ntroduction. Currently, total gastrectomy with D2 lymphadenectomy is the standard surgical treatment for proximal gastric cancer at the resectable stages (I-III). The issue of advisability of splenectomy as a component of lymphadenectomy remains a controversial one, especially when the tumor is localized in the region of the body or cardiac region of the stomach.The aim of the study was to compare immediate and long-term outcomes, including the quality of life, between spleen preserving and spleen removing surgeries.Methods. The study included 363 patients with gastric cancer II-III stages, localized in the upper and/or the middle third of the stomach, who underwent surgery at the Voronezh Regional Clinical Oncology Hospital and the Voronezh Clinical Hospital of the Russian Railway-Medicine in 2015-2017. All patients were conditionally divided into 2 groups for comparative retrospective analysis. All patients of the first (experimental or spleen-preserved) group (144 patients) were performed R0 total gastrectomy with D2 lymphadenectomy, including splenic hilar nodes (№ 10,11) removal without splenectomy. Patients of the second (control or splenectomy) group (219 patients) were performed R0 total gastrectomy with D2 lymphadenectomy and prophylactic splenectomy (for splenic hilar nodes removal).Results. The average duration of the operation and the volume of blood loss did not differ in both groups. The incidence of early postoperative surgical complications was lower in the spleen-preserved group. Splenectomy was associated with more severe complications of class 4 and 5 according to the Clavien-Dindo classification. Conclusion. Parameters of the 1- and 3-year overall survival rate did not differ in both groups. The results of the GSRS questionnaire were similar in both groups, excluding reflux-esophageal symptoms scale. The reflux scale demonstrated a statistically and clinically significant advantage of spleen preservation.
Relevance.The col lective concept of" incidence " of the adrenal glands includes a group of neoplasms of more than 1 cm in diameter, accidentally revealed by radiation methods of research. With the development of methods of instrumental diagnostics, the number of adrenal glands detected by the incident is steadily increasing, including in patients with a history of malignant neoplasm (ZNO). Objective.Study of the frequency of occurrence metastaties of adrenal tumors in cancer patients. Materials and methods. Made 137 fine-needle aspiration biopsies (TAB) of adrenal tumors in the patients in whom during follow-up were detected adrenal incidence. Results. According to the results of morphological verification in 44(32%) cases of adrenal tumors were metastatic. Conclusion. Adrenal tumors, detected in patients with malignant neoplasms of different localization, can be provided as metastatic and benign tumors. However, each revealed a tumor in the adrenal glands of patients undergoing treatment after testing shall be considered as potentially metastatic.
Background. Gynecomastia is one of the most famous and common paraneoplastic syndromes. With the growth of equipment clinics with modern diagnostic equipment, including the CT, increases the detection of breast pathology in men. There is the need for a correct interpretation of the data about the state of male breast by radiologists, and the attending physician, oncologist, mammologist, urologist, endocrinologist. The purpose of the study to identify possible differences in frequency and radiation pattern of gynecomastia in patients with cancer and without it and also to follow the dynamics of the development of gynecomastia in patients with cancer, to identify the probable causes of the progression of gynecomastia in patients with cancer. Materials and methods. It's data of 400 chest CT of men who were screened and treated for the different oncological pathology in Voronezh regional clinical oncological hospital in 2013-2015. And also data of 150 chest CT of men who were screened and treated for the various diseases (excluding oncological diseases) in the Voronezh regional clinical diagnostic center and Kursk regional clinical hospital in 2013-2015 was used. Results. The data of the frequency of occurrence various types of gynecomastia in patients with cancer pathology and without it was obtained. The frequency of occurrence of gynecomastia in patients with cancer depending on the localization and morphology of tumor was analyzed. The dynamics of the gynecomastia in patients with cancer was tracked and possible causes of its progression in patients in this group were identified. Conclusions 1. Gynecomastia is a frequent pathology revealed by chest CT in men as suffering from oncological disease and without it. Gynecomastia significantly more often found in patients suffering from prostate adenocarcinoma and renal cell carcinoma. Surgical injury may be one of the reasons for the development of gynecomastia. Feature of gynecomastia in patients with cancer is its asymmetry. When the detection of asymmetrical gynecomastia by chest CT is recommend the further examination of patient to exclude him cancer pathology, special attention should be paid to the prostate gland and the kidneys. Upon detection of the progression of gynecomastia in a patient with a history of cancer need further examination to exclude cancer pathology progression.
For many years the main method of treatment of patients with prostate cancer remains surgical treatment, which consists in performing a difficult and traumatic operations, leading to reduced quality of life. Currently, as an equal alternative to radical prostatectomy is radiotherapy, presented with a standard 3D conformal beam radiation, stereotactic radiotherapy and brachytherapy using sources with a low or high dose. Brachytherapy using sources of high power is a safe and effective treatment for localized prostate cancer, providing a summing fatal dose to the tumor with the short period of hospitalization, minimal complications, which may be used in combination with external beam radiotherapy and standalone version. A brief review of the literature on the use of combined radiation therapy in the treatment of prostate cancer. Describes the comparative characteristics of results of treatment of this pathology, complications, early and late toxic reactions when used brachytherapy isotopes of different dose in combination with external beam radiation therapy. The vector of further research in this direction is justified.
In the Russian Federation, the incidence of malignant neoplasms is more than 50 thousand new cases per year. Since 1990 the combined treatment method is the standard in the treatment of patients with locally advanced rectal cancer. During the evolution of this method, preoperative radiation / chemo-radiation therapy has taken a strong position in the standards for treatment of rectal cancer. Currently, preoperative remote radiation therapy at a dose of 45-52Gy is included in treatment standards for rectal cancer. The main objective of neoadjuvant treatment is to achieve tumor regression. When a complete regression of the tumor is achieved, the task of choosing tactics arises - to carry out surgical treatment, or to apply expectant tactics. In the first clinical case, the patient underwent preoperative chemoradiation treatment with 40.8 Gy combined with capecitabine, after which 4 courses of consolidating chemotherapy were carried out followed by surgery. In the second case, the patient underwent neoadjuvant chemoradiation therapy with 52.5 Gy combined with capecitabine. Given the pronounced positive dynamics, 4 courses of consolidating chemotherapy were performed. After the control study, a complete tumor response to the therapy was revealed. Considering the MRI data and the pronounced positive dynamics, the decision of the multidisciplinary team was the tactics of dynamic observation of the patient.
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