AIM: to study the perianal infection (PI) in patients with granulocytopaenia (GCP) and hematological malignancies (HM).

PATIENTS AND METHODS: the prospective study (2016-1018) includes 95 episodes of PI in 76 patients with HM (male/female 35/44; mean age of 35 (17-69)). 43(54.4%) of the patients were detected to develop acute leukemia (AML – 34 (43%); ALL – 9(11.4%); NHL – 17(21.5%).
The comparison of PI episodes within the GCP period (number of granulocytes less than 0.5x109/l) and without it was done.

RESULTS: PI episodes within the period of GCP were significantly much more often than those without GCP (77.9% vs 22.1%, relative risk 3.5 (95% CI: 2.4-5.2).
The biggest number of PI episodes in the setting of GCP was registered within the period of chemotherapy (ChT): in the phase of consolidation (28.4%) and induction (13.3%) of acute leukemia ChT and lymphomas’ ChT (20.3%). Anal fissures were the most frequent source of PI within GCP period (66.2% vs 19.1% without GCP, p<0.001). Inflammatory changes in perianal tissues were clinical features of PI in the setting of GCP in 89.2% of the cases: inflammatory mass in 71.6% (vs 23.8% without GCP, p<0.001), abscess in 8.1% (vs 66.7% without GCP, p<0.001).
In 10.8% of the cases of PI with GCP only perianal pain and fever were registered. No tissues change was detected with the lowest WBC count (Me 0.2 (0.1-0.5) x109/l). Bloodstream infections were detected in 15 (20.3%) episodes within the period of GCP only, of them in 6 (8.1%) cases the species matching of microorganisms in blood and in rectum was noticed.
Within the period of GCP antibacterial therapy was carried out in 98.6% of the cases: antibacterial therapy  alone was applied in 87.8% of the episodes (vs 7.2% without GCP, p<0.001); both antibacterial therapy and  surgical treatment were carried out in 10.8% (vs 61.9% without GCP, p<0.001) of the cases. Mean duration of antibiotic treatment of patients with GCP was drastically longer in the group of postoperative patients in  comparison with the group of those who had conservative treatment (25.5 vs 15.1 days, p=0.05). Antimicrobial therapy within GCP period resulted into inflammation regress in 83.1% of the cases; abscess or fistula  formation, hence surgical treatment in 13.8% of the cases; progression of infection in 3.1% of the cases. Increase of GCP duration up to 30 and more days is connected with bacteremia rate increase (12.5% vs 28%, p<0.05); combinations of PI with other infections (25% vs 52%, p<0.05); requirement of antimicrobial therapy modification (16.7% vs 40%, p<0.05).

CONCLUSION: GCP significantly raises risk of PI. PI that develops in the setting of GCP, is characterized by  abnormal, often low clinical manifestations and high risk of sepsis. Invasion of microorganisms through affected tissue seals is the basic mechanism of perianalinfection within the period of GCP. Antibacterial therapy is the prior method of PI treatment in the settings of GCP; antibacterial therapy efficiency is 83.1%. Need for surgery in the period of GCP is associated with the infectious episode and antibacterial therapy duration increase. Lengthening of GCP is a negative predictor in PI treatment.

The development of methods for effective diagnosis and monitoring of colorectal cancer (CRC) treatment is one of the basic scientific problem. The circulating plasma contains extracellular nanovesicles (EVs) secreted mainly by blood and endothelial cells. The minor fraction of plasma EVs is produced by cells of various tissues, including cells of the intestinal epithelium. The biochemical composition of such vesicles should have tissue-specific features. Presented study was aimed to identify surface markers of EVs secreted by intestinal epithelium cells and to assess the possibility of isolating and quantification of such vesicles for the diagnosis of CRC. The cell cultures (HCT-116, HT-29, COLO-320, HuTu-80, SW837), plasma of CRC patients and healthy donors were used in the study. The methods of nanoparticle tracking analysis (NTA), atomic force microscopy (AFM), dot-blotting and flow cytometry were applied for EVs characterization. With the original technology of immunosorption we have demonstrated an increased amount of CLRN3, GAL4 and Meprin A, i.e. positive EVs in plasma of CRC patients  comparing to healthy donors. Based on the quantitative analysis of such EVs, new methods of diagnostics and monitoring of CRC therapy can be developed.

AIM: to evaluate the diagnostic capabilities of contrast-enhanced ultrasound for the diagnostics of epithelial rectal tumors.

PATIENTS AND METHODS: the study included 15 patients, who underwent endorectal ultrasound and transvaginal contrast-enhanced ultrasound. All the patients underwent surgery.

RESULTS: morphology revealed adenomas in 9 cases, and adenocarcinomas with different invasion depth in 6 cases. When analyzing the tumors contrast, significant differences in arrival time of contrasting between adenomas and adenocarcinomas were obtained (p = 0.041), and the contrast enhancement of adenocarcinomas was faster (p = 0.036). Negative correlations of peak intensity of contrast enhancement of hypoenhanced zones in adenocarcinoma with indices T (rxy =-0.781; p = 0.001) and N (rxy = - 0.519; p = 0.047)and a positive correlation with the tumor differentiation degree (rxy=0.742; p = 0.002) were established. Also, the negative correlation of the arrival time with the index T (rxy=-0.552; p=0.033) was found.

CONCLUSION: contrast-enhanced ultrasound is an imaging technique that allows real-time qualitative and quantitative assessment of tumor tissue perfusion. The method is not standardized, but it can be a useful non-invasive method for assessing the blood supply of rectal tumors at the preoperative stage, and also has the potential to assess risk factors for lymphogenic metastasis.

BACKGROUND: biological markers of inflammation belong to the main tool for predicting the risk of infectious complications at the preclinical stage. One of such biomarkers is the neutrophil-to-lymphocyte ratio (NLR), but an insufficient number of studies does not allow us to estimate its value as a predictor of infectious complications in colorectal surgery.

AIM: to determine the predictive value of NLR as a predictor of infectious complications after colorectal surgery.

PATIENTS AND METHODS: from January 2018 to December 2019 192 patients after colorectal surgery were included in the study. The rate of infectious complications, NLR levels differences in patients with and without infectious complications were determined, the area under the curve (AUC), sensitivity, specificity, negative and positive prognostic value of NLR on the 3rd (POD) and the 6th (POD) postoperative days were assessed. A literature search and meta-analysis of the data in accordance with the preferred reporting items for systematic reviews and meta-analyses checklist (PRISMA) were conducted. The information was taken from the Medline electronic database and the E-library, scientific electronic library, among the English and Russian literature without publication date restrictions by the keywords: “neutrophil/lymphocyteratio”, “neutrophil-to-lymphocyte  ratio”, “neutrophil lymphocyte ratio”, “neutrophil ratio”, “lymphocyte ratio”, “colorectal”, “colon”, “rectum”.
The systematic review included all the studies related to assessing the prognostic value of NLR as a predictor of infectious complications in colorectal surgery.

RESULTS: infectious complications were detected in 29 (15.1%) of 192 patients. On the 3rd and the 6th POD, the patients with infectious complications had higher median NLR values than the patients without complications (p=0.0017 for the 3rd POD; p=0.018 for the 6th POD). 
On the 3rd POD, the area under the curve at the NLR cut-off point 5.13 was 0.644, sensitivity – 69.7%,  specificity – 60.7% (p=0.019). On the 6th POD, similar indicators at an NLR cut-off point of 3.94 were 0.75,  75.9% and 70.6%, respectively (p<0,001). Four studies, which included 1,152 observations, were added in the meta-analysis. On the 3th POD, the summarized AUC was 0.671, sensitivity – 86.3%, specificity – 60.3% 
(p=0.014). The risk of infection with a biomarker above the threshold increased by more than 10 times  (OR=10.2; 95% CI: 1.4-72). On the 4th POD, the above indicators were 0.711, 75.4%, 87.5%, respectively (p=0.002). Odds ratio was 51 (95% CI: 20-128).

CONCLUSION: the neutrophil-to-lymphocyte ratio is a reliable indicator for predicting the risk of developing infectious complications in colorectal surgery. In addition, the low values of this biomarker are an important criterion for the safe discharge of patients from hospital. The prevalence and availability of this test makes it easily feasible in clinical practice.

High-quality bowel cleansing is the basis for effective colon examination. Inadequate preparation of the colon can be the reason for nondetection of colorectal polyps during the examination and reach 12%. The objective of this publication is to present current literature data based on the principles of evidence-based medicine that address the safety of using trisulfate in preparation for colonoscopy. It was found that the drug for intestinal cleansing, which is a low-volume one-liter hyperosmotic based on a combination of sodium, potassium and magnesium sulfate salts, has a high efficiency of preparing the intestine for colonoscopy. The percentage of patients with successful bowel preparation using trisulfate is 97%. At the same time, the drug has an acceptable safety profile, including for patients from risk groups. The results of this review indicate that the new low-volume one-liter trisulfate is an effective remedy for providing one of the most important indicators of highquality  colonoscopy - bowel cleansing and has a high safety profile.

AIM: to present a clinical case of treatment of colorectal anastomosis leakage complicated by secondary diffuse postoperative peritonitis with preservation of the anastomosis.

PATIENTS AND METHODS: the patient was a 69-year-old male, with a diagnosis of the rectal cancer pT3N0M0, after surgery treatment (laparoscopic TME, ileostomy). The postoperative period was complicated by anastomosis leakage.

RESULTS: we applied the method of surgical treatment, which included stage relaparotomy without resection of  anastomosis with installing intraabdominal and pelvic system of negative pressure treatment and transanal  endoluminal vacuum drainage at the anastomotic leakage site. 

CONCLUSION: the primary use of the method gave us encouraging results, which enables to consider the proposed technical approach as a promising option for treatment of such a complicated group of patients.

Colorectal resection for cancer in a patient with partial situs inversus was described for the first time.
Hemicolectomy with D3 lymph node dissection for left-sided ascending colon cancer was performed in a 78-year-old woman with abdominal organ transposition and laevocardia.
There were no intraoperative complications, but the procedure was technically challengeable due to advanced  adhesions in the abdomen after the previous cholecystectomy.
The case illustrates following the oncological principles in patients with abnormality. In order to determine proper volume of surgery and to minimize risk of intra-and postoperative complications, application of high-tech diagnostic tools is preferable, including CT reconstruction of vessels and other anatomical structures situated in the surgical site.

INTRODUCTION: Lateral internal sphincterotomy (LIS) is considered the ‘gold standard’ therapy for chronic anal fissure (CAF).  Advantages of LIS over other surgical techniques include higher rate of healing and lower risk of fissure recurrence. However, this procedure is associated with a high risk of anal sphincter insufficiency (ASI) in the postoperative period. Anal advancement flap (AAF) is an alternative surgical procedure for CAF, which requires the use of local flaps. Anal advancement flap is associated with a significantly lower risk of anal incontinence.

AIM: to compare short-term and long-term outcomes of аnal advancement flap and lateral internal sphincterotomy in patients with chronic anal fissure.

METHODS: a systematic review and meta-analysis of studies comparing outcomes of Anal advancement flap and lateral internal sphincterotomy was conducted. We evaluated the following parameters: the rate of epithelialization, the rate of anal sphincter insufficiency, and the rate of postoperative complications. We carried out statistical analysis using the Review Manager software (Review Manager 5.3.)

RESULTS: the systematic review included four studies that presented the results of 278 patients. Compared with LIS, the odds for healing after AAF were 63% lower (OR=0.37; CI=0.19;0.74; P<0.005). We found no significant differences in the rate of postoperative complications (OR=1.43; CI=0.54;3.78; P=0,47). Compared with AAF, the odds for anal incontinence after LIS were 94% greater (OR=0.06; CI=0.01;0.37; P=0,002).

CONCLUSION: both lateral internal sphincterotomy and аnal advancement flap are effective in curing CAF. However, considering the ambiguity and poor quality of data from the studies comparing these procedures, a high risk of bias for comparison groups and heterogeneity of the studies, one should interpret the results with caution; the aforementioned limitations dictate the need for further research.

Isolated colorectal peritoneal metastases occur in 1.8% of patients. This type of tumor is characterized by certain phenotypic and molecular genetic characteristics, which determines the choice of specific treatment options. In this literature review, along with a description of the main principles of the pathogenesis of the disease, the sensitivity and specificity of various diagnostic methods for colorectal peritoneal lesions, the choice of systemic therapy, the need to perform peritonectomy and Intraperitoneal hyperthermic chemoperfusionare considered.

INTRODUCTION: the NOSES technique allows one to remove specimen without incisions on the anterior abdominal wall and is accompanied by fewer complications by reducing the frequency of wound infections. The results of these surgical operations on colorectal tumors are presented in a limited number of heterogeneous studies, which necessitates obtaining objective data using metaanalysis.

STUDY OBJECTIVE: compare the short and long-term outcomes of two methods for surgical treatment of colorectal cancer.

MATERIALS AND METHODS: a systematic review is carried out in accordance with PRISMA practice and recommendations.

RESULTS: nine comparative studies were selected for the period from 2014 to 2019. 1693 patients were included in the meta-analysis: in 765 (45%), the tumor preparation was removed transanally (NOSES group) and in 928 (55%) it was removed via minilaparotomic access (LA group). The tumor size in the NOSES group was 0.5 cm smaller (OR=0.5, CI95% 0.2-0.8, p=0.0004) than in the LA group. In regards to other parameters the groups had no publication bias. The duration of the operation when comparing NOSES with LA was comparable (p =0.11). VAS pain was on average 2 points (OR=1.8, CI95% 1.2-2.4, p<0.00001) more pronounced in the LA group. The postoperative bed day was less in the group with transanal removal of the preparation (OR=0.8, CI95% 0.4-1.3, p=0.0003). The chance of developing postoperative complications in the NOSES group was (OR=0.5, CI95% 0.4-0.8, p=0.0004) with a frequency of 62/765 (8%) cases, compared with the control group - 130/931 (14%). The chance of developing wound infection was higher in the LA group (OR=0.2, CI95% 0.1-0.3, p <0.00001). There were no differences in the incidence of colorectal anastomotic leakage (p=0.97). There were also no differences in the five-year overall (p=0.74) and cancer-specific survival (p=0.76).

CONCLUSION: using NOSES technologies creates better conditions for the rehabilitation of patients due to the low frequency of postoperative complications due to the absence of wound infection and is a safe manipulation. However, the presence of publication biases requires a careful interpretation of the data obtained.

AIM: to analyze the literature on the molecular genetic characteristics in patients with peritoneal carcinomatosis and liver metastases of colorectal cancer.

PATIENTS AND METHODS: RSCI, Google Scoolar, PubMed, Web of Science databases were used for review. Over 200 literature sources on the given subject were analyzed, of which 67 were included in this review.

RESULTS: in the review, the data on molecular genetic changes occurring during peritoneal carcinomatosis and liver metastases in patients with colorectal cancer were presented. The key points for treatment patients with metastatic colorectal cancer were identified. 

CONCLUSION: the presented data summarizes molecular genetic studies, which in turn enable clinical oncologists, surgeons and chemotherapists to determine treatment modality.