In suitable cases of HHD, MIS seems to be a good alternative to traditional OS for it is comparably safe and with a better postoperative outcome and a shorter postoperative rehabilitation period. Based on this experience we can advice MIS in selected patients with definitive indications.
The emergence and continuous development of immune checkpoint inhibitors (ICIs) therapy brings a revolution in cancer therapy history including urothelial carcinoma. Early accurate targeting and adequate treatment are critical to patient prognosis and overall survival. To overcome these limitations, two strategies are actively being pursued: identification of predictive biomarkers for clinical response to ICIs and multi-pronged combination therapies. Biomarkers might allow clinicians to practice a precision medicine approach in ICIs (biomarkerbased patient selection). The development of predictive biomarkers is needed to optimize patient benefit, minimize risk of toxicities, and guide combination approaches.The greatest focus in clinical trials and reviews has been on tumor-cell PD-L1 expression. Although PD-L1 positivity enriches for populations with clinical benefit, PD-L1 testing alone is insufficient for patient selection in most malignancies. In this review, we discuss the status of PD-L1 testing and explore emerging data on new biomarker strategies with tumor-infiltrating lymphocytes, mutational burden, immune gene signatures, microsatellite instability and molecular subtypes.
Background. Surgical treatment after chemotherapy is extremely difficult technically and should only be performed in a specialized medical center. The postoperative period after these surgical interventions is aimed not only at minimizing complications, but also at early mobilization and rehabilitation of patients. The principles of fast-track surgery, or ERAS (Enhanсed Recovery After Surgery) significantly reduce the incidence and degree of complications after various surgical interventions. However, the results of studies on the use of fast track in retroperitoneal lymphadenectomies have not yet been presented.Aim. To determine the effect of enhanced recovery program on treatment outcomes in patients with germ cell tumors of the testicle after retroperitoneal lymphadenectomy.Materials and methods. Retrospective analysis of 2 groups of patients (n = 93) treated at the N.N. Petrov National Medical Research Center of Oncology (Saint Petersburg) was performed. In the 1st group of patients, standard postoperative care after retroperitoneal lymphadenectomy was performed; in the 2nd group, fast track elements were used. Since the introduction of the ERAS protocol into clinical practice (September 2017), all patients have been included in the 2nd group.Results. The presence or absence of preoperative preparation did not affect the incidence of intraoperative complications (p = 0.031). There were significant differences in the duration of hospitalization between the 1st and 2nd groups –15.3 and 11.9 days (p = 0.03), respectively. Assessment of the pain syndrome using the Numeric Rating Scale for Pain (NRS) showed that median pain level in the 1st group was significantly higher than in the 2nd group: 5 ± 1.5 and 3 ± 1.7, respectively (p = 0.04), which indicates a more severe and less controlled pain syndrome in the 1st group of patients. The rate of infectious complications in the postoperative wound in the 2nd group was 3 cases versus 13 in the 1st group (p = 0.009). The rate of lymphorrhea in 2nd group was significantly lower (p = 0.003), median drainage duration was higher in 1st group (p <0.05). In the 2nd group, 70.6 % of patients did not require drainage, which was an important factor in rapid rehabilitation.Conclusion. The use of fast-track principles in patients after retroperitoneal lymphadenectomy significantly reduces the incidence of postoperative complications and rehabilitation time.
Development and introduction into clinical practice of the reliable and functionally valuable, simple in performance cervical esophago-gastric anastomosis after esophagectomy due to cancer of the thoracic site of esophagus resulting in reduction of the number of failure and cicatricial stenosis, decrease in pathological signs of pharyngeal and/orgastroesophageal reflux. Methods: Clinical investigation was performed on 212 patients with cancer of thoracic esophagus during the period from 2000 to 2008. Esophagectomy by trans-thoracic approach was performed on 33 patients, and trans-hiatus-on 179 ones. The one-stage esophageal plasty with isoperistaltic tube from the greater curvature of stomach, transposition of the graft through the bed of the esophagus removed (posteriomediastinal approach) and manual formation of the cervical esophagogastric anastomosis (EGA). The patients were divided into 2 groups in relation to the type of cervical EGA formation: group 1 included 55 (25.9%) patients who were made cervical EGA end-to-end after esophago-gastrectomy during the period from 2000 to 2003; group II comprised of 157 (74.1%) patients were performed antireflux cervical EGA end-to-side developed in our center after esophagectomy from 2004. Results: Comparative analysis of the results of cervical EGA formation between groups showed sharp reduction of the number of suture failures from 23.5% to 6.1%, of EGA stricture from 33.3% to 4.4%, of reflux-esophagitis from 72.5% to 3.4%, of aspiration complications from 21.6% to 1%, respectively. The lethality was 6.6%. The cause of death was not related to the methods of EGA formation and its complications in all the cases. Conclusions: The formation of the cervical EGA according to the developed technique allowed avoidance of severe complications of the suture failure in anastomosis, minimization of the frequency of stenosis, avoidance of marked gastrointestinal reflux in the long-term period. The formation of gastro stoma in the oral end of the graft gives opportunity to begin early enteric nutrition, to avoid oral nutrition for a long period, the manner of its formation prevents leakage of the stomachic contents beside the tube and skin maceration, without necessity of stoma closing with special methods.
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