AIM: to compare methods of high and low ligation of the inferior mesenteric artery (IMA) in relation to early and late outcomes in surgery for rectal and sigmoid cancer.

MATERIALS AND METHODS: the systematic review performed in accordance with PRISMA practice and guidelines.

RESULTS: eighteen studies (5 randomized clinical trials and 13 retrospective studies) are included in the study. The meta-analysis demonstrated that left colic artery (LCA) preservation significantly reduced the incidence of anasto- motic leaks compared with high ligation of IMA (OR = 1.60; CI 1.23–2.10; p = 0.0006). There were no differences in operation time, blood loss, frequency of splenic flexure mobilization, number of harvested lymph nodes, incidence of urinary dysfunction, postoperative hospital stay and 5-year disease-free survival.

CONCLUSION: low ligation of the IMA improves the blood supply to the anastomosis and reduces the risk of anasto- motic leakage.

AIM: to assess the early results in patients with benign epithelial colorectal neoplasms which underwent endoscopic mucosal resection with a circumferential incision (C-EMR).

PATIENTS AND METHODS: a prospective randomized trial included 50 patients who underwent endoscopic removal of benign epithelial colorectal neoplasms sized 20–30 mm (November 2020 — January 2022). The main group included 26 patients which underwent C-EMR. The control group included 24 patients which underwent endoscopic submucosal dissection (ESD).

RESULTS: postoperative complications developed in the C-EMR group in 5 (19.2%), and in the ESD group — in 7 (29.2%) cases (p = 0.51). The operative time in the C-EMR group was significantly less than in the ESD group — 30 vs 60 min., respectively (p < 0.001). In all cases in both groups, tumors were removed en bloc. There R0 resection were performed in 22 (84.6%) and in 23 (95.8%) cases in the main and control groups, respectively (p = 0.3). Two (8.3%) procedures in the control group were converted to the C-EMR procedure.

CONCLUSION: endoscopic mucosal resection with a circumferential incision is an effective and safe method for removing benign epithelial neoplasms sized 20–30 mm, as well as submucosal dissection. The removal of the tumor by the C-EMR method reduces operative time by half compared with ESD method.

AIM: to compare long-term outcomes and safety of the addition of paclitaxel to chemoradiotherapy for squamous cell anal carcinoma.

PATIENTS AND METHODS: A prospective phase 3 randomized trial included patients with histologically verified non-metastatic anal squamous cell carcinoma. Patients received radiotherapy 52-54 Gy (for T1-T2 tumors) and 56-58 Gy (for T3- T4 tumors) in 2 Gy daily fractions during chemotherapy with mitomycin C (10 mg/m² i.v. day 1), capecitabine (625 mg/m² 2 times a day orally on days of radiation therapy), paclitaxel (45 mg/m² i.v. on days 3, 10 , 17, 24, 31) during 2013-2019. In the control group patients received a similar course of RT and chemotherapy with mitomycin C (12 mg/m² i.v. day 1 ), capecitabine (825 mg/m² 2 times a day orally on radiotherapy days). The primary endpoint was 3-year disease-free survival (DFS). Secondary endpoints included complication rate (NCI-CTCAE 4.0), complete clinical response rate at 12 weeks and 26 weeks after completion of CRT, and 3-year overall survival (OS).

RESULTS: The study and control groups included 72 patients each. The median follow-up was 39.5 months. A complete clinical response at the 26-week follow-up was recorded in 64 (88.9%) patients in the study group and in 54 (75%) patients in the control group (p=0.049). There were no differences in the incidence of complications of grades 3-4 in the two groups (39/72 [54.2%] in the study group versus 35/72 [48.6%] in the control group (p=0.617)). Three-year progression-free survival in the study group was 87.1%, in the control group - 64.4% (p=0.001). Three-year overall survival in the study group was 95.5%, in the control group - 80.0% (p<0.001).

CONCLUSION: CRT with paclitaxel for squamous cell anal carcinoma has acceptable toxicity and may improve long-term treatment outcomes.

AIM: to determine the diagnostic efficiency of magnetic resonance enterocolonography using inflammation indices (CDMI, MEGS) in assessing activity of the inflammatory process in the colon and small intestine in Crohn's disease.

PATIENTS AND METHODS: the study included 42 patients with Crohn's disease (age ranged from 19 to 47 years). All patients underwent magnetic resonance enterocolonography (MRE) with intravenous contrast and diffusion-weighted images. According to the results of MRE, were determined MR indices of inflammation activity in the small and large intestine - CDMI and MEGS. The MR inflammatory activity indices CDMI and MEGS were compared with the endoscopic inflammatory activity index SES-CD.

RESULTS: the MR inflammation activity index CDMI did not show a statistically significant diagnostic efficiency (p>0.05). The MR inflammation activity index MEGS showed a statistically significant diagnostic efficiency (p<0.0001). According to the nomogram, the MR inflammation activity index MEGS demonstrated a high predictive ability to determine the true activity of the inflammatory process in the small and large intestine. Correlation demonstrated direct strong relationship between the quantitative values of the MEGS inflammation indices and the endoscopic inflammation index (SES-CD) (r=0.843, p<0.0001).

CONCLUSION: magnetic resonance enterocolonography using the MEGS activity index has a high diagnostic efficiency in assessing the activity of the inflammatory process in the small and large intestine in Crohn's disease. The MR inflammation activity index CDMI did not show statistically significant diagnostic efficacy. The results of the study should be considered preliminary and require further study of the possibilities of these indices of inflammation activity in a larger sample of patients.

AIM: to create a marked data set (histoscans of lymph nodes) for use in the development of medical decision support systems (based on machine learning) in pathomorphology, which will allow determining the presence of metastatic lymph node lesions in CRC.

RESULTS: the dataset included 432 files with digital images and markings of 1000 lymph nodes, including lymph nodes with and without metastases. Based on the marked-up data, a neural network model was trained to determine the probability of metastatic lesion for each pixel in the area of interest - the lymph node (Dice 0.863 for the replaced tissue, Dice macro 0.923). In addition, pre- and postprocessing methods were implemented to represent input data in a form acceptable for machine learning and to represent the AI model's response in a form convenient for user perception. Additionally, a neural network model has been developed that predicts the probability of finding artifacts in digital images of lymph nodes with the possibility of forming an artifact probability map (Dice macro0.776; Dice for artifacts 0.552; IoU macro 0.725 and IoU for artifacts 0.451).

CONCLUSION: the developed model is a good basis for the implementation of a full-fledged solution, on the basis of which a system can be developed to assist doctors in finding and evaluating the replacement of tissue structures and determining metastatic lymph node lesions, detecting artifacts and evaluating the quality of digital images.

AIM: to identify risk factors for burnout of healthcare employees and to identify the most vulnerable category of practicing physicians.

PATIENTS AND METHODS: an observational study based on a public survey started from June to August 2022. The validated Maslach Burnout Inventory questionnaire was used as a burnout assessment tool. An integral burnout index was calculated, on the basis of which significant risk factors were analyzed. The results obtained are presented in the form of a predictive nomogram.

RESULTS: the high degree of emotional burnout in Russia among doctors reaches 32%. The most significant professional risk factors are relationships between colleagues (p = 0.0002), overtime work (p = 0.006), work in outpatient unit (p = 0.006), with severe patients (p = 0.008) and uneven planning of work activities (0.0004). The protective factors are: family (p = 0.001), sports (p = 0.001), meditation (p = 0.005) and talking about own problems (p = 0.01).

CONCLUSION: burnout is a multifactorial problem. The proposed nomogram is useful for identification of the most vulnerable specialists.

AIM: to evaluate the effect of surgery for metastases in retroperitoneal and pelvic lymph nodes on overall and disease-free survival.

PATIENTS AND METHODS: the analysis included 30 patients with retroperitoneal lymph node metastases of colorectal cancer. Synchronous metastases to the retroperitoneal lymph nodes, were diagnosed in 21/30 (70%).

RESULTS: the median overall and disease-free survival in patients who underwent lymphodissection was 32 and 13 months, respectively. Recurrence occurred in 14/30 (47%) patients. One-, two-, three-year disease-free survival was 61 ± 11%, 20 ± 11%, 0%; general 95 ± 4%, 74 ± 14%, 37 ± 19%, relatively. The median disease-free survival in the group with isolated retroperitoneal lymph node lesion was 14 (9–29) months and 10 (6–18) months in the group with retroperitoneal lymph node metastases in combination with synchronous liver lesion. One-and three-year disease-free survival was the same in the groups and was 58 ± 15% and 0%, p = 0.2. The univariate analysis did not reveal any factors related to overall and disease-free survival.

CONCLUSION: in a selected group of patients with colorectal cancer, with lesions of retroperitoneal lymph nodes, including resectable metastases to the other organs, surgery can be justified, since it is accompanied by a relatively low rate of complications. However, the small cohort requires further study.

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This paper presents interdisciplinary consensus on the use of protocols of high-intensity magnetic stimulation for the treatment of pelvic floor muscles dysfunction with anal incontinence in Russia.

AIM: to highlight the discussion and the decision-making on the basis of an interdisciplinary consensus on the use of a new algorithm of peripheral and transcranial magnetic stimulation in the treatment of pelvic floor muscles dysfunction with the clinic of anal incontinence.

RESULTS: the adoption of this consensus can serve as a basis for further research of this problem and optimize the results of treatment of patients with pelvic floor muscle dysfunction with anal incontinence. The data may be interesting for a wide range of medical specialists: general practitioners, gastroenterologists, coloproctologists, surgeons, neurosurgeons, gynecologists, urologists — anyone who encounter with manifestations of this disorder in a routine practice and chooses diagnostic and treatment options.

CONCLUSION: protocols for the treatment of anal incontinence using high-intensity magnetic stimulation aimed at improving the quality of treatment of patients with anal incontinence are based on the Russian experience of using the methods discussed and the analysis of the results obtained are validated.

OBJECTIVE: to study the immediate results of the treatment of patients with benign epithelial neoplasms of the colon by endoscopic mucosal resection with a circular incision (C-EMR).

PATIENTS AND METHODS: from November 2020 to January 2022, a prospective randomized comparative study was recruted 50 patients who underwent endoscopic removal of benign epithelial neoplasms of the colon with sizes from 20 to 30 mm. In the main group the endoscopic resection of the mucous with a circular incision technique was used (26 patients). The neoplasms of the colon in the control group were removed by endoscopic dissection in the submucosal layer (ESD) – 24 patients.

RESULTS: postoperative complications developed in the C-EMR group in 5 (19.2%), and in the ESD group - in 7 (29.2%) cases (p=0.51). The operative time in the C-EMR group was significantly less comparative with the ESD group – 30 and 60 min., respectively (p<0.001). In all cases in both groups, tumors were removed en bloc. There R0 resection were performed in 22 (84.6%) and in 23 (95.8%) cases in the main and control groups, respectively (p=0.3). Two (8.3%) operation in the control group were converted to the C-EMR procedure.

CONCLUSION: endoscopic resection of the mucosa with a circular incision is an effective and safe method for removing benign epithelial neoplasms ranging in size from 20 to 30 mm, as well as submucosal dissection. The removal of the tumor by the C-EMR method requires two times less time than the ESD method.

A clinical case demonstrates the potential of transabdominal ultrasound of the large intestine in diagnosis and follow-up in a patient with ulcerative colitis. It is shown that transabdominal ultrasound examination performed in seroscan mode (B-mode) with the use of Doppler color mapping allows to monitor the degree of resolution of inflammation in the mucosa of the large bowel, as well as to evaluate the effectiveness of conservative approach.

Solitary rectal ulcer syndrome (SRUS) is a chronic benign disease with an unclear pathogenesis and a wide range of macroscopic changes of rectal and sigmoid colon wall, without any specific clinical symptoms. Its detection and differential diagnosis with tumors and inflammatory bowel disease often is challenging. The aim was to assess the entire spectrum of SRUS manifestations, as well as to analyze the possibilities of ultrasound and other imaging modalities (barium enema, defecography, MRI, CT) in its diagnostics. Clinical cases showed that every method solves its own tasks, revealing structural and/or functional changes in SRUS, and makes a valuable contribution to the final diagnosis

AIM: to estimate the features of pseudomembranous colitis in patients with COVID-19, diagnostics, conservative treatment and surgery for complications.

PATIENTS AND METHODS: a retrospective analysis of 396 patients with pseudomembranous colitis (PMC) in patients with new coronavirus infection was carried out for the period from March 2020 to November 2021. Among them there were 156 (39.3%) males, females — 240 (60.6%), moderate and severe forms of COVID-19 occurred in 97.48%.

The diagnosis of PMC was established due to clinical picture, laboratory, instrumental methods (feces on Cl. difficile, colonoscopy, CT, US, laparoscopy).

RESULTS: the PMC rate in COVID-19 was 1.17%. All patients received antibiotics, 2 or 3 antibiotics — 44.6%, glucocorticoids were received by all patients. At 82.8%, PMC developed during the peak of COVID-19. To clarify the PMC, CT was performed in 33.8% of patients, colonoscopy — 33.08%, laparoscopy — in 37.1% (to exclude bowel perforation, peritonitis). Conservative treatment was effective in 88.8%, 76 (19.1%) patients had indications for surgery (perforation, peritonitis, toxic megacolon). Most often, with peritonitis without clear intraoperative confirmation of perforation, laparoscopic lavage of the abdominal cavity was performed (60 patients — 78.9%, mortality — 15.0%), colon resection (n = 6 (7.9%), mortality — 66.6%), ileo- or colostomy (n = 8 (10.5%), mortality — 37.5%), colectomy (n = 2 (2.6%), mortality — 50.0%). The overall postoperative mortality rate was 22.4%, the incidence of surgical complications was 43.4%. In addition, in the postoperative period, pneumonia was in 76.3%, thrombosis and pulmonary embolism in 22.3% of patients. In general, the overall mortality in our patients with PMC was 11.4%, with conservative treatment — 8.8%.

CONCLUSION: pseudomembranous colitis is a severe, life-threatening complication of COVID-19. In the overwhelming majority of patients, conservative therapy was effective, but almost 1/5 of patients developed indications for surgery, the latter being accompanied by high mortality and a high morbidity rate. Progress in the treatment of PMC, apparently, is associated with early diagnosis, intensive conservative therapy, and in the case of indications for surgery, their implementation before decompensation of the patient’s condition and the development of severe intra-abdominal complications and sepsis.

BACKGROUND: to date, there are no clear guidelines for MutYH-associated polyposis (MAP) surgery.

AIM: to study the world literature on MutYH-associated polyposis surgery using a meta-analysis.

MATERIALS AND METHODS: the systematic review was carried out in accordance with the practice and guidelines of PRISMA. The meta-analysis included the results of 14 case studies, 4 cohort studies, as well as own data on patients with MAP. A total of 474 patients with MAP were analyzed.

RESULTS: when analyzing the number of colorectal polyps, the total occurrence value (95% CI: 0-14) of less than 10 polyps was 10%, in 52% cases (95% CI: 0-100) from 10 to 100 polyps were detected, in the remaining cases there were more than 100 polyps. Colorectal cancer was diagnosed in 56% of patients (95% CI: 45–66) of patients, while tumors with the T1-T3 were found in 38% of cases, tumors with the T4 were found in 7% of cases, lesions of the regional lymph nodes N + were found in 8%. The synchronous tumors were detected in 12%, and metachronous — in 5%. In 87%, some parts of the large intestine were preserved, in 38% [95% CI: 0-100] — colectomy with ileorectal anastomosis, in 27% [95% CI: 23-31] — colorectal resection, in 22% [95% CI: 16-27] — polypectomy), in other cases total removal of all parts of the large bowel was performed.

CONCLUSION: patients with MAP who have been diagnosed with less than 100 colorectal polyps may undergo endoscopic polypectomy, if technically possible. Despite the risk of developing CRC, which in most cases has a nonaggressive course, the clinical course of MutYH-associated polyposis is relatively favorable. For this category of patients, it is possible to limit colorectal resection with annual endoscopic control and removal of detectable polyps in the remaining parts of the large bowel

One of the specific manifestations of hemophilia A is the spontaneous abdominal hematoma mimicking the clinical picture of acute abdominal disease. The appearance of auto-antibodies to FVIII leads to a loss of response to replacement hemostatic therapy and requires an individualized approach as well as highly sensitive laboratory monitoring to reduce the risk of uncontrolled bleeding. The paper presents the case of multi-stage surgical treatment of this complication.