Aim: to evaluate the impact of primary tumor resection (PTR) on treatment outcomes in patients with asymptomatic or minimally symptomatic colorectal cancer (CRC) and synchronous unresectable metastases.

Patients and Methods: treatment outcomes of patients with minimally symptomatic CRC and synchronous unresectable metastases were retrospectively assessed (2016–2022). Patients with PTR followed by chemotherapy were compared to patients receiving chemotherapy only. Survival was determined by the Kaplan-Meier method and differences were evaluated using the log-rank test and Cox proportional-hazards regression model. To reduce potential selection bias between two groups a propensity score matching (PSM) was performed.

Results: no significant differences in 30-day mortality rate (р = 1,00) and the rate of surgical intervention due to complications of first treatment (р = 1,00) between the two groups. Before matching the median survivals were 27,8 and 24 months in the PTR and chemotherapy groups, respectively (р = 0,2). After PSM the overall survival rate at 3 years was 42,1% for the PTR group and 34% for the chemotherapy group (р = 0,47). The median survivals were 27,9 and 24,4 months, respectively. Three-year overall survival rate for patients with stage IVB was significantly higher in the PTR group than in the chemotherapy group (37,8% versus 4,8%; р = 0,02). The median survivals were 36,1 and 17,2 months, respectively. In multivariate analysis radical resection (R0) if unresectable metastases converted into resectable after initial treatment was the only significant prognostic factor for survival (p < 0,001).

Conclusions: PTR in patients with asymptomatic or minimally symptomatic CRC and synchronous unresectable metastases is associated with acceptable postoperative morbidity and mortality rates and may improve overall survival for patients with stage IVB comparing to chemotherapy as a treatment of first line. However, randomized controlled trials are needed.

Ailm: to assess metabolic processes in the serous layer of the large intestine in the acute period of spinal injury.

Materials and Methods: the experiment was carried out on laboratory animals — Wistar rats (n = 20). Spinal injury was simulated by complete transection of the spinal cord at the level of Th5-Th6 vertebrae. Metabolic changes in the intestinal wall were assessed before injury, 3 and 24 hours after spinal cord transection. Metabolism was assessed in vivo using fluorescence time-resolved macroimaging technology (macroFLIM) by autofluorescence in the spectral channel of the metabolic cofactor NAD(P)H.

Results: a significant (p = 0.041) increase in the mean fluorescence lifetime (τm) by 12% and the lifetime of the long component (τ2) of the NAD(P)H cofactor by 13% (p = 0.008) was detected 24 hours after injury. MacroFLIM showed an increase in the intensity of metabolism in the large intestine wall.

Conclusion: for the first time in an in vivo experiment, it has been shown that the acute period of spinal injury is accompanied by an increase in metabolic activity in the tissues of the large intestine. The revealed phenomenon confirms the role of the large intestine in compensatory reactions to spinal injury and open up new possibilities for therapy in the acute period of spinal cord injury.

Aim: to evaluate the diagnostic value of computed tomography (CT) and abdominal ultrasound (US) for chronic inflammatory complications in patients with diverticular disease (DD).

Patients and Methods: the prospective cohort study included 50 patients with complicated DD. All patients underwent preoperative abdominal CT with intravenous contrast and abdominal US, with further elective bowel resection. The results of CT and ultrasound were compared with morphology of the removed specimens.

Results: the sensitivity and specificity for chronic diverticulitis was 66.7% and 95.7% for CT and 100.0% and 95.7% for US. For chronic pericolic abdominal mass it was 94.8% and 90.9% for CT, 94.8% and 100.0% for US; for abdominal abscesses/cavities it was 87.5% and 96.2% for CT and 91.6% and 100.0% for US; for diverticular fistulas it was 87.5% and 100.0% for CT and 87.5% and 100.0% for US. No significant differences were obtained between two diagnostic modalities. A high level of consistency (κ-coefficient 0.71) of CT and US for the diagnosis of inflammatory complications of DD was found.

Conclusion: CT and US have a similar high diagnostic value for chronic inflammatory complications of DD. Each of them can be used as a single diagnostic modality or both depending on the clinical case.

Aim: to analyze outcomes of multimodal treatment including preoperative chemotherapy with FOLFOX 4 regimen in patients with upper rectal cancer.

Patients and Methods: the pilot study included 24 patients. Stages II and III were confirmed in 2 (8.3%) and 22 (91.7%) patients, respectively. All patients underwent 3 cycles of chemotherapy in FOLFOX 4 regimen followed by surgery. In the postoperative period, patients with T4 and N+ underwent adjuvant chemotherapy administered over 6 months including the time of preoperative treatment.

Results: all patients completed preoperative chemotherapy with the FOLFOX 4 regimen. The toxicity of chemotherapy was 38.9%; adverse events did not exceed grades I-II. Partial tumor regression (RECIST 1.1 criteria) was achieved in 18 (75.0%) patients. All patients underwent surgery 4 weeks after chemotherapy. Postoperative complications occurred in 4 (16.7%) patients, 1 (4.2%) had grade IIIb complication (Clavien-Dindo scale), which required re-surgery. Pathological complete response (TRG1 by Mandard scale) was revealed in 1 (4.2%) patient. Thirteen patients (54.2%) received adjuvant chemotherapy. The mean follow-up was 38 (17-54) months. Three patients (12.5%) developed local recurrence and 4 (16.7%) patients — distant metastases. The 3-year overall and diseasefree survival rates were 91.7% и 79.2%, respectively.

Conclusion: multimodal treatment including preoperative chemotherapy with the FOLFOX 4 regimen was well tolerated and produced tumor regression with high 3-year survival rates in patients with upper rectal cancer.

Aim: to evaluate hybrid techniques in patients with stage III and IV hemorrhoids.

Patients and Methods: from January 2017 to December 2021, 154 patients with external and internal hemorrhoids of the 3rd and 4th stages were treated at the Moscow Medical Center “ON CLINIC”, including men — 118 (76.6%) and women — 36 (23.4%), aged of 45.8 ± 10.3 (27–72) years. The history of the disease was 8.8 ± 2.2 (5–15) years. All patients underwait transanal dearterialization with mucopexy. With its inefficiency, a hybrid operation technique was performed.

Results: all patients were operated under spinal anesthesia in a one-day hospital. Operation time was 38.05 ± 4.7 (27–55) min. Postoperative pain syndrome on the first day was 34.1 (30–40) mm on the VAS scale, due to the elective use of Ketorolac tromethamine, 30.1 ± 1.2 (30–40) mg. By the 5–6th day, the pain syndrome decreased to 24.2 (20–30) mm and 15.3 (0–30) mm. Hospital stay was 24.5 ± 2.3 (21–38) hours. The mean period of disability was 12.8 ± 3.1 (10–14) days. When comparing the clinical results of treatment with a follow-up period of 29.9 months, there was no progression of the disease manifestation.

Conclusion: the use of hybrid techniques in the treatment of complex forms of hemorrhoids allows to minimize trauma of the anal canal and to reduce the rehabilitation period.

Aim: to evaluate learning curve for transanal hemorrhoidal dearterialization (THD) with mucopexy for chronic hemorrhoids II-IV stage.

Patients and Methods: the THD was performed by one surgeon in 459 patients under local anesthesia in 2013- 2021. Patients were aged 45 (37;54) years, 355 (77.3%) — males. Stage II was diagnosed in 85 (18.5%) cases, stage II-III — in 47 (10.2%), stage III — in 296 (64.5%), stage III-IV and IV — in 27 (5.9%) and 4 (0.9%) cases. Regression and CUSUM analysis were used to construct the learning curve. The operation time, postoperative morbidity and recurrence rate were assessed.

Results: the operation time was 25 (25;32.5) minutes, it was achieved on 210 cases. The postoperative complications occurred in 7 (1.5%) cases and were significantly often in stage III-IV and IV — 3 (9.7%) cases (p = 0.001). Recurrence was showed in 29 (6.3%) cases after 1 year of follow-up. The CUSUM function graph showed that with the experience level, a 2-fold decrease in the morbidity rate and recurrence rate was achieved after 24 and 28 procedures, respectively. When experience is achieved, the morbidity rate was low regardless of the disease stage. Despite the experience obtained, in patients operated in the 3rd and 4th quartiles, the recurrences occurred in 10 (7.7%) and 9 (8.8%) patients, respectively.

Conclusion: the indicator of experience obtained is the decrease of operation time and post-op morbidity. The experience level dies not affect recurrence rate in stages III-IV due to limitations of the technique.

Aim: to evaluate diagnostic value of magnetic resonance enterocolonography (MR-enterocolonography) with the use of the segmental index MaRIAs (Simplified Magnetic Resonance Index of Activity) for inflammation activity in small and large intestine colon compared with ileocolonoscopy.

Patients and Methods: the prospective cohort study included 58 patients with Crohn’s disease aged 19–45 years. All patients underwent MR-enterocolonography with intravenous contrast and ileocolonoscopy. MR-enterocolonography assessed inflammatory activity in the large and small intestine (406 segments) using the MaRIAs index (segmental). MRI data were compared with ileocolonoscopy.

Results: ileocolonoscopy showed no signs of inflammatory activity in 71 (71/406, 17.5%) segments. In 168 (168/406, 41.3%) segments endoscopic signs of low or moderate inflammatory activity were detected, in 167 (167/406, 41.2%) segments inflammatory activity with the presence of ulcers were detected. MR-enterocolonography did not detect any activity in 121 (121/406, 29.8%) segments (0 points by MaRIAs index), in 285 (285/406, 70.2%) segments, the inflammation activity was revealed by MaRIAs index from 1 to 5 points. There was a moderate agreement (Cohen’s Kappa: 0.57) between the data of MR-enterocolonography and ileocolonoscopy in detection of affected segments. ROC analysis revealed that with the value of the MaRIAs index (segmental) of 1 point or more with sensitivity of 82.0% and specificity of 92.0% (AUC 0.85), it is possible to consider the presence of inflammatory activity of any severity, and with index value of 2 points or more with sensitivity of 75.0% and specificity of 91.0% (AUC 0.91) can diagnose the severe inflammation with ulcers.

Conclusion: the results obtained revealed the value of MaRIAs index and the further study to evaluate the effectiveness of conservative treatment of Crohn’s disease is needed.

Aim: to improve diagnostics for descending perineum syndrome.

Patients and Methods: the prospective cohort study included 127 patients (85 (66.9%) — females), aged 49.9 ± 14.4 years with descending perineum syndrome. All patients had proctogenic constipation, anal incontinence and/or chronic neurogenic pelvic pain. All patients underwent a neurophysiological examination according to the original complex pudendal nerve terminal motor latency (PNTML) method — neurophysiological protocol for detection of the pelvic floor muscles innervation disorders.

Results: the latency of the M-response of the pudendal nerve increased on at least one side in 85 (66.9%) patients (50 women and 35 men). The use of a new complex neurophysiological diagnostic protocol made it possible to identify signs of pudendal neuropathy in 29.9% of patients. The incidence of neuropathy in patients with clinically significant perineal prolapse syndrome was 96.5% in females and 97.6% in males.

Conclusion: the new complex neurophysiological diagnostic algorithm made it possible to identify disorders of innervation along the efferent pathway in the Alcock’s canal and distally in 85 (66.9%) cases, along the efferent pathway proximal to the Alcock’s canal — in 23 (18.1%); a combination of efferent and afferent disturbances occurred in 15 (11.8%).

Aim: to assess primary results of robot-assisted ventral mesh procedure using the new Senhance® robotic system for obstructive defecation syndrome.

Patients and Methods: the prospective cohort study included patients who underwent robot-assisted ventral mesh rectopexy with the Senhance® system for obstructive defecation syndrome caused by rectocele and/or rectal prolapse and/or internal intussusception. The optimal trocar sites, the location of robotic arms, operation time and intraoperative blood loss were evaluated, as well as post-op morbidity rate (Clavien-Dindo scale), pain intensity (VAS scale) and recurrence rate.

Results: the study included 22 patients. Operation time was 87.1 ± 24.3 minutes. The intraoperative blood loss was 19.8 ± 9.6 ml. No conversion to open or laparoscopic approach occurred, no morbidity occurred. Pain intensity on day 1 was 0.255 mm according to VAS. No anatomical recurrence was revealed. The median follow-up period was 20.4 months (7–22 months).

Conclusion: robotic-assisted ventral rectopexy using the Senhance® system is effective and safe. The results are similar to laparoscopic ones. However, the use of the Senhance® system is cost effective compared to other robotic systems.

Aim: to present a clinical case and a literature review.

Patient and Methods: a 39-year-old man admitted to the clinic with abdominal pain, vomiting, urge to defecate, hiccups. He reported that a group of people forcibly injected him with an object through the anal canal. General check-up, chest and abdominal X-ray were done. The diagnosis was established: a foreign body of the rectum, sigmoid and colon. Under anesthesia, transanal removal of a foreign body was performed — a fragment of a pipe made of polymer materials with a length of 55 cm, a diameter of 6.5 cm.

Results: the item was extracted completely without complications. After 2 years, the man is healthy. In the world literature, we did not find reports of such a large length of transanally removed objects.

Conclusion: in the absence of peritonitis and perforation of the intestinal wall, transanal removal of a foreign body of the rectum and colon under anesthesia may be the method of choice.

Two patients with metastatic colorectal cancer underwent R0 large bowel resection followed by surgery liver and lungs metastases, retroperitoneal lymph nodes and post-op chemotherapy. The total follow-up period of the first patient was currently 12 years, the recurrence-free period was 5 years. In the second patient, stabilization of the disease was observed for 12 years, and the total follow-up period – 18.5 years. An integrated treatment approach to metastatic CRC with active surgery for removable distant metastases or perioperative use of the most effective drug therapy for potentially resectable metastases can control the disease even with an aggressive course.

Background: transanal endoscopic microsurgery (TEM) is a safe method of local excision of benign tumor and early cancer. Emphysema is rare complication after transanal procedures, occurring only in 1.5%. There is no accepted approach for these patients. AIM: definition and treatment options of ectopic air after TEM.

Materials and Methods: the search was performed using PubMed and e-Library database with the following keywords: «transanal», «emphysema», «microsurgery», «pneumoperitoneum». Data about patients, symptoms, complications, treatment and results were extracted and systematized.

Results: the clinical emphysema rate after TEM was 0,02%. The most frequent symptoms is crepitation in lower abdomen and fever. Increase in C-reactive protein level and leukocytosis — important markers. The method of choice for diagnosis is computed tomography. Management of emphysema symptoms is possible with conservative methods.

Conclusion: the accumulation of experience in the treatment of emphysema after TEM will allow a unified approach of managing these patients.

Aim: to present a clinical case of a rare granular cell tumor (Abrikosov’s tumor) with perianal site.

Patients and Methods: a patient had a slowly progressive growth of a perianal tumor. The tumor with dimensions of 40 × 30 mm intimately adheres to the lower ampullary rectum and anterior portion of m. levator ani, no signs of malignant transformation occurred. Trepanobiopsy was performed followed by immunohistochemical study. The biopsies contain mainly fibrous tissue and clusters of cells with rounded nuclei and granular cytoplasm. Immunohistochemistry showed diffuse positive cytoplasmic reaction with antibodies to S100. The tumor was positive for CD8, vimentin and negative for GFAP. The expression of the Ki67 protein was 2%. Diagnosis: granulocellular tumor (Abrikosov’s tumor), the tumor was removed by perineal access.

Resultss: the removal of the tumor, originating from the low rectum, was performed with perineal access and with the restoration of the muscular layer of the bowel wall. No complications occurred, patient discharged 5 days after surgery.

Conclusion: Abrikosov’s tumor is a rare benign neoplasm. Surgery is possible in coloproctological units with sufficient level of surgeons.

Background: metastasis in lateral pelvic lymph nodes (LPLN) occurred in 6–15% of patients with middle or low rectal cancer. Currently there are still no criteria of diagnosis of this. There is no generally accepted management this group of the patients.

Aim: to systematize the available literature data about lateral pelvic lymph node dissection in patients with rectal cancer.

Materials and Methods: literature search was performed in the PubMed and e-Library databases using the keywords: LLND, lateral lymph node, rectal cancer, lymphodissection. The search date: July 2023.

Results: preoperative CRT with total mesorectumectomy supplemented with selective LTLD for suspected metastases seems to be a rational strategy to achieve a favorable oncological treatment outcome.

Conclusion: Additional studies are required.

Aim: to compare the efficacy and safety of hybrid laparo-endoscopic operations and laparoscopic segmental colectomy for benign endoscopically non-removable colorectal tumors.

Materials and Methods: systematic review and meta-analysis included 17 studies which evaluate the results of hybrid laparo-endoscopic procedure (main group) and laparoscopic segmental colectomy (control group). The study included 835 patients — 517 in main group and 318 controls.

Results: operation time was significantly lower in main than in control group (mean difference = −38,7 minutes; 95% CI: −51,4 — −26, p < 0,00001). There was significant difference in postoperative hospital stay. It was shorter in main group (mean difference = −2,3 days; 95% CI: −3,17 — −1,57, p < 0,00001). There was not significant difference between odds ratio of postoperative morbidity (OR = 0,7; 95% CI: 0,38–1,53, p = 0,44), mortality (OR = 0,4; 95% CI: 0,07–3,11, p = 0,43) and local recurrence rate as well (OR = 2,8; 95% CI: 0,68–11,35, p = 0,15).

Conclusion: the hybrid laparo-endoscopic technique patients with benign endoscopically non-removable colon tumors does not increase the postoperative morbidity and mortality. At the same time, the hybrid technology reduces the operation time and postoperative hospital stay.

Currently, there is no clear answer which option of preventive intestinal stoma should be preferrable after low anterior resection for rectal cancer. The aim of this review was to search predictors of complications of preventive ileostomy. The disorders occur after ileostomy like dehydration, loss of electrolytes, and prerenal acute renal failure, are due to a deficiency of microvilli remaining in the digestion of the small intestine, as well as the inability of the intestine to adapt to new conditions.