AIM: to test a method of free intraperitoneal colorectal cancer (CRC) cells isolation for the immunophenotyping and evaluation of mitomycin C hypertermic intraabdominal chemotherapy (HICT) PATIENTS AND METHODS: twenty-seven patients with CRC were included in the study.Peritoneal lavage prior and after HICT was performed for 10 of them. We defibrinated lavage fluid and stained concentrated tumour cells with monoclonal antibodies CD133 Vio Bright - FITC, CD24 PE, CD26 ECD, CD184 PC5 and CD44 PC7. FACS analysis was done after staining. RESULTS: patients with colon cancers had the increased expression of CD133 (p<0.001) and CD184 (p<0.05). Mesenteric lymph nodes involvement was followed by an increase of CD26 expression (p<0.05) in CD133+ cancer cells. The ratio of CD44/CD26 expression was increased in patients with peritoneal carcinomatosis (p<0.05). HICT lowers CD24 expression on CD133+ cancer stem cells. CONCLUSION: the method proposed for free peritoneal CRC cells identification and phenotyping can be used in clinical practice, particularly for evaluating the HICT efficacy. Suppressive effect of HICT on cancer stem cells is detected.

AIM: to assess objective criteria for the prolapsed of internal hemorrhoids piles and to define the degree ofexternal hemorrhoids enlargement in comparison with the Goligher classification. PATIENTS AND METHODS: the clinical and anatomical status of patients with various forms of hemorrhoids was evaluated within the multicenter observation program «REVISION». The study is based on the analysis of clinical and instrumental examination of 1020 patients with stages I-IV of hemorrhoids aged 44.1+12.7 (18-81) years. The study included 506 (49.6%) females. RESULTS: the data obtained show an irregular increase of internal and external piles, which can be expressed in digital form. In patients with stage I-II, the presence of external pileswas detected in 64.7% and 55.7% and in stage III-IV was revealed in 77.7% and 93.5%. Compliance with Goligher classification and the degree of piles enlargementin patients with stages I and II was notedin 225 (84.6%) and 236 (72.2%) cases (p<0.001). In patients with stages III and IV this compliance was detected only in 211 (66.1%) and 58 (53.7%) cases (p<0.001). CONCLUSION: the study showed that the Goligher classification is an inadequate tool for assessing the surgical status of hemorrhoids and evaluating surgical outcomes. The degree of prolapse can be classified according to the size of the internal hemorrhoid piles relative to the sector of the circumference of the anal canal and to the displacement of the pilein relationshipwith the "dentate line". The size of the external hemorrhoid piles is determined similarly in accordance with the perianal region.

BACKGROUND: nowadays laparoscopic liver resection (LapLR) in contrast to traditional open approach is more preferable because of reduction of intraoperative blood loss and postop morbidity, decrease of postop hospital stay. Unfortunately, the place of LapLR in surgery for colorectal liver metastases is still controversial because of small number of comparative studies. PATIENTS AND METHODS: between November 2017 and December 2018 fifty two patients with resectable colorectal liver metastases were included in our pilot study - 35 in the prospective group for laparoscopic liver resection and 17 patients in retrospective group of open-approach liver resections (selected group of historical control) (OLR). RESULTS: one patient was excluded from LapLR group because of absence of intraoperative evidence for metastatic disease (in spite of preop MRI). Two patients had lap-to-open conversion (in one case because of technical difficulties due to the location of the permanent ileostomy in the right mesogastric region; in the other case due to intraoperative bleeding). These patients were included into open group. Atypical liver resections were the most often procedures in both groups - 79% (23/32) and 76% (13/19), p=0.3 (LapLR and OLR, respectively). Duration of the procedure was shorter in the OLR group: 218+71 min vs. 237+101min in LapLR, p=0.6. The mediana for blood loss in LapLR was 100 ml (quartile 100; 200) vs. 320 ml (quartile 200;600) in OLR, p=0.0001. The rate of R0 resections was comparable in both groups (p=1.0). The patients of OLR group more often had >1 complication (16 vs. 13, p=0.01) and had higher frequency of bile fistulas, abscesses in the liver resection area and clostridial colitis. Postoperative hospital stay was shorter in the LapLR group: 11+3 vs. 14+5 days, p=0.008. CONCLUSION: laparoscopic liver resections for metastases of colorectal cancer were associated with less intraoperative blood loss, morbidity, and shorter postoperative hospital stay, with comparable rate of R0 resections.

AIM: to standardize surgical care for the malignant colonic obstruction. PATIENTS AND METHODS: the retrospective cohort study included 797 patients with complicated colorectal cancer. Malignant colonic obstruction was diagnosed in 572 patients: 247 of them were treated in 2011-2013 (I group); 325 - in 2014-2017 (II). Urgent bowel resection was performed more often in I group (one-stage treatment), fecal diversion or stent- in II (two-stage treatment). Seventy-seven patients with tumor bleeding were included as well: 62 of them were treated conservatively or underwent endoscopic coagulation or arterial embolization (III group); 15 patients - underwent urgent bowel resection (IV). All of 148 patients with bowel perforation were underwent urgent surgery: resection was performed in 115 patients (V), suturing the perforation site-in 15 (VI), extraperitoneal drainage of the abscess - in18 (VII). Elective bowel resection was performed in 241 patients (186 - from I-II group, 40 - from III, 15 - from VI-VII) after 0.1-6 months. The comparative analysis of the early and late results of one- and two-stage treatment was carried out with assessment of the 3-year cumulative survival. RESULTS: postoperative mortality was significantly lower in elective resection groups compared with urgent resection groups: 3.6% vs 29.2% (II vs I); 5.0% vs 20.0% (III vs IV); 0.0% vs 35,7% (VI-VII vs V). The survival rate was higher in elective resection groups than in urgent ones: 0.809 vs 0.680 (II vs I), 0.8882vs 0.3571 (III vs IV), 0.8615 vs 0.4257 (VI-VII vs V). CONCLUSION: multi-stage approach for complicated colorectal cancer is more effective than one-stage.

AIM: to evaluate the efficacy of preoperative oral antibiotics in reduction of surgical site infection (SSI) in rectal surgery. METHODS: patients undergoing rectal resection were assigned randomly to 2 groups: control (standard preoperative care and intravenous injection of 3d generation cephalosporin) and oral antibiotics group (the above was complemented by three-knit oral metronidazole 500 mg and erythromycin 500 mg after beginning of mechanical bowel cleansing at 5.00, 8.00 and 10.00 p.m.). The primary endpoint was the overall rate of SSI. RESULTS: between November 2017 and October 2018, 104 patients (48 in the oral antibiotics group and 56 in control group) were enrolled for this study. The incidence of SSIs was 19.6% (11/56) in control group and 4.1% (2/48) in the oral antibiotics group(р=0.01). Both groups had no statistically significant differences in intensity of SSIs and rate of anastomotic leakage. CONCLUSION: preoperative oral antibiotic significantly reduced the risk of SSIs following rectal surgery. The study needs to be continued for evaluation of preoperative oral antibiotics impact to intensity of SSIs and rate of anastomotic leakage.

AIM: to assess the effect of age comorbidity on the early and late results of urgent surgery in patients with complicated colorectal cancer. PATIENTS AND METHODS: the study included 1098 patients, which underwent urgent surgery in Smolenskhospitals in 2001-2013 for complicated colorectal cancer. They were divided into 2 groups depending on age: the first group - aged <70 years, the second - aged >70 years. RESULTS: the average age in the first group was 58.2 (18-70) years and 75.8(70-93) years in the second group. Complications IIIb-V by Clavien-Dindo scale were significaтntly higher in the 2ndgroup (p<0.0001). R0 resections were performed in 86.6% in first group and 79.4% - in second one (p<0.0001). The 5-year overall survival was significantly better for the first group (34.5% vs 15.2%, p = 0.00001). Disease-free survival had no difference between groups 1 and 2 in specialized hospitals (31.8% vs 29.1%, p=0.07). CONCLUSION: R0 resections in specialized hospitals for older patients with complicated colorectal cancer provide better survival

The review presents data from various Western and Russian papers, which assess QoL of patients with ulcerative colitis, who underwent a proctocolectomy with a terminal ileostomy or with ileal pouch. Both procedures have advantages and disadvantages. The QoL assessment was performed using different validated and not validated scales. Study results show that QoL of patients with ileal pouch and end ileostomy are relatively similar. Improvement of QoL after surgery mostly depends of disease elimination by proctocolectomy but by the restoration of anal defecation. However, meta-analysis is complicated due to the inability to comply with methodological requirements and use of different QoL scales. There is a need to continue research in this field.

Pouchitis is a most frequent complication in patients with ileal pouch, it occurs at least 50% of them once in a lifetime. However, pouchitis can be treated fast and effectively. Twenty per cent of patients with chronic pouchitis have unfavourable prognosis because of antibiotic resistance and antibiotic dependence. It is hard to choose an effective treatment in this group of patients, which should include induction and maintenance therapy. Ineffective conservative treatment indicates a necessity of detection of secondary causes of pouchitis. Currently, there is not enough experience and less understanding of the causes of pochitis to decrease its incidence. Further studies are needed.

Hot polypectomy is a standard technique for removal of colon polyps. However, this technique is associated with a risk of complications: bleeding, perforation and postcoagulation syndrome. Therefore, it could be interesting to pay attention to using "cold" polypectomy for which means removal without electrothermal lesion. This technique deserves more attention due to simple use, less complications and good results for polyps <1 cm. There are some unclear issues, such as technical and methodological improvement of cold loop polypectomy, determination of the optimal construction of the snare and need for preliminary submucosal injection. No data on long-term results are obtained, because randomized studies are based on the removal of polyps >1 cm. Further studies are needed for evidence-based conclusions.

Cytomegalovirus infection (CMVI) with clinical manifestations is a valuable problem in patients with immunosuppression, particularly in patients with inflammatory bowel disease (IBD) treated with steroids and other immunosuppressive drugs. Clinical activity of cytomegalovirus-associated IBD, natural history and stage of IBD, steroids use and anti TNF-a-agents were identified as risk factors. CMVI diagnostics should clarify not only the presence of CMV but its etiological role in clinical features of the disease. The most significant are the virologic and serological methods. All patients with steroid resistance, loss of effect and severe IBD should undergo CMVI screening. It is likely that joining CMVI to IBD is one of the main causes of resistance to steroids, immunosuppressive and biological treatment. requires further studies.