Pub Date : 2023-06-21DOI: 10.33878/2073-7556-2023-22-2-112-117
E. I. Semionkin, D. A. Khubezov, R. V. Lucanin, D. K. Puchkov, A. Y. Ogoreltzev, E. A. Yudina, I. Bragina, A. S. Gordeeva
AIM: to evaluate the effectiveness of transabdominal ultrasound for complicated diverticular disease (CDD).PATIENTS AND METHODS: a retrospective study included 108 patients with CDD. All patients had left-sided diverticula, while in the vast majority of patients, diverticula were located in the sigmoid colon.RESULTS: transabdominal ultrasound was informative in 84.3% of patients; in 74.1% of cases (80 patients), diverticula were clearly identified with sizing, infiltration of the intestinal wall, fluid around the intestine, the presence of a fistulous tract in perforation, gas collections; 11 (10.2%) patients had indirect signs, such as diffuse hypoechogenic thickening of the intestinal wall, its infiltration, fistulous tract, liquid near the intestine, hyperechogenic structure of fat near the intestine, the presence of a paracolic abscess, absence or slowing down of peristalsis; 17 (15.7%) patients showed no changes, one had a false positive conclusion.CONCLUSION: transabdominal ultrasound is an informative and non-invasive method for diagnosing complicated diverticular disease in urgent surgery.
{"title":"Transabdominal ultrasound for complicated diverticular disease","authors":"E. I. Semionkin, D. A. Khubezov, R. V. Lucanin, D. K. Puchkov, A. Y. Ogoreltzev, E. A. Yudina, I. Bragina, A. S. Gordeeva","doi":"10.33878/2073-7556-2023-22-2-112-117","DOIUrl":"https://doi.org/10.33878/2073-7556-2023-22-2-112-117","url":null,"abstract":"AIM: to evaluate the effectiveness of transabdominal ultrasound for complicated diverticular disease (CDD).PATIENTS AND METHODS: a retrospective study included 108 patients with CDD. All patients had left-sided diverticula, while in the vast majority of patients, diverticula were located in the sigmoid colon.RESULTS: transabdominal ultrasound was informative in 84.3% of patients; in 74.1% of cases (80 patients), diverticula were clearly identified with sizing, infiltration of the intestinal wall, fluid around the intestine, the presence of a fistulous tract in perforation, gas collections; 11 (10.2%) patients had indirect signs, such as diffuse hypoechogenic thickening of the intestinal wall, its infiltration, fistulous tract, liquid near the intestine, hyperechogenic structure of fat near the intestine, the presence of a paracolic abscess, absence or slowing down of peristalsis; 17 (15.7%) patients showed no changes, one had a false positive conclusion.CONCLUSION: transabdominal ultrasound is an informative and non-invasive method for diagnosing complicated diverticular disease in urgent surgery.","PeriodicalId":17840,"journal":{"name":"Koloproktologia","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-06-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"86979522","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-06-21DOI: 10.33878/2073-7556-2023-22-2-86-91
I. A. Matveev, B. K. Gibert, A. I. Matveev, N. A. Borodin, L. A. Morozova, N. N. Povarnin
AIM: to assess of the results of transmucosal laser ablation (TMLA) for internal piles and simultaneous elimination of external piles in patients with combined hemorrhoids of 2–3 stages.PATIENTS AND METHODS: the retrospective study included 226 patients. TMLA of internal nodes with excision or destruction of external piles was performed in 136 patients (the main group) and 90 laser destructions of internal nodes only consisted the control group. The procedure was performed under local anesthesia on a Lakhta-Milon device with a wavelength of 1.47 μm with a power of 8.0 W. The operation time, the pain syndrome, its duration after surgery, the complication rate and the recurrence rate up to 18 months were estimated.RESULTS: the operation time in the main group was 15.0 minutes (10 min in control group; p = 0.001), the pain intensity during procedure was determined by patients at 2.5 points of VAS (2.5 — in controls; p = 0.81). Postoperative pain was detected up to 6 days (5 days in controls; p = 0.44). Postoperative bleeding occurred in 4 (2.9%) (8 — in controls; p = 0.051), recurrence occurred in 3 (4.8%) patients after 12 months (1 patient in controls; p = 0.5).СONCLUSION: TMLA has a good tolerability and good late results, which is the motivation for wide implementation for patients with hemorrhoids in outpatient basis.
{"title":"Transmucosal laser ablation for combined hemorrhoids of 2–3 stages","authors":"I. A. Matveev, B. K. Gibert, A. I. Matveev, N. A. Borodin, L. A. Morozova, N. N. Povarnin","doi":"10.33878/2073-7556-2023-22-2-86-91","DOIUrl":"https://doi.org/10.33878/2073-7556-2023-22-2-86-91","url":null,"abstract":"AIM: to assess of the results of transmucosal laser ablation (TMLA) for internal piles and simultaneous elimination of external piles in patients with combined hemorrhoids of 2–3 stages.PATIENTS AND METHODS: the retrospective study included 226 patients. TMLA of internal nodes with excision or destruction of external piles was performed in 136 patients (the main group) and 90 laser destructions of internal nodes only consisted the control group. The procedure was performed under local anesthesia on a Lakhta-Milon device with a wavelength of 1.47 μm with a power of 8.0 W. The operation time, the pain syndrome, its duration after surgery, the complication rate and the recurrence rate up to 18 months were estimated.RESULTS: the operation time in the main group was 15.0 minutes (10 min in control group; p = 0.001), the pain intensity during procedure was determined by patients at 2.5 points of VAS (2.5 — in controls; p = 0.81). Postoperative pain was detected up to 6 days (5 days in controls; p = 0.44). Postoperative bleeding occurred in 4 (2.9%) (8 — in controls; p = 0.051), recurrence occurred in 3 (4.8%) patients after 12 months (1 patient in controls; p = 0.5).СONCLUSION: TMLA has a good tolerability and good late results, which is the motivation for wide implementation for patients with hemorrhoids in outpatient basis.","PeriodicalId":17840,"journal":{"name":"Koloproktologia","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-06-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"85812643","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-06-21DOI: 10.33878/2073-7556-2023-22-2-70-78
A. Zakharenko, M. V. Zavgorodniaia, A. Afanasiev, A. Potapchuk
AIM: to estimate effect of unimodal short preabilitation on functional reserves of patients, hospital stay, complication rate and quality of life.PATIENTS AND METHODS: a single-centre, prospective, randomized study will include 128 patients undergoing colon resection for colorectal cancer. Patients will be divided into an intervention group that will receive 14 days of unimodal prehab (Group 1) and a control group that will not receive prehab (Group 2). Perioperative management of patients in both groups will be carried out in accordance with the guidelines for accelerated recovery after surgery (ERAS). The primary endpoint of the study will be the six-minute walk test (6MWT). Secondary endpoints will be: number of postoperative complications (by Clavien-Dindo), duration of the postoperative period, postoperative mortality, quality of life of patients and adherence of patients to the passage of the prehabilitation program.DISCUSSION AND CONCLUSION: it is expected that short-term unimodal prehabilitation will improve the functional reserves of patients, reduce the duration of inpatient treatment and reduce the number and severity of postoperative complications, which can lead to a decrease in postoperative mortality and an improvement in the quality of life of patients. The adherence of the domestic cohort of patients to prehabilitation will be analyzed.
{"title":"Short-term prehabilitation of patients with colorectal cancer — protocol of a randomized trial","authors":"A. Zakharenko, M. V. Zavgorodniaia, A. Afanasiev, A. Potapchuk","doi":"10.33878/2073-7556-2023-22-2-70-78","DOIUrl":"https://doi.org/10.33878/2073-7556-2023-22-2-70-78","url":null,"abstract":"AIM: to estimate effect of unimodal short preabilitation on functional reserves of patients, hospital stay, complication rate and quality of life.PATIENTS AND METHODS: a single-centre, prospective, randomized study will include 128 patients undergoing colon resection for colorectal cancer. Patients will be divided into an intervention group that will receive 14 days of unimodal prehab (Group 1) and a control group that will not receive prehab (Group 2). Perioperative management of patients in both groups will be carried out in accordance with the guidelines for accelerated recovery after surgery (ERAS). The primary endpoint of the study will be the six-minute walk test (6MWT). Secondary endpoints will be: number of postoperative complications (by Clavien-Dindo), duration of the postoperative period, postoperative mortality, quality of life of patients and adherence of patients to the passage of the prehabilitation program.DISCUSSION AND CONCLUSION: it is expected that short-term unimodal prehabilitation will improve the functional reserves of patients, reduce the duration of inpatient treatment and reduce the number and severity of postoperative complications, which can lead to a decrease in postoperative mortality and an improvement in the quality of life of patients. The adherence of the domestic cohort of patients to prehabilitation will be analyzed.","PeriodicalId":17840,"journal":{"name":"Koloproktologia","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-06-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"72597397","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-06-21DOI: 10.33878/2073-7556-2023-22-2-160-171
P. Maksimova, E. Golubinskaya, B. D. Seferov, E. Zyablitskaya
This article analyzes the statistical data on colorectal cancer in Russia and in the world, including incidence, mortality and survival. The main pathways of colorectal cancer carcinogenesis, molecular subtypes and their influence on the difference in lesions of the proximal and distal large intestine are presented. The paper provides an overview of the leading chemotherapy agents and targeted therapy in colorectal cancer, as well as the main reasons for the development of therapeutic resistance, including changes in the cellular microenvironment of the tumor.
{"title":"Colorectal cancer: epidemiology, carcinogenesis, molecular subtypes and cellular mechanisms of therapy resistance (analytical review)","authors":"P. Maksimova, E. Golubinskaya, B. D. Seferov, E. Zyablitskaya","doi":"10.33878/2073-7556-2023-22-2-160-171","DOIUrl":"https://doi.org/10.33878/2073-7556-2023-22-2-160-171","url":null,"abstract":"This article analyzes the statistical data on colorectal cancer in Russia and in the world, including incidence, mortality and survival. The main pathways of colorectal cancer carcinogenesis, molecular subtypes and their influence on the difference in lesions of the proximal and distal large intestine are presented. The paper provides an overview of the leading chemotherapy agents and targeted therapy in colorectal cancer, as well as the main reasons for the development of therapeutic resistance, including changes in the cellular microenvironment of the tumor.","PeriodicalId":17840,"journal":{"name":"Koloproktologia","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-06-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"78764112","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-06-21DOI: 10.33878/2073-7556-2023-22-2-64-69
E. N. Desyatov, F. Aliev, M. S. Tsvetkov, I. S. Verkhovodova, I. L. Yakovleva
AIM: to evaluate the pilot program results for colorectal cancer (CRC) screening of the Sverdlovsk region (April — October 2021)PATIENTS AND METHODS: a pilot program of three-stage CRC screening included at the first stage, the fecal immunochemical test was performed (patients aged 45–65 years). The second stage included questionnaire. According to the results of the questioning, patients with a positive fecal test and a potential risk of CRC underwent colonoscopy at the third stage.RESULTS: at the first and second stages, 969 fecal immunochemical tests and questionnaires were performed. In 149 (15.4%) cases, a positive fecal test was detected. In 22 cases, employees with a negative fecal test were referred for colonoscopy according to the results of the questionnaire. At the third stage, 168 screening colonoscopies were performed. In 87 (51.5%) patients, epithelial colorectal neoplasia was detected, adenoma — in 57 (33.7%) cases, adenocarcinoma in 4 (2.4%), including T0 — in 3 patients, T2 — in 1 patient. In 182 cases, neoplasia occurred in 17.6% in the rectum and in 82.4% in the colon.CONCLUSION: colorectal cancer (CRC) screening showed high efficacy.
{"title":"Screening for colorectal cancer in employees of ROSTEСH enterprises in the Sverdlovsk region. Pilot project","authors":"E. N. Desyatov, F. Aliev, M. S. Tsvetkov, I. S. Verkhovodova, I. L. Yakovleva","doi":"10.33878/2073-7556-2023-22-2-64-69","DOIUrl":"https://doi.org/10.33878/2073-7556-2023-22-2-64-69","url":null,"abstract":"AIM: to evaluate the pilot program results for colorectal cancer (CRC) screening of the Sverdlovsk region (April — October 2021)PATIENTS AND METHODS: a pilot program of three-stage CRC screening included at the first stage, the fecal immunochemical test was performed (patients aged 45–65 years). The second stage included questionnaire. According to the results of the questioning, patients with a positive fecal test and a potential risk of CRC underwent colonoscopy at the third stage.RESULTS: at the first and second stages, 969 fecal immunochemical tests and questionnaires were performed. In 149 (15.4%) cases, a positive fecal test was detected. In 22 cases, employees with a negative fecal test were referred for colonoscopy according to the results of the questionnaire. At the third stage, 168 screening colonoscopies were performed. In 87 (51.5%) patients, epithelial colorectal neoplasia was detected, adenoma — in 57 (33.7%) cases, adenocarcinoma in 4 (2.4%), including T0 — in 3 patients, T2 — in 1 patient. In 182 cases, neoplasia occurred in 17.6% in the rectum and in 82.4% in the colon.CONCLUSION: colorectal cancer (CRC) screening showed high efficacy.","PeriodicalId":17840,"journal":{"name":"Koloproktologia","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-06-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"90203550","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-06-21DOI: 10.33878/2073-7556-2023-22-2-79-85
N. V. Malgina, G. Rodoman, T. U. Dolgina
AIM: to assess late results of parastomal hernia repair using Sugarbaker’s technique modifications.PATIENTS AND METHODS: prospective non-randomised study included 60 patients with parastomal hernia, which underwent surgery in 2013-2019. Patients were divided in two groups. The control group included 30 patients with “classic” Sugabacker method, the main group included 30 patients with Sugarbaker’s procedure added by suture of abdominal wall defect. Both groups were homogenous by age, gender, hernia size, type of primal disease and preoperative quality of life (EQ-5D-5L). The efficacy of the treatment was estimated by recurrence rate and quality of life 1 and 2 years after surgery.RESULTS: the recurrence rate in the main group was significantly lower after 1 and 2 years (3 vs 13; p = 0.01). Quality of life in the main group was significantly higher after the first year of follow-up (the median of the weighted coefficient 0.92 vs 0.89; p = 0.04) and this trend has preserved 2 years after surgery.CONCLUSION: suture of abdominal wall defect in Sugarbaker’s procedure for parastomal hernia reduces recurrence rate significantly and provides better quality of life.
目的:评价Sugarbaker技术改良修复造口旁疝的后期效果。患者和方法:前瞻性非随机研究纳入了60例造口旁疝患者，这些患者于2013-2019年接受了手术。患者分为两组。对照组30例采用“经典”Sugarbaker方法，主组30例采用Sugarbaker方法加腹壁缺损缝合。两组患者的年龄、性别、疝大小、原发疾病类型和术前生活质量(EQ-5D-5L)均相同。通过术后1年和2年的复发率和生活质量来评估治疗效果。结果:主组1年和2年复发率显著低于对照组(3 vs 13;P = 0.01)。随访一年后，主组患者的生活质量显著提高(加权系数中位数0.92 vs 0.89;P = 0.04)，术后2年仍保持这一趋势。结论:Sugarbaker术中腹壁缺损缝合治疗造口旁疝可显著降低复发率，提高患者的生活质量。
{"title":"Late outcomes of parastomal hernia repair","authors":"N. V. Malgina, G. Rodoman, T. U. Dolgina","doi":"10.33878/2073-7556-2023-22-2-79-85","DOIUrl":"https://doi.org/10.33878/2073-7556-2023-22-2-79-85","url":null,"abstract":"AIM: to assess late results of parastomal hernia repair using Sugarbaker’s technique modifications.PATIENTS AND METHODS: prospective non-randomised study included 60 patients with parastomal hernia, which underwent surgery in 2013-2019. Patients were divided in two groups. The control group included 30 patients with “classic” Sugabacker method, the main group included 30 patients with Sugarbaker’s procedure added by suture of abdominal wall defect. Both groups were homogenous by age, gender, hernia size, type of primal disease and preoperative quality of life (EQ-5D-5L). The efficacy of the treatment was estimated by recurrence rate and quality of life 1 and 2 years after surgery.RESULTS: the recurrence rate in the main group was significantly lower after 1 and 2 years (3 vs 13; p = 0.01). Quality of life in the main group was significantly higher after the first year of follow-up (the median of the weighted coefficient 0.92 vs 0.89; p = 0.04) and this trend has preserved 2 years after surgery.CONCLUSION: suture of abdominal wall defect in Sugarbaker’s procedure for parastomal hernia reduces recurrence rate significantly and provides better quality of life.","PeriodicalId":17840,"journal":{"name":"Koloproktologia","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-06-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"84200868","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-06-21DOI: 10.33878/2073-7556-2023-22-2-126-140
Iuliia Alimova, Y. Shelygin, E. Rybakov, M. Alekseev
AIM: to evaluate outcomes (overall survival, rate of surgical intervention due to complications of first treatment, 30-day mortality rate) of palliative primary tumor resection (PTR) followed by chemotherapy and chemotherapy/ radiotherapy (chemo/RT) alone in patients with asymptomatic or minimally symptomatic colorectal cancer (CRC) and synchronous unresectable metastases.MATERIALS AND METHODS: a meta-analysis based on Preferred Reporting Items for Systematic Reviews and Metaanalyses (PRISMA) guidelines was conducted on PubMed and Cochrane database. Odds ratio (OR) and 95% confidence interval (95% CI) were used as the treatment effect measure for comparing results. Combined overall effect measures were calculated for a random effect model. All analyses were performed using the Review Manager 5.3 software.RESULTS: eighteen non-randomized studies, including a total of 2,999 patients (1,737 PTR and 1,262 chemo/RT) were identified. Gender, age, site of primary tumor and distant metastasis of patients were comparable between groups in all analyzed studies. Two-year (38.2% vs. 21.1%; OR 0.42; 95% CI 0.28–0.64; p < 0.0001) and 5-year (12.7% vs. 5.3%; OR 0.45; 95% CI 0.21–0.97; p = 0.04) overall survival rates were significantly higher in the PTR group than in the chemo/RT group. No significant differences in 30-day mortality rate between the two groups (1.7% vs. 1%; OR 1.92; 95% CI 0.79–4.68; p = 0.15). However, the rate of surgical intervention due to complications of first treatment was significantly lower in the PTR group comparing to the chemo/RT group (2.3% vs. 14.53%; OR 0.18; 95% CI 0.08–0.40; p < 0.0001). At the same time, one hundred and fourteen patients (13.8%; OR 0.19; 95% CI 0.09–0.40; p < 0.0001) in the chemo/RT group required surgery for symptoms associated with a primary tumor.CONCLUSIONS: PTR in patients with asymptomatic or minimally symptomatic CRC and synchronous unresectable metastases significantly improves overall survival, allows to prevent surgical intervention due to complications related to primary tumor and is not associated with increased postoperative mortality rate comparing to systemic chemotherapy/radiotherapy as a treatment of first line. The current data are based on non-randomized comparative studies and data from early terminated randomized controlled trials (RCTs) and further well-designed RCTs are required.
目的:评价无症状或最低症状结直肠癌(CRC)伴同步不可切除转移的患者姑息性原发肿瘤切除(PTR)后化疗和单独化疗/放疗(chemo/RT)的预后(总生存率、首次治疗并发症手术干预率、30天死亡率)。材料和方法:在PubMed和Cochrane数据库中进行基于系统评价和荟萃分析首选报告项目(PRISMA)指南的荟萃分析。采用优势比(Odds ratio, OR)和95%置信区间(95% CI)作为治疗效果的衡量标准来比较结果。计算随机效应模型的综合总体效应测度。所有的分析都使用Review Manager 5.3软件进行。结果:18项非随机研究，共纳入2999例患者(1737例PTR和1262例化疗/RT)。在所有分析的研究中，患者的性别、年龄、原发肿瘤部位和远处转移在组间具有可比性。2年(38.2% vs. 21.1%;或0.42;95% ci 0.28-0.64;P < 0.0001)和5年(12.7% vs. 5.3%;或0.45;95% ci 0.21-0.97;p = 0.04) PTR组总生存率显著高于化疗/RT组。两组间30天死亡率无显著差异(1.7% vs. 1%;或1.92;95% ci 0.79-4.68;P = 0.15)。然而，PTR组因首次治疗并发症而进行手术干预的比率明显低于化疗/RT组(2.3% vs. 14.53%;或0.18;95% ci 0.08-0.40;P < 0.0001)。同时，114例患者(13.8%;或0.19;95% ci 0.09-0.40;p < 0.0001)，化疗/放疗组需要手术治疗与原发肿瘤相关的症状。结论:与作为一线治疗的全身化疗/放疗相比，PTR在无症状或最低症状的结直肠癌和同步不可切除转移的患者中显著提高了总生存率，允许防止因原发肿瘤相关并发症而进行手术干预，并且与术后死亡率增加无关。目前的数据是基于非随机对照研究和早期终止随机对照试验(rct)的数据，需要进一步设计良好的rct。
{"title":"Palliative primary tumor resection in minimally symptomatic (asymptomatic) patients with colorectal cancer and synchronous unresectable metastases versus chemotherapy alone: a metaanalysis","authors":"Iuliia Alimova, Y. Shelygin, E. Rybakov, M. Alekseev","doi":"10.33878/2073-7556-2023-22-2-126-140","DOIUrl":"https://doi.org/10.33878/2073-7556-2023-22-2-126-140","url":null,"abstract":"AIM: to evaluate outcomes (overall survival, rate of surgical intervention due to complications of first treatment, 30-day mortality rate) of palliative primary tumor resection (PTR) followed by chemotherapy and chemotherapy/ radiotherapy (chemo/RT) alone in patients with asymptomatic or minimally symptomatic colorectal cancer (CRC) and synchronous unresectable metastases.MATERIALS AND METHODS: a meta-analysis based on Preferred Reporting Items for Systematic Reviews and Metaanalyses (PRISMA) guidelines was conducted on PubMed and Cochrane database. Odds ratio (OR) and 95% confidence interval (95% CI) were used as the treatment effect measure for comparing results. Combined overall effect measures were calculated for a random effect model. All analyses were performed using the Review Manager 5.3 software.RESULTS: eighteen non-randomized studies, including a total of 2,999 patients (1,737 PTR and 1,262 chemo/RT) were identified. Gender, age, site of primary tumor and distant metastasis of patients were comparable between groups in all analyzed studies. Two-year (38.2% vs. 21.1%; OR 0.42; 95% CI 0.28–0.64; p < 0.0001) and 5-year (12.7% vs. 5.3%; OR 0.45; 95% CI 0.21–0.97; p = 0.04) overall survival rates were significantly higher in the PTR group than in the chemo/RT group. No significant differences in 30-day mortality rate between the two groups (1.7% vs. 1%; OR 1.92; 95% CI 0.79–4.68; p = 0.15). However, the rate of surgical intervention due to complications of first treatment was significantly lower in the PTR group comparing to the chemo/RT group (2.3% vs. 14.53%; OR 0.18; 95% CI 0.08–0.40; p < 0.0001). At the same time, one hundred and fourteen patients (13.8%; OR 0.19; 95% CI 0.09–0.40; p < 0.0001) in the chemo/RT group required surgery for symptoms associated with a primary tumor.CONCLUSIONS: PTR in patients with asymptomatic or minimally symptomatic CRC and synchronous unresectable metastases significantly improves overall survival, allows to prevent surgical intervention due to complications related to primary tumor and is not associated with increased postoperative mortality rate comparing to systemic chemotherapy/radiotherapy as a treatment of first line. The current data are based on non-randomized comparative studies and data from early terminated randomized controlled trials (RCTs) and further well-designed RCTs are required.","PeriodicalId":17840,"journal":{"name":"Koloproktologia","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-06-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"73279664","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-06-21DOI: 10.33878/2073-7556-2023-22-2-92-102
D. Mtvralashvili, D. Shakhmatov, A. Likutov, A. G. Zapolsky, D. I. Suslova, A. Borodinov, O. Sushkov, S. Achkasov
AIM: to estimate the implementation of the original method that uses artificial intelligence (AI) to detect colorectal neoplasms.MATERIALS AND METHODS: we selected 1070 colonoscopy videos from our archive with 5 types of lesions: hyperplastic polyp, serrated adenoma, adenoma with low-grade dysplasia, adenoma with high-grade dysplasia and invasive cancer. Then 9838 informative frames were selected, including 6543 with neoplasms. Lesions were annotated to obtain data set that was finally used for training a convolution al neural network (YOLOv5).RESULTS: the trained algorithm is able to detect neoplasms with an accuracy of 83.2% and a sensitivity of 77.2% on a test sample of the dataset. The most common algorithm errors were revealed and analyzed.CONCLUSION: the obtained data set provided an AI-based algorithm that can detect colorectal neoplasms in the video stream of a colonoscopy recording. Further development of the technology probably will provide creation of a clinical decision support system in colonoscopy.
{"title":"AI-based algorithm for clinical decision support system in colonoscopy","authors":"D. Mtvralashvili, D. Shakhmatov, A. Likutov, A. G. Zapolsky, D. I. Suslova, A. Borodinov, O. Sushkov, S. Achkasov","doi":"10.33878/2073-7556-2023-22-2-92-102","DOIUrl":"https://doi.org/10.33878/2073-7556-2023-22-2-92-102","url":null,"abstract":"AIM: to estimate the implementation of the original method that uses artificial intelligence (AI) to detect colorectal neoplasms.MATERIALS AND METHODS: we selected 1070 colonoscopy videos from our archive with 5 types of lesions: hyperplastic polyp, serrated adenoma, adenoma with low-grade dysplasia, adenoma with high-grade dysplasia and invasive cancer. Then 9838 informative frames were selected, including 6543 with neoplasms. Lesions were annotated to obtain data set that was finally used for training a convolution al neural network (YOLOv5).RESULTS: the trained algorithm is able to detect neoplasms with an accuracy of 83.2% and a sensitivity of 77.2% on a test sample of the dataset. The most common algorithm errors were revealed and analyzed.CONCLUSION: the obtained data set provided an AI-based algorithm that can detect colorectal neoplasms in the video stream of a colonoscopy recording. Further development of the technology probably will provide creation of a clinical decision support system in colonoscopy.","PeriodicalId":17840,"journal":{"name":"Koloproktologia","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-06-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"79271086","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-06-21DOI: 10.33878/2073-7556-2023-22-2-32-39
E. G. Azimov, S. Aliyev
AIM: to estimate the rate, causes and features of neurogenic bladder dysfunction in patients with rectal cancer after total mesorectumectomy.PATIENTS AND METHODS: the results of surgical treatment of 103 patients with rectal cancer were analyzed in the light of immediate and long-term outcomes, who underwent total mesorectumectomy using traditional (56-54.4%) and laparoscopic (47-45.6%) technologies. In 20 (19.4%) of 103 patients, the course of the immediate postoperative period was complicated by the development of neurogenic bladder dysfunction. In order to study the frequency of neurogenic bladder dysfunction depending on the technique of mesorectumectomy, the patients were divided into 2 groups. Group 1 included 9 patients who underwent laparoscopic total mesorectumectomy. Group 2 included 11patients who underwent traditional (open) mesorectumectomy.RESULTS: the study of the functional state of the bladder according to the flowmetric indicators revealed that the frequency of development of postoperative bladder dysfunction has a gender dependence. The frequency of neurogenic bladder dysfunction was 25% in men and 10,7% in women. It is shown that during 1 week and 6 months after surgery, the average urination rate tends to increase in women and decrease in men, regardless of the technique of total mesorectumectomy. In both groups, there was not a statistically significant decrease in the maximum volumetric velocity in both men and women within 6 months after surgery. At the same time, during this period, there was a decrease in the average rate of urination only in men, regardless of the technique of total mesorectumectomy. And in women, this indicator remained unchanged or slightly increased.CONCLUSION: it is shown that a complex system of therapeutic measures, including drug stimulation of the detrusor and urethral sphincter, repeated catheterization of the bladder, as well as epicystostomy performed according to indications, allows adequate correction of bladder dysfunction after total mesorectumectomy in patients with rectal cancer.
{"title":"Neurogenic bladder dysfunction after total mesorectumectomy","authors":"E. G. Azimov, S. Aliyev","doi":"10.33878/2073-7556-2023-22-2-32-39","DOIUrl":"https://doi.org/10.33878/2073-7556-2023-22-2-32-39","url":null,"abstract":"AIM: to estimate the rate, causes and features of neurogenic bladder dysfunction in patients with rectal cancer after total mesorectumectomy.PATIENTS AND METHODS: the results of surgical treatment of 103 patients with rectal cancer were analyzed in the light of immediate and long-term outcomes, who underwent total mesorectumectomy using traditional (56-54.4%) and laparoscopic (47-45.6%) technologies. In 20 (19.4%) of 103 patients, the course of the immediate postoperative period was complicated by the development of neurogenic bladder dysfunction. In order to study the frequency of neurogenic bladder dysfunction depending on the technique of mesorectumectomy, the patients were divided into 2 groups. Group 1 included 9 patients who underwent laparoscopic total mesorectumectomy. Group 2 included 11patients who underwent traditional (open) mesorectumectomy.RESULTS: the study of the functional state of the bladder according to the flowmetric indicators revealed that the frequency of development of postoperative bladder dysfunction has a gender dependence. The frequency of neurogenic bladder dysfunction was 25% in men and 10,7% in women. It is shown that during 1 week and 6 months after surgery, the average urination rate tends to increase in women and decrease in men, regardless of the technique of total mesorectumectomy. In both groups, there was not a statistically significant decrease in the maximum volumetric velocity in both men and women within 6 months after surgery. At the same time, during this period, there was a decrease in the average rate of urination only in men, regardless of the technique of total mesorectumectomy. And in women, this indicator remained unchanged or slightly increased.CONCLUSION: it is shown that a complex system of therapeutic measures, including drug stimulation of the detrusor and urethral sphincter, repeated catheterization of the bladder, as well as epicystostomy performed according to indications, allows adequate correction of bladder dysfunction after total mesorectumectomy in patients with rectal cancer.","PeriodicalId":17840,"journal":{"name":"Koloproktologia","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-06-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"89953254","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-06-21DOI: 10.33878/2073-7556-2023-22-2-149-159
S. B. Kozyreva, I. Kostarev, L. Blagodarny, V. V. Polovinkin, A. Zakharyan, A. Titov
AIM: to estimate the effectiveness of minimally invasive methods for treatment of chronic inflammation in pilonidal sinus disease by systematic review.PATIENTS AND METHODS: fifty-two clinical trials were selected from 2,576 papers in databases for systematic review. It included the following methods: the fibrin glue, the sinusectomy, the video-assisted pilonidal sinus treatment, the laser coagulation and the chemical destruction using crystallized phenol or its solution. Regarding the last two methods, a meta-analysis was carried out.RESULTS: the meta-analysis demonstrated the high effectiveness of phenol and laser coagulation for pilonidal sinus disease. When comparing the results of phenol use and excisional techniques, there was a significant difference in higher frequency complications rate after excisional techniques (HR 0.42; 95% CI: 0.05–3.71), while the recurrence rate was the same (HR 0.98; 95% CI: 0.45–2.16). The probability of recurrence was significantly higher than after excision techniques in compare with SiLaC (HR 4.02; 95% CI: 1.13 14.3, p = 0.03). However, there was no significant differences in complication rate after SiLaC and excisional techniques (HR 0.63; 95% CI: 0.29–1.34).CONCLUSION: the chemical destruction and laser coagulation are the most effective methods for pilonidal sinus treatment.
{"title":"Minimally invasive treatment of pilonidal sinus disease (a systematic review and meta-analysis)","authors":"S. B. Kozyreva, I. Kostarev, L. Blagodarny, V. V. Polovinkin, A. Zakharyan, A. Titov","doi":"10.33878/2073-7556-2023-22-2-149-159","DOIUrl":"https://doi.org/10.33878/2073-7556-2023-22-2-149-159","url":null,"abstract":"AIM: to estimate the effectiveness of minimally invasive methods for treatment of chronic inflammation in pilonidal sinus disease by systematic review.PATIENTS AND METHODS: fifty-two clinical trials were selected from 2,576 papers in databases for systematic review. It included the following methods: the fibrin glue, the sinusectomy, the video-assisted pilonidal sinus treatment, the laser coagulation and the chemical destruction using crystallized phenol or its solution. Regarding the last two methods, a meta-analysis was carried out.RESULTS: the meta-analysis demonstrated the high effectiveness of phenol and laser coagulation for pilonidal sinus disease. When comparing the results of phenol use and excisional techniques, there was a significant difference in higher frequency complications rate after excisional techniques (HR 0.42; 95% CI: 0.05–3.71), while the recurrence rate was the same (HR 0.98; 95% CI: 0.45–2.16). The probability of recurrence was significantly higher than after excision techniques in compare with SiLaC (HR 4.02; 95% CI: 1.13 14.3, p = 0.03). However, there was no significant differences in complication rate after SiLaC and excisional techniques (HR 0.63; 95% CI: 0.29–1.34).CONCLUSION: the chemical destruction and laser coagulation are the most effective methods for pilonidal sinus treatment.","PeriodicalId":17840,"journal":{"name":"Koloproktologia","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-06-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"86489578","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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