Vol 15, No 4 (2025)

Small cell lung cancer (SCLC) is the most aggressive histological subtype of lung cancer and accounts for approximately 13–15 % of all lung cancers. The aggressive nature of SCLC is manifested through rapid progression of the disease accompanied by early metastases. Despite good response to chemotherapy, recurrences and progression quickly develop requiring switching to the second line of chemotherapy, efficacy of which remains very low. As a result, the purpose of our publication is to review data on the standard therapy schemes, as well as new drugs used in the second line of SCLC therapy, namely lurbinectedin and tarlatamab. The review contains literature sources on the research on these drugs from the PubMed database published between 2015 and 2024.

Background. Thoracoscopic approach was proved to be safe and effective for surgical treatment of patients with locally advanced lung cancer. However, the role of this approach in pneumonectomy has not been sufficiently studied which limits its use.

Aim. To develop and implement an original safe surgical technique of thoracoscopic multiport pneumonectomy and to compare immediate surgical outcomes of open surgery and thoracoscopic (both uniport and multiport) approaches.

Materials and methods. Retrospective analysis included data on patients who underwent open and thoracoscopic pneumectomy due to lung cancer between 2016 and 2023. Inclusion criteria were primary resectable lung cancer, age between 18 and 75 years, ECOG performance status 0–2. Study design involved an exploratory pilot study aimed at evaluation of immediate results of thoracoscopic pneumectomy and the rate of postoperative complications.

Results. A total of 100 patients were included in study, of which 51 underwent open pneumonectomy and 49 – minimally invasive pneumonectomy, including both uniport (n = 20) and multiport (n = 29) approaches. Between the groups of thoracoscopic and open pneumectomy no differences were found in the number of dissected lymph nodes (19.1 and 22.3, respectively; p = 0.06) and the rate of R0-resections (100 and 94.1 %; p = 0.226). Median operative time was 200 min with mean values of 211.9 min in the thoracoscopy group and 210.9 min in the open surgery group (p = 0.617). Operative time did not correlate with the side of surgical intervention (p = 0.312) or the type of surgical approach (p = 0.939). Thoracoscopic pneumonectomy was associated with lower average length of hospital stay (p = 0.086) and lower duration of postoperative opioid consumption (p = 0.001) compared to open surgery.

Conclusion. The obtained data show that thoracoscopic approach for pneumonectomy is equally effective as thoracotomy and decreases duration of postoperative in-hospital treatment and use of opioid analgesics. However, considering retrospective character of the study, further data validation in a prospective study is planned.

Background. Indices calculated based on complete blood count data (neutrophil to lymphocyte ratio, platelet to lymphocyte ratio, systemic immune-inflammation index) are considered potential predictors of clinical outcomes in patients with colorectal cancer, although their prognostic value has not been definitively established.

Aim. To evaluate prognostic significance of the above-mentioned indices for evaluation of risk of immediate complications after surgical treatment in patients with cancer of the left half of the colon and to establish threshold values of each index affecting prognosis.

Materials and methods. The study included 187 patients with stage I–III colorectal cancer who underwent radical surgical treatment between 2019 and 2023. The values of the specified indices were assessed before surgery and on postoperative days 1, 3, and 5, as well as the rate and pattern of postoperative complications (according to the Clavien – Dindo classification) and the incidence of anastomotic leak. ROC analysis was used to determine threshold values of indices influencing the risk of anastomotic leak; statistical analysis included logistic regression.

Results. No statistically significant effect of the studied hematological prognostic indices on the risk of anastomotic leak was observed (p > 0.05). The threshold value of the neutrophil to lymphocyte ratio on postoperative day 5 that may affect the risk of anastomotic leak was 3.25 (area under curve (AUC) 0.842); for the platelet to lymphocyte ratio on postoperative day 3–172.3 (AUC 0.678); for systemic immune-inflammation index on postoperative day 5–1027.9 (AUC 0.866).

Conclusion. The analysis revealed statistically non-significant trends regarding the influence of the dynamics of certain indices on the risk of anastomotic leak, but no evidence of their independent role was found. The use of hematological indices may be considered only a part of comprehensive clinical and laboratory risk stratification.

Aim. To investigate the learning curve for laparoscopic colon resections in a specialized regional clinical setting.

Materials and methods. Analysis of the data from the Omsk Regional Cancer Registry and the hospital information system of the Omsk Clinical Oncology Center from the period between 2015 and 2023 was performed. The study included patients who underwent laparoscopic colon resections for cancer. Risk-adjusted cumulative sum (RA-CUSUM) method was used to define the stages of mastering the technique. The primary outcome measure was the incidence of severe postoperative complications (Clavien–Dindo grade IIIB and above). Operative time, intraoperative blood loss, conversion rate, length of hospital stay and long-term treatment outcomes were also analyzed.

Results. Data from 305 laparoscopic colon resections were included in the analysis. The proportion of laparoscopic procedures increased from 8.9 % in 2015 to 27.8 % in 2023. The learning curve analysis revealed four distinct phases of proficiency acquisition. In the 1^st phase (procedures 1–30), the complication risk was 0 %. The 2^nd phase (procedures 31–80) was characterized by the highest risk of severe complications at 20.00 % (95 % confidence interval 11.24–33.04). A decrease in risk was observed during the 3^rd phase (procedures 81–93). The final, 4^th phase (procedures 94–304) achieved consistently low complication risk of 2.84 % (95 % confidence interval 1.31–6.06). The critical point for completing the learning phase was identified at the 93^rd procedure. Analysis of the learning curve for conversions revealed the peak conversion rate of 23.1 % during the recovery phase, which subsequently decreased to 2.4 % in the stability phase. The overall conversion rate for the entire series decreased from 11.1 % in 2015 to 6.0 % in 2023. Operative time and intraoperative blood loss remained stable throughout the observation period. The 5-year overall survival rate was 81.6 %, and the recurrence-free survival rate was 81.1 %.

Conclusion. The implementation of laparoscopic technologies requires structured training with increase in the number of surgeons performing minimally invasive surgeries. The period of intense learning occurs between the 30^th and 80^th procedures, after which stable and predictable results are achieved.

Spinal osteoblastoma is a rare benign tumor characterized by aggressive growth and high risk of recurrence. Surgical treatment requires ablative tumor removal followed by reconstruction of the postresection cavity to restore spinal load-bearing capacity, especially in children who experience further bone growth. This article presents a clinical case of a 17-year-old patient with an aggressive osteoblastoma of the Th4–5 vertebrae, accompanied by severe pain syndrome and spinal canal stenosis. As part of neoadjuvant therapy, denosumab was used off label, leading to tumor sclerosis, pain reduction, and improved visualization of the tumor margins. Surgical intervention included radical tumor resection, transpedicular fixation, and defect replacement with a customized allograft modeled according to the patient’s anatomical features. Postoperative follow-up confirmed complete tumor removal and hardware stability. This clinical case demonstrates a successful application of a combined approach in treating aggressive spinal osteoblastoma, including neoadjuvant denosumab therapy, ablative tumor removal, and reconstruction of an extensive defect with a customized allograft and metal fixation. This case highlights the importance of a multidisciplinary approach and the need for individualized surgical planning, considering tumor stage and anatomical features.

Background. Incidence of synchronous rectal and prostate cancers remains relatively low. However, with growing numbers of newly diagnosed separate pathologies, it can be assumed that the number of patients with a combination of these diseases will also increase.

Information on treatment tactics in these cases is sparse, and a limited number of articles reflects the authors’ modest experience in this problem. This article presents clinical examples of single-step surgical treatment of these pathologies.

Clinical cases. Two patients aged 62 and 63 years were diagnosed with synchronous rectal and prostate cancers. Considering disease stages and potential progression risk per the Gleason scale, simultaneous surgeries – low anterior resection of the rectum with formation of a protective stoma and radical retroperitoneal prostatectomy – were performed. The surgeries were not accompanied by significant blood loss.

In the postoperative period, one of the patients had coloanal anastomosis failure which was resolved using conservative treatment methods.

Postoperative period of the second patient did not have any significant complications. Both patients underwent chemotherapy: in the 1^st case as adjuvant therapy, in the 2^nd case as neoadjuvant therapy. Follow-up period for the 1^st patient was 36 months (observation continues), for the 2^nd patient, 18 months. In both patients, there are no data on rectal and prostate cancer progression. Currently the patients demonstrate satisfactory functional results, continue observation.

Conclusion. Treatment of primary synchronous rectal and prostate cancers is an exceptionally complex clinical problem. It cannot be solved without a multidisciplinary team, as well as sharing of experience between experts of various medical facilities.

We present a rare clinical observation of histologically confirmed endosalpingiosis of the bladder in a female patient aged 44 years who underwent combination treatment. This observation is the 8^th documented case of isolated endosalpingiosis of the bladder in the world.

The article demonstrates the rarity of endosalpingiosis of the bladder, complexity of differential diagnosis of this disease, and the necessity of comprehensive examination with mandatory accurate tumor histogenesis prior to determination of treatment tactics in patients with bladder neoplasms.