Vol 16, No 1 (2026)

Selection of surgical tactics in cancer of the splenic fixture is associated with certain difficulties due to tumor location and characteristic lymphatic outflow. In case of the presence of such complication as intestinal obstruction, determination of the most effective surgical strategy remains debatable.

Aim of the review is to study the optimal volume of emergency surgical intervention based on the analysis of immediate and long-term results of treatment of spleniс fixture cancer complicated by acute intestinal obstruction. Due to low frequency of this pathology in scientific literature, there is insufficient information on its surgical treatment. However, in recent years some studies have considered which type of surgical intervention could achieve the best immediate and long-term results in patients with cancer of the splenic flexure. The article considers publications on various types of surgical operations in cancer of the splenic flexure complicated by intestinal obstruction.

Background. Neoadjuvant chemotherapy (NACT) is not included in standard treatment protocols for patients with intrahepatic cholangiocarcinoma (ICC).

Aim. To compare immediate treatment outcomes in ICC patients receiving NACT versus surgery alone.

Materials and methods. The retrospective analysis included patients who underwent surgery for ICC between 2010 and 2024. NACT-related complications were assessed using CTCAE v.5.0, treatment response was evaluated per the RECIST 1.1 criteria, and the impact of NACT on postoperative complications and likelihood of adjuvant chemotherapy (ACT) completion were analyzed.

Results. The surgery-only (control) group included 108 patients, while the NACT group included 49 patients. Grade III NACT-related complications developed in 2 (4.4 %) patients. Partial response (PR) to NACT was observed in 5 (10.2 %) patients, with stable disease was achieved in 40 (81.6 %) patients. R0 resection was achieved in 91 (84.3 %) patients in the surgery-only group and 47 (95.9 %) in the NACT group (p = 0.113). NACT did not affect the risk of severe postoperative complications (hazard ratio 0.482; 95 % confidence interval 0.183–1.268; p = 0.139). Patients receiving NACT completed ACT more frequently compared to control group: 76 (70.4 %) versus 43 (87.8 %), respectively (p = 0.026).

Conclusion. NACT demonstrated high safety but low PR rates and no impact on R0 resection achievement probability.

Introduction. Neuroendocrine carcinomas (NEC) of gynecologic tract are rare and aggressive tumors for which there are currently no standardized approaches to systemic therapy. Platinum-based chemotherapy regimens are the main treatment method, but data on their efficacy are limited to a few retrospective studies.

Aim. To evaluate the efficacy of platinum-based chemotherapy as first-line treatment for patients with metastatic gynecologic NEC, as well as the prognostic role of tumor histology, tumor location, disease extent, frequency of second-line therapy, and progression-free survival (PFS).

Materials and methods. A retrospective analysis was conducted of the efficacy of platinum-based chemotherapy as first-line therapy for primary metastatic or recurrent (with a platinum-free interval ≥12 months) NEC of gynecologic tract at the N. N. Blokhin National Medical Research Centre for Oncology in 2017–2024.

Results. The most common site of primary tumor was the cervix (n = 18; 62.1 %), 5 patients had ovarian NEC (17.2 %), 3 had uterine NEC (10.3 %), 2 had vulvar NEC (6.9 %), and 1 case of vaginal NEC was diagnosed (3.4 %). In 15 patients (51.7 %), the disease was detected at stage IV, and in 14 (48.3 %), progression was noted after primary treatment with a platinum-free interval of ≥12 months. Small-cell histological type was detected in 17 patients (58.6 %), large-cell in 12 of 29 (41.4 %). The frequency of high microsatellite instability (MSI) cases was 13.3 % (2 out of 15 examined), and positive expression of somatostatin receptors 2 and / or 5 (SSTR) was found in 33.3 % (4 out of 12 examined). In most cases, etoposide + cisplatin / carboplatin regimens were used (n = 25; 86.2 %), and 4 patients (13.8 %) received the paclitaxel + carboplatin regimen. The objective response rate was 44.8 %; the median PFS was 7.5 months (95 % confidence interval (CI) 2.9–12.1), median overall survival (OS) was 14 months (95 % CI 13–16.2). Disease control ≥6 months was achieved in 15 (51.7 %) patients, ≥12 months in 6 (20.7 %). Peritoneal carcinomatosis was significantly associated with worse PFS (hazard ratio 4.37; p = 0.01), and ECOG status 1–2 was associated with worse OS (hazard ratio 3.4; p = 0.01). No statistically significant differences in survival were found between histological types.

Conclusion. First-line platinum-based chemotherapy demonstrates efficacy comparable to previously published data in metastatic NEC of gynecologic tract. The high frequency of MSI-high cases justifies its routine measurement. The expression of somatostatin receptors is of interest for further study as a prognostic and therapeutic marker.

Background. Distinguishing rectosigmoid colon cancer as a separate nosological entity does not affect the choice of modern treatment strategy.

Aim. To evaluate differences in short-term and long-term oncological outcomes of surgical treatment for sigmoid colon cancer (SCC) and rectosigmoid colon cancer (RSCC).

Materials and methods. This single-center retrospective cohort study included patients with RSCC and SCC who underwent radical surgical treatment between January 2019 and December 2023. The primary endpoints were the rate of grade IIIB and higher complications per the Clavien–Dindo classification, anastomotic leak rate, recurrence rate, and 3-year overall survival and disease-free survival.

Results. The study included 50 patients with RSCC and 137 patients with SCC. The rates of grade IIIB and higher complications were 2 (4 %) and 9 (6.6 %), p = 0.115; the rates of colorectal anastomotic leak were 4 (8 %) and 4 (2.9 %), p = 0.213, respectively. Three-year overall survival was 84.6 % and 85.6 % (p = 0.856); 3-year disease-free survival was 72.8 % and 81.8 % (p = 0.227), respectively.

Conclusion. Within the framework of this retrospective analysis, no clinically significant differences were found in short-term and long-term treatment outcomes for sigmoid colon cancer and rectosigmoid colon cancer.

Introduction. Therapeutic options for 3^rd-line treatment of metastatic colorectal cancer (mCRC) include chemotherapy retreatment with previously used regimens and regorafenib. Due to the lack of phase III prospective studies and conflicting retrospective results, we performed a comparative analysis of the efficacy and safety of chemotherapy ± targeted therapy retreatment versus regorafenib in a large patient cohort.

Materials and methods. The study included mCRC patients from 4 oncology centers in the Russian Federation treated between 2010 and 2021 who received 3rd-line therapy either with chemotherapy ± targeted agents (epidermal growth factor receptor or vascular endothelial growth factor antibodies) (CTT group) or with regorafenib. The primary endpoint was 9-month overall survival (OS); secondary endpoints were progression-free survival (PFS), objective response rate (ORR) and toxicity. Univariable and multivariable analyses were conducted to identify prognostic factors.

Results. A total of 334 patients were included. Median follow-up was 30.3 months (95 % confidence interval (CI) 26.0–34.5) in the CTT group and 23.8 months in the regorafenib group. The groups differed in several baseline characteristics: primary tumor resection was performed more frequently (76.1 % versus 67.6 %; p = 0.088) and ECOG 0 status was more common (25.2 % versus 14.2 %; p = 0.006) in the CTT group. Patients treated with regorafenib more frequently had elevated carcinoembryonic antigen ≥50 ng / mL (45.3 % versus 65.3 %; p < 0.001) and indolent disease course ≥20 months (64.3 % versus 49.1 %; p = 0.005), while a «treatment-free interval» ≥6 months after oxaliplatin or irinotecan was observed less frequently (68.1 % versus 43.3 %; p < 0.001).

Chemotherapy retreatment demonstrated a statistically significant advantage in median OS (18.1 months versus 10.2 months; hazard ratio (HR) 0.51; 95 % CI 0.39–0.67; p < 0.0001) and PFS (6.0 month versus 2.8 months; HR 0.54; 95 % CI 0.43–0.67; p < 0.0001). ORR was 6.1 % in the CTT group compared to 0.6 % in the regorafenib group.

In multivariable analysis, unfavorable prognostic factors were worse ECOG status (ECOG 1: HR 1.77; p = 0.002; ECOG 2: HR 2.56; p = 0.001), right-sided primary tumor location (HR 1.98; p < 0.001), presence of ≥2 liver metastases (HR 1.52; p = 0.021), absence of radical resection of the primary tumor (HR 1.91, 95 % CI 1.32–2.78; p = 0.001), shorter interval between 1^st-line and 3^rd-line therapy (a longer course >20 months correlated with better prognosis: HR 1.38, 95 % CI 1.04–1.85; p = 0.028), and carcinoembryonic antigen ≥50 ng / mL (HR 1.38, 95 % CI 1.04–1.82; p = 0.026). Based on these factors, a prognostic model was created that identifies favorable (median OS 19.4 months), intermediate (median OS 13.0 months), and poor (median OS 6.6 months) risk groups. The C-index was 0.698 (standard error 0.02).

Conclusion. Chemotherapy retreatment showed superiority over regorafenib in 3rd-line treatment of mCRC. Its higher efficacy was confirmed across all prognostic subgroups. Predictive analysis did not identify any subgroup with advantage from regorafenib therapy.

Background. Acute large bowel obstruction is one of the most common complications requiring emergency or immediate surgical intervention. This condition is diagnosed in 10–26 % of patients with nonresectable metastases of colorectal cancer. Resection of the primary lesion is an extensive intervention which is often associated with the risk of delaying systemic therapy. Therefore, less invasive surgical strategies – formation of a defunctioning stoma or placement of a self-expandable metallic stent – have come to the forefront.

Aim. To compare early and long-term clinical outcomes of using self-expanding metallic stents (SEMS) and defunctioning stoma formation in patients with stage IV colorectal cancer complicated by intestinal obstruction.

Materials and methods. The retrospective cohort study included 82 patients with a diagnosis of stage IV colorectal cancer and clinically confirmed intestinal obstruction caused by progression of the main disease. The patients were divided into 2 groups: in the 1^st group, SEMS were placed (SEMS group, n = 18); in the 2^nd group, stoma was formed (stoma group, n = 64). Clinical success (elimination of obstruction symptoms during the 1^st day after the surgery), rates of early (under 30 days) and late (after 30 days) postoperative complications, necessity of repeat interventions, and overall survival were assessed.

Results. Clinical success was achieved in 17 (94 %) patients in the SEMS group and 64 (100 %) patients in the stoma group (p = 0.221). The rate of early postoperative complications was 3 (16.7 %) cases in the SEMS group and 9 (14.1 %) cases in the stoma group (p = 0.720). The groups did not significantly differ in the rates of late complications (4 (22.2 %) cases in patients after stenting versus 5 (7.8 %) in patients with stoma (p = 0.101)). The frequency of repeat interventions did not differ between the groups and was 2 (11.1 %) cases in the SEMS group and 6 (9.4 %) in the stoma group (p = 0.810). Analysis of overall survival (OS) included 82 patients, 18 in the SEMS group and 64 in the stoma group. At the end of follow-up period, deaths were reported for 17 (94.4 %) and 52 (81.3 %) patients, respectively; 1 (5.6 %) and 12 (18.7 %) observations, respectively, were censored. Median follow-up was 38.2 months therefore OS was calculated at the maximal horizon of 36 months as to not exceed the median follow-up. At month 36, OS was 7.3 % (95 % confidence interval (CI) 0.5–27.8) in the SEMS group and 16.7 % (95 % CI 7.9–28.3) in the stoma group; differences between the OS curves were not statistically significant (log-rank test; p = 0.069) with a trend towards less favorable OS in the SEMS group. Median OS was 7.4 months in the SEMS group and 18.0 months in the stoma group. Cox’s model showed a marked dynamic toward higher risk of death in the SEMS group compared to the stoma group (hazard ratio 1.71; 95 % CI 0.95–3.07).

Conclusion. Placement of SEMS and defunctioning stoma formation in patients with stage IV colorectal cancer complicated by large bowel obstruction were characterized by similar clinical efficacy and early safety with faster functional recovery and earlier start of systemic therapy in the SEMS group. In the long term at 36-month horizon, a trend toward less favorable OS in the SEMS group without statistically significant differences between the curves and increased relative risk of death in this group were observed. Considering limitations of the study (retrospective design, single center, small number of patients in the SEMS group), the results should be considered hypothesis-forming and requiring further prospective studies.

Background. Cholangiocarcinoma is a rare primary liver malignancy accounting for 10–15 % of hepatic cancers. Diagnosis of this condition in the setting of cirrhosis is challenging and is often established posthumously.

Clinical case. A 47-year-old male patient with chronic alcohol abuse and hepatitis C seropositivity presented with acute upper gastrointestinal bleeding on March 18, 2025. Child–Pugh class B cirrhosis, portal hypertension, and esophageal varices (grade II–III) were diagnosed. Ultrasonography showed multiple focal liver lesions suggestive of malignancy. The patient failed to comply with oncology consultation and continued his previous lifestyle. Over the subsequent 7-month period, the patient experienced four episodes of massive variceal hemorrhage requiring intensive hemostatic therapy and massive blood transfusions. Successful endoscopic variceal ligation was performed during the third admission. Death occurred during the fourth hemorrhagic episode (October 4, 2025). Autopsy and histopathological examination revealed cholangiocarcinoma of the intrahepatic bile ducts (International Classification of Diseases 10 (ICD-10) code C22.1) with multiple hepatic metastases on a background of mixed-etiology micro-macronodular cirrhosis (hepatitis C virus + chronic alcohol intoxication).

Conclusion. This case illustrates diagnostic challenges of detecting cholangiocarcinoma in cirrhotic patients, progressive severity of recurrent variceal hemorrhages, and natural progression of untreated disease. It emphasizes the importance of active cancer surveillance, morphological verification, and the high effectiveness of endoscopic variceal ligation.