Surgery and Oncology

Background. Colorectal cancer remains one of the leading causes of cancer-related mortality worldwide, and early detection is crucial for improving patient outcomes. Circulating microRNAs have emerged as promising non-invasive biomarkers; however, comparative evaluation of their diagnostic performance, particularly in combination panels, remains limited.

Aim. To compare the diagnostic value of circulating microRNAs and their combinations for early colorectal cancer detection in adults using network meta-analysis approach.

Materials and methods. A systematic review and network meta-analysis of studies identified through the PubMed and Embase databases was conducted. The primary outcomes included the area under the ROC curve (AUC), sensitivity, specificity, accuracy, and surface under the cumulative ranking curve (SUCRA). Risk of bias was assessed using the Quality Assessment of Diagnostic Accuracy Studies 2 (QUADAS-2) tool. Statistical analyses were performed using the R software environment.

Results. The included studies demonstrated substantial methodological and clinical heterogeneity (predominance of case – control design, variability in sample types and cohort characteristics), accompanied by high statistical heterogeneity in the network for AUC (I² = 74.8 %). According to the network comparison, the most promising single biomarkers were miRNA-760 and miRNA-221, which achieved the highest SUCRA rankings (0.773 and 0.753, respectively). The most extensively studied miRNA-21 showed intermediate performance (SUCRA = 0.677). The highest diagnostic performance was observed for multi-biomarker panels: miRNA-21 + miRNA-25 + miRNA-18a + miRNA-22 (0.888), miRNA-21 + miRNA-92a + miRNA-221 (0.797), and miRNA-21 + miRNA-221 + miRNA-150 (0.797).

Conclusion. Circulating microRNAs represent a promising approach for non-invasive early detection of colorectal cancer. The most relevant candidates include miRNA-760, miRNA-221, and high-performing microRNA panels. Clinical implementation requires further prospective clinical validation and standardization of the analytical methods.

Background. Gynecologic malignancies including ovarian, cervical, endometrial, vulvar, and fallopian tube cancers affect over 1.4 million women annually, significantly impacting sexual function and quality of life.

Aim. To systematize current knowledge on sexual dysfunction in women with gynecologic cancers and to develop recommendations for improving their well-being.

Materials and methods. A literature review (2013–2023) was conducted using PubMed, Google Scholar, Scopus, SAGE, World of Science, and ScienceDirect databases. Only full-text English publications were included; short reports, letters, case studies, and patents were excluded.

Results. Of 195 identified studies, 15 met the inclusion criteria. The analyzed studies involved between 13 and 102 participants diagnosed with cervical, endometrial, ovarian, or vulvar cancers. Methods included semi-structured and in-depth interviews and focus groups. Findings indicate reduced sexual satisfaction, libido, and body image, accompanied by pain and emotional distress. Health professionals should inform patients about potential sexual consequences and offer comprehensive medical and psychological support.

Conclusion. Gynecologic cancer has a profound impact on women's psychosexual health. Close collaboration among healthcare teams, patients, and partners is essential to ensure awareness, timely prevention, and rehabilitation of sexual function, enhancing overall quality of life.

Background. Currently, adjuvant chemotherapy of choice after surgical treatment of uterine leiomyosarcoma is doxorubicin. The same approach is used for the 1^st line of systemic drug therapy in patients with initially metastatic process, or those who have not previously received adjuvant treatment with anthracyclines. Disseminated forms of metastatic leiomyosarcoma are characterized by unfavorable prognosis, and the options for potentially effective drug treatments are limited.

Aim. To evaluate the efficacy of 1^st and 2^nd line chemotherapy regimens for uterine leiomyosarcoma in a population of patients in real clinical practice.

Materials and methods. The retrospective analysis included 43 patients with histologically verified uterine leiomyosarcoma. The study included patients with primarily localized forms of the disease, who underwent surgical treatment at the 1^st stage (with or without adjuvant chemotherapy), and patients with initially metastatic disease. All patients had a history of 1–2 lines of systemic drug therapy due to disease progression.

Results. The analysis included 43 patients who underwent treatment at the N. N. Blokhin National Medical Research Center of Oncology between 2021 and 2024. The efficacy of the 1^st line was assessed in 35 (81.4 %) patients: the objective response rate reached 17.6 %, and median progression-free survival from the start of the 1^st line was 7.4 months. The efficacy of 2^nd line of therapy was assessed in 18 (41.9 %) patients: the objective response rate was 11.1 %, median progression-free survival from the start of the 1^st line to progression after the 2^nd line was 13.2 months, and median progression-free survival from the start of the 2^nd line to progression after it was 3.3 months.

Conclusion. Analysis of the efficacy of systemic drug therapy for uterine leiomyosarcoma in real clinical practice demonstrates comparable long-term treatment results with data from international literature. Further study of the efficacy of combined adjuvant and 1^st line therapy regimens seems promising.

Background. The negative side of immunotherapy with immune checkpoint inhibitors for patients with metastatic non-small cell lung cancer (NSCLC) is the development of immune-mediated adverse events (imAE).

Aim. To determine the association between imAE and overall survival (OS), progression-free survival (PFS) in patients with metastatic NSCLC receiving immunotherapy.

Materials and methods. The study included data on treatment of patients with metastatic NSCLC who received immunotherapy at the N. N. Blokhin National Medical Research Center of Oncology between 2015 and 2023. The patients were divided into two groups: those who developed any grade imAE and those who did not. The primary endpoints of the study were PFS and OS. Landmark analysis was performed to avoid immortal time bias.

Results. The study included 461 patients. Any grade imAE occurred in 138 patients, while 323 patients did not experience imAE. The median follow-up time was 60.7 months. For the patients with and without imAE in a 16-month landmark analysis, median OS was 70.0 months (95 % confidence interval (CI) 39.93–100.06) and 45.4 months (95 % CI 38.78–52.01) (p = 0.048), respectively. And in a 6.5-month landmark analysis, median PFS was 16.7 months (95 % CI 1.25–32.14) and 20.6 months (95 % CI 14.98–26.21) (p = 0.942) for patients with and without imAE, respectively.

Conclusion. Immune-mediated adverse events during immunotherapy in patients with metastatic NSCLC are associated with better overall survival when a landmark analysis was applied.

Background. First-line therapy for advanced pancreatic cancer often involves combination regimens, including gemcitabine plus nab-paclitaxel (GEM-NAB), whereas the optimal treatment strategy in the second-line setting remains a subject of debate.

Aim. To compare efficacy and tolerability of gemcitabine (GEM) monotherapy and GEM-NAB combination as second-line treatment for pancreatic cancer.

Materials and methods. This retrospective single-center study was conducted in patients with pancreatic adenocarcinoma receiving second-line chemotherapy with one of two regimens: GEM monotherapy or the GEM-NAB combination. The primary endpoint was overall survival. Secondary endpoints included progression-free survival, objective response rate, disease control rate, and safety.

Results. A total of 118 patients were included: 57 received GEM and 61 received GEM-NAB. The groups were comparable in baseline clinical and demographic characteristics. Median follow-up was 9 months. Median OS was 5.9 months (95 % confidence interval (CI) 3.8–8.0) in the GEM group and 6.4 months (95 % CI 4.5–8.3) in the GEM-NAB group (p = 0.772). Median progression-free survival was 3.3 months (95 % CI 2.8–3.8) and 4.7 months (95 % CI 3.6–5.8), respectively (p = 0.079). Objective response rate was 15.8 % and 28.6 %, respectively (p = 0.127). The incidence of grade III–IV adverse events was comparable between the groups. In multivariate analysis, ECOG status ≥ 2, liver metastases, and decreased hemoglobin level were identified as independent predictors of poor survival.

Conclusion. Gemcitabine plus nab-paclitaxel combination as 2^nd line therapy did not demonstrate statistically significant improvement in overall survival compared with gemcitabine monotherapy and showed a comparable safety profile.

Background. Retroperitoneal end colostomy creation is a safe and effective method of parastomal hernia (PH) prevention.

Aim. To investigate the rate of PH in patients after abdominoperineal resection of the rectum. To compare effects of retroperitoneal end colostomy created through laparoscopic and open accesses on PH prevention.

Materials and methods. In the single-center study, incidence of PH was retrospectively analyzed in 110 patients who underwent abdominoperineal resection of the rectum between January of 2018 and December of 2024 due to rectal cancer, persistent or recurrent squamous cell carcinoma of the anal canal after chemoradiation therapy. PH was diagnosed using computed tomography with independent evaluation by an expert 1 or more years after the surgery. Patient characteristics, PH incidence, rate and severity of postoperative complications were compared in the groups of laparoscopic and open surgeries.

Results. Median follow-up was 19.2 months in the group of extraperitoneal colostomy and 12.8 months in the group of transperitoneal colostomy. Statistically significant differences (р = 0.027) were found in the incidence of hernias 1 and more years after surgery in the laparoscopic surgery group: hernias developed in 5 (14.3 %; 95 % confidence interval (CI) 48–29.8) patients with extraperitoneal colostomy and in 10 (40 %; 95 % CI 21.1–61.2) patients with transperitoneal colostomy. There were no significant differences in the rate of adverse events (р = 0.76). In the total group and group of open surgeries, no statistically significant differences were observed (р = 0.146): hernias developed in 10 (17.9 %; 95 % CI 8.8–30.5) patients with extraperitoneal colostomy and 16 (29.6 %; 95 % CI 17.9–42.4) patients with transperitoneal colostomy in the total group, in 5 (22.7 %; 95 % CI 8.3–45.4) patients with extraperitoneal stoma, and in 6 (20.7 %; 95 % CI 8.4–39.5) patients with transperitoneal stoma in the open surgery group.

Conclusion. The results of our study do not demonstrate benefits of extraperitoneal colostomy using open access. However, the results show safety and efficacy of retroperitoneal end colostomy creation in laparoscopic abdominoperineal resection.

Background. Temporary intestinal stoma reduces the risk of life-threatening complications in the early postoperative period. However, psychological stress related to the stoma and the need for repeat surgical intervention necessitate the search for ways to narrow the indications for this procedure.

Aim. To evaluate the safety of a strategy designed to restrict indications for preventive intestinal stoma formation after rectal resections.

Materials and methods. The study included patients over 18 years of age who underwent rectal resections for various indications between 2017 and 2026. Patients were divided into 2 groups. Before 2019 (1^st group), routine mobilization of the splenic flexure was not performed; an end-to-end (predominantly) or side-to-end stapled anastomosis was created at the operating surgeon’s discretion, or a primary coloanal anastomosis was performed for low rectal tumors. A preventive ileostomy was selectively created based on the presence of risk factors, at the operating surgeon’s discretion. From 2020 (2^nd group), routine mobilization of the splenic flexure of the colon, mandatory creation of a side-to-end stapled anastomosis, or a hand-sewn two-stage Turnbull–Cutait pull-through coloanal anastomosis were introduced into practice, allowing for narrower indications for preventive ileostomy creation. The primary endpoint of the study was the incidence of anastomotic leak. Secondary endpoints included the overall complication rate, postoperative mortality, operative time, blood loss, and the rate of preventive intestinal stoma formation.

Results. A total of 300 patients were included in the study: 76 in the 1^st group and 224 in the 2^nd group. The overall rate of grade IIIB–IV complications was 12 (15.8 %) in the group operated on before 2020, and 7 (3.1 %) in the group operated on after 2020 (р <  0.001). In the 1^st group, preventive ileostomies were created in 3 (7.9 %) patients after partial mesorectal excision, 9 (50 %) after total mesorectal excision, and 14 (100 %) after ultra-low rectal resection with coloanal anastomosis. Anastomotic leakage developed in 3 (21.4 %) patients after ultra-low rectal resection with coloanal anastomosis, and in 5 (27.8 %) after rectal resections. Among those in the 2^nd group, preventive ileostomies were created in 1 (0.8 %) patient after partial and in 7 (13.7 %) patients after total mesorectal excision. Anastomotic leakage developed in 1 (0.8 %) patient who underwent partial mesorectal excision, 4 (7.8 %) patients after low anterior rectal resection, and 2 (3.9 %) patients after the Turnbull–Cutait procedure. After multivariate analysis, the following factors for anastomotic leakage were identified: the decision to create a preventive ileostomy (hazard ratio (HR) 9.463; 95% confidence interval (CI) 1.137–78.761; p = 0.038), chemoradiotherapy (HR 9.283; 95% CI 1.112–77.514; p = 0.04), American Society of Anesthesiologists classification score III or higher (HR 10.093; 95% CI 1.888–53.945; p = 0.007), and blood loss over 100 mL (HR 4.889; 95% CI 1.016–23.531; p = 0.048).

Conclusion. Standardization of surgical approaches for rectal cancer treatment, including routine mobilization of the splenic flexure, creation of a side-to-end anastomosis, and the use of the Turnbull–Cutait operation for ultra-low resections, allows for a reduction in the preventive intestinal stoma formation rate without increasing the risk of severe postoperative complications. Meticulous monitoring of the patient’s condition in the postoperative period is an essential requirement.

Treatment of synchronous multiple primary rectal and prostate cancer is not standardized. Simultaneous surgery is not widespread. However, more and more reports are appearing in the world literature on the performance of simultaneous operations using robotic platforms.

We present a description of surgical treatment of a 64-year-old patient with synchronous primary rectal and prostate cancer. A robotic-assisted low anterior rectal resection with D3 lymph node dissection, combined with radical prostatectomy and bilateral lymph node dissection was performed. The duration of surgery was 610 minutes with a blood loss of 500 ml. A lymphocele developed in the left lateral lymph node dissection area, requiring ultrasound-guided drainage. Morphological examination revealed negative resection margins for both tumors. No metastatic cells in the pelvic lymph nodes were detected. Adjuvant chemotherapy for rectal cancer was conducted. No signs of rectal or prostate cancer recurrence were observed in 12 months after surgery. Continuity of the colon was restored.

Simultaneous robotic surgery may be considered as a treatment option for synchronous rectal and prostate cancer in a limited group of patients.