The aim: to evaluate the own direct results of the RFA of kidney tumors in A.V. Vishnevsky National Medical Research Center of Surgery.Materials and methods. The study included the results of examination and treatment of 22 patients with kidney tumors treated at A.V. Vishnevsky National Medical Center of Surgery (16 men and 6 women aged 40 to 81, mean age 61.5 years). All patients underwent preoperative ultrasound, MSCT with contrast enhancement., Patients underwent RFA of kidney tumors using the Radionics Cool-Tip ® Ablation System (USA) at various stages of treatment In the postoperative period, all patients underwent MSCT monitoring with contrast enhancement and ultrasound with duplex scanning, as well as ultrasound with contrast enhancement – in 7 patients and MRI with contrast enhancement on the first day after the intervention – in 5 patients. Dynamic follow-up was performed in the postoperative period from 3 to 60 months (median 17.8 months).Results. Depending on the surgical tactics, the patients were divided into two groups: the first (16 patients) – RFA was performed as the first independent stage of treatment; the second (6 patients) – RFA was performed as a staged treatment for kidney resection. The tumor was solitary in 19 patients of both groups, multiple – in 3. In tumors of the first group, with sizes exceeding 30.0 mm in diameter, a positive effect was obtained from the manipulation: no progression of the tumor was detected during dynamic observation. These patients underwent 2 to 3 RFA sessions. In tumors of the second group, the size did not exceed 30.0 mm, 2 to 4 sessions (on average 3 sessions) of RFA were performed, which was due to multiple lesions in 3 cases. The use of RFA in the treatment of patients with small kidney cancer in patients with concomitant diseases that do not allow for radical treatment, made it possible to obtain a relapse-free period of an average of 16.5 months. The use of RFA, as a stage in the treatment of primary multiple kidney cancer, showed a relapse-free period of an average of 21.2 months.Conclusion. The use of radiofrequency ablation in the treatment of kidney cancer patients can significantly expand the scope of surgical care, both in the case of patients with concomitant diseases that do not allow a significant amount of surgical intervention, and in the treatment of patients with primary multiple cancer of both kidneys as a stage treatment.
Intraoperative ultrasound (IOUS) is a diagnostic technique that allows obtaining additional information about the number and localization of colorectal cancer (CRC) metastases in the liver (especially with their intraparenchymal location), determining their relationship with the arteries and veins of the liver, navigating for puncture biopsy and / or performing minimally invasive treatment of lesions, and adjusting the amount of resection intervention on the liver during surgery. When performing minimally invasive medical procedures, IOUS application helps to avoid injuries to blood vessels, bile ducts and adjacent organs, and also allows evaluating the effectiveness of treatment and identifying potential complications. An important component of IOUS is the support of surgical procedures with a staged assessment of the liver hemodynamics, providing an immediate correction of the surgical situation. Thus, IOUS is a safe, inexpensive and highly informative diagnostic option, which should be a mandatory diagnostic step in the surgical treatment of CRC liver metastases.Based on literature data and personal experience, the authors present indications, technical aspects and features of application of various IOUS options and modalities in the surgical treatment of CRC liver metastases.
Aim: to present a clinical case of pancreatic PEComa with liver metastases with an emphasis on morphological features, radiology diagnostic methods and features of treatment tactics, allowing practitioners to get an idea about this rare mesenchymal tumors composed of “perivascular epithelioid cells”, and a review of literature data on pancreatic PEComa, including 32 author's cases.General statements. A 22-year-old woman who was surgically treated for pancreatic head PEComa with infiltration of the duct of Wirsung, common bile duct, duodenal wall, focal invasion into the blood and lymphatic vessels, and perineural space infiltration. Synchronously, metastases were detected in both liver lobes, for which she took Everolimus for 6 years under the control of radiology methods with dose adjustment and frequency of administration. At the A.V. Vishnevsky National Medical Research Center of Surgery, the patient underwent right-sided hemihepatectomy and atypical resection of II-III liver segments.Conclusion. To determine clearer criteria for the diagnosis and differential diagnosis of PEComa, to identify criteria for the malignancy of these tumors, to develop treatment tactics and further dynamic monitoring, a set of statistical data of significant group and randomized clinical trials are needed. Pancreatic PEComas in this group are extremely rare and often have a benign course. The presented clinical case demonstrates the most malignant form of this tumor with localization in the pancreas and liver metastases.
Федеральное государственное бюджетное учреждение «Национальный медицинский исследовательский центр хирургии имени А.В. Вишневского» Министерства здравоохранения Российской Федерации, 115093, г. Москва, Российская Федерация ДЛЯ КОРРЕСПОНДЕНЦИИ Степанова Юлия Александровнадоктор медицинских наук, ученый секретарь ФГБУ «НМИЦ хирургии им. А.В. Вишневского» Минздрава России
Introduction. Venous invasion and tumor thrombus formation are rare, but life-threatening complications of renal cell carcinoma (RCC), especially in combination with metastases, are considered significant adverse prognostic factors. Aim. To systematize the existing knowledge and summarize the clinical experience of surgical treatment (open and robot-assisted surgery) of RCC with inferior vena cava (IVC) tumor thrombus. Materials and methods. A literature search in the period 2000-2022 was performed in core databases MEDLINE, Scopus, Clinicaltrials.gov, Google Scholar and Web of Science. The PICO framework (Population-Intervention-Comparison-Outcome) was used to develop a literature search strategy. The following keywords were used to search databases: «renal cell carcinoma», «venous invasion», «inferior vena cava tumor thrombus», «surgical treatment», «robot-assisted», «clinical outcomes». Results. A total of 65 publications were identified. Various classifications of tumor thrombus level are considered, their inferiority and superiority in terms of selecting optimal surgical treatment, both open or robot-assisted surgeries, are discussed. Independent predictors of severe perioperative complications are determined. Optimal surgical treatment of RCC with tumor thrombus is highlighted. Functional and oncological outcomes of patients with RCC with IVC tumor thrombus, who underwent open surgical intervention and robot-assisted ones, are presented. Conclusion. Open surgery in patients with RCC and IVC tumor thrombus above the hepatic veins is associated with prolonged surgery duration, higher intraoperative blood loss, and prolonged in-hospital stay. Prolonged in-hospital stay, the need for blood transfusion, metastasis, sarcomatoid differentiation, and Clavien-Dindo grade 3-5 postoperative complications are predictors of poor outcomes.
Testicular cancer is a rare oncourological disease. Of great significance is the fact of the disease onset precisely at the age when men are planning their future life: education, family, etc. According to current clinical guidelines, the treatment of this disease should be complex, including surgical treatment, polychemotherapy and external beam radiation therapy, which leads to a cure in 90% of cases.In the presented clinical case, a 25-year-old patient was diagnosed with right testicular cancer stage III, T2N3M1S0 [PUL]. However, despite the significant initial prevalence of the pathological process, as well as the detection of a single retroperitoneal metastasis in the pancreas two years after the last stage of surgical treatment, the applied multi-stage tactics of complex treatment of the patient allowed not only removing the tumor and metastases, but also rehabilitating the patient socially.
Cystic echinococcosis is a chronically severe parasitic disease of humans and animals caused by parasitism of the larval stage of Echinococcus unicameral.Ultrasound (ultrasound) being the most widely used option of visual diagnostics is the leading method of radiological diagnosis of echinococcosis of the liver and other organs. The technique is generally available and allows diagnosing echinococcosis at a stage when parasitic cysts are still small in size, starting from 1.5-2 cm. However, with the high accuracy and specificity of ultrasound in the differential diagnosis of echinococcosis cysts, there are certain disadvantages of the approach.Due to constant study and, accordingly, changes in knowledge about the course of the disease, methods for its diagnosis and treatment, there is no unified and stable ultrasound classification of liver echinococcosis. The paper analyzes the criteria that justify various classifications of echinococcus, substantiates forming trends. The standardized ultrasound classification of hydatid echinococcosis of the liver, which was adopted by the World Health Organization in 2003 and revised in 2010, is discussed.The potential and advantages of dynamic ultrasound monitoring of echinococcal cysts and postoperative characteristics of the residual cavity after echinococcectomy are demonstrated.
ntroduction. A distinctive feature of kidney cancer is a frequent, compared with other tumors, spread of the tumor through the venous collectors (in the renal and inferior vena cava up to the right atrium), along the path of least resistance to invasive growth.The aim of the study was to present a clinical case of radical treatment of kidney cancer involving extensive IVC thrombosis.Materials and methods. The study describes a clinical case of radical treatment of patient M. with kidney cancer involving extensive IVC thrombosis, extending to the right atrium (written informed consent for patient information and images to be published was obtained prior to the study). During preoperative examination, the patient was diagnosed with renal cell carcinoma with non-occlusive hypervascular tumor thrombus of the renal vein, the inferior vena cava and the right atrium based on the findings of ultrasound examination (transabdominal and transthoracic, and transesophageal), multislice computed tomography (MSCT) and magnetic resonance imaging (MRI).Results and discussion. Surgical treatment remains the main method of treatment of renal cell cancer, moreover, the inferior vena cava thrombosis cannot serve as a cause for refusing surgical treatment. The thrombus spreading along the venous collectors is an important factor in determining the tactics of surgical treatment. The length of the tumor thrombus, as well as the degree of its fixation and ingrowth into the vein wall is of great significance for planning surgical techniques and predicting clinical outcomes. Based on various methods of radiological examination, patient M. was diagnosed with cancer of the right kidney, 3 stage T3cNxM0, IVC tumor thrombus, paraneoplastic syndrome (hyperthermia), right-sided nephrectomy with aortocaval lymphadenectomy, thrombectomy from the IVC, vascular isolation of the liver, resection of the IVC, thrombectomy from the right atrium combined with cardiopulmonary bypass.Conclusion. Despite the technical complexity of nephrectomy with thrombectomy from the IVC, especially in the presence of a massive supradiaphragmatic thrombus, these interventions have no alternatives if a radical treatment is to be achieved. Step-by-step support using radiological methods of investigation is an important aspect of patients preparation; this allowing determining the exact volume of the damage and non-invasively assessing clinical outcomes of surgical treatment.
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