Vol 7, No 2 (2017)

Background. The choice of the best surgical approach to colon cancer treatment remains a complicated and controversial problem of modern coloproctology. Current data shows better long-term outcomes after procedures performed in accordance with embryological layers and concept of complete mesocolic excision, while level of vessel ligation remains debatable. In the US and Europe D3 lymph node dissection is not routinely performed for colon cancer, while in eastern countries it is considered to be a standard. Up-to-date there is no published data from randomized trials comparing long-term outcomes of D2 and D3 dissection. Materials and methods. A literature review was performed to evaluate current data on colon cancer lymph node dissection. A design of ran-domized trial was proposed to obtain the evidence on the superiority of D3 over D2 lymph node dissection. Discussion. As evidence regarding long-term outcomes of D3 lymph node dissection is lacking the choice of lymph node dissection is made according to surgeon’s or clinic preferences. Conclusion. To objectify the preferred lymph node dissection extent randomized controlled studies are needed.

Addition of monoclonal antibodies to metastatic colorectal cancer therapy increases both the survival and treatment costs. This raises the question of economic efficacy of these agents. This review focuses on trials with pharmacoeconomical analysis of chemotherapy and targeted therapy of colorectal cancer.

The problem of wound closure after abdominoperineal resection to treat oncological diseases remains unsolved. Formation of a primary suture in the perineal wound can lead to multiple postoperative complications: seroma, abscess, wound disruption with subsequent perineal hernia. Chemoradiation therapy as a standard for locally advanced rectal or anal cancer doesn’t improve results of treatment of perineal wounds and increases duration of their healing. Currently, surgeons have several reconstructive and plastic techniques to improve both direct and long-term functional treatment results. In the article, the most common methods of allo- and autotransplantation are considered, benefits and deficiencies of various techniques are evaluated and analyzed.

The clinical observation demonstrates a successful surgical treatment of a 61-year-old female patient K. (body mass index 38.4) diagnosed with locally advanced sigmoid colon cancer protruded into the bladder and uterus (сT4bN2M0) with formation of a colovesical fistula. The patient underwent surgical treatment in the form of laparoscopic resection of the sigmoid colon and supralevator anterior pelvic exenteration with formation of a Bricker conduit. Intraoperative blood loss was 200 ml. Postoperative period was smooth, with fast track rehabilitation; the patient was discharged on day 9. Considering cancer stage, the patient received XELOX as adjuvant chemotherapy for 6 months after the surgery. During a year of follow-up, no signs of disease progression were evident. The patient is fully socially rehabilitated.