e23579 Background: Retroperitoneal tumors are rare heterogeneous malignant tumors. Due to their poor response to chemoradiotherapy, surgery is the main treatment option. Currently, there is little data on treatment outcomes in patients who underwent en block resection of retroperitoneal tumors and major vessels. Our purpose was to analyze surgical and oncological results in patients with retroperitoneal tumors and major blood vessel involvement. Methods: 27 patients received surgery for retroperitoneal tumors with major vessel resection in 2015-2019. Results: The mean tumor diameter was 17 cm (11-39 cm). The most frequent histological types were moderately differentiated liposarcoma (33.4%), well differentiated (18.5%), poorly differentiated sarcoma (18.5%), pleomorphic liposarcoma (22.2%), leiomyosarcoma (7.4%). Resection of the suprarenal inferior vena cava (IVC) with prosthetics was performed in 4 cases, resection of its renal segment with renal vein reimplantation - 1, resection of the infrarenal IVC with prosthetics - 8. PTFE prostheses were used as a conduit in all cases. Marginal excision of the suprarenal IVC was performed in one patient, that of the infrarenal IVC - in 5 patients; resection of the infrarenal IVC without the reconstruction - in one case. The iliac venous segment resection was required in 6 patients, in one case – with the iliac arterial segment resection and prosthetics. Macroscopic complete resection (R0-R1) was achieved in 92.6%. The postoperative morbidity was 25.9%, with no fatal outcomes. Despite the anticoagulant therapy, the frequency of thrombosis of the venous reconstruction area in the early postoperative period (1 month) was 7.4%. The median relapse-free survival was 14 months; the median overall survival was not achieved. Conclusions: Combined surgeries with simultaneous removal of retroperitoneal tumor and angioplasty demonstrate an acceptable level of morbidity and mortality. Radical removal of tumors with major blood vessel involvement allows increasing the survival in patients often considered inoperable.
According to the point of view that has been dominating for many years, pancreatoduodenal resection was indicated only for localized tumors of the pancreas without involvement of the major vessels. In view of the prevalence of this pathology, many authors have recently pointed out the need to perform resection of a pancreatic tumor in a single bloc with the vessels involved, which gives a chance to increase the resectability in a larger number of patients. Aim. Analysis of resectability of pancreatic tumors on the basis of the data of current clinical research. In recent decades many different surgical approaches have been improved which increases chances for successful and safe surgical intervention. The data of the analysis of literature on vascular reconstructions in surgery for tumors of the hepatopancreatobiliary zone showed that resections and reconstructions of the mesenteric portal venous segment permit to increase resectability of tumor and should correspond to the fundamental principles of surgical oncology. To date, in terms of the incidence of postoperative complications and mortality, no statistically significant differences were found between the group of patients in whom vascular resection was performed, and the group with a standard pancreatoduodenal resection. A thorough preoperative selection of patients along with the correct strategy of venous reconstruction is equally important for correct and successful resection of the blood vessels en bloc.
The article provides a modern vision of the problem of cardiotoxicity in oncology. Integrity and generality of nodal pathogenetic events in the body in case of carcinogenesis, antitumor therapy and cardiopathology are caused by similar mechanisms at different hierarchical levels. Identity of potential risk factors, including inflammation, aging, obesity, diabetes and smoking, has been noted. Similarly, in the development of metabolic syndrome and carcinogenesis, the level of growth factors (IGF-1), neoangiogenesis, hormones and other triggers of oncological and cardiovascular pathology is increasing. It is important that a variety of clinical manifestations of cardiotoxicity are due to the rapid expansion of the number of therapeutic options for effects. This thesis is illustrated by vivid examples of the use of anthracycline-based drugs whose mechanism of action is aimed at damaging genetic targets. The use of monoclonal antibodies -trastuzumab, is directed against HER2 / ErB2 receptors in breast cancer and is accompanied by distinct signs of cardiotoxicity especially in the elderly. A new strategy to enhance the targeted cytotoxic immune response to cancer cells (Ipilimumab, Nivolumab) has a chance to cause autoimmune myocarditis and myositis. Modern anti-angiogenic methods of cancer therapy, including inhibition of VEGF, significantly increase the risk of myocardial ischemia, hypertension and atherosclerosis. This indicates the need for monitoring of complications, a targeted selection of preventive and curative strategies, as well as attention to the mechanisms of tissue homeostasis in the implementation of the antitumor effect.
e15508 Background: The most important stages of metastatic cascade are extravasation and invasion of malignant cells and their surviving in blood. The vast majority of circulating tumor cells (CTC) is destroyed by immune cells. The role of immune system which is able to play not only antitumor but also prooncogenic role is manifested both on local and systemic levels. We studied correlations between lymphocyte subsets` content in blood and in tumor of colorectal cancer patients (II, III, IV stages) with and without CTC. Methods: 60 colorectal cancer patients with II (n = 20), III (n = 20) and IV (n = 20) stages underwent surgery without previous chemotherapy. CTC were measured in blood by CellSearchSystem™ (JanssenDiagnostics, LLC), cell-mediated immunity was assessed in blood by flow cytometry (BD Canto II) and in tissue after surgery by immunohistochemistry; some markers of proliferation and epithelial-mesenchimal transition (EMT) in tumor cells (Ki-67, E- and N-cadherins) were also studied. Criteria of CTC-positive and CTC-negative samples were > 3 and ≤3 respectively. Correlative analysis was performed between the data of the patients with and without CTC in each stage, r was counted. Results: In CTC-positive patients with all the stages the number of strong and moderate correlations between system immunologic factors involving CD8+ appeared to be fewer than in CTC-negative ones (7 vs 19). On the contrary, the number of correlations with T regs in CTC-positive was increased: 5 vs 3 in CTC-negative patients. In patients with CTC > 3 fewer correlations were noted between factors of local and systemic immunity than in CTC-negative ones (9 vs 4 in II stage) and total disruption of all the correlations between system immunologic factors and proliferating tumor cells in III and IV stages was established. Some pathologic correlations appeared in CTC-positive patients like moderate direct one between activated T-lymphocytes` amount and Ki-67+ tumor cells. The number of correlations between intratumoral lymphocytes and tumor cells expressing proliferation and EMT markers in CTC-positive patients was decreased in comparison with CTC-negative ones (4 vs 10 in II stage, 1 vs 9 in III, 2 vs 9 in IV stage). Conclusions: The presence of CTC in colorectal cancer patients rather than tumor stage is associated with imbalance of their systemic and local immunologic factors. This provides some evidence that disruption of interactions in the immune system is at least partly due to CTC.
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