Vol 6, No 2 (2016)

Introduction. Standardized protocols for perioperative management of patients are increasingly used in colorectal surgery. We compared the results of right-sided hemicolectomy in elderly patients before and after implementation of this protocol.

Materials and methods. The results of a prospective database of the department of surgical oncology of Treatment and Rehabilitation Center for 2009–2016 years were analyzed. A comparative analysis of 86 case of elective right-sided hemicolectomy was performed in patients aged 60 years and over as a part of standardized protocol for perioperative management of patients, and 34 similar surgeries carried out earlier without compliance with the protocol. Clinically, there was no significant differences between groups.

Results. In the study group we revealed statistically significant decrease in the number of sever (grade III–V by Clavien–Dindo) postoperative complications and mortality from 33 % to 13 % and from 12 % to 1 %, respectively. Also, despite the fact that surgical operations in the test group were carried out by less experienced surgeons, introduction of the unified surgical technique reduced median duration of the surgery from 185 to 165 minutes.

Conclusion. Introduction of the standardized protocol for perioperative management of elderly and old patients, that need right-sided hemicolectomy, reduces the number of complications and lethal cases.

Objective: improve the results of treatment of patients with metastatic cancer of liver by reducing the risk of post-resection liver failure based on the assessment of liver functional reserve.

Materials and methods. The study included 2 independent samples of patients underwent surgery for liver metastases in the department of abdominal oncology at the P. A. Herzen Moscow Oncological Research Institute. Group 1 included 47 patients: in addition to the standard treatment algorithm they underwent 13C methacetin breath test and dynamic scintigraphy of liver in the preoperative stage. Patients from the group 2 (n = 30) underwent standard clinical and laboratory examination, without preoperative evaluation of liver functional reserves; the level of total bilirubin, albumin and prothrombin time showed no decrease in liver function. Post-resection liver failure was established based on 50/50 criterion when evaluated on the 5th postoperative day.

Results. The analysis of operational characteristics of functional tests showed absolute sensitivity of 13C methacetin breath test (SE ≥ 100 %) and negative predictive value (–VP ≥ 100 %) in case of integrated application of 2 diagnostic methods. An incidence of post-resection acute liver failure in the study group was significantly 2.2-fold lower than in the control group – 10.6 % and 23.3 %, respectively (p < 0.001).

Conclusion. Combination of preoperative dynamic scintigraphy of liver with 13C methacetin breath test allows to perform comprehensive assessment of liver functional reserves, and it can greatly improve preoperative assessment and postoperative results of anatomic resections in patients with liver metastases.

Toxic megacolon complicating pseudomembranous colitis is a very rare condition that confirms by a few reports. In our case report probably described a case after extraperitoneal preventive colostomy closure toxic megacolon was developed with fatal final.