Radical Surgical Treatment Research Articles

Management and long-term follow-up of basilar trunk artery aneurysms: a single center experience.

Basilar trunk artery (BTA) aneurysm is a serious disease, management of which remains controversial and challenging. We conducted a single-center retrospective cohort study of 67 patients with 72 BTA aneurysms diagnosed and treated at our institution. Finally, 39 participants underwent conservative treatment and 27 received endovascular surgical treatment, including one patient who underwent external carotid artery-radial artery-second segment of the posterior cerebral artery bypass. Data on patient clinical and aneurysm characteristics were collected and risk factors for unfavorable outcome and death analyzed. 33 patients presented with subarachnoid hemorrhage and 15 had a poor Hunt-Hess grade. Mean aneurysm diameter was 14.8 ± 12.6mm and 28 aneurysms were > 15mm. The total proportions of favorable outcome and mortality at discharge were 64.2% and 17.9%, respectively, while the corresponding proportions in the surgery groups were 53.6% and 17.9%. Moreover, we conducted long-term follow-up from initial diagnosis to 3 years. 57 patients had ≥ 6 months of follow-up and 31 patients reached 3 years. Mean follow-up time was 23.23 ± 21.58 months. The proportions of patients with unfavorable outcome and death increased in the group undergoing conservative treatment during the 3-year follow-up period. Further, the natural rupture rate increased from 43.3% initial diagnosis to 81.8% at 3 years. Poor Hunt-Hess grade was an important risk factor for unfavorable outcome and death. Undergoing surgery was a protective factor against death at six months; however, the complications rate was higher in the surgery group than that in patients receiving conservative treatment. In conclusion, although BTA aneurysm management remains controversial and unsatisfactory, patients with BTA aneurysm in the surgical intervention group appeared to have better outcomes.

Role of radical surgical treatment in patients with soft tissue sarcomas invading bone

To analyze the overall survival, mid-term, and long-term outcomes, as well as the complication structure in a group of patients after endoprosthetic replacement for soft tissue sarcomas infiltrating bone, the treatment results of 19 patients who underwent 24 primary and repeated surgeries from May 2004 to November 2021 were analyzed. The average follow-up period was 132.5 months. The average age at the time of endoprosthetic replacement was 47.7 ± 15.3 years. It was shown that the event-free survival of the operated patients after 3 years was 61.5 ± 11.5 %, after 5 years – 54.7 % ± 12.1 %, and remained at the same level after 10 years. The average time to tumor recurrence was 11 months, lung metastasis occurred at 96 months, and both recurrence and metastases were detected on average within 2 months. The overall survival of patients with soft tissue sarcomas through 3 years was 93.3 ± 6.4 %, through 5 years – 80.0 ± 10.3 %, and through 10 years – 65.5 ± 12.6 %. Across the entire group of respondents, disease progression was observed in 42.1 % of cases, tumor recurrence in 31.6 %; metastases (to the lungs) in 5.3 %; recurrence of the disease and metastases in 5.3 %. These data indicate that endoprosthetic replacement as a component of combined organ-preserving treatment for patients with soft tissue sarcomas infiltrating bone is an effective treatment method for improving the quality of life of patients, despite certain risks of disease recurrence, metastasis, and complications.

Current trends and evidence on post-TEVAR aorto-pulmonary and -bronchial fistula: a narrative review.

Aorto-bronchial or aorto-pulmonary fistulas (ABPF) are a rare but life-threatening complication following thoracic endovascular aortic repair (TEVAR). This narrative review aims to provide an overview of the current trends and available evidence on ABPF following TEVAR, evaluating risk factors, diagnostic approaches, and possible preventive and therapeutic strategies. Relevant publications on post-TEVAR ABPF were selected through a literature search on PubMed. Studies providing data on post-TEVAR ABPF concerning pathogenesis, clinical presentation, diagnostic tools, surgical approaches, and outcomes were included. The literature search obtained 169 articles. After selection, 37 studies, published between 2000 and 2024, remained for analysis. The primary symptom of ABPF is typically hemoptysis, which may be recurrent or persistent. The diagnostic pathway for ABPF encompasses medical history, clinical evaluation, blood tests, sputum and blood cultures. CTA is the first-line imaging modality in suspected ABPF, while bronchoscopy is reserved for hemodynamically stable patients. Moreover, 18-fluoro-deoxyglucose positron emission tomography (PET-CT) can aid in the diagnosis of graft infection. Post-TEVAR ABPF are associated with multiple risk factors, mainly patient-specific clinical conditions (i.e. chronic inflammatory conditions, underlying mediastinal oncologic pathologies, and infectious diseases) and anatomical characteristics, mainly large aortic aneurysms, severe aortic tortuosity, and an extensive peri-aortic hematoma. Strategies to minimize the risk of ABPF formation include appropriate device oversizing, long sealing zones, limited extent of aortic coverage, selective hematoma evacuation, and strict adherence to sterility and antibiotic prophylaxis. Radical surgical interventions have shown superior outcomes compared to endovascular approaches, which may be adopted as initial step to stabilize the patient in a staged treatment. Post-TEVAR ABPF is a rare and life-threatening condition. Literature is scarce and a deeper understanding of risk factors, diagnostic pathways, and therapeutic strategies is essential for the prevention and management of ABPF secondary to TEVAR.

Treatment outcomes in young adults with gastric cancer

Introduction. According to global data, gastric cancer (GC) is the 5-th most common malignancy with a high cancer-related mortality rate. However, in recent decades, there has been a tendency towards an increase in the incidence of GC among young patients (18 to 40 years old), which currently amounts to 4.4–9.8%. Aim: to evaluate the effectiveness of surgical, combined and palliative treatment options in early-onset GC. Material and Methods. the study included 129 patients aged 18–45 years, who underwent radical, cytoreductive and palliative surgery with or without combination with drug therapy for localized, locally-advanced and primary disseminated GC. the patients were divided into three clinical groups: 1) the surgical group (n=27) included patients with only surgical treatment; 2) the group of combined treatment (n= 58) included patients with PCI <7 who underwent surgery with the volume of CC0 in combination with CT (neoadjuvant, adjuvant, perioperative, simultaneously with or without hyperthermic intraoperative intraperitoneal chemotherapy (HIPEC) and patients who underwent only HIPEC; 3) the additional (palliative) group (n=44) included patients with PCI>7 who underwent systemic CT in combination with pressurized intraperitoneal aerosol chemotherapy (PIPAC). Results. the median overall survival (OS) in three groups was 58, 30 and 13 months, respectively. In patients with IV stage of disease who underwent HIPEC with CC0 surgery, OS in the 2nd group was 17 in comparison with 13 months in the third group (PIPEC). Conclusion. Aggressive multimodal treatment in the absence of comorbid status in young patients will allow for intensification of both the perioperative drug therapy component and the implementation of extended multivisceral resections that facilitate radical surgical treatment to improve both DFS and OS.

Long-term overall and relapse-free survival in a patient with metastatic non-small cell lung cancer treated with immunotherapy. A case report

Background. lung cancer is one of the most common cancers worldwide. Most cases of newly diagnosed lung cancer are associated with distant metastasis. High incidence and mortality rates as well as high rates of recurrence in patients with stage I–III non-small cell lung cancer (NSCLC), even after radical surgical treatment, determine the relevance of developing new approaches to drug therapy. The aim of the study was to demonstrate a successful clinical case showing a long-term, more than 8-year overall and relapse-free survival in a patient with metastatic NSCLC treated with an immune checkpoint inhibitor. Case presentation. An 80-year-old patient with stage IB lung adenocarcinoma underwent radical surgery in august 2014. A follow-up examination in April 2016 revealed disease progression (liver metastases and mediastinal lymph node metastases, and solitary metastasis to the chest wall on the right). Taking into account the absence of driver mutations, 102 cycles of durvalumab monotherapy were administered as a phase III multicenter open randomized trial. At a follow-up period of 96 months, no signs of disease progression and treatment-related serious adverse events were observed. Conclusion. Drug therapy of metastatic NSCLC remains challenging and should take into account the clinical, molecular, genetic, and immunohistochemical characteristics of the tumor. Further in-depth studies of new approaches and treatment options for NSCLC patients are required.

Early diagnosis of lung cancer using a sensor gas analysis complex: case report

Background. Currently, low-dose computed tomography (LDCT) is the only screening test that reduces the risk of death from lung cancer. However, there are a number of disadvantages, such as lack of widespread use, high cost, high false-positive rate and the need to conduct studies only in high-risk groups, which significantly limit mass screening. exhaled breath analysis, which uses sensitive breath sensors, is a promising method to improve early diagnosis of lung cancer. Cancer Research Institute of Tomsk National Research Medical Center together with Tomsk State University and Tomsk Polytechnic Research Institute has developed a gas analysis complex capable of analyzing the gas composition of exhaled air with remote sampling from bags. during the study, data obtained by digitizing signals from gas analysis system sensors and patient metadata are recorded in a database for subsequent automated processing and analysis using a neural network. Case description. A 48-year-old female patient with a long history of smoking came to the clinic of the Cancer Research Institute for consultation with suspected pathological infiltration around the celiac trunk detected by abdominal CT. As a clinical trial of the developed gas analytical complex for cancer detection, a sample of exhaled air was taken, and the comparison of the composition of volatile organic compounds (VOCs) with that in the control group (healthy individuals) revealed abnormalities characteristic of lung cancer. the patient underwent a chest CT scan, which revealed stage IIB peripheral cancer of the lower lobe of the left lung. the original sensor gas analysis complex, which has no analogues in Russia, was used for the first time in the detection of lung cancer. the data obtained allowed us to suspect the presence of lung tumor in the patient and perform radical surgical treatment. the composition of VOCs in exhaled air was assessed on day 10 after surgery, and no significant changes in the composition of exhaled air were observed. Conclusion. Machine learning algorithms are actively used to diagnose socially significant diseases. the platforms being developed based on arrays of chemical sensors with data analysis using a neural network are promising candidates for implementation in screening activities.

MANAGEMENT OF HEPATIC HYDATID CYST WITH CYSTOBILLIARY COMMUNICATION

Background: Hepatic hydatid cysts, caused by the larval stage of Echinococcus granulosus, are a significant health concern in regions where livestock farming and animal-human interactions are prevalent. The liver is the most commonly affected organ, and while cysts may remain asymptomatic for years, complications such as cystobilliary communication (CBC) can lead to jaundice, cholangitis, and biliary obstruction. Effective management strategies are essential to mitigate these complications and improve patient outcomes. Objective: To evaluate the management strategies for hepatic hydatid cysts with cystobilliary communication and determine the effectiveness of surgical and medical approaches. Methods: This observational study was conducted at Bolan Medical College, Quetta, from January to July 2024, involving 85 patients diagnosed with hepatic hydatid cysts and CBC. Inclusion criteria were confirmed cases of hepatic hydatid cysts with CBC, identified via ultrasound (US), computed tomography (CT), or magnetic resonance imaging (MRI). Patients with previous hydatid surgery, other liver pathologies, or age under 18 were excluded. Data collection included demographic details, clinical symptoms, comorbidities, and imaging findings. Patients were categorized into surgical and medical treatment groups. Surgical procedures included cystectomy and partial hepatectomy, while medical management comprised albendazole or mebendazole. Patients were followed for three months to assess outcomes, symptom resolution, and recurrence. Results: The study included 85 patients, with a mean age of 47.3 ± 12.6 years (range: 18–78). Males constituted 55.3%, and females 44.7%. Comorbidities were present in 35.3% of patients, including hypertension (15.3%), diabetes mellitus (10.6%), and chronic liver disease (4.7%). Jaundice (61.2%), abdominal pain (56.5%), and elevated liver enzymes (78.8%) were the most common symptoms. Cysts were predominantly located in the right lobe (88.2%), with minor CBC observed in 44.7%, moderate CBC in 38.8%, and severe CBC in 16.5% of patients. Surgical treatment was administered to 64.7% of patients, with cystectomy being the most frequent procedure (58.2%). Symptom resolution rates were significantly higher in the surgical group compared to the medical group. Recurrence rates were lower in the surgical group (3.6%) compared to the medical group (6.7%). Conclusion: Surgical management, particularly cystectomy, demonstrated superior outcomes for hepatic hydatid cysts complicated by CBC, achieving higher symptom resolution and lower recurrence rates than medical management. The degree of CBC influenced treatment outcomes, underscoring the importance of individualized management strategies.

Changes in Levels of MiR-21, MiR-27a, MiR-221, and MiR-429 in the Thymus after Photodynamic Therapy and Surgical Treatment of Breast Cancer in Female Wistar Rats.

We studied the expression levels of microRNAs (miR-21, miR-27a, miR-221, and miR-429) in the thymus of female Wistar rats after surgical treatment of breast cancer (BC) and after photodynamic therapy for BC followed by tumor resection. In the group without treatment, the levels of pro-oncogenic miR-21, miR-27a, and miR-221 in the thymus were reduced in comparison with those in the group of intact control. After surgical treatment of BC, the levels of miR-21 and miR-27a in the thymus increased in comparison with those in BC without treatment. Surgical removal of the tumor followed by photodynamic therapy led to an even greater increase in the levels of miR-21 and miR-27a in the thymus in comparison with those in the group of surgical treatment alone. Expression of the tumor-suppressive miR-429 in the thymus significantly exceeds the levels in the BC without treatment and BC+surgery groups.

Robotic cystprostatectomy in a 13-year-old child with prostate rhabdomyosarcoma

Introduction. R Rhabdomyosarcoma is the most common type of sarcoma in children, which can affect the genitourinary system. Treatment protocols for patients with rhabdomyosarcomas of the prostate and bladder differ, particularly regarding the need, extent, and timing of surgical treatment. Currently, there are two main treatment protocols for rhabdomyosarcomas of the bladder and prostate: the European (SIOP), approved by the International Society of Pediatric Urology, and the North American one, supported by the Children's Oncology Group (COG). Both protocols share the use of neoadjuvant chemotherapy after biopsy of the lesion to clarify the diagnosis. However, the North American protocol recommends further radiotherapy to prevent dysfunction of pelvic organs after surgery, while the European protocol advocates for surgical correction after chemotherapy. Moreover, there is no unified approach to selecting the surgical treatment method. Specialists use both organ-preserving and organ-sparing operations. Objective. To describe a clinical case of using robotic cystoprostatectomy as a radical treatment method for a patient with prostate rhabdomyosarcoma. Clinical case. The paper describes a clinical case of a 13-year-old boy with prostate rhabdomyosarcoma who received staged chemotherapy and radiotherapy. Since residual tumor tissue remained, the child underwent radical surgery, including robotic cystoprostatectomy with the creation of bilateral ureterostomy. Conclusion. In this case, it was decided to opt for a radical surgical treatment method — cystoprostatectomy with removal of the bilateral ureterostomy. This decision was based on the presence of residual tumor tissue according to MRI data, as well as after numerous blocks of chemotherapy and radiotherapy. This approach allowed the patient to undergo an adjuvant course of chemotherapy without the risk of postoperative complications, such as infection of the intestinal reservoir in cases where it is created simultaneously with cystoprostatectomy.

Fertility Sparing in Endometrial Cancer: Where Are We Now?

Endometrial cancer is the most common gynecological neoplasm with an increased incidence in the premenopausal population in recent decades. This raises the problem of managing endometrial cancer in fertile women who have not yet achieved pregnancy. In these women, after careful selection, hysterectomy may be postponed in favor of conservative management if specific requirements are met. The latest evidence is focused on early endometrial carcinoma, endometrioid histotype, Grading 1, with no evidence of myometrial infiltration. Few clinical trials have opened this possibility also for women with an endometrial cancer Grading 2 diagnosis. There are still questions about the best medical therapy, dosage, route, and duration of treatment. Oral progestins or levonorgestrel-releasing intrauterine devices appear to be the options associated with the best outcome in terms of complete response and lower recurrence rates. Other options include the use of GnRH analogues, surgical hysteroscopy, or metformin, in a therapeutic approach that takes into account the characteristics of the patient. The pursuit of pregnancy should start as soon as two consecutive endometrial biopsies are obtained 3 months apart from each other; it is recommended to refer the patients to ART centers to maximize the success rate. After having reached the fulfillment of the reproductive desire, surgical radical treatment is still recommended.

Enhanced Benefit of STA-MCA Bypass Surgery in Chronic Terminal Internal Carotid and/or Middle Cerebral Artery Occlusion Patients With Impaired Collateral Circulation: Introducing a Novel Assessment Approach for Collateral Compensation.

Background: Ischemic stroke is one of the major emergency diseases leading to death and disability worldwide, characterized by its acute onset and the urgent need for prompt medical intervention to reduce mortality and long-term disability. Chronic terminal internal carotid artery and/or middle cerebral artery occlusion (CTI/MCAO) is an important subtype of intracranial artery occlusive disease. The superficial temporal artery-to-MCA (STA-MCA) bypass has been proposed to improve cerebral blood flow (CBF) and cerebrovascular reserve (CVR), potentially enhancing neurological outcomes. However, its safety and efficacy in CTI/MCAO patients remain controversial. Methods: A total of 107 CTI/MCAO patients from Nanjing Brain Hospital, enrolled between July 2019 and June 2022, were divided into surgical and medical treatment groups. Cerebral perfusion and collateral formation were evaluated using pseudocontinuous arterial spin labeling (pCASL) and digital subtraction angiography (DSA). Modified Rankin scale (mRS) score and complication rates were compared between the two groups. In addition, correlations between Matsushima grades, early-arriving flow proportion (EFP), and lesion-side cerebrovascular (LCBV) scores were analyzed. Results: The surgical group showed significantly lower mRS scores than the medical group (p=0.018), with no significant differences in complication rates at the 6-month follow-up (p=0.861). CBF differed significantly among affected MCA segments (p < 0.001), particularly in the insular and opercular regions (M2-M3) (p=0.006). Matsushima grades in unilateral CTI/MCAO patients were negatively correlated with preoperative LCBV scores (γ s = -0.468, p=0.005) and EFP (γ s = -0.648, p=0.007). EFP demonstrated high accuracy in predicting LCBV scores in CTI/MCAO patients (AUC = 0.902, p=0.004). Conclusion: STA-MCA bypass surgery improved neurological outcomes in CTI/MCAO patients, particularly those with poor preoperative collateral compensation. EFP may serve as a reliable, noninvasive tool for assessing collateral circulation status in this population.

Синдром Бланда-Уайта-Гарланда: клинические особенности течения и лечения у пациентки молодого возраста

Bland-White-Garland syndrome (SBUG) is a rare, high–risk fatal outcome in infancy and sudden death in adults, an anomaly of the divergence of the left coronary artery (LCA) from the pulmonary artery (PA) (ALCAPA - abnormal left coronary artery arising from the pulmonary artery). In 85-90% of cases, children without radical surgical treatment do not live up to a year. In our clinical case, in a 36-year-old patient, the disease debuted with recurrent ventricular arrhythmias, Imaging diagnostic methods coronary angiography, spiral computed tomography, magnetic resonance imaging of the heart revealed in the patient, in addition to the pathology of the LCA, individual anatomical features of the coronary bed, which provided adequate myocardial perfusion and maintained sufficient myocardial reserve. A combined operation was performed on a patient at the "Federal Center for Cardiovascular Surgery" of Khabarovsk: prosthetics of the LCA trunk with a vascular prosthesis "Vascutek PTFE" № 6. Plastic surgery of the pulmonary trunk (PT) with a patch from the autopericardium. Mitral valve repair (MV) on the "MedInj" support ring № 28. The postoperative period was uneventful. The period of dynamic observation was 22 months. Currently, the patient is in a satisfactory condition and is able to work. Given the different clinical variants of SBUG, specialists providing primary health care - district pediatricians, internists, cardiologists - should be wary of this rare but life-threatening congenital malformation. Keywords: Bland-White-Garland syndrome, anomaly of the left coronary artery, ALCAPA.

Radical surgical treatment methods for pancreatic tumors

Annotation. Pancreatic cancer is the leading cause of cancer-related mortality worldwide, ranking seventh among other neoplastic diseases with high mortality rates. The purpose of the work is to review and analyze the effectiveness of various surgical methods of pancreatic cancer treatment. Currently, the only radical treatment method for pancreatic cancer is surgical intervention. There is a range of surgical operations for pancreatic cancer, requiring the surgeon to differentiate and appropriately apply them to each clinical case. The choice of surgical treatment strategy primarily depends on assessing the resectability of the tumor, with the goal of achieving R0 resection and conducting lymphadenectomy. This article presents the results of an analysis of literature data and the outcomes of our own surgical experience over the past 15 years. It has been determined that among all radical surgical methods for treating pancreatic tumor lesions, segmental resections lead to significantly better overall patient condition with a lower percentage of complications and early mortality. Additionally, segmental resections allow for tumor removal while preserving the maximum volume of healthy parenchyma and maintaining normal anatomical and physiological conditions of the gastrointestinal tract. This substantially reduces the risk of pancreatic endocrine insufficiency, while maintaining a high quality of life and work capacity for patients. The main goal of treating pancreatic cancer is to improve and optimize radical surgical treatment methods while adhering to all oncological principles, reducing complication and mortality rates, and improving the rehabilitation period and overall patient condition.

FIRST EXPERIENCE WITH VATS BRONCHOPLASTIC LOBECTOMY

Relevance: Surgical treatment for lung cancer is the primary radical approach in antitumor therapy, utilized as a standalone method and as part of a combined strategy. Radical surgical intervention typically involves anatomical lung resection accompanied by lymph node dissection. Modern oncological surgery increasingly emphasizes organ- and function-preserving procedures that maintain oncological efficacy. Video-assisted thoracoscopic surgery (VATS) presents an alternative to traditional open methods, although it is technically more challenging and generally more expensive. Nonetheless, its advantages – such as reduced postoperative pain, shorter duration of pleural drainage, better preservation of lung function, decreased length of hospital stay, and quicker return to normal activities—continue to motivate the surgical community to adopt minimally invasive techniques. This report highlights the first observation of a VATS lobectomy with bronchoplasty. The study aimed to demonstrate the feasibility of minimally invasive bronchoplastic lobectomy as an alternative to pneumonectomy and traditional thoracotomy lobectomy with bronchoplasty. Methods: This paper details a case of video-assisted thoracoscopic surgery performed on a patient with non-small cell lung cancer (NSCLC), along with the technical specifics of the surgical procedure. Results: The article presents short-term outcomes of the VATS bronchoplastic lobectomy, showcasing the effectiveness of this surgical approach. Conclusion: For the first time in Kazakhstan, we successfully performed a thoracoscopic bronchoplastic lobectomy. Based on our experience and insights from international colleagues, we believe this intervention is safe and effective for patients with centrally located lung tumors.

The experience of using chemoradiotherapy for esophageal cancer with the FOLFOX chemotherapy regimen

Introduction. For an extended period, numerous studies have been conducted to find the optimal treatment regimen for esophageal cancer. Chemoradiotherapy has demonstrated satisfactory results in the treatment of localized and locally advanced forms of this disease. However, the search for the best chemotherapy regimen in combination with radiotherapy remains a current focus of many researchers.Aim. To evaluate the effectiveness and safety of chemoradiotherapy (CRT) using the FOLFOX regimen in patients with esophageal cancer.Materials and methods. A prospective study was conducted at the Ulyanovsk Regional Clinical Oncology Dispensary. The analysis included patients who received chemoradiotherapy with the FOLFOX regimen from December 1, 2022, to March 1, 2024. A total of 19 cases of esophageal cancer treatment at stages I–III were analyzed. Radical surgical treatment was subsequently performed on 5 patients (26.3%). The characteristics of the studied patients were evaluated according to a standardized protocol.Results. In the study group, 18 patients (94.7%) completed the planned course of treatment. One patient received an incomplete course of radiotherapy but completed the entire planned chemotherapy. The most common hematologic complication was leukopenia, observed in 9 patients (47.3%) after the full course of chemoradiotherapy. No cases of febrile neutropenia were reported. The hematologic complications were manageable and did not lead to the discontinuation of treatment. Among non-hematologic complications, the most frequently reported were grade 1–2 nausea in 11 patients (58%) and grade 1–2 vomiting in only 2 cases (10%), which was effectively controlled with antiemetic therapy. Overall and relapse-free survival were assessed. The reason for discontinuing radiotherapy in 1 patient (5.3%) was ulcerative stomatitis. Surgery was performed on 5 patients, with tumor regression (TRG) grades 1–2 according to the Mandard scale observed in 4 of them (80%). One patient (20%) had a TRG 3 response.Conclusions. After chemoradiotherapy with the FOLFOX regime in patients with squamous cell carcinoma of the esophagus, the rate of therapeutic tumor regression (TRG1–2) in operated patients reached 80%. One-year relapse-free survival was 58%, one-year overall survival was 73%, indicating the effectiveness and safety of this chemotherapy regimen as part of the comprehensive treatment of esophageal cancer.

Reliability of non-invasive imaging methods in the evaluation of pancreatic parenchyma changes in tumors of the pancreaticoduodenal zone

Background. Pancreatoduodenectomy is a radical surgical intervention in case of neoplasms of the pancreatoduodenal zone. Assessment of changes in the pancreatic parenchyma at the preoperative stage will allow appropriate therapeutic and preventive measures to be taken to reduce the frequency of pancreatic fistula. The purpose of the study: to determine the diagnostic significance of non-invasive imaging methods in the assessment of fibrous changes in the pancreatic parenchyma of patients with neoplasms of the pancreatoduodenal zone. Materials and methods. The study included 82 patients who underwent pancreatoduodenectomy for neoplasms of the pancreatoduodenal zone. The age of the patients varied from 34 to 77 years, there were 42 (50.9 %) men and 40 (49.1 %) wo­men. At the preoperative stage, all patients underwent non-invasive imaging using multidetector computed tomography and ultrasound shear wave elastography (SWE). In the postoperative period, histological studies of pancreatic biopsies taken in the isthmus region were performed. Morphological studies were carried out on a Primo Star microscope (Carl Zeiss) using the AxioCam program (ERc 5s). Ki-67, a marker of proliferative activity, was used to conduct immunohistochemical study. The reaction of alpha-smooth muscle actin (α-SMA) was evaluated by a semiquantitative method depen­ding on the intensity of staining. Primary monoclonal antibodies from Dako (Denmark) and Thermo Scientific were used. Results. According to the applied morphological Ammann’s fibrosis score, mild fibrosis was diagnosed in 23 (28.1 %) patients, moderate — in 22 (26.8 %) patients, severe — in 37 (45.1 %). Immunohistochemical study found that without fibrosis and with mild fibrosis, the average Ki-67 was (6.4 ± 2.3), while in moderate fibrosis, it was (16.1 ± 2.5) (p &lt; 0.05 compared to mild fibrosis), with severe fibrosis, the average Ki-67 indicator was (18.3 ± 2.4) (р &lt; 0.05 compared to mild fibrosis). According to the results of the correlation analysis, a strong positive relationship was found between the expression of α-SMA and stromal Ki-67 (r = 0.75, p &lt; 0.001). In patients with mild pancreatic fibrosis in the postoperative period, the native density of the pancreatic parenchyma at the preoperative stage was 1.5 times (p &lt; 0.001) lower than in the group with moderate fibrosis and 1.9 times (p &lt; 0.001) lower compared to patients with pronounced pancreatic fibrosis. According to SWE, the Young’s modulus, which characterizes the stiffness of the pancreatic parenchyma, was highest in severe fibrosis, (8.55 ± 1.75) kPa, which was 2.2 times (p &lt; 0.001) higher than in mild fibrosis and 1.3 times (р &lt; 0.01) higher than in moderate pancreatic fibrosis. According to the results of the correlation analysis, a direct strong relationship was found between the Young’s modulus and the level of stromal Ki-67, α-SMA and the Ammann’s fibrosis score, as well as medium positive correlations of the native pancreatic density with morphological indicators. Conclusions. Non-invasive diagnostic parameters such as parenchymal stiffness according to SWE (sensitivity 90.9 %, specificity 81.2 %) and native density according to computed tomography (sensitivity 69.7 %, specificity 87.5 %) can be used as diagnostic criteria for assessing pancreatic fibrosis in patients with neoplasms of the pancreaticoduodenal zone in the preoperative period.

The role of cetuximab in treatment of squamous cell carcinoma of the head and neck

Squamous cell carcinoma of the head and neck (SCCHN) is one of the causes of cancer mortality. The mortality rate of patients within a year from the moment of diagnosis reaches 27% in patients with tumors of the oral cavity and 35.2% in patients with tumors of the pharynx. Despite the visual localization of SCCHN more than 50% of patients at the time of diagnosis are not subject to radical surgical treatment. More than half of the patients develop relapses of SCCHN within 3 years after the end of radical treatment. Most patients with SCCHN receive antitumor drug therapy either when an unresectable/metastatic tumor is detected or when a relapse develops after previously performed radical treatment. Epidermal growth factor receptor (EGFR) is expressed in almost 100% SCCHN and its expression is generally associated with decreased overall survival and progression-free survival. EGFR is a target receptor for targeted drugs. Cetuximab is a monoclonal antibody that blocks EGFR. The review examines the role of cetuximab in the treatment of recurrent and/or metastatic SCCHN in combination with chemotherapy and radiation therapy. The main undesirable phenomenon of cetuximab is dermatological toxicity: acne-like rash, dry skin, paronychia. Preventive therapy, including the antibiotic doxycycline, avoids the development of dermatological toxicity of 2–3 degrees. One of the most important biological processes involved in the progression of SCCHN is tumor escape from immune response associated with the expression of programmed death receptor 1 (PD-1), which inhibits the anti-tu mor immune response. Immunotherapy with checkpoint inhibitors pembrolizumab and nivolumab has shown a significant improvement in the survival of patients with progressing SCCHN after previously performed chemotherapy with the inclusion of cisplatin. Pembrolizumab in combination with cytostatics is an effective first-line therapy regimen for SCCHN in the presence of PD-L1 expression (CPS ≥ 1). In approximately 10–20% of patients, effective therapy changes due to poor tolerability. Timely prevention and relief of adverse events, control of disease manifestations, and a multidisciplinary approach to the patient make it possible to achieve optimal treatment results.

FEATURES OF LATE CORONARY ARTERY REVASCULARIZATION IN PATIENTS WITH ACUTE MYOCARDIAL INFARCTION

Objective. To compare the results of surgical and conservative treatment of patients with acute myocardial infarction admitted to a medical institution 48 hours after the occurrence of a coronary event.Materials and methods. The analysis of surgical treatment and postoperative observation of 43 patients with acute coronary syndrome admitted to hospital treatment within 72 to 120 hours from the onset of acute myocardial infarction was performed. All patients were divided into 2 groups: Group 1 (n = 17) included patients who underwent PCI for vital indications due to the presence of one or more emergency conditions in patients. Group 2 (n = 26) included patients who were hospitalized in a stable condition: they had no pain syndrome, life-threatening cardiac arrhythmias; hemodynamic parameters were within normal limits. The patients underwent complex conservative therapy, PCI was recommended on a delayed basis.Results. Two months after the treatment, higher myocardial functioning indices, and, as a result, better quality of life, were recorded in patients in the surgical treatment group. A greater number of fatal complications were recorded in patients after myocardial revascularization (which is explained, in all likelihood, by the extensive area and depth of damage to the heart muscle), and the number of non-fatal complications prevails in the conservative treatment group.

Management of Post-Operative Wound Dehiscence Following Tendoachilles Reconstruction

Background: Post-operative wound dehiscence is a significant complication following tendoachilles reconstruction, which can lead to infection, delayed healing, and compromised tendon recovery. The unique anatomical and physiological characteristics of the Achilles tendon area contribute to the susceptibility of surgical wounds to dehiscence. Objective: This study aims to evaluate the outcomes related to wound dehiscence management in patients undergoing tendoachilles reconstruction, focusing on the effectiveness of various treatment and rehabilitation protocols. Method: A retrospective cohort analysis was conducted involving 300 patients who underwent tendoachilles reconstruction, categorized into surgical, early weight-bearing, and immobilization treatment groups. Data on demographic variables, rerupture rates, complication rates, and follow-up duration were collected and analyzed using random effects rate ratios to assess treatment efficacy. Results: The findings revealed a male predominance in all groups, with the minimally invasive group showing a rerupture rate of 3%, the open standard group at 2%, and the nonoperative group at 9%. Both surgical groups had a complication rate of 4%, while the nonoperative group had no complications. Early weight-bearing strategies demonstrated shorter time to weight-bearing but were associated with a slight increase in complications. Conclusion: Surgical interventions for tendoachilles reconstruction are associated with lower rerupture and complication rates compared to nonoperative treatments. Effective management of wound dehiscence requires a multifaceted approach that includes vigilant monitoring, appropriate wound care, and individualized rehabilitation strategies to optimize patient outcomes and enhance recovery.

Pathophysiology, diagnostics and treatment of slow-transit constipation: a review

Introduction. The work is a review article that examines the pathophysiology, diagnostics and treatment options for slow-transit constipation.Aim. The main goal of this study is to define slow-transit constipation, describe the primary pathophysiological mechanisms involved in its development, identify key aspects of diagnosing the condition, and thoroughly examine the existing treatment methods and their clinical efficacy.Methods. A systematic search of the literature in electronic databases PubMed, EMBASE and Cochrane covering the past 20 years was conducted. Studies on clinical outcomes and pathophysiological mechanisms of slow-transit constipation were included in this review prepared in accordance with PRISMA guidelines.Results. It has been established that, despite the widespread use of conservative therapy for idiopathic chronic constipation, its effectiveness in treating slow-transit constipation is low. Conversely, surgical treatment shows high effectiveness in improving symptoms and quality of life. This brings up the question about making surgical approach the method of preference in treating slow-transit constipation. Yet, aspects related to the frequency of postoperative complications and the selection of the most appropriate surgical approach remain underexplored, leaving the question of the preferred option open for further investigation.Conclusion. Despite the limited efficacy of conservative therapy for slow-transit constipation, radical surgical treatment shows significant improvement in symptoms and quality of life, requiring further studies to optimise treatment approaches and investigate postoperative complications.