AIM. To analyze the short-term and long-term outcomes two alternative surgical strategies: 1) simultaneous resections for colorectal cancer and synchronous colorectal liver metastases;2) conventional surgery for the primary tumor during the initial operation. After time, the liver resection is performed at a second operation METHODS. Meta-analysis was performed to compare outcomes simultaneous resections for colorectal cancer and synchronous colorectal liver metastases and staged surgery. Tumor localization, spread and number of metastasis, extent of operation, blood loss, length of hospital stay, postop mortality, complication rates, overall survival rates were analyzed. RESULTS. Twenty-nine studies with 5518 patients were included in meta-analysis. Multiple (р=0,007) and bilobed (р=0,0004) metastasis were more often in patients in group ofstaged resections. Major hepatectomy was also performed more often in group of staged resections. There were no significant differences in blood loss and postopirative mortality rates (p>0,05). Complication rate in group of simultaneous resections was lower than in group of staged resections (0R=0,8, 95 %CI: 0,7-1.0, p=0,048). 3- and 5-year overall survival rates were similar in both groups: 54% vs 55 %, and 37% vs 38%, respectively (р=0,007). CONCLUSION. Simultaneous resection of the primary tumor and the minor liver resection or extended hepatectomy in selected patients didn’t adversely affect on complications and mortality rates in equivalent long-term survival compared to staged liver resection. An important limitation of the present study is the bias and heterogeneity in compared groups due to retrospective data over the 20-year period.

PURPOSE. Examine the results of surgical treatment of fistulas of the anus and rectum. MATERIALS AND METHODS. Generalized material surgical treatment of 53 patients with different types of fistulas of the anus and rectum during the period 2010-2015. based coloproctological DRKTMU center. We used clinical, laboratory and instrumental methods of investigation according to generally accepted standards of coloproctology. RESULTS. We used an individualized approach, which, along with the known operations: seton, Gabriel-1, Gabriel-2, and used more modern methods of radical surgical procedures, taking into account «case» building the wall of the rectum: 1) muco-submucosal flap; 2) muco-muscular flap (consisting of mucosal and submucosal layers and inner circular smooth muscle layer of the gut). Methods of radical plastic surgery were performed in 39 (73,6%) patients with transsphincteral and extrasphincteral fistulas. Among them by the method of V.M.Maslyak (1990) - 18 (34,0 %) patients and mucosalflap according to the technique developed in the clinic - 21 (39.6%) patients. Patients satisfactorily suffered an intervention. In 4 (7,6 %) patients the disease recurred. Among them in 1 patient after 3 weeks and in 3 patients after 2-3 months after the intervention the recurrence of disease was detected. Of these in 2 (3,8 %) patients was detected transsphincteral fistulae and in 2 (3,8 %) -extrasphincteral rectumfistulas. Patients with recurrent fistulas were reoperated. CONCLUSION. The results indicate the feasibility of application in surgical proctology transanal plastic interventions with the movement of mucous-submucosal or mucosal-muscle flap from the known and improved our procedures.

The AIM of this study was to evaluate the influence of defunctioning colostomy after low anterior resection for cancer on early postoperative period and effectiveness of Fast Track protocol. MATERIALS. Retrospective analysis of medical records of 186 patients with rectal cancer who underwent anterior resection of the rectum in our department was done. All patients were allocated into 2 groups - conventional (had conventional perioperative care) and optimized (perioperative treatment according to Fast Track protocol). Both groups were subdivided into 3 subgroups (unprotected anastomosis, defunctioning colostomy and Hartmann procedure). The following data were analysed: average time of operation, operative bloodloss, volume of infusion and urination, time of mobilization removement of dranages and catheters, postoperative complications. RESULTS. Age, sex, comorbidities had no effect on decision about a preventive colostomy. The main reason for preventive colostomy was a middle-rectum location of a tumor. Preventive colostomy didn’t affect the course of early postoperative period in groups. Defunctioning colostomy effectively prevent catastrophic consequences of anastomotic leakage and didn’t compromise Fast Track protocol. CONCLUSION. Defunctioning colostomy did not reduce postoperative anastomotic leak rate, but mitigate consequences of an anastomotic leakage. Defunctioning colostomy did not affect the course of early postoperative period and Fast Track protocol.

AIM. To evaluate the influence of standardized enhanced recovery protocol on the results of oncological colorectal resections in elderly (≥75) patients. MATERIALS AND METHODS. We retrospectively analyzed the results of 745 colorectal resections, performed from March 2009 till Oct. 2016. During 2009-2013 (220 procedures, 45 among the elderly) only sporadic components of enhanced recovery were used. In 2014-2015 (354 surgeries, 82 among the elderly) new surgical team developed and started to implement a standardized enhanced recovery protocol. In 2016 (186 procedures, 51 among the elderly) the protocol was systematically used in every patient. Short-term surgical results were analyzed. RESULTS. Generally, implementation of enhanced recovery protocol led to mild but not statistically significant improvement of short-term results. Only postoperative hospital stay decreased significantly. However, we observed a dramatic improvement of short-term results after the implementation of enhanced recovery protocol among the elderly patients. CONCLUSION. Standardized evidence-based enhanced recovery protocol leads to significant improvement of short-term surgical results in elderly patients undergoing colorectal surgery for cancer.

AIM. To prove primary efficiency of Fissario in comparison with RelifAdvansfor anal fissure therapy and to confirm previously received safety data. MATERIAL AND METHODS. Multicenter, open, randomized, comparative clinical trial in parallel groups with active control (RelifAdvans) was conducted at 18 clinical centers in Russia, 188 patients participated.. Patients with deep and superficial analfissure in combination with chronic hemorrhoids were eligible for participation in trial. Patients administered investigational drugs 2 times a day for 28 days. Efficacy primary endpoint assessed as part ofpatients withfull healing of analfissure and epithelization on Day 28 from start of therapy. Also pharmacokinetics research was performed.: concentration of Nifedipinein blood plasma was assessed. Safety assessment was performed based on frequency and character of registered adverse events. RESULTS. Efficacy analysis showed statistically significant differences in favor of investigational drug in comparison with comparator on efficacy primary endpoint -part of patients with healing of anal fissure at Day 28. Difference of parts of defendants between group of investigational drug and comparator in full data population (with replacement of missed data) was 24,5 % (two-sided confidence interval 95 % for a difference of parts [11,9; 37,0 %], р <0,001), ratio of parts 1,4. Pharmacokinetics analysis based on Nifedipine concentration in plasma showed that observed concentration of Nifedipine in plasma after single rectal and topical use are significantly lower than therapeutic range. Most common adverse events registered during trial were gastrointestinal tract reactions and reactions at investigational drug application site. No serious adverse events, no serious unexpected adverse drug reactions nor cases of death were registered during trial. No influence of Fissario on results of clinical blood tests, biochemical blood tests, general urinalysis and ECG were registered during trial. CONCLUSION. Fissario, ointment for rectal and topical use, is an effective and safe drug for local therapy of acute anal fissure in combination with a chronic hemorrhoids. Fissario achieved more than 40 % superiority in comparison with Relif Advans based on anal fissure epithelizationrate at Day 28 of treatment.

INTRODUCTION. The gastro-colonic fistula: a common definition of a pathological communication between the stomach and colon. This pathology is a rare complication. Fistula can be primary (spontaneous) or secondary (iatrogenic) and can be suspected by the presence of typical symptoms. Most often it allows by the barium enema. Computer tomography and endoscopy (colonoscopy, gastroscopy) in combination with biopsy also have a certain diagnostic value. Clinical case: We present a case report of gastro-colonic fistula in a 64-year-old men patient with colon adenocarcinoma. Symptoms and clinical examination did not reveal typical signs of this complication. Colonoscopy revealed abnormal communication between the colon and stomach. It was confirmed by gastroscopy and computed tomography. Biopsy verified colon adenocarcinoma. The patient underwent radical surgery. Morphological study confirmed colon adenocarcinoma with fistula formation into the stomach. CONCLUSION. Morphological confirmation of the neoplasm grows from the originating organ (colon) to the other (stomach) with the formation of the pathologicalfistulous tract allows the diagnosis of primary colono-gastric fistula. This definition makes clear the mechanism of the fistula's formation and indicates the localization of the primary tumor.