ congenital kyphosis in children caused by anterior bony bridges of less than three vertebrae in the thoracic segment can be followed up for a long period, and type Ⅱ/Ⅲ congenital kyphosis caused by anterior bony bridges of the vertebrae in the thoracolumbar, lumbar, and lumbosacral segments requires early surgery.

Clinical Feasibility of Dual-Layer CT With Virtual Monochromatic Image for Preoperative Staging in Patients With Breast Cancer: A Comparison With Breast MRI.

Dual-layer CT (DLCT) can create virtual monochromatic images (VMIs) at various monochromatic X-ray energies, particularly at low keV levels, with high contrast-to-noise ratio. The purpose of this study was to assess the clinical feasibility of contrast-enhanced chest DLCT with a low keV VMI for preoperative breast cancer staging, in comparison to breast MRI. A total of 152 patients with 155 index breast cancers were enrolled in the study. VMIs were generated from contrast-enhanced chest DLCT at 40 keV and maximum intensity projection (MIP) with three-dimensional (3D) reconstruction was performed for both bilateral breast areas. Two radiologists reviewed in consensus the 3D MIP images of the chest DLCT with VMI and breast MRI in separate sessions with a 3-month wash-out period. The detection rate and mean tumor size of the index cancer were compared between the chest DLCT with VMI and breast MRI. Additionally, the agreement of tumor size measurement between the two imaging modalities were evaluated. Of all index cancers, 84.5% (131/155) were detected in the chest DLCT with VMI, while 88.4% (137/155) were detected in the breast MRI (P = 0.210). The Bland-Altman agreement between the chest DLCT with VMI and breast MRI was a mean difference of -0.05 cm with 95% limits of agreement of -1.29 to 1.19 cm. The tumor size in the chest DLCT with VMI (2.3 ± 1.7 cm) was not significantly different from that in the breast MRI (2.4 ± 1.6 cm) (P = 0.106). The feasibility of chest DLCT with VMI was demonstrated for preoperative tumor staging in breast cancer patients, showing comparable cancer detectability and good agreement in tumor size measurement compared to breast MRI. This suggests that chest DLCT with VMI can serve as a potential alternative for patients who have contraindications to breast MRI.

Less qualitative multiparametric magnetic resonance imaging in prostate cancer can underestimate extraprostatic extension in higher grade tumors.

Multiparametric magnetic resonance imaging (mpMRI) is increasingly used for risk stratification and preoperative staging of prostate cancer. It remains unclear how Grade Group (GG) interacts with the ability of mpMRI to determine the presence of extraprostatic extension (EPE) on surgical pathology. A retrospective review of a robotic assisted laparoscopic radical prostatectomy (RALP) database from 2016-2020 was performed. Radiology mpMRI reports by multiple attending radiologists and without clear standardization or quality control were retrospectively assessed for EPE findings and compared with surgical pathology reports. The data were stratified by biopsy-based GG and a multivariable cluster analysis was performed to incorporate additional preoperative variables (age at diagnosis, PSA, etc.). Hazard ratios were calculated to determine how mpMRI findings and radiographic EPE relate to positive surgical margins. 289 patients underwent at least one mpMRI prior to RALP. Preoperative mpMRI demonstrated sensitivity of 39.3% and specificity of 88.8% for pathological EPE and had a negative predictive value (NPV) of 49.5%, and positive predictive value (PPV) of 84.0%. Stratification of NPV by GG yielded the following values: GG 1-5 (49.5%), GG 3-5 (40.8%), GG 4-5 (43.4%), and GG 5 (30.4%). Additionally, positive EPE on preoperative mpMRI was associated with a significantly decreased risk of positive surgical margins (RR: 0.655; 95% CI: 0.557-0.771). NPV of prostate mpMRI for EPE may be decreased for higher grade tumors. A detailed reference reading and image quality optimization may improve performance. However, urologists should exercise caution in nerve sparing approaches in these patients.

The role of non-invasive preoperative imaging techniques in predicting the risk of pancreatic fistula development in pancreaticoduodenal tumours

Background. In pancreaticoduodenal tumours, pancreaticoduodenectomy (PDE) is a radical surgical intervention. The most important stage of the operation is the pancreaticojejunoanastomosis (PEA), the admissibility of which depends on many factors: the degree of fibrous changes in the pancreatic parenchyma, the degree of mechanical jaundice, and the operating surgeon’s technique. Identification of factors that reflect changes in the structure of the pancreatic parenchyma and its ductal system, which are important predictors in predicting the risk of developing pancreatic fistula (PF) after PDE, is of great scientific importance. Purpose. Evaluation of changes in the structure of the pancreatic parenchyma and its ductal system using non-invasive preoperative imaging methods in predicting the risk of pancreatic fistula development during pancreaticoduodenectomy. Materials and Methods. This study included 302 patients who underwent pancreaticoduodenectomy. Mechanical jaundice was detected in 246 (81.5%) patients, 56 (18.5%) patients had no jaundice, the age of patients ranged from 31 to 77 years, 178 (58.9%) were men and 124 (41.1%) were women. Ultrasound elastography and multidetector computed tomography were used for preoperative non-invasive visualisation of the degree of changes in the pancreatic parenchyma and its ductal system. The following parameters of visualisation of the pancreatic parenchyma with an assessment of the anatomical features of the isthmus and the duct of Wirsung were identified: diameter and cross-sectional area of the duct of Wirsung (at the level of the isthmus), width and thickness of the pancreas (at the level of the isthmus), cross-sectional area of the pancreatic isthmus (without the area of the duct of Wirsung), native density, and stiffness of the pancreatic parenchyma. Results and discussion. The ROC analysis of the parameters for assessing the state of the parenchyma of the pancreas and the duct of Wirsung obtained from computed tomography made it possible to determine the validity of these indicators in predicting the risk of developing PF. According to the results of the ROC analysis, the following indicators were identified as markers of moderate risk of developing PF: the diameter of the duct of Wirsung is less than 4 mm, the cross-sectional area of the duct of Wirsung is less than 0.23 cm2 , the thickness of the isthmus of the pancreas is greater than 15 mm, the width of the isthmus of the pancreas is greater than 19 mm, the cross-sectional area of the isthmus of the pancreas (without the area of the duct of Wirsung) is greater than 3 cm2 , and the native density is greater than 24 HU. To assess the high risk of developing PF, the use of ROC analysis allowed us to establish the high quality of diagnostic models for such computed tomography parameters as the diameter of the duct of Wirsung – the area under the ROC curve is 0.965, the cross-sectional area of the duct of Wirsung – AUC is 0.894, the cross-sectional area of the isthmus of the pancreas (without the area of the duct of Wirsung) – AUC is 0.873, the width of the isthmus of the pancreas – the area under the ROC curve is 0.859, the native density – AUC is 0.844. Determination of the parameter of stiffness of the pancreatic parenchyma by shear wave elastography in predicting high and moderate risk of developing PF also corresponded to the high quality of the diagnostic model. Conclusions. The use of non-invasive imaging methods allows changes in the structure of the pancreatic parenchyma, anatomical features of the pancreatic isthmus and the duct of Wirsung to be detected at the preoperative stage, the risk of developing a pancreatic fistula to be predicted and the number of complications during pancreaticoduodenectomy to be reduced.

Optically Guided High-Frequency Ultrasound Shows Superior Efficacy for Preoperative Estimation of Breslow Thickness in Comparison with Multispectral Imaging: A Single-Center Prospective Validation Study.

Melanoma is the most aggressive form of skin cancer that is known for its metastatic potential and has an increasing incidence worldwide. Breslow thickness, which determines the staging and surgical margin of the tumor, is unavailable at initial diagnosis. Novel imaging techniques for assessing Breslow thickness lack comparative data. This study evaluates optically guided high-frequency ultrasound (OG-HFUS) and multispectral imaging (MSI) for preoperative estimation of Breslow thickness and staging. We enrolled 101 patients with histologically confirmed primary melanoma and categorized them based on tumor thickness. Optically guided 33 MHz HFUS and MSI were utilized for the assessment. Our MSI-based algorithm categorized melanomas into three subgroups with a sensitivity of 62.6%, specificity of 81.3%, and fair agreement (κ = 0.440, CI: 0.298-0.583). In contrast, OG-HFUS demonstrated a sensitivity of 91.8%, specificity of 96.0%, and almost perfect agreement (κ = 0.858, CI: 0.763-0.952). OG-HFUS performed better than MSI in estimating Breslow thickness, emphasizing its potential as a valuable tool for melanoma diagnosis and patient management. OG-HFUS holds promise for enhancing preoperative staging and treatment decision-making in melanoma.

HYBRID MINIMALLY INVASIVE TECHNOLOGIES IN DIAGNOSING AND ASSESSING THE PROGNOSIS FOR THE COURSE OF THE DISEASE IN PATIENTS WITH BREAST CANCER: PUNCTURE-NEEDLE BIOPSY USING OZONE-OXYGEN MIXTURE AND TISSUE SPECTROPHOTOMETRY TECHNIQUE

Breast cancer is the most common malignant disease in women worldwide. According to the World Health Organization and the International Agency for Research on Cancer, it accounts for 25.1% of all cancer cases in women. Intracystic breast cancer is one of the most rare and difficult to diagnose forms of this disease. Due to this improving existing methods of breast cancer diagnosis and developing new ways for the early detection of this pathology are of great importance. The aim of the study is to evaluate the effectiveness of new methods for breast cancer diagnosis – an improved technique of puncture–needle biopsy under ultrasound control and a hybrid technology for assessing the local metabolism of mammary tumors. Materials and methods. The article presents the results of examining 67 female patients with intracystic breast cancer using the traditional technique of puncture-needle biopsy and a new method of cytological diagnosis of this disease. The article presents the pilot results of using the hybrid technology for evaluating local metabolism of mammary gland tumors in 22 patients with suspected breast cancer to clarify the diagnosis and assess the prognosis using optical diagnostic methods: fluorescence spectroscopy (at wavelengths of fluorescence excitation of 365 and 450 nm) and diffuse reflectance spectroscopy (with a source of polychromatic radiation). Results. The sensitivity of puncture-needle biopsy performed according to the traditional method in the diagnosis of intracystic breast cancer was 81.8%, and the sensitivity of the improved method was 97.06% (p &lt; 0.05). To asses reliably the effectiveness of the hybrid technology for determining the local metabolism of tumors in the diagnosis of breast cancer, examination of a larger number of patients is required. Among the patients examined using the optical diagnostic methods, the following data were obtained: the redox index in the tumor was 0.67±0.10 relative units, in the surrounding tissue – 0.77±0.14, tissue saturation in the tumor – 64±14%, in the surrounding tissue – 68±9%. Two cases of breast cancer in patients prior to the start of treatment and after 6 courses of neoadjuvant polychemotherapy are considered separately. The following data were obtained: the redox index in the tumor in the patient without treatment was 0.53± 0.01 relative units, in the patient after 6 courses of neoadjuvant therapy – 0.81±0.01 relative units; the value of tissue saturation in the tumor in the patient without treatment – 71±1%, in the patient after 6 courses of neoadjuvant therapy – 64± 2%. To asses reliably the effectiveness of the hybrid technology for determining the local metabolism of tumors in the diagnosis of breast cancer and to have the opportunity to assess the prognosis for the disease course, examination of a larger number of patients is required. Conclusions. A new method of cytological diagnosis of cancer in a breast cyst using ozone-oxygen mixture proved to be more effective than the traditional method, which proves the expediency of its use in order to improve the diagnosis of this pathology at the preoperative stage. To solve the question of the expediency of using the technique of spectrophotometry of tumor tissues in patients with breast cancer in order to assess the effectiveness of chemotherapy, a larger number of women under examination and a period of their follow-up for 3–5 years are required.

Lymphovascular Invasion at the Time of Radical Prostatectomy Adversely Impacts Oncological Outcomes.

Lymphovascular invasion, whereby tumour cells or cell clusters are identified in the lumen of lymphatic or blood vessels, is thought to be an essential step in disease dissemination. It has been established as an independent negative prognostic indicator in a range of cancers. We therefore aimed to assess the impact of lymphovascular invasion at the time of prostatectomy on oncological outcomes. We performed a multicentre, retrospective cohort study of 3495 men who underwent radical prostatectomy for localised prostate cancer. Only men with negative preoperative staging were included. We assessed the relationship between lymphovascular invasion and adverse pathological features using multivariable logistic regression models. Kaplan-Meier curves and Cox proportional hazard models were created to evaluate the impact of lymphovascular invasion on oncological outcomes. Lymphovascular invasion was identified in 19% (n = 653) of men undergoing prostatectomy. There was an increased incidence of lymphovascular invasion-positive disease in men with high International Society of Urological Pathology (ISUP) grade and non-organ-confined disease (p < 0.01). The presence of lymphovascular invasion significantly increased the likelihood of pathological node-positive disease on multivariable logistic regression analysis (OR 15, 95%CI 9.7-23.6). The presence of lymphovascular invasion at radical prostatectomy significantly increased the risk of biochemical recurrence (HR 2.0, 95%CI 1.6-2.4). Furthermore, lymphovascular invasion significantly increased the risk of metastasis in the whole cohort (HR 2.2, 95%CI 1.6-3.0). The same relationship was seen across D'Amico risk groups. The presence of lymphovascular invasion at the time of radical prostatectomy is associated with aggressive prostate cancer disease features and is an indicator of poor oncological prognosis.

RISK FACTORS FOR ATRIAL TACHYARRHYTHMIA RECURRENCE IN PATIENTS WITH NON-PAROXYSMAL ATRIAL FIBRILLATION AFTER «BOX LESION SET» THORACOSCOPIC ABLATION

Highlights Identification of risk factors impacting the effectiveness of thoracoscopic ablation according to the box session set scheme will allow us to formulate criteria for the selection of patients with non-paroxysmal atrial fibrillation for epicardial ablation of the left atrium.Duration of atrial fibrillation for more than 7.5 years and the volume of the left atrium indexed to the body surface area of more than 47 mL/m2 statistically significantly reduce the effectiveness of thoracoscopic ablation of stable atrial fibrillation by 34.2 and 55.8% during the three-year follow-up period, respectively.The need to assess the function of left atrium using modern two-dimensional speckle-tracking echocardiography technology should be considered to determine the criteria for the successful ablation of non-paroxysmal atrial fibrillation. The aim. To study risk factors for atrial tachyarrhythmias recurrence after thoracoscopic ablation (TSA) of non-paroxysmal atrial fibrillation (AF) in the long-term follow-up period.Methods. The retrospective study included a series of 100 patients with non-paroxysmal AF undergoing “Box lesion set” TSA with one-stage exclusion of the left atrial (LA) appendage. The efficacy of TSA in the long-term follow-up period was evaluated using 24-h HM ECG results. A retrospective analysis of risk factors for atrial tachyarrhythmias recurrence after TSA was performed. The analysis included the main clinical characteristics of patients in the preoperative period, as well as data of transthoracic echocardiography with inclusion of left atrial strain in the reservoir and conduit phases.Results. In the presented study, the main risk factors for atrial tachyarrhythmias recurrence after TSA were: duration of AF more than 7.5 years and LAVI more than 47 mL/m2. However, univariate analysis showed that for every 1-year increase in the duration of AF, the risk of arrhythmia recurrence after TSA increased 1.07-fold [95% CI: 1.01; 1.17, p = 0.0374], and for every 10 mL/m2 increase in LAVI, the risk of atrial tachyarrhythmia recurrence increased 1.95-fold [95% CI: 1.49; 2.56, p&lt;0.001]. According to the data of two-dimensional speckle-tracking echocardiography there was a tendency towards the decrease of the parameters of left atrial strain in the reservoir phase mainly in patients with AF, which requires further more detailed study on a larger cohort of patients.Conclusion. It is necessary to consider not only the assessment of the anatomy of the left atrium, but its function with the use of modern methods of radial imaging at the preoperative stage in order to improve the effectiveness of TSA “Box lesion set” for non-paroxysmal AF in the long-term follow-up period.

Impact of preoperative [18F]FDG PET/CT vs. contrast-enhanced CT in the staging and survival of patients with clinical stage I and II non-small cell lung cancer: a 10-year follow-up study.

To elucidate the impact of [18F]FDG positron emission tomography/computed tomography (PET/CT) vs. CT workup on staging and prognostic evaluation of clinical stage (c) I-II NSCLC. We retrospectively identified 659 cI-II NSCLC who underwent CT (267 patients) or preoperative CT followed by PET/CT (392 patients), followed by curative-intended complete resection in our hospital from January 2008 to December 2013. Differences were assessed between preoperative and postoperative stage. Five-year disease-free survival (DFS) and overall survival (OS) rates were calculated using the Kaplan-Meier approach and compared with log-rank test. Impact of preoperative PET/CT on survival was assessed by Cox regression analysis. The study included 659 patients [mean age, 59.5years ± 10.8 (standard deviation); 379 men]. The PET/CT group was superior over CT group in DFS [12.6 vs. 6.9years, HR 0.67 (95% CI 0.53-0.84), p < 0.001] and OS [13.9 vs. 10.5years, HR 0.64 (95% CI 0.50-0.81), p < 0.001]. In CT group, more patients thought to have cN0 migrated to pN1/2 disease as compared with PET/CT group [26.4% (66/250) vs. 19.2% (67/349), p < 0.001], resulting in more stage cI cases being upstaged to pII-IV [24.7% (49/198) vs. 16.1% (47/292), p = 0.02], yet this was not found in cII NSCLC [27.5% (19/69) vs. 27.0% (27/100), p = 0.94]. Cox regression analysis identified preoperative PET/CT as an independent prognostic factor of OS and DFS (p = 0.002, HR = 0.69, 95% CI 0.54-0.88; p = 0.004, HR = 0.72, 95% CI 0.58-0.90). Addition of preoperative [18F]FDG PET/CT was associated with superior DFS and OS in resectable cI-II NSCLC, which may result from accurate staging and stage-appropriate therapy.

A differentiated approach to the selection of pancreaticojejunostomy during pancreatoduodenectomy

Background. Pancreatoduodenectomy is a radical surgical intervention in case of neoplasms of the pancreatoduodenal zone, which is accompanied by frequent postoperative complications. The critical point of the reconstructive stage of pancreatoduodenectomy is pancreaticojejunostomy (PES), which dictates the importance of improving the techniques of its repair and drainage, as well as the development of a differentiated approach to the choice of PES. The aim of the study: to evaluate the effectiveness of a differentiated approach to the choice of PES technique when performing pancreatoduodenectomy. Materials and methods. The study included 302 patients who underwent pancreatoduodenectomy for pancreatic neoplasms. The age of patients varied from 31 to 77 years, there were 178 (58.9 %) men, and 124 (41.1 %) women. In the comparison group (154 patients), a standard diagnostic and treatment algorithm was used with the choice of PES technique taking into account the intraoperative evaluation of the degree of the pancreatic parenchyma density and the assessment of the ductal system (surgeon’s experience and intuition). In the main group (148 patients), an improved diagnostic and treatment algorithm was used, which included non-invasive preoperative methods of visualization of changes in the pancreatic parenchyma, anatomical features of its isthmus and ductal system, as well as the use of developed methods for repair and drainage of the PES. Results. In the main group, the applied differentiated approach to the selection of PES consisted in the fact that at the preoperative stage, the degree of risk of developing pancreatic fistula (PF) was predicted: in 66 (44.6 %) patients, a low risk was detected, in 42 (28.4 %) — a moderate risk, 40 (27.0 %) people had a high risk. Identification of patients with a high risk of developing PF made it possible to carry out the necessary medical measures not only in the operating room, but also in the pre-operative stage, which affected a decrease in the frequency of severe forms of PF. Specifically, in the compari­son group, type B was noted 2.5 times (χ2 = 3.94; p = 0.047) and type C — 6.4 times (p = 0.034 according to Fisher’s exact test) more often than in the main group. This became the basis for the development of PES techniques with plastic covering of the anastomotic zone and improvement of PES drainage techniques with simultaneous drainage of the biliodigestive anastomosis. The developed differentiated approach to the choice of PES method based on the preoperative assessment of the risk of PF made it possible to reduce the frequency of its development, especially severe forms (types B and C) from 16.2 % of cases in the comparison group to 5.4 % in main group (χ2 = 8.01; p = 0.005). Mortality due to pancreatic fistula in the main group was 0.7 %, in the comparison group — 4.8 % (p = 0.034, Fisher’s exact test). Conclusions. Carrying out a preoperative non-invasive assessment of the degree of changes in the pancreatic parenchyma and the state of the duct of Wirsung by means of fibroelastography and computer tomography made it possible to develop a differentiated approach to the choice of PES technique, taking into account the prediction of the risk of PF in the postoperative period (sensitivity — 90.5 %, specificity — 81, 8 %, diagnostic accuracy — 86.1 %). The use of the developed methods with a falciform ligament wrap and cholangiodrainage to drain PES in soft pancreas made it possible to reduce in half the frequency of PF development (p &lt; 0.05), which led to a decrease in mortality by almost 7 times (p &lt; 0.05).

THE INFLUENCE OF PREOPERATIVE INTERVIEW BY AN ANESTHESIOLOGIST WITH A VIDEO PRESENTATION ON THE LEVEL OF PREOPERATIVE ANXIETY IN PATIENTS WITH EXCESSIVE WEIGHT AND OBESITY

Introduction. The preoperative period is one of the most stressful stages of treatment. Anxiety is the first phase of stress, a universal reaction of the body to an extreme situation. During the anticipation phase of the threat, the human body mobilizes and tries to resist it by activating various compensatory reactions.&#x0D; Objective. To evaluate the influence of a preoperative interview by an anesthesiologist with a video presentation and without it on the level of anxiety during the preoperative preparation stage in patients with excessive weight and obesity.&#x0D; Materials and methods. The level of anxiety was assessed at the preoperative preparation stages in patients with surgical profiles, excessive weight, and obesity. The study included 145 patients, divided into two groups: Group 1–71 patients and Group 2–74 patients. A visual analog scale of anxiety (VAS-A) was used to assess the level of anxiety. The patient's level of anxiety was evaluated before the start of the interview with the anesthesiologist, after the preoperative examination, and before the beginning of the surgical intervention. The visual analog scale of anxiety at different stages of the study was provided on other questionnaire sheets to exclude visual comparison of the patient's previous result.&#x0D; Results. In Group 1, the classic interview significantly reduced patient anxiety (Z=2.62; p=0.008). The level of anxiety before the start of the surgical intervention significantly increased compared to the level of anxiety after the interview (Z=3.28; p=0.001) and compared to the level of anxiety before the start of the interview (Z=2.62; p=0.1), the indicator was higher, without statistically significant difference. In Group 2, the classic interview by the anesthesiologist supplemented with a video presentation significantly reduced anxiety (Z=2.4; p=0.01). The level of anxiety significantly increased before the start of the surgical intervention (Z=2.48; p=0.01), but compared to the anxiety before the beginning of the interview (Z=1.38; p=0.16), this indicator was lower, although without a statistically significant difference. Before the surgical intervention, most patients noted the usefulness of the video presentation, indicating a greater confidence in safety and trust in the surgical team&#x0D; Conclusion. A comprehensive and informative preoperative interview with an anesthesiologist reduces the patient's anxiety level before the operation.