AIM: to estimate the effectiveness of a medical decision support system based on artificial intelligence in the endoscopic diagnosis of benign tumors during tandem study.
PATIENTS AND METHODS: from October to December 2023, a single-center comparative tandem study of medical decision support system based on artificial intelligence “ArtInCol” was done. The first stage was a traditional colonoscopy under sedation, the second one — colonoscopy using AI. A pairwise comparison of the main indicators of the effectiveness was made.
RESULTS: in the primary endpoint, the polyp detection rate (PDR) in the traditional colonoscopy group was 40.6% vs 56.4% in the AI group, p = 0.0001 (RR = 1.39; 95% CI: 1.04–1.87). The mean number of lesions detected (MPP) was 1.63 (± 1.2) vs 2.47 (± 1.8) in the AI group (mean difference = 0.84; (95% CI: 1.07–0.61).
CONCLUSION: the study demonstrated the effectiveness of the original medical decision support system for benign colon tumors detection in real clinical practice. The further stage, a multicenter randomized trial is needed.

AIM: to assess the relationship between clinical features and diagnostic tests results in idiopathic megacolon/megarectum patients.
PATIENTS AND METHODS: the retrospective analysis of clinical manifestations and diagnostic tests included 157 patients with idiopathic megacolon/megarectum in 2002-2023. The diagnosis of megacolon/megarectum was verified with a barium enema, Hirschsprung’s disease was excluded byanorectal manometry and (if needed) rectal Swenson’s biopsy.
RESULTS: the rate of integral parameter “abdominal discomfort” and Wexner constipation scale rate do not significantly correlate with barium enema, gut transit test, defecography and rectal compliance test results, besides of sigmoid colon width (p = 0.03). The rate of integral parameters “defecation difficulties” correlates with rectum width (p < 0.001) and do not correlate with gut transit time, results of defecography and rectal compliance test (p > 0.05). Distal contrast retention during gut transit test is associated with rectum width only (p < 0.01). The parameters of defecography do not correlate neither clinical features nor other diagnostic tests results (p > 0.05).
CONCLUSION: there was not significant relationship between rate of abdominal discomfort, Wexner constipation scale rate and diagnostic tests results. The rate of integral parameters “defecation difficulties” significantly correlates with rectum width (based on barium enema) only. Rectum width seems to be most important parameter to assess the rectum function and in a minor degree — rectal compliance test. The defecography do not correlate either with the severity of clinical symptoms or with the results of other diagnostic methods, which casts doubt on the appropriateness of using this diagnostic test in patients with megacolon.

AIM: to compare the hernia rate and the post-operative morbidity in patients after retroperitoneal and traditional (direct) colostomy during laparoscopic APR.
PATIENTS AND METHODS: the retrospective study included patients with rectal and anal cancer after laparoscopic APE in 2019-2022. Direct or retroperitoneal end colostomy were the surgeon’s choice. Primary endpoints were the hernia rate after ≥ 1 year by abdominal CT and post-operative morbidity (Clavien-Dindo).
RESULTS: fifty patients were included in the study (30 patients with retroperitoneal colostomy and 20 patients with direct colostomy). There were no significant differences in parameters that could affect the results. Four (13.3%) vs 8 (40%) patients developed parastomal hernias in the retroperitoneal and direct colostomy group, accordingly (p = 0.045). No post-operative morbidity grade 4–5 and no other complications that could be attributed to retroperitoneal colostomy occurred. Post-operative morbidity grade 3 developed in 3 (10%) patients in the retroperitoneal colostomy group and in 1 (5%) — in the direct one (p = 0.64).
CONCLUSION: retroperitoneal colostomy in laparoscopic APE may reduce the parastomal hernia rate. It is important to conduct prospective comparative studies.

AIM: to evaluate the early results ileocecal resection with extended lymphadenectomy in patients with localized cecal cancer.
PATIENTS AND METHODS: from December 2021 until June 2023 40 patients with verified malignant cecal tumors were included in the study. The patients were divided into two groups: 20 patients underwent ileocecal resection with extended lymphadenectomy in the D3 volume; the control group included 20 right hemicolectomies with D3 lymphadenectomy.
RESULTS: no postoperative mortality. The differences were revealed in the course of the intraoperative and early postoperative period, the volume of the removed mesentery and the length of the resected section of the intestine, and the number of removed lymph nodes. Metastasis to lymph nodes was detected at the level of 201 and 202 groups.
CONCLUSION: ileocecal resection with extended D3 lymphadenectomy is an effective and safe method for localized forms of cecal cancer and can be considered as an alternative to the standard right hemicolectomy.

AIM: to assess the effectiveness of proton radiotherapy as part of a combined approach to the treatment of rectal malignancies and to assess acute radiation toxicity, which directly affects patients’ quality of life.
PATIENTS AND METHODS: between 2020 and 2023, a study included 74 patients with rectal cancer. The mean age of the patients was 65 ± 9.9 years, 44 (60%) males. Stage I occurred in 8 (10.8%) patients, stage II — in 14 (18.9%) patients, stage III — in 52 (70.3%) patients. At the first stage, all patients completed proton radiation therapy in the classical fractionation mode.
RESULTS: of the adverse events, 49 (66%) patients had grade 1–2 radiation reactions in the form of proctitis and cystitis. There were no local radiation reactions of grade 3 or higher. Systemic complications of grade 3 were noted in 2 (2%) patients in the form of hematological toxicity — anemia (1%), afebrile neutropenia (2%). Of the 62 operated patients, 12 (19.3%) people showed complete therapeutic pathomorphosis. With a median follow-up of 23 months (13;35), 1 (1.35%) patient showed continued tumor growth 28 months after completed radiotherapy, 2 (2.7%) patients had local recurrence 3 and 18 months after treatment. Distant metastases to the lungs, liver, or bones were detected in 9 (12.2%) patients, median — 12 months (6;23). Mortality during the entire observation period was 9 (12.2%) patients. Sixty-two (83.8%) patients showed no signs of relapse or progression of the disease, of which 9 (14.5%) patients did not receive any treatment after chemoradiotherapy and are in the process of active follow-up.
CONCLUSION: proton radiation therapy in patients with rectal cancer in two-year overall survival (90.5%) and progression-free survival (88.9%) are comparable with the literature data of recent studies, but are superior in overall survival pathological response (19.3%).

AIM: to develop ultrasound semiotics of solitary rectal ulcer (SRU).
PATIENTS AND METHODS: fifty-eight patients with a histologically verified SRU were included in the retrospective study. All patients underwent colonoscopy and transrectal ultrasound (TRUS). Changes in rectal wall detected by TRUS were compared with colonoscopy data.
RESULTS: On TRUS SRU is represented by a significantly thickened rectal wall (median thickness of the rectal wall in the region of SRU is 9 (7–10) mm and 5 (4–6) mm outside, p < 0.001), most often with a predominance of muscular and submucosal layers (46/58, 79%). The structure and echogenicity of these layers are changed: the connective tissue layer is visualized in muscular layer (51/58, 88%), submucosal layer is hypoechogenic (47/58, 81%), boundaries between rectal wall layers are faded (50/58, 86%). Ulcers in SRU are characterized by presence of areas where the mucous layer cannot be traced (sensitivity 100%, specificity 95%), its extent is comparable to extent of ulcers detected on colonoscopy (p = 0.528). Polypoid SRU is characterized by local thickening of the mucosa (sensitivity 89%, specificity 95%). TRUS location of the SRU in height (p = 0.644) is comparable with colonoscopy data.
CONCLUSION: the study determined general ultrasound signs of SRU and made it possible to differentiate macroscopic forms of SRU from each other with TRUS.

AIM: to assess the postoperative complications rate in the groups with intra- and extracorporeal ileotransverse anastomosis in laparoscopic right colectomy.
PATIENTS AND METHODS: a single-center, randomized, non-inferiority trial was conducted with intention-to-treat data analysis. There were two groups of patients in whom performed laparoscopic right colectomy using a standardized technique. In the main group (n = 39) intracorporeal ileotransverse anastomosis (IA) was formed, in the comparison group — extracorporeal anastomosis (EA) (n = 40).
RESULTS: the operation time in the IA group was 192.4 ± 62.3, and in the EA group — 144.1 ± 41.3 minutes (p = 0.0002). The time of anastomosis formation was also significantly different: 53 (35; 71) minutes in intracorporeal and 30 (26; 35) minutes inn extracorporeal methods (p < 0.0001). The morbidity rate was not significantly different (25.6% vs 27.5%; p = 0.95). In the main group it was 25.6%, and in the control group 27.5% (p = 0.95). Postoperative hospital stay in the main group was significantly less — 5 vs 7.3 days in the comparison group (p < 0.001).
CONCLUSION: the randomized trial demonstrated that IA is safe and comparable to EA in terms of the morbidity rate, despite its longer operation time. At the same time, in the IA group, patients achieved discharge criteria earlier, which reduced postoperative hospital stay.

AIM: to assess original method of hemorrhoidectomy with lateral ultrasonic dissection in cutting mode in patients with stages 3–4 hemorrhoids.
PATIENTS AND METHODS: a retrospective study included 140 patients with hemorrhoids 2–4 stages. In the main group (n = 80), an original technique of lateral ultrasound dissection in cutting mode was used (patent for invention No. 2722997). Patients in the control group (n = 60) underwent Milligan-Morgan hemorrhoidectomy using electrosurgical scalpel.
RESULTS: significant differences were achieved in intensity of pain syndrome, morbidity rate, which were significantly in the main group. Histology showed that the depth of coagulative necrosis when in the original technique was 145 ± 25 µm vs 1730 ± 180 µm in the controls (р < 0,001). Anorectal manometry data, significantly less dysfunction anal sphincter was noted in the postoperative period in the main group.
CONCLUSION: hemorrhoidectomy with lateral ultrasonic dissection in cutting mode reduces tissue trauma, morbidity rate and intensity of pain, and also promotes rapid restoration of anal continence.

AIM: to find histological prognostic factors for survival in patients with anorectal melanoma.
PATIENTS AND METHODS: single center retrospective study of histological specimens of patients with anorectal melanoma (2005-2023). A revision of histological specimens was carried out, using the following criteria: multifocal growth, maximum tumor size, maximum thickness by Breslow, ulceration, perineural and lymphovascular invasion, as well as depth of invasion. Statistical processing was carried out using the Cox regression.
RESULTS: twenty-one patients were included in the study. In all patients, treatment started with surgery: 13 (61.9%) — abdominoperineal excision (APE); 8 (28.1%) — local excision). The sample contained patients with the following initial stages of the process: IB–IIB — 12 (57.1%); III — 9 (42.9%). Nine (42.9%) patients developed local recurrence, and 8 (38.1%) — distant metastases. On univariate analysis, DFS was significantly affected by ulceration RR 0.061 (CI 95.0%; 0.004–0.097, p = 0.048), there was a trend towards the role of neurotropism RR 3.654 (CI 95.0%; 0.934–14.297, p = 0.063) and pigmentation RR 2.485 (CI 95.0%; 0.832–7.424, p = 0.103). In multivariate analysis, none of the criteria had a significant effect on DFS. On OS in univariate analysis was a trend towards an effect of Breslow invasion depth of more than 2 cm HR 1.028 (CI 95.0%; 0.998–1.060, p = 0.070) and depth of tumor invasion HR 2.117 (CI 95.0%; 0.990–4.525, p = 0.053). In multivariate analysis, none of the criteria had a significant effect on OS.
CONCLUSION: evaluation of the effectiveness by histological features of skin melanoma showed the potential use of neurotropism, Breslow invasion of more than 2 cm and depth of tumor invasion as factors of unfavorable impact on DFS and OS in ARM. More trials are needed.

AIM: to demonstrate the first experience of using the platform for transanal endoscopic microsurgery treatment for fistula of the colorectal anastomosis.
PATIENTS AND METHODS: from October 2017 to March 2023 5 patients (36-77 years old) with persistent fistula of the colorectal anastomosis were included in the cohort. All of them underwent rectal resection for cancer. The surgery technique was presented on clinical case with defect of colorectal anastomosis on the posterior side up to 0.5 cm length with presacral sinus up to 2.5 cm in the largest dimension.
RESULTS: no postoperative morbidity developed. Patient discharged on the 6th day.
CONCLUSION: TEM platform allows to consider it promising approach for the persistent fistula of colorectal anastomosis.

Surgical treatment of acute abdomen during the SARS-CoV-2 pandemic was accompanied by an extremely high mortality rate, however, only a few studies have presented the results of acute inflammatory complications of diverticular disease (AICDD).
AIM: analysis of treatment of AICDD in a COVID-19 hospital.
PATIENTS AND METHODS: the retrospective study included 78 patients with acute diverticulitis (AD) from a COVID hospital, confirmed by CT or intraoperative revision. Assessment of COVID pneumonia, comorbidities, organ dysfunction, CT findings, peritonitis, treatment methods, and in-hospital mortality among patients was performed.
RESULTS: organ dysfunction of ≥ 1 point on the qSOFA scale was detected in 59.0% of the patients. According to CT data, abdominal distant gas was detected in 48 (61.5%) patients, and pericolic gas in 14 (17.9%) patients. Segmental colon resection was performed in 60 (76.9%) patients, laparoscopic lavage (LL) of the abdominal cavity — in 3, non-operative treatment (NOT) with drainage of fluid collections — in 6, and only NOT in 10 patients. Most patients with distant or pericolic gas were operated on within an average time of 1 [0; 3.5] hours after admission. Diffuse peritonitis was detected during surgery in 45 (75%) of them. After resection, organ dysfunction of ≥ 2 points on the SOFA scale developed or progressed in 52 (86.7%) patients. The overall mortality rate was 48.7%, and the postoperative mortality was 63.3%. All patients (n = 38) died after segmental colon resection. Successful NOT was achieved in 4 patients with pericolic gas and 3 patients with distant gas.
CONCLUSION: surgery for AICDD in patients with COVID-19 is associated with extremely high mortality, therefore, in the absence of obvious signs of diffuse peritonitis, initial non-operative treatment may be life-saving.

AIM: to assess the impact of colorectal anastomotic leakage on the severity of low anterior rectal resection syndrome and the quality of life.
PATIENTS AND METHODS: the results of 375 patients with rectal tumors were analyzed. In 26 patients, surgery was complicated by anastomosis failure. For a assessment of the quality of life of patients with anastomotic leakage, each patient was matched with a pair from the group of respondents with an uncomplicated postoperative period. The quality of life was assessed in all patients using the EORTC QLQ-C30 questionnaire with the Cr-29 module.
RESULTS: patients with anastomosis leakage have more severe low anterior rectal resection syndrome — 29 (17;34), versus 20 (9;28) points (p = 0.03) and a lower global score (p = 0.01), physical (p = 0.01) and social (p = 0.04) functioning. The symptom scales of the EORTC QLQ-C30 questionnaire, supplemented by the Cr-29 module, had significant differences between groups on the scales of body image (p = 0.01), fecal incontinence (p = 0.04) and embarrassment (p = 0.01).
CONCLUSION: colorectal anastomosis leakage negatively affects the quality of life of patients.

AIM: the optimal extent of adhesiolysis for stoma takedown after Hartmann’s procedure is still unknown. This study is for evaluation the early and late results after partial and total dissection of adhesions during Hartmann’s reversal (HR).
PATIENTS AND METHODS: a prospective non-randomized study included 99 patients with end colostomy. Fifty patients were included in the main group, in which partial adhesiolysis was performed during HR, and 49 — were the control group, in which complete dissection of adhesions was performed. The groups did not differ in the basic demographic characteristics, number of previous operations, and the severity of the adhesions.
RESULTS: the operation time in the groups of partial and total adhesiolysis was 222 vs 205 minutes, respectively (p = 0.9). Injury of the intestinal wall occurred in 18 patients in the main group, and in 19 controls (p = 0.8). The postoperative stay was 12 in the main group vs 11 in the control (p = 0.7). The morbidity rate in the main group was 42% (n = 21), in controls — 29% (n = 14) (p = 0.2). Reoperations were performed in 4 patients of the main group, no reoperations in the control group were required, but no significant differences were obtained (p = 0.5). In the group of partial adhesiolysis, 1 fatal outcome was registered. By the regression analysis, the only factor increasing the likelihood of postoperative complications was a BMI > 35 kg/m2 (OR = 5.3; 95% CI: 1.5–21.2; p = 0.01).
CONCLUSION: total adhesiolysis does not affect the operation time and traumatism of Hartmann reversal, does not increase morbidity rate.

AIM: to present a rare clinical observation of a combination of Crohn’s disease (CD) and breast cancer (BC).
PATIENTS AND METHODS: the case of accidental detection of metastatic lesions of the mesentery of the small intestine and the walls of the small and large intestines in patient A., 46 years old, during reconstructive surgery after ileum resection for CD is described. A preoperative standard examination (chest X-ray, mammography, CT scan of the abdominal cavity), except for infiltration in the middle third of the transverse colon, revealed no other pathology.
RESULTS: laparotomy, right-sided hemicolectomy, resection of the terminal ileum, formation of ilotransverse anastomosis side by side were performed elective. During the operation, the loop of the ileum and its mesentery 20 cm from the edge of the ileostomy had specific signs of CD. Histology revealed metastasis of breast carcinoma ICD-O code 8500/6. The postoperative period was uneventful. The patient was discharged on the 8th day with recommendations to continue anti-relapse therapy with vedolizumab. After receiving the results of the IHC study, further examination by an oncologist-mammologist was also recommended. Upon further checkup in the oncological institution, signs of lung metastases, pleural carcinomatosis, damage to the lymph nodes of the mediastinum, lymph nodes of the axillary region, the left subsectoral group and supraclavicular nodes on the left were revealed. Chemotherapists, along with recommendations for the treatment of breast cancer, confirmed the need to continue taking vedolizumab for the treatment of CD.
CONCLUSION: the clinical case demonstrates the detection of CD and breast cancer in one patient at the same time, which is rare in routine practice. The common pathogenesis of CD and breast cancer causes both the complexity of differential diagnosis and complicates the search for adequate treatment. The emergence of new biological drugs, such as vedolizumab, provides additional opportunities for the management of such a complex category of patients, demonstrating a high safety profile in relation to the risk of development and progression of cancer.

AIM: to compare the diagnostic informativeness of mucosal dye spraying (chromoendoscopy) (CE) and virtual chromoendoscopy (VCE) in detecting dysplasia in patients with a long history ulcerative colitis (UC).
MATERIALS AND METHODS: a systematic review and meta-analysis of studies comparing the results of the use of CE and VCE for the diagnosis of colitis-associated dysplasia was performed. The following indicators were evaluated: the frequency of patients with endoscopically detected colitis-associated dysplasia and the frequency of endoscopic diagnosis of colitis-associated dysplasia among the total number of identified lesions. The statistical analysis was carried out using the Review Manager software 5.3
RESULTS: the systematic review included 4 studies, analyzing 364 patients in total. In the study groups, there were no statistical differences in patients with endoscopically detected colitis-associated dysplasia and in endoscopic diagnosis of colitis-associated dysplasia among total number of detected colorectal neoplasms (OR = 0.87; 95% CI 0.60–1.27; p = 0.47 and OR = 0.82; 95% CI 0.58–1.18; p = 0.29).
CONCLUSION: meta-analysis could not demonstrate a significant difference between CE and VCE. However, additional studies are needed to recognize the role of VCE in the differentiation of neoplastic and non-neoplastic lesions in patients with UC

AIM: to study the effect of total neoadjuvant therapy with consolidation chemotherapy for rectal cancer.
MATERIALS AND METHODS: the meta-analysis performed in accordance with PRISMA practices and guidelines.
RESULTS: short-course radiotherapy with consolidation chemotherapy compared to chemoradiotherapy (CRT) improves the rate of complete pathological responses (OR = 1.88; CI 1.47–2.42; p < 0.00001); does not affect the rate of local relapses (OR = 0.95; CI 0.72–1.24; p = 0.69), three-year disease-free survival (OR = 1.19; CI 0.99–1.44; p = 0.06) and overall survival (OR = 1.09; CI 0.88–1.35; p = 0.45). TNT increases the incidence of grade ≥ 3 toxicity (OR = 1.87; CI 1.10–3.18; p = 0.02), and does not affect treatment compliance (OR = 0.57; CI 0.17–1.95; p = 0.37).
CONCLUSION: the use of TNT can improve the oncological results of treatment of patients with rectal cancer by increasing the frequency of complete pathological responses.

BACKGROUND: patients with rectal cancer after low anterior resections and with permanent colostomy inevitably face negative functional consequences of treatment. The question of anastomosis performing often remains unanswered. AIM: to compare the quality of life of patients with rectal cancer after low anterior resections and surgical treatment with a permanent colostomy.
MATERIALS AND METHODS: literature search was performed in MEDLINE database according to PRISMA criteria using the keywords: “QoL”, “Quality of life”, “EORTC”, “low anterior resection” “rectal”, “stoma”, “ostomy” using suffixes [OR], [AND]. The meta-analysis included 9 retrospective studies with 2438 patients.
RESULTS: no significant differences were found in global health status between the groups (p = 0.11). A significant difference with a worse score in ostomy patients is noted on the physical (p = 0.003), role (p = 0.002), emotional (p = 0.03) and social functioning (p = 0.004). In contrast, patients undergoing sphincter-preserving surgery have a higher incidence of constipation and diarrhea (p < 0.00001).
CONCLUSION: patients with permanent stoma and after low anterior resections have comparable global health status. These patients have different profiles of disturbances in QoL patterns and functional consequences of surgery.

INTRODUCTION: genetically engineered biological drugs (GIBD) used in the treatment of moderate to severe inflammatory bowel diseases (IBD) currently. Despite a significant improvement in disease outcomes, improvement in the quality of life of patients and a decrease in surgical activity, in the long term, it is often not possible to achieve full-fledged clinical and instrumental remission or the loose of response over time.
OBJECTIVE: to systematize data on the efficacy and safety of IBD infliximab therapy, as well as methods of early and late efficacy assessment; indications, types and features of therapy optimization.
CONCLUSIONS: despite the appearance of a relatively large number of new GIBD and TIS, the problem of inefficiency or loss of response remains. In our opinion, the solution to this problem may be the personification of the appointment and treatment regimens of GIBP. Currently, there are many studies devoted to both clinical and laboratory markers of prognostic importance in the management of patients with IBD during infliximab therapy. However, these studies are not localized for the Russian patient population. Multicenter studies on the Russian patient population are required.

AIM: to study modern approaches to the application of machine learning and deep learning technologies for the management of patients with colorectal cancer.
MATERIALS AND METHODS: after screening 398 publications, 112 articles were selected and the full text of the works was studied. After studying the full texts of the articles, the works were selected, machine learning models in which showed an accuracy of more than 80%. The results of 41 original publications were used to write this review.
RESULTS: several areas have been identified that are the most promising for the use of artificial intelligence technologies in the management of patients with colorectal cancer. They are predicting the response to neoadjuvant treatment, predicting the risks of metastasis and recurrence of the disease, predicting the toxicity of chemotherapy, assessing the risks of leakage of colorectal anastomoses. As the most promising factors that can be used to train models, researchers consider clinical parameters, the immune environment of the tumor, tumor RNA signatures, as well as visual pathomorphological characteristics. The models for predicting the risk of liver metastases in patients with stage T1 (AUC = 0.9631), as well as models aimed at assessing the risk of 30-day mortality during chemotherapy (AUC = 0.924), were characterized with the greatest accuracy. Most of the technologies discussed in this paper are software products trained on data sets of different quality and quantity, which are able to suggest a treatment scenario based on predictive models, and, in fact, can be used as a doctor’s assistant with very limited functionality.
CONCLUSION: the current level of digital technologies in oncology and in the treatment of colorectal cancer does not allow us to talk about a strong AI capable of making decisions about the treatment of patients without medical supervision. Personalized treatment based on the microbiotic and mutation spectrum and, for example, personal pharmacokinetics, so far look fantastic, but certainly promising for future developments.