BACKGROUND/OBJECTIVE. Hand-assisted laparoscopic surgery (HALS) has been introduced into clinical practice almost three decades ago, very soon after the introduction of conventional laparoscopic surgery. It combines the advantages of both laparoscopic (minimally invasive) and open surgery. Despite a good piece of data in the medical literature, the clear place of this kind of laparoscopic surgery today is not easy to delineate. Our study aimed to review single centre experience in treating patients with left colon and rectal cancers using HALS. METHODS. This study was a retrospective analysis of prospectively collected data of 459 patients undergoing hand assisted laparoscopic colorectal surgery for left colon and rectal cancer, in a single tertiary care institution, National Cancer Institute, from January 1, 2006, to December 31, 2016. All consented patient with confirmed invasive cancer of left colon and rectum undergoing HALS were included in the analysis. RESULTS. The patients’ mean age was 64.14±9.75 years. Female and male ratio was similar: 232 (50,5 %) versus 227 (49,5 %). The mean length of postoperative hospital stay was 6.7 (from 2 to 34) days. There were 5 (1,1 %) conversions to open surgery. Histological examination revealed mean lymph node harvest to be 15 ± 12, ranging from 8 to 90. Stage I, II and III cancer was similar in distribution accounting for 133 (28,9%), 139 (30,3 %), 151 (32,9 %) patients respectively and 36 (7,8 %)patients with stage IV. 244 (53,2) of patients underwent surgery for the cancer of the left colon (sigmoid colectomy or left hemicolectomy), and 215 (46,8 %) patients underwent surgery for rectal cancer. Postoperative complications occurred in 28 (6.1 %) patients, eight of them (1,7 %) needed reintervention (laparotomy) because of anastomotic insufficiency and intraabdominal abscesses. Two (0,4 %) patients died during 30 day postoperative period. CONCLUSION. In our experience, HALS was very reliable andfeasible minimally invasive surgical technique for the cancers of left colon and rectum, related with short learning curve and excellent oncological clearance, short operating time and low number of postoperative complications. It may be used as a standard approachfor this type of pathology, or as a safe bridge from open to conventional laparoscopic surgery.

INTRODUCTION. The spread of microorganisms of the genus Clostridium in the population is 15 %. This phenomenon has not been studied in coloproctology department in Russia. AIM. To estimate the spread of toxin - producing strains of Clostridium spp. among the medical staff in coloproctology department. MATERIALS AND METHODS. There were analysed 39 of intraluminal faeces. The material was examined for the presence of glutamate dehydrogenase, toxins A and B of C.difficile using the immunochromatographic method. To detect microorganisms a matrix-activated laser desorption ionization time-of-flight mass spectrometry technique was used. RESULTS. Positive tests for toxins A and B of C.difficile were in 28 (71,8 %) of 39 samples. We have identified the culture of the genus Clostridium in 24 (61,5 %) of the 39 samples of intraluminal faeces. 17 (70,8 %) of these samples had positive tests for C.difficile toxins and 7 (29,2 %) was negative. In addition to C. difficile (3) others Clostridium were identified: C.perfringens (17), C.bifermentas (4), C.tertium (3), C.disporicum (2), C.sordellii (2). CONCLUSION. C.difficile was identified in 3 (7,7 %) cases. The spread of Clostridium microorganisms in medical stuff is almost 5 times higher than the average in the population. Professional activity is a risk factor for the spread of toxic strains of the genus Clostridium.

Comparative analysis of laparoscopic reversal procedure after Hartamn's operations on the left half of the colon from 46 patients completed by the single surgeon for 3 year period. The study confirmed that growing number of procedures allowed to expand indications for laparoscopic approach for restoring the continuity of the large intestine. It also decrease the time of intervention, reduces dimensions of operating wounds, blood loss and rate of intra-abdominal complications.

AIM. To evaluate the effectiveness and diagnostic value of FIT «Colon View Hb and Hb/Hp» («Colon View»). MATERIALS AND METHODS. The study included 588 patients who underwent FIT «Golon View Hb and Hb/Hp» («Golon View»). RESULTS. When performing a three-time «Colon View» the diagnostic accuracy of the procedure increased for both -for hemoglobin (sensitivity -92,86 specificity - 73,17) and for hemoglobin-haptoglobin complex (sensitivity - 88,1 specificity - 63,41), p<0,05. However, only 39,4 % of patients with a positive «Colon View» test agreed to undergo a colonoscopy. CONCLUSION. Three-fold execution of the FIT «Colon View» increases the diagnostic accuracy of the method, as for Hb andfor Hb/Hp. However, the effectiveness of the test using hemoglobin is higher. Joint use of two indicators (Hb and Hb/Hp) further improves the precision of this model for screening large adenomas and CRC.

AIM. To сотраге short-term outcomes of extralevator abdominoperineal excision (ELAPE) of the rectum with laparoscopic and open abdominаl approach and a conventional abdominoperineal excision (APE). METHODS. А total of 90 patents who underwent APE for low rectal cancer were screened between 2013 and 2015. Patients of the first group (group I, n=42) underwent ELAPE: subgroup 1а (n=18) -with laparoscopic abdominаl approach, 1b (n=24) - llaparotomy; patients of the second group (group 2,n=48) - conventional APE. RESULTS. The operation time for the group 1 was 250,2± 73,8 min vs 155,9 ± 28,4 min for the group 2 (p<0,001). There were significant differences betweensubgroup 1a and subgroup 1b and group 2 in terms of blood loss (193,4± 97,6 ml vs 307,1 ± 58,4 and 322,3 ± 175,4 ml). The postoperative complications rate was lower in the group 1 compared with the group 2 (7,1 % vs 22,9 %, p=0.03).Compared with APE with open abdominаl approach (subgroup Ib and group II), laparoscopic ELAPE patients demonstrated less need in postoperative analgesia and shorter postoperative recovery period.. The rates of inadvertent intra operative bowel perforation in the group I was significantly lower than it was in the group II (2,4 vs 16,7%, p=0,024).The circumferential resection margin involvement rate was lower in the ELAPE group compared with the conventional APE group (4,8 % vs 22,9 %, p=0,015). CONCLUSION: The ELAPE for rectal cancer patients is safe, and is associated with lower postoperative complications rate, circumferential resection margin involvement rate, and intraoperative bowel perforation rate compared with the conventional APE group. Laparoscopic ELAPE has advantages in operative blood loss, duration postoperative analgesia and postoperative recovery over ELAPE and conventional APE with open abdominаl approach.

AIM. The problem of treatment of postoperative wounds of the anal canal and perineum does not lose its relevance to the present time. Operated surgeons are concerned about finding new drugs for conservative treatment of postoperative perineal wounds. In the State Scientific Center of Coloproctology, from December 2015 to January 2017, a study was conducted to evaluate the effectiveness of the Gem drug for the treatment of postoperative crotch injuries and anal canal. METHODS. The study included 82 patients diagnosed with a chronic anal fissure, hemorrhoids, fistulas of the rectum. The main group (1) consisted of 40 patients who were treated with Gem, control (2) - 42 patients treated with water-soluble ointments for topical application. The evaluation methods included clinical examination, profilometry, cytological examination of print smears, quality of life of patients on the QoL SF-36 scale before surgery, at discharge and on the 28th day after surgery. In each group, patents were included, homogeneous in terms of key indicators. RESULTS. The quality of life and the intensity of the pain syndrome in the early postoperative period did not have statistically significant deviations in the patients of the main and control groups. Clinical evaluation of the course of the wound process with the use of the Gem drug showed that the duration of hyperthermia already decreases on the second day of the postoperative period from 35.7 % in the control patients to 10 % in the patients of the main group (p<0,05). In the patients of the main group, in a cytological study, a significant decrease in the inflammatory wound reaction was revealed from 59.5 % to 10 % as early as the 15th day after surgery (p<0.001). Compared with patients of the control group, statistically significant clinical acceleration of wound surface healing was observed on the 15th and 28th days after the operation (by 34 % and 40 %, respectively) against the background of administration of the Hem preparation (p<0,05). Hem demonstrated itself as a safe drug - no side effects or allergic reactions were observed in any observation against its background. In patients of the main group on day 28 after the operation, a significant improvement in the quality of life as a physical from 36.7 ± 0.56 to 44.9 ± 0.42 and a mental state from 35,6 ± 0,5 to 44,8 ± 0,37, (p<0,001).

BACKGROUND. The choice type of surgery between staged and simultaneous operations remains an actual issue in patients with colorectal cancer with synchronous liver metastases. The aim of this prospective study is to compare Short-term outcomes of patients with synchronous colorectal liver metastases treated by simultaneous or staged surgery. METHODS. 172 suitable patients were treated in State Scientific Centre of coloproctology named after А.N. Ryzhih, Moscow, Russia between January 2013 and February 2017. Simultaneous colorectal and hepatic resections were performed in 128 patients; 44 patients underwent delayed hepatectomy. Short-term outcomes were compared in patients who underwent simultaneous colorectal and hepatic resection and staged surgery depending on the demographic, clinical and morphological characteristics and type of operations. RESULTS. Median size and number of metastases in the liver were significantly smaller in the group of simultaneous operations: 2.2 cm vs 3.2 cm (p=0.034) and 2 vs 3.5 (p=0.0001), respectively. Major liver resections were rarely performed in group of simultaneous operations: 20 % vs 61 % (р=0,0001). Mortality and complications rates were similar in both groups: 1 % vs 2% (p=0,98) and 30% vs 45 % (р=0,08), respectively. Median days after surgery were also similar in both groups: 14 (12-21) vs 14 (12-21) days, (р=0,6), respectively. Median bloodloss in cases of major liver resections in group of simultaneous operations was lower than in analogical group in staged surgery: 345 ml vs 900 ml (р=0,007), respectively. There was no difference in mortality and complications rates between major liver resections in both groups: 0 vs 4 % (p=0,98) and 52 % vs 48 % (p=1,0), respectively. Rates of acute hepatic insufficiency were similar in both groups of major liver surgery: 4 % vs 11 %, (p=0,36). Median inpatient days were also similar in both groups of major liver surgery: 19 (15-27) vs 19 (11-27) days (р=0,1), respectively. CONCLUSION. Simultaneous operations, requiring economical resections are indicated in cases of synchronous metastases of colorectal cancer in the liver. Simultaneous major liver surgery do not lead to increased bloodloss, complications, mortality rates and inpatient days regardless on type of colorectal surgery in cases of synchronous colorectal cancer liver metastases.

AIM. to evaluate results of anterior (AR) and low anterior resection (LAR) for rectal carcinoma with stapler anastomosis. MATERIALS AND METHODS. 114 patients aged from 33 to 84 years were included into study. Of them 60 patients had low anterior rectal resection. RESULTS. Anastomotic leakage developed in 7 (6,1 %) cases (5 (8,3 %) 5 after LAR and 2 (3,7 %) after AR) between POD 3 and 7 days (р<0,05). CONCLUSION. Mechanical preparation of the colon, precise techniques of mobilization of the rectum and mesorectum, prevention of tension on suture line, compliance with the application techniques of mechanical anastomosis, control of its integrity, considering of risk factors allow to produce a secure suture and are important in prevention of anastomosis leakage.

AIM. To establish cut-off point of strain ratio for rectal adenocarciomas. PATIENTS AND METHODS. Forty-five patients (29 female) at mean age ± SD of 61 ± 9.5 (range, 38-80) years with histologically confirmed rectal neoplasia were included into study. Endorectal Ultrasonography accomplished by strain elastography was performed by Hitachi Hi Vision Preirus (Japan). All patients were treated by Transanal Endoscopic Microsurgery. RESULTS. Pathologic examination of operative specimen revealed 31 adenomas (5 intraepithelial carcinomas) and 14 invasive carcinomas. Cut-off point of Strain Ratio was 5,7 with sensitivity of 0.94 (95 °%CI 0,68-0,99), specificity of 0.92 (95 %oCI 0,74-0,98), positive predictive value of 0,90 (95 % CI 0,84-0,96) and negative predictive value of 0,96 (95 %CI 0,85-0,99). CONCLUSION. Obtained results testified high diagnostic value of strain elastography and made one perspective method for detection of occult malignancy in large rectal adenomas.

AIM. To assess results of cytoreductive surgery (CRS) and intraperitoneal intraoperative chemotherapy (IIC) in patients with peritoneal carcinomatosis (PC) and PC recurrence (PCR) of colorectal origin. METHOD. 76 patients with PC were treated by cytoreductive surgery (CRS) and intraperitoneal chemotherapy with mitomycine C (20 mg/m²). In 57 (75 %) pts. carcinomatosis was synchronous. The median PCI - 3 (2; 6) (1-23). There were 15/76 (20 %) pts. with potentially resectable distant liver and lung metastases. RESULTS. Complications occurred in 15 (20 %) pts. Mortality rate was 1,3 %. The first PCR was developed in 34 (45 %) pts. The median time after first surgery -11 (9; 19) months. 19 (56 %) were underwent CRS with IIS and CC0 status was achieved in 18 cases. The second PCR registered in 8 (18) pts. after last CC0-resection Median time was 12 (6; 29) (2-37) months. In 6 (8) pts. CC0-operation was performed. The median disease-free survival (DFS) and overall survival (OS) was 20 and 36 months, respectively. The 1-, 3-, 5-year OS and DFS rate was 64 %, 31 %, n/d and 86 %, 48 %, 24 %, respectively. The median OS of patients operated for PCR was statistically significantly greater than nonoperativepatients with PCR - 37 and 26 months, respectively (p=0,029). CONCLUSION. Combined treatment approach for patients with PC from colorectal origin achieved low postoperative morbidity and mortality, and it provided good long-term survival in our experience.CRS with IIS in PCR is feasible in selected patients and improve survival rates.

Anastomotic leakage (AL) following surgical interventions associated with total mesorectal excision (TME) and formation of fistula is the most common and dangerous complication of this kind of intervention, its incidence is 17 %. OBJECTIVE. Determine diagnostic value of Neutrophil-to-Lymphocyte Rato (NLR) in the diagnosis of low colorectal anastomosis leakage after low anterior resection (LAR). Patients and methods: 100 patients with epithelial tumors of rectum in the period 2013-2016 yy underwent surgery - LAR with colorectal anastomosis and preventive stoma. In patients without clinical symptomsrent genological study was performed in order to identify asymptomatic AL on day 7 after the surgery. An incidence of AL, difference in the levels of NLR in patients with AL and consistent anastomosis, we also assessed sensitivity, specificity, positive (PPV) and negative predictive value (NPV) of these markers. RESULTS. AL was diagnosed in 20 % (20/100): in 11 % (11/100) with clinical manifestations, in 9 % (9/100) - without them (contrast leakage according to X-ray examination). In the group of patients with anastomotic leakage, the median of NLR differed from that in patients without compromised integrity of anastomosis at both postoperative day 3 (7,1 vs 5,7, respectively, ((t-test) p=0,042) and postoperative day 6 (6,8 vs 4.4, respectively, ((t-test) p=0,004). Conclusion: an incidence of anastomotic leakage was 20 %, but only 11 % of the patients had clinical manifestations. Changes in the level of NLR in the postoperative period correlated with the fact of AL.