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The study aimed to perform a systematic review of the literature on surgical treatment for right colon cancer (RCC) with complete mesocolic excision (CME) and D2/D3 lymph node dissection (LND). Material and Methods. A literature review was performed for studies published between 2013 and 2023 by the online resources from the official Web sites of the societies/panels and PubMed database. Sources included guidelines, meta-analyses, randomized and nonrandomized clinical studies, guidelines by European Society of Medical Oncology, the Japanese Society for Cancer of the Colon and Rectum, and the National Comprehensive Cancer Network, Russian clinical guidelines. Results. CME significantly improved both immediate and long-term treatment results, which was confirmed by numerous meta-analyses. The extent of LND remains one of the most controversial issues in RCC. For many Asian surgeons, D3 LND is the standard procedure for the treatment of RCC, whereas the European approach is more conservative and apical lymph node dissection is not mandatory. There are also large differences in understanding the extent of D3 LND in RCC. Most surgeons understand this term as dissection of adipose tissue along the anterior and lateral surface of the superior mesenteric vein, however, there are authors who perform circular dissection along the superior mesenteric vessels, considering this extent of surgery to be the most radical. Conclusion. It is necessary to standardize methods and effective criteria for quality control of CME for RCC and LND. In this case, external independent assessment of the quality of surgical intervention is important. There is also currently a growing number of studies in which intraoperative fluorescence imaging makes it possible to better visualize the location of the apical lymph nodes and individualize LND.

Aim. Given the potential for physiological alterations in the gastrointestinal tract following appendix removal, which may influence carcinogenesis, we embarked on a systematic review and meta-analysis to explore the possible association between appendectomy and the subsequent risk of colorectal cancer (CRC).Methods. Our systematic investigation utilized sources including the Cochrane Library, Embase, PubMed, ClinicalTrials.gov, and Web of Science, covering research up to February 1, 2023. We assessed the impact of appendectomy on colorectal cancer, employing a random effects model to calculate the pooled hazard ratio (HR) for developing CRC post-appendectomy and its 95 % confidence interval (CI).Results. This review and meta-analysis incorporated a total of 10 studies, comprising 1,001,693 cases of appendectomy and 39,463 instances of CRC. The meta-analysis revealed a pooled HR of 1.04 (95 % CI: 1.0–1.08) for developing CRC following appendectomy. Notably, the HR for CRC development increased to 1.20 (95 % CI: 0.69–1.69) when considering only cases with more than 10 years of follow-up.Conclusion. The findings indicate a marginally increased risk of colorectal cancer in cases without a specified follow-up period. However, this elevated risk did not persist over the long term (exceeding 10 years). The heterogeneity of the included studies appears to have influenced our results. Nevertheless, it is advisable for physicians to weigh the potential benefits of alternative therapies and consider the future complications that may arise from an unnecessary appendectomy.

The aim of the study: to evaluate the 1- and 3-year survival of patients operated for complicated forms of colon cancer (СC) in general surgical hospital. Materials and methods. The study group included 71 (100 %) patients with complicated forms of СС. Acute intestinal obstruction was detected in 49 (69.1 %) patients, tumor perforation – in 13 (18.3 %), acute colonic bleeding – in 3 (4.2 %) patients, a combination of acute intestinal obstruction with tumor perforation – in 4 (5.6 %) and intestinal obstruction with bleeding – in 2 (2.8 %) operated patients. Radical operations were performed in 48 (67.6 %) patients, palliative operations – in 18 (25.4 %), symptomatic operations – in 5 (7.0 %) patients. II stage of the disease was diagnosed in 15 (21.1 %), III stage – in 32 (45.1 %), IV stage – in 24 (33.8 %) operated patients. 19 (30.2 %) patients underwent specific chemotherapy after surgery. Results. Among patients with the II stage of the oncological process 1-year survival was 76.9 ± 11.7 %, 3-year – 53.8 ± 13.8 %; with stage III, 1-year survival was 65.6 ± 8.4 %, 3-year – 50.0 ± 8.8 %; in persons with IV stage of СC – 29.2 ± 9.3 % and 8.3 ± 2.6 % respectively (χ2 = 21.8, p = 0.0001). Among male patients, 1-year survival was 51.4 ± 8.5 %, 3-year – 31.4 ± 7.9 %; women – 61.1 ± 8.1 % and 44.4 ± 8.3 %, respectively (χ2 = 2.3, p = 0.1302). Better indicators were found in the case of cancer of the left sections of the large intestine than the right sections – the 1-year survival rate was 60.4 ± 7.1 % and 43.5 ± 10.3 % respectively; 3-year – 39.6 ± 7.1 % and 30.4 ± 9.6 % (χ2 = 0.74, p = 0.3906). Conclusions. The conducted analysis indicates a clear dependence of the survival results on the stage of the disease, gender and localization of the tumor process.

The increased risk of colorectal cancer following ionizing radiation exposure was demonstrated in a number of epidemiological studies. Earlier, no impact of occupational radiation exposure on colorectal cancer incidence or mortality was observed in a cohort of workers of the nuclear industrial facility, Mayak Production Association (PA). Extension of the follow-up of the cohort and improvement of dose estimates for personnel made it possible to update the earlier findings. The study objective is to assess the risk of colorectal cancer incidence associated with chronic occupational radiation exposure taking into account non-radiation factor effects. The study cohort included 22,377 workers employed at the reactor, plutonium-producing and radiochemical plants of Mayak PA (hiring period 1948–1982; follow-up period ended on December 31, 2018). Using the Poisson regression (EPICURE software), the relative risks (RRs with 95 % confidence intervals, (95 % CI)) of colorectal cancer incidence were estimated depending on the most significant non-radiation factors (sex, age, smoking, alcohol consumption, excessive body mass and obesity, intestinal polyps, chronic colitis). These values were also calculated for certain ranges of occupational exposure doses relying on data provided by ‘The Mayak Worker Dosimetry System – 2013’. The linear model was used to analyze the dose-response relationship. In the study cohort, the RR of colorectal cancer incidence was lower in females than in males: 0.72 (95 % CI: 0.55; 0.96) for colon and 0.48 (95 % CI: 0.34; 0.67) for rectum. The increased RR of the rectum cancer incidence was observed for cases with intestinal polyps: 3.42 (95 % CI: 1.68; 6.19). The colon cancer incidence risk increased with increasing age of workers, but other non-radiation factors were not shown to affect the results. This study supported the earlier results: no association was observed between the risk of colorectal cancer incidence and doses of occupational external gamma-ray or internal alpha-particle exposures.

A clinical case of the development of tubular-villous adenoma with moderate epithelial dysplasia (high grade) is described, taking into account the presence of foci of squamous metaplasia in the epithelium of the glands. The pathology presented in the article according to ICD-O has code 8263/2.Description of the clinical case. The patient had an initial colonoscopy in 2020 and was diagnosed with chronic ileitis and colitis with moderate and in some areas high inflammation activity, which is most characteristic of nonspecific ulcerative colitis. The patient was treated by a gastroenterologist. In December 2021, she had a follow-up colonoscopy with the histological material sampling. Endoscopic conclusion: ulcerative colitis, total lesion, exacerbation phase.Results and discussion. When the device was inserted into the rectum at a distance of 13 cm, a neoplasm was visualized, the mucosa was pale, shiny, when trying to pass the device through the narrowing of the contact-vulnerable mucosa, with instrumental palpation, the formation was displaced by a conglomerate, a polyfragmentary biopsy was taken. In the study of histological preparations of the recto-sigmoid junction, a tubular-villous adenoma with moderate epithelial dysplasia (high grade) is determined, taking into account the presence of foci of squamous metaplasia in the epithelium of the glands. According to the literature, with ulcerative colitis affecting almost the entire colon for more than 10 years, there is an increased risk of colon cancer formation (10 %), which increases by 2–5 % annually. The possibility of malignancy is present in 10–20 % of patients with ulcerative colitis for more than 20 years. Other researchers describe the identified low-grade dysplasia as progressing to high-grade dysplasia and carcinoma in 29–54 % of cases.Conclusions. The study of patients with this pathology should be carried out against the background of thorough preparation of the large intestine with modern preparations using high-tech verification methods and polyfragmental biopsy with a qualified assessment of biopsy specimens.

Purpose of the study. To assess the effect of inclusion of lactoglobulin in complex preoperative preparation of colon cancer patients on their tumor and resection line tissue microbiota.Materials and methods. 40 patients with colon cancer stages II–III, in whom the operation was the first stage of treatment, during standard preoperative preparation, were injected with a preparation of antibodies against opportunistic intestinal microorganisms obtained from colostrum of immunized cows, 2 g twice a day orally before surgery for 3 days (total dose of 12 g) (main group); 40 patients received standard antibiotic prophylaxis (control group). The quantitative composition of the microbiota was determined in the samples of the removed tumor and tissue of the resection line.Results. The total microbial contamination of the tumor was 9.2 times lower in the main group relative to the control group; the frequency of E.coli and Clostridiae excretion was also statistically significantly lower (p = 0.004 and 0.03, respectively). In the tumors of patients of the main group out of twelve studied representatives of microorganisms, the number of six was statistically significantly lower than in control group, and three of those found in the control group were not detected. Since they were potentially pathogenic (Pseudomonas aeruginosa, Staphylococcus aureus, fungi of the Candida spp.), the microbial composition of the tumor of patients in the main group can be considered more favorable than the control group. Similar differences were noted in non-t umor intestinal tissue, in which the content of Enterobacter spp, Streptococcus, Clostridiae, Peptostreptococci was statistically significantly lower than in the control group.Conclusion. Thus oral administration of colostrum antibodies caused positive changes in tumor and colon tissue microbiota. We suggest the application of lactoglobulin to be useful for surgical treatment of such patients taking into account the possible impact of microbiota in patients’ response to chemo- and immunotherapy.

Background. surgery is the main method of treatment of colon cancer (cc). Radical surgery performed in non-specialized hospitals can lead to the adverse outcomes.The aim of this study was to assess CC survival after radical surgery performed in state hospitals of the arkhangelsk region (North-West Russia) in 2010–21.Material and Methods. data on all the 2142 cases of radical surgery of CC were obtained from the arkhangelsk regional cancer registry (ARCR). One- and five-year cancer-specific survival rates were estimated by the survival tables; cumulative survival function was calculated by the Kaplan–meier method. Univariate and multiple cox regression analysis was carried out to identify independent predictors associated with CC death risk after radical surgery in state hospitals (incl. sex, age at the time of diagnosis, topography, morphology and stage of CC).Results. less than half (42.8 %) of patients underwent surgery at the arkhangelsk clinical cancer center (accc), a single specialized hospital. one- and five-year survival rates of all patients were 86.5 % (95 % CI: 84.9–87.9 %) and 65.1 % (95 % ci: 62.7–67.4 %), respectively. The 5-year survival rate of patients who underwent surgery in the accc was significantly higher than that in patients who underwent surgery in other state non-specialized hospitals (76.0 % (95 % ci: 72.5–79.0 % versus 49.3–73.8 %, p

The objective of the study is to compare the effectiveness of various systemic therapies in the 3rd and subsequent lines of therapy of metastatic colon cancer. Material and Methods. Retrospective multicenter study collected data from 2 clinics of the Russian Federation. We considered overall survival (OS) as the main criterion of effectiveness. Progression-free survival (PFS) was the additional criterion. We performed a single- and multifactorial analysis of the effect of various parameters on PFS. To evaluate the effectiveness of regorafenib and the reintroduction of previously effective drugs, we should prove the equivalence of reintroduction of the 3rd line chemotherapy (CT) and targeted therapy to regorafenib on the 6-month overall survival, provided that the equivalence boundaries would be between 0.8 and 1.25. To reach the 0.05 probability of type I error and the 80 % study power, 178 patients (89 in each group) should be included in the study. Results. The database identifed 215 patients with morphologically confrmed metastatic colon cancer who received two or more lines of antitumor drug therapy from 2010 to 2021. We selected 132 patients with the history of regorafenib therapy and 83 patients with the reintroduction of a previously used chemotherapy regimen as 3rd line treatment. The median OS in the reintroduction and regorafenib groups did not differ (HR, 1.01; 95 % CI, 0.7–1.45; p=0.920); 6-month OS were 74 and 70 %, respectively. Progression-free survival was signifcantly higher in the reintroduction group (HR, 1.94; 95 % CI, 1.3–2.7; p

Aim. To analyze the latest literature data on stem cells in general, intestinal stem cells in particular, as well as cancer stem cells in the context of colon carcinogenesis. Over the past decade, a significant amount of data confirming the existence of cancer stem cells, their importance in cancer progression, resistance to current treatment regimens, and the occurrence of relapses has been accumulated. These cells are a small fraction of cancer cells that initiate tumor growth and provide tumor tissue heterogeneity. In addition, these cells are distinguished by a significant resistance to effects of various cytotoxic factors. Therefore, the possibility of isolating cancer stem cells and further targeted action are highly important for enabling a complete tumor eradication. A study on intestinal stem cells has always been in the focus of stem cell biology researchers’ attention because intestinal stem cells are an example of an active cell population that provides regular rapid renewal of the epithelium, which is constantly exposed to toxic, bacterial, and other aggressive factors. Accordingly, colon carcinogenesis is a convenient model for studying the role of stem cells in tumorigenesis. At the same time, there are two main current schemes of colon carcinogenesis, which are acknowledged – these are so-called “bottom-up” and “top-down” modes of transformed cell spreading. The “bottom-up” scheme was substantiated first, proving to be in good agreement with modern ideas about the structure of intestinal crypts. However, a little later, reports about the possibility of the “top-down” direction began to appear: differentiated cells located in the superficial parts of the intestinal crypts, undergoing mutations, could dedifferentiate and return to the basal parts; a pathological increase in the surface epithelial cells proliferation level was possible as well, leading to an increase in the luminal surface area, formation of grooves mimicking the intestinal crypts. This review provides the latest data on stem cells in general, in particular on intestinal stem cells, as well as on cancer stem cells in the context of colon carcinogenesis. We also analyze the latest literature data on the possibility of isolating cancer stem cells in colon carcinomas using molecular markers, difficulties associated with this process, and issues that are still unresolved. Conclusions. Today, there is no doubt about the existence and importance of cancer stem cells in carcinomas. Quite a lot of molecular markers of cancer stem cells have been identified and studied. It is worth noting that certain aspects of cancer stem cells can not be studied one-sidedly but require a multidimensional analysis.

Purpose of the study. Was to reveal characteristics of the immunocompetent cells in colon cancer (CC) according to the disease stage, and to identify prognostic factors of cancer development.Materials and methods. The study included 50 patients with CC: stage I – 4 patients (8 %), II – 25 (50 %), III – 21 (42 %). All patients underwent standard surgical intervention at the initial stage, the obtained material was used for subsequent studies: a cell suspension was obtained from the tumor tissue, peritumoral zone (1–3 cm from the tumor), which was treated with an antibody panel (Becton Dickinson, USA) to identify the main subpopulations of leukocytes and lymphocytes.Results. The tumor tissues of patients with stages I + II showed a decrease in the relative number of DP, DN, NKT and CD19+, compared to peritumoral tissues, by 33 %, 42 %, 31 % and 82 % respectively. Tumor tissues of stage III patients demonstrated elevated relative numbers of CD3+, CD4+, NK by 57 %, 34 %, 48 %, and decreased DP, DN, NKT, CD19+ by 33 %, 74 %, 31 %, 59 %, compared to peritumoral tissues. DP, DN, NKT and CD19+ in the tumor decreased by 78 %, 74 %, 39 %, 60 %, respectively, and the relative number of lymphocytes increased by 138 %, compared to the tissues of the resection line. A comparative analysis of local immunological parameters in the tumor tissues of patients with СС revealed that the relative numbers of lymphocytes and CD19+ were 58 % and 87 % higher, and DP and DN were 33 % and 27 % lower in tumor tissues of stage III patients, compared to tumor tissues of stage I + II patients.Conclusion. Thus, the obtained features of the local population and subpopulation composition of immunocompetent cells in CC, depending on the stage of the tumor process, can be used to predict the clinical course of the disease.

Objectives. To establish the associations of genetic variants of genes and viral DNA/RNA in liver cancer (LC) and colorectal cancer (CRC). Material and methods. Tissue and blood samples of individuals with morphologically diagnosed CRC and LC (n=130) served as the material for the study. The age of the examined persons was 61.8±13.7 years. A molecular biological study of the detection of DNA/RNA of the virus genome and a study of the BRCA1/2 and hMSH2 genes were performed. The control group was represented by blood samples of 80 healthy individuals with no neoplasms and infections. Statistical processing – SPSS software package. Results. The number of mutations in the BRCA1/2 and hMSH2 genes in blood samples from patients with CRC was 2.04%, while the frequency of changes in the hMSH2 gene was 4.17%, which is lower than that of detected mutations in the same genes in tumor tissue samples (p=0.003). The frequency of mutations in the BRCA1 and hMSH2 genes in the population was 1.25%. Mutations of the BRCA 1/2 genes in women showed their dependence on the hMSH2 gene (p

Purpose of the study. To evaluate the number of cells with the CD45+/- phenotype expressing Toll-like receptors (TLRs) in tissues of the tumor, peritumoral area and resection line tissues in colon cancer (CC) with various tumor locations.Materials and methods. The study included 50 patients with CC. All patients underwent surgery as the primary treatment, and tissue material was collected from the patients. Expression of TLRs (2, 3, 4, 8, 9) on CD45+, CD45- cell populations was determined by flow cytometry in cell suspensions obtained from tissues of the tumor, peritumoral area (1–3 cm from the tumor) and resection line tissues (~10 cm from the tumor) with further calculation of the percentage of cells with the corresponding phenotype from the total number of cells.Results. An analysis of left-sided colon tumors showed lower percentage of CD45- cells expressing TLR4, 8, compared to rightsided tumors, by 38 % and 25 %. A comparative analysis of the number of CD45+ cells expressing TLR 2, 4 showed their decrease by 81 % and 87 %, respectively, compared with right-sided tumors. An assessment of the data in the perifocal zone of left-sided colon tumors, compared with right-sided ones, demonstrated a decrease in the percentage of cells with the CD45- phenotype that express TLR4, by 61 %. Resection line tissues in left-sided tumors, compared with right-sided ones, showed a statistically significant increase in the percentage of CD45- cells that express TLR 2, 4 by 205 % and 55 %, respectively. The number of CD45+ cells expressing TLR 4 decreased by 87 %. An assessment of the number of cells expressing TLRs 3 and 9 in the tumor, peritumoral area and resection line tissues did not reveal significant differences.Conclusions. Lower number of cells with CD45+ and CD45- phenotypes express TLRs 2, 4, 8 in left-sided colon tumors and their peritumoral tissues, compared to right-sided cancer.

Purpose of the study. Was to evaluate overall survival of CC patients after D2 and D3 lymph node dissections and assess the frequency of postoperative complications and dynamics of postoperative recovery.Materials and methods. The study included 50 CC patients aged 39–84 years.Results. The comparative assessment of the overall survival, frequency of postoperative complications and dynamics of postoperative recovery was performed in patients divided into 2 groups depending on the lymph node dissection extent. Group 1 included 23 patients (46 %) with D2 lymph node dissection, group 2–27 patients (54 %) with D3 lymph node dissection. 8 (16 %) patients developed complications in the early postoperative period. Patients in group 1 had grade I (5 patients) and grade IIIb (1 patient) surgical complications, according to the Clavien-Dindo classification. 2 patients in group 2 developed grade III b complications. No significant differences were found between groups in peristalsis, gases and bowel movement, starting eating and drinking. A significant increase in the number of postoperative bed-days was observed in patients who underwent open surgery, compared with the group with laparoscopic access. No statistically significant difference was found in the overall survival in patients of the two groups (p = 0.918).Conclusion. The rates of postoperative complications that required repeated surgery were comparable between the groups with D2 and D3 lymph node dissections. D3 lymph node dissection did not affect the dynamics of postoperative recovery and the overall survival of patients.

Purpose of the study. The investigation is aimed to provide a systematic comparison of different contrasting methods for in vivo micro-CT diagnostic of orthotopic colorectal cancer models extracted by ortotopic implantation into the caecum of immunocompromised mice BALB/c Nude lines.Materials and methods. BALB/c Nude (N = 25) female mice were implanted by transplanted human colorectal cancer strain into the cecum. 20 days after the implantation mice were administered with iodine-based contrast agent Optiray by means of different administration method (intravenously, per os, intraperitoneally, per rectum) and micro-CT scans have been registered via Quantum GX2 tomograph. Measurement of tumor nodes was performed both by means of estimation from micro-CT images via RadiAnt DICOM Viewer software and by means of explicit measurements using calipers upon laparotomy and posthumously. At the last stage of the study, the animals were euthanized by cervical dislocation. The tumors were excised, measured with a caliper and placed in 10 % formalin for the standard histological analysis according to the standard methods.Results. The average volumes of tumor xenografts in animals with intravenous, oral, and intraperitoneal contrast administration measured at micro-CT were 53.7 ± 5.2 mm3, 52.7 ± 6.4 mm3 and 63.6 ± 5.6 mm3 respectively; measured at laparotomy – 43.0 ± 5.5 mm3, 44.5 ± 5.4 mm3 and 58.5 ± 5.5 mm3 respectively; measured post-mortem – 55.2 ± 6.6 mm3, 53.2 ± 8.8 mm3 and 65.9 ± 3.8 mm3 respectively. The average volumes of tumor xenografts isolated post-mortem in these groups were comparable with the values shown at micro-CT, but larger than the volumes measured at laparotomy.Conclusion. The results obtained demonstrated that intravenous, peroral and intraperitoneal administration techniques provide the best visualization of laboratory rodents pathological tissue upon in vivo micro-CT diagnostics and thus are preferred.

Purpose of the study: to investigate the composition of the intestinal microbiota and determine the feasibility of using it in diagnosis and prognosis of colorectal cancer (CRC). Material and methods. The study included 75 patients with CC (study group I) and 25 healthy individuals (control group II) who were treated at Chita State Medical Academy from 2017 to 2021. Group I patients underwent surgery and adjuvant chemotherapy. To determine the composition of the intestinal microbiota, biopsy specimens were taken from the tumor tissue and from the visually unchanged colon mucosa after the completion of surgery in the study group and from the visually unchanged colon mucosa during colonoscopy in the control group. Results. The counts of Bifidobacterium spp., E. Coli (typical) in the intestinal microbiota were significantly lower and the concentration of Clostridium spp. Was higher in CRC patients than in healthy individuals. Significant relationships between the counts of Lactobacillus spp., Bifidobacterium spp., Bacteroides spp., E. Coli and the patient’s gender; Lactobacillus spp., Bifidobacterium spp., Staphylococcus spp. (CNS) and the tumor grade; conditionally pathogenic microflora and the form of tumor growth were found. Some combinations of the composition of the intestinal microbiota in CRC patients are predictive factors for the development of postoperative complications (Lactobacillus spp., Bacteroides spp., E. Coli

The treatment of colon cancer with a mesenchymal-like phenotype poses a great challenge. Purpose of the study: to research expression of FRMD6, ZEB1, HTR2B, CDX2 in the primary tumor tissue with relation of the clinical and pathological features of colon cancer. Material and methods. a combined analysis of the expression of FRMD6, ZEB1, HTR2B, CDX2 with pathological criteria was performed in 100 patients with T1–4bN0–2bM0 colon cancer. Results of the study show that tumors with mesenchymal signs are characterized by a large size of the primary tumor, a high grade of differentiation, regional metastases, and eventually advanced stage of the disease. The frequency and expression levels of FRMD6, ZEB1 and HTR2B are depended of grade of adenocarcinoma. in cases with positive expression and a high percentage of expression of these proteins in the cancer cells, the degree of tumor morphological anaplasia increases. Conclusion. The study made it possible to reveal the relationship of IHC markers (FRMD6, ZEB1, HTR2B, CDX2) with tumor characteristics that determine the outcome. The studied markers may have prognostic and predictive value in treatment approaches of colon cancer.

Colorectal cancer (CRC) is a relevant issue of modern oncology and ranks the third place among most common malignancies. Every year, more than 1 million new cases of CRC are diagnosed worldwide, with approximately the same frequency of prevalence among the male and female population. Colon cancer (CC) amounts for more than half of all cases of CRC, and it’s incidence and mortality remain rather high.Surgery remains the main method of CRC treatment, and determining the extent of surgery and lymph node dissection remains an urgent problem.For the first time in Japan, a classification of groups of lymph nodes (l.n.) was proposed depending on the level of lymph outflow and location in relation to the main vessels. According to the numbering of l.n. groups by the Japanese Society for Cancer of the Colon and Rectum (JSCCR), all lymph nodes are numbered with three digits.As a rule, lymphogenic metastasis occurs in one direction, bilateral spread is possible if the tumor is located at the same distance from two feeding vessels. With tumors of the right-sided localization, all groups of l.n. located along the branches of the superior mesenteric artery are removed, and with tumors of the left half of the colon, all l.n. located along the trunk of the inferior mesenteric artery are removed. The presence of affected l.n. is important for assessing the prognosis and further determining the need for adjuvant therapy. Some literature data demonstrate good results of surgical interventions performed in accordance with the concept of embryonic planes and complete mesocolonic excision. D3 lymph node dissection is not performed in daily practice in some European countries and North America, unlike a number of Eastern countries. However, the level of vessel ligation remains the subject of scientific discussion.The purpose of this review was to analyze the available literature on the problem of choosing the level of lymph node dissection in CC surgery.

Background: Colorectal cancer is now an urgent problem in oncology. Recently, specialists have been interested in a comparative analysis of differences in the clinical course of malignant tumors in the proximal and distal colon. The sections differ not only in their embryogenesis and sources of blood supply, but also in the clinical course and population and epidemiological characteristics. The issue of distinctive immunological characteristics of tumors of the colon depending on the location remains open.Objective: A comparative analysis of local subpopulations of immunocompetent cells and an assessment of number of cells with the CD45+/- phenotype expressing toll-like receptors (TLRs) depending on the tumor location on the right or left sides of the colon.Material and methods: The study included 50 patients with verified colon cancer. The majority of patients were females – 26 (52%), aged 67 ± 0.4 years, and 50% of patients with stage II disease. Depending on the tumor location (the right or left sides of the colon), the patients were divided into 2 groups of 25 people each. All patients underwent standard surgery at the initial stage. The obtained material was used for subsequent studies: a cell suspension was obtained from a tumor tissue fragment, the perifocal zone (1–3 cm from the tumor) which was processed using an antibody panel (Becton Dickinson, USA) to identify the main subpopulations of leukocytes and lymphocytes. Expression of TLRs (2, 3, 4, 8, 9) on CD45+, CD45- cell populations was also determined using the BD FACSCanto flow cytometer (Becton Dickinson, USA). Statistical processing of the results was performed using the STATISTICA 13.3 package (StatSoft Inc., USA).Results: A comparative analysis of immunological parameters, depending on the tumor location on the right or left sides of the colon, showed:Tissues of the right-sided tumors had a higher T-lymphocytic infiltration, compared to the left-sided tumors, while the latter showed a higher B-lymphocytic infiltration (p = 0.025).Peritumoral zone tissues of left-sided tumors demonstrated a decrease of lymphocytes levels (p = 0.027), NKT – (p = 0.035), NK – (p = 0.041) and В lymphocytes (p = 0.038), and a significant increase in CD8+- (p = 0.02) and DP cells (p = 0.0018).Left-sided tumors showed a percentage decrease of CD45- cells expressing TLR4 and TLR8, compared to right-sided tumors, by 38% (p = 0.038) and 25% (p = 0.043).There was a decrease in the number of CD45+ cells expressing TLR2 and TLR4 in left-sided tumors by 54% (p = 0.035) and 33% (p = 0.04) respectively, than in right-sided tumors.The percent of CD45- cells expressing TLR4 in the perifocal tissues of left-sided tumors decreased by 61% (p = 0.031) in comparison to the corresponding tissues in right-sided tumors.The numbers of CD45+ cells expressing TLR2 and TLR4 were 81% (p = 0.02) and 87% (p = 0.018) lower respectively in the peritumoral tissues of left-sided tumors, compared to the corresponding tissues in right-sided tumors.Conclusion: The revealed characteristics of the local subpopulations of immunocompetent cells and the numbers of CD45+/- cells expressing TLRs depending on the tumor location on the right or left sides of the colon can serve as a prognosis of the disease clinical course and the choice of further treatment tactics.

Background: At present, the problem of treating common forms of colorectal cancer does not lose its relevance due to the increase in its incidence. Systemic chemotherapy is the main line of treatment for patients with unresectable liver metastases. However, a significant problem of modern oncology is the further treatment tactics for patients with chemoresistant metastases. Aims: to improve the treatment results for patients with chemoresistant liver metastases of colorectal cancer. Method: 36 patients with unresectable liver metastases of colorectal cancer were treated at the Granov Russian Research Center of Radiology and Surgical Technologies and the RZD-Medicine Central Clinical Hospital. For all the patients, systemic chemotherapy was considered unreasonable due to the development of chemoresistance or a high degree of toxicity. The patients underwent regional chemotherapy chemoinfusion and/or chemoembolization of the hepatic artery. Results: The treatment evaluation was performed using the RECIST 1.1 scale. After 6 months, a partial response was reached in 1 patient (2.8%), stabilization was observed in 29 (80.5%) patients, and 6 patients (16.7%) had the disease progression. In 2 (5.6%) cases, a lethal outcome was observed against the background of the systemic progression of the oncological disease. One year later, stabilization of the malignant process was detected in 21 (58.3%) cases, progression was detected in 15 (41.7%) cases. A one-year survival of patients was 83.3%, the overall survival 22 months. Conclusion: The use of interventional radiology methods has shown its effectiveness in patients with unresectable chemoresistant liver metastases of colorectal cancer.

Promising results of neoadjuvant therapy have encouraged changes in treatment standards for many types of cancer, including triple negative and HER-positive breast cancer, gastric cancer, rectal cancer, etc. Preoperative chemotherapy can decrease the tumor burden, which might reduce the volume of surgery; it also improves the disease prognosis by reducing the number of viable tumor cells and micrometastases in regional lymph nodes; it increases the proportion of patients receiving systemic treatment, which often leads to an improved overall survival of patients; it enables the evaluation of tumor sensitivity to therapy, which also allows the investigation of tumor sensitivity to new pharmacological agents. However, colon cancer seems to stay away from these trends. This literature review focuses on studies analyzing neoadjuvant therapy for resectable colon cancer and analyzes the role of preoperative therapy in this disorder.

Molecular genetic diagnostics is an essential element to plan for management of colorectal cancer (CRC) patients. The choice of systemic treatment for CRC is impossible without molecular testing of the tumor. For instance, the assessment of the KRAS and NRAS genes is mandatory for consideration of anti-EGFR agents. Tumors with BRAF V600E mutation are characterized by aggressive behavior, the necessity of intensive cytostatic regimens, as well as by sensitivity to combination therapy with BRAF and EGFR inhibitors. Inactivation of the DNA mismatch repair, the MUTYH gene or DNA polymerase epsilon (POLE) leads to an excessive tumor mutational burden; these CRC types are highly immunogenic and therefore respond to immune checkpoint inhibitors. Some colorectal carcinomas are characterized by overexpression of the HER2 oncogene, which make them sensitive to corresponding target therapies. There are CRCs with clinical signs of hereditary predisposition, which require germline genetic testing. Nowadays the molecular diagnosis of CRC is being seriously modified due to worldwide implementation of the next-generation sequencing (NGS) and hypersensitive variants of polymerase chain reaction, for example, droplet digital polymerase chain reaction (ddPCR). Non-invasive liquid biopsy is an example of another highly useful innovation that has growing importance for CRC screening, control of surgical intervention efficacy and monitoring of the disease course.

Objective: to compare the efficacy and toxicity of aflibercept and bevacizumab in combination with fOLfIRI in secondline therapy for patients with metastatic colon cancer.Materials and methods. we performed a retrospective analysis of data on patients with metastatic colon cancer treated in 9 clinics in the Russian federation. The inclusion criteria were as follows: metastatic or locally advanced colon cancer; treatment with bevacizumab or aflibercept plus fOLfIRI in the second-line therapy. The primary outcome measure was progression-free survival (PfS). Secondary outcome measures included objective response rate and incidence of adverse events.Results. A total of 271 patients with metastatic colon cancer who received second-line therapy with bevacizumab (n = 81) or aflibercept (n = 190) between 2014 and 2018 were selected for this study. Study groups were matched for main prognostic signs. The objective response rate was 18.1 % in the bevacizumab group and 20.5 % in the aflibercept group (p = 0.7). The median PfS was 5 months (95 % confidence interval 3.8–6.1) in the aflibercept group and 7 months (95 % confidence interval 0.81–2.1) in the bevacizumab group (hazard ratio 1.4; 95 % confidence interval 0.99–2.1; p = 0.04). multivariate regression analysis demonstrated that the type of the targeted drug independently had no effect on PfS (hazard ratio 1.3; 95 % confidence interval 0.9–1.9; p = 0.2). we observed no statistically significant differences in the incidence of complications of any grades between the groups (58 % vs 72 %, p = 0.1). Patients receiving aflibercept were more likely to develop grade III–Iv arterial hypertension (2 % vs 9.5 %) and diarrhea (0 % vs 5.4 %), whereas thrombotic complications were more common in the bevacizumab group (10 % vs 1.8 %).Conclusion. we observed no significant differences in objective response rate and PfS between patients with metastatic colon cancer receiving bevacizumab or aflibercept in combination with fOLfIRI as second-line therapy. The toxicity profiles were different. Our findings can be used for choosing an optimal targeted drug for second-line treatment.

Purpose of the study: to review the available data on the heterogeneity of colon cancer and to assess the prognostic significance of colon cancer subtypes.Material and Methods. Medline, PubMed, Cochrane library, elibrary databases were used to identify studies that characterized the current view on the problem of choosing the optimal postoperative treatment for colon cancer.Results. the review showed the results of international studies of colon cancer subtypes based on complex multomics characteristics. Particular attention was paid to the description of modern studies on the search for prognostic markers for colon cancer. The relevance of the study of immunohistochemical markers was confirmed by the analysis of the world literature. the outcomes will make it possible to classify colon cancer into molecular subtypes in real clinical practice and, as a consequence, significantly improve the effectiveness of adjuvant therapy.

Objective: to determine the level of growth factors in the blood serum of patients with left-sided colon cancer and to assess the feasibility of using these findings in the tumor detection.Material and Methods. The study group included 63 patients aged 20 to 75 years who underwent surgery for left-sided colon adenocarcinoma (descending, sigmoid, rectosigmoid) with stage i (t1–2n0m0), ii (t3–4an0m0), and iii (t1–2n1m0). Only 5 patients developed metastases in one regional lymph node. The remaining patients had no regional metastases. In all patients, before hospitalization, the tumor was confirmed by colonoscopy followed by histological examination. The group of comparison consisted of 25 patients with chronic hemorrhoids without exacerbation, who underwent colonoscopy. In patients of the study group, blood tests were drawn on the day of surgery before its starting. In patients of the comparison group, blood was taken after excluding colon cancer (after colonoscopy). Blood tests were carried out using a test system (Biolegend): multiplex set for determining growth factors (angiopoietin-2, (ang-2), egf, epo, FGF-basic, G-csf, GM-csf, HGF, M-csf, pdgf-aa, pdgf-BB, scf, tgf-α, vegf).Results. In cancer patients, the levels of egf, HGF, M-csf, pdgf-aa, and pdgf-BB were several times higher than in the control group (p

According to the literature review, the use of modern endoscopes with high resolution and a narrow-band imagine function with optical magnification, as well as autofluorescence, chromoscopy, endosonography, makes it possible to establish a diagnosis of early colorectal cancer with a high degree of accuracy. Nowadays, endoscopic submucosal dissection and endoscopic mucosal resection are the methods of choice in the treatment of early (Tis, T1sm1N0M0) colon cancer.

Objective: to compare the efficacy and tolerability of second‑line chemotherapy with original bevacizumab (Avastin) and biosimilar bevacizumab produced by “Biocad” (Avegra) in patients with metastatic colon cancer.Materials and methods. This retrospective observational study included patients with metastatic colon cancer treated in 9 clinics in the Russian Federation. Inclusion criteria were as follows: metastatic or locally advanced colon cancer and second‑line therapy with bevacizumab (Avastin or Avegra). The primary outcome measure was overall survival (OS). Secondary outcome measures included progression‑free survival (PFS), disease control rate (DCR), and incidence of adverse events associated with antiangiogenic therapy.Results. We identified 209 patients with metastatic colon cancer who received second‑line therapy with biosimilar bevacizumab (n = 37; 17.7 %) or original bevacizumab (n = 90; 43 %) or no targeted therapy (n = 82; 39.3 %) between 2014 and 2018. Patients in these three groups were matched for their main prognostic characteristics. The DCR was 59.5 % in the group of biosimilar bevacizumab, 58.9 % in the group of original bevacizumab, and 50 % in the control group (without targeted therapy). PFS was 6 months in the chemotherapy group and 8 months in the groups of bevacizumab (hazard ratio (HR) 0.77; 95 % confidence interval (CI) 0.65–0.91; p = 0.002); the difference in PFS between patients receiving biosimilar bevacizumab and original bevacizumab was insignificant (HR 1.3; 95 % CI 0.81–2.1; р = 0.3). Median OS was 16 months in the chemotherapy group, 30 months in the biosimilar bevacizumab group, and 20 months in the original bevacizumab group (HR 0.89; 95 % CI 0.72–1.1; р = 0.3). We observed a tendency to longer OS in patients receiving biosimilar bevacizumab (HR 0.44; 95 % CI 0.17–1.1; р = 0.08). Bevacizumab‑ associated toxicity was limited to arterial hypertension and was registered in 4 patients with only one patient who developed grade III hypertension.Conclusions. There was no significant difference in PFS between patients receiving biosimilar and original drug, while OS was higher in the group of biosimilar bevacizumab. Both medicines demonstrated similar toxicity. Therapy with biosimilar bevacizumab ensured lower incidence of hypertension and proteinuria compared to the original drug. An additional prospective observational study assessing the efficacy and tolerability of biosimilar bevacizumab in colon cancer patients is needed.

This article explores evolution of treatment options in colorectal cancer with synchronous metastatic disease, role of surgical approach on different stages of combined‑modality therapy, including “liver first” strategy. Prospects of perioperative and neoadjuvant polychemotherapy in patients with colorectal cancer with synchronous distant metastases to liver, data on possibility of using radiation therapy in treatment of primary tumor and liver metastases, as well as risks and benefits of this approach and available clinical research data are analyzed.

Background. The incidence of colon cancer over the past decade has been growing markedly in the Russian Federation, with about 50 % cases detected at stagesIII–IV of the disease, when a clear clinical picture of the disease appears. In this regard, the search for new methods for early diagnosis of RTK is undoubtedly relevant.Objective. To determine the standard composition of the aerobic parietal colon microbiota and the level of cytokines (chemokines and growth factors) in patients with cancer of the left half of the colon and to assess the possibility of using these data in the diagnosis of the tumor process.Materials and methods. Blood tests were performed on the day of the study using two test systems (BioLegend): multiplex kit for determining growth factors, chemokine multiplex kit. The composition of the intestinal microbiota was determined in colon biopsy specimens by the bacteriological method using the standard test systems StaphyTest, StreptoTest, and EnteroTest.Results. There is an increase in the number of Clostridiumspp. and a decrease in Bifidobacteriumspp., E. coli in the colon during the transformation of a healthy person’s mucosa into a malignant tumor (p < 0.05); a clear tendency was revealed for both an increase (EGF, HGF, M-CSF, PDGF-AA, PDGF-BB, IP-10) and a decrease (MCP-1, RANTES) of the level of chemokines and growth factors under colon cancer conditions. In addition to general quantitative changes in the intestinal microbiota, the level of the investigated substances, a statistically significant dependence was established on the sex, age of the patient, as well as the degree of differentiation and form of tumor growth.Conclusion. It was established that changes in the quantitative composition of the intestinal microbiota, the level of some biologically active substances that occur precisely in the conditions of colon cancer, can be interconnected and interdependent, and also serve as an additional diagnostic marker in the detection of a malignant tumor.

Isolated splenic metastases from colorectal cancer after radical surgical treatment are quite rare. This frequency of metastases is explained by the anatomical, functional and immunological characteristics of the spleen. The literature usually describes single clinical cases followed by accompanied systematic analysis and discussion. Most of the cases are asymptomatic and are accidentally diagnosed, during different types of imaging tests, including increased levels of tumor markers. The progression free survival was 3 144 months after surgical treatment of the primary tumor in most of the patients. By the nature of the lesion, metastases can be synchronous and metachronous, as well as solitary and multiple. Aim. To discuss two clinical observations of isolated splenic metastases in patients after left colic flexure cancer surgical treatment. Materials and methods. We observed 2 female patients, 68 and 70 years old, with isolated splenic metastatic after left colic flexure cancer radical surgical treatment. Results. Both cases are considered to be metachronous and the interval of absence of disease manifestations are 21 and 10 months, respectively. The patients with stage IIB and IIC left colic flexure cancer underwent left hemicolectomy followed by adjuvant polychemotherapy using regimen with 6 cycles of FOLFOX. The histological study revealed a moderately differentiated adenocarcinoma with invasion into all layers of the wall and into the surrounding tissue. There were no lymph node metastases. In the course of dynamic observation, during the next examination with the help of ultrasound examination we revealed splenic metastasis, and confirmed this using positron emission tomography/computed tomography. The disease was without clinical picture. The time interval after the surgery before diagnosis was 21 and 10 months, respectively. Surgery was performed in the volume of splenectomy. Isolated splenic metastases in the absence of other manifestations of the disease were found intraoperatively. The histological study showed the splenic metastasis of the same type of cancer as the primary tumor. The polychemotherapy using regimen with 6 cycles of XELOX was performed during the postoperative period. Patients are alive without signs of the disease over the period of 5 and 26 months, respectively. Conclusion. Isolated splenic metastases are extremely rare, more often when the primary tumor is located in the left side of the colon. The showed cases illustrate the need and importance of the monitoring the patients after surgical treatment for colon cancer. The use of positron emission tomography/computed tomography helps to understand the real prevalence of the tumor process, without using invasive methods. The surgery in the volume of splenectomy followed by chemotherapy are the main therapeutic options. In one clinical case, the metastases were multiple, and in the other one was solitary metastasis. Patients are alive without signs of the disease over the period of 5 and 26 months, respectively.

Introduction. Colon cancer (RCC) clinically manifests itself in the late stages, therefore, early diagnosis presents significant difficulties. There are many types of microorganisms in the human colon that form symbiosis with intestinal cells to maintain normal function. Аim of the study was to determine the composition of the parietal microflora of the colon under conditions of a tumor process and to assess the possibility of using these data in the diagnosis of colon cancer. Material and methods. The main group included 63 patients operated on for cancer (adenocarcinoma) of the left half of the colon (descending, sigmoid, rectosigmoid regions) with I T1-2N0M0, II T3-4aN0M0, III T1-2N1M0 stages of the tumor process. Among them are 32 men and 31 women aged 20 to 75 years (57.7 ± 3.8 years). In all patients, before hospitalization, the tumor was confirmed by colonoscopy followed by histological examination. The group of clinical comparison in the amount of 25 people consisted of patients with chronic hemorrhoids without exacerbation, who underwent colonoscopy. Material from the main group, biopsies of tumor tissue and visually unchanged colon mucosa, were taken intraoperatively during tumor removal. In patients of the clinical comparison group, the material was taken during the colonoscopy process. The composition of the intestinal microbiota was determined by a bacteriological method. Results and discussion. As a result of comparing the colon microbiota of cancer patients and the clinical comparison group, statistically significant differences in the quantitative composition of Lactobacillus spp., Bifidobacterium spp., Bacteroides spp., Clostridium spp., Enterococcus spp., Escherichia coli (typical), Escherichia coli (lactose-negative), Enterobacteriaceae, Staphylococcus spp. (CNS), Candida spp. It was established for the first time that Bifidobacterium spp., Enterococcus spp. and the age of the patient can be further used in the diagnosis of a malignant process. Conclusion. The created additive model can be used as an additional screening criterion in the early diagnosis of colon cancer.

The development of new treatment options gradually brings metastatic colon cancer closer to a chronic disease that can last for years. One of such options is trifluridine / tipiracil (FTD / TPI, TAS-102), a new chemotherapeutic agent, which has already been registered in more than 60 countries. It increases patients’ survival and has an acceptable toxicity profile (adverse events primarily include hematological complications). This literature review aims to cover various aspects related to this new drug, including its pharmacokinetics, maximum tole rated dose, possibility of its use in patients with liver disorders, results of its simultaneous use with targeted therapy, comparison with other therapeutic approaches in patients with chemorefractory metastatic rectal cancer, etc.

Acromegaly is a relatively rare disease, with the incidence of 0.2 - 1.1 cases in 100 000 people per year. Increased secretion of growth hormone (GH) is the main pathomechanism. GH stimulates the liver to the insulin-like growth factor type 1 (IGF-1) production. It leads to the tissues overgrowth, facial changes, metabolic and cardiovascular comorbidities, such as diabetes, hyperthyroidism, or hypertension. The main aim of this review is to provide the most up to date knowledge about epidemiology and risk factors of neoplasms which occur more often in acromegaly, than in the general population. Some studies showed that substances from the IGF group – including IGF-1, have a cancerogenic effect on the cells. According to that fact, groups of acromegalic patients were examined in the search for cancers. Studies delivered that there is a higher chance of neoplasms in acromegalic patients. The most widely described cancers in the relation with this disease are: prostate cancer, breast cancer, thyroid cancer, and colon cancer. There are some neoplasms which have lesser number of studies, such as: renal cancer, neoplasms of the female reproductive system, haematological cancers as well as osteosarcoma. Cancers occurs more frequently in acromegalic patients and have a major impact on patients' life-span. Early detection as well as quick provision with the adequate treatment is highly necessary for extending patients’ lives.

Lynch syndrome (LS), which occurs as a result of the defects in DNA mismatch repair, is characterized by an increased risk of colon, endometrial and urinary tract cancers. It is known that in case of colorectal cancer, the presence of high-frequency microsatellite instability (MSI-H) is associated with better survival rates, independent of other prognostic factors, including the stage of tumor development. Thus, in stage II sporadic colorectal cancer, MSI-H occurs in 22% of cases, in stage III in 12% of cases, and in stage IV only in 2% of cases. Regardless of the type of the tumor, immunotherapy using checkpoint inhibitors has been approved for treating patients with unresectable or metastatic tumors with deficient DNA mismatch repair (dMMR), this fact can be used as an approach to treatment patients with LS. The article describes the clinical observation of the patient with germline mutation in MLH1 gene, suffering from multiple primary malignancies of the colon, who has been receiving nivolumab for 26 months. This observation demonstrates the success of immunotherapy after sixth-line chemotherapy, showing the potential control of tumor growth in patients with LS.

Purpose of the study. To evaluate the clinical and economic efficiency of colorectal cancer screening model in the Yaroslavl region. Materials and methods. To achieve this goal, we have given a clinical and economic assessment of the existing approach to the diagnosis and treatment of colon cancer. We have also developed a clinical and economic model of colorectal cancer screening strategy in the Yaroslavl region. After that, we made a comparative assessment between the strategies on such parameters as total costs, efficiency, and CER coefficient. Results. The strategy for the absence of colorectal cancer screening has a cost-effectiveness rate equal to 246 712 rubles (3820$)/LYG, with the value of added years of life in 2.9 years. According to our calculations, the implementation of the program of screening of CRC based on fecal occult blood immunochemical method, followed by the implementation of colonoscopy in the case of a positive result, will require an increase in funding for patients with colon cancer by 6.9% per year. At the same time, by changing the structure of morbidity and increasing the part of early forms in the implementation of the screening program, an increase in the estimated life expectancy of patients will be achieved, which is consistent with the long-term results of programs conducted in Europe and the United States. The CER for the screening strategy is 103.95 thousand rubles (2030$) / LYG. Long-term modeling shows that the introduction of screening program will reduce the incidence of CRC by 12% from the baseline by the 15th year of implementation and reduce the cost of diagnosis and treatment of colon cancer by 16.1% per year without taking into account inflation expectations. Conclusion. The introduction of a colorectal cancer-screening program at the regional level is clinically effective and cost-effective.

Objective: epidemiological evaluation of global trends in colorectal cancer and assessment of colon cancer incidence in the Republic of Uzbekistan in 2012–2017.Materials and methods. We used GLOBOCAN data to analyze the situation with colorectal cancer worldwide. We also assessed the incidence of colon cancer, trends, and mean age of patients (by years) registered in the Republic of Uzbekistan. This article emphasizes the need for epidemiological studies of colorectal cancer in Uzbekistan.Results. World trends in colorectal cancer incidence and mortality indicate that these parameters vary across different regions and depend on the economic situation. There are also some sex differences: men are more likely to develop colorectal cancer than women (male to female ratio 1.25:1.0). The number of patient died of colorectal cancer is growing; the male to female ratio is 1.22:1.0.Conclusions. Our assessment of epidemiological situation of colon cancer in the Republic of Uzbekistan demonstrated that its incidence tends to increase, which necessitates further research evaluating regional differences and risk factors for colorectal cancer.

The efficacy of intraabdominal chemotherapy in management of local recurrences of colon cancer was studied. Intraabdominal intraoperative and early postoperative chemotherapy made it possible to prolong of the recurrenceless term and to improve the life quality of the patients with local recurrences of colon cancer. There was observed a tendency to increase the five-year survival.

The efficacy of intraabdomlnal chemotherapy in patients with prevailing forms of colon cancer, such as peritoneal carcinomatosis, local disseminated and local recurrent colon cancer was estimated. The comparative analysis showed that the intraabdominal chemotherapy allowed to amend the remote results of the treatment in the cases with carcinomatosis, local disseminated colon cancer and local recurrence.

Aim. To evaluate the efficacy of transarterial chemoembolization in patients with metastases of colorectal cancer in the liver.Materials and methods. A study aimed at investigating the effect of selective transarterial chemoembolization (TACE) of the hepatic artery on liver metastases in colorectal cancer was conducted at the Oncology Centre of the RZhD Central Clinical Hospital No. 2 named after N.A. Semashko, Moscow. The research basis included data for 10 patients, who had undergone chemoembolization of the hepatic arteries using Biosphere microspheres 50– 100 µm — 25 mg and doxorubicin 50 mg.Results. Both immediate and long-term results of up to 12 months were evaluated using the RECIST 1.1 scale. A partial response was achieved after 4 TACE treatments in 22.2 % of cases. The stabilization of the oncological process in the liver was observed after 9 TACE treatments in 50 % of cases. Disease progression was noted after 5 procedures in 27.8 % of cases.Conclusions. Transarterial chemoembolization of metastatic liver lesions in patients with colorectal cancer can be used according to certain indications in specialized centres providing endovascular treatment services.

Over the past years, due to increase of detection of patients with early-stage stomach cancer and colorectal cancer, and improvement of survival rate, the efforts have been made to gradually develop the concept of sentinel lymph nodes detection in order to improve postoperative quality of life. The article presents the review of the literature on the feasibility of sentinel lymph nodes intraoperative diagnosis the choice of surgical treatment of patients with tumors of the stomach and colon. Analytical work demonstrates that the real time intraoperative visualization of lymph sineses using fluorescent imaging of indocyanine green during laparoscopic surgery for stomach or colorectal cancer is possible and it is a useful method of the lymph nodes mapping, therefore it can lead to intraoperative changes at lymphadenectomy as well as to reduce the surgical injury. It indicates the need in further research and improvement of approach.

Objective: to assess the frequency of liver resections in patients with metastatic colon cancer and isolated non-resectable liver metastases receiving FOLFOXIRI. Materials and methods. In this single-center non-randomized prospective study, we assessed the frequency of liver resections. According to the statistical hypothesis, the frequency of R0-resections in patients with metastatic colon cancer receiving FOLFOXIRI is between 11 % and 33 % (mean 20 %); to increase it up to 50 % in patients with isolated metastatic lesions in the liver, we had to recruit 20 patients (with β = 0.9 and a = 0.05). We enrolled 20 patients with potentially resectable metastases and 22 patients with non-resectable metastases. The primary endpoint was the frequency of R0 liver resections; secondary endpoints included objective response rate, progression-free survival, overall survival, and tolerability of therapy. Patients receiving targeted therapy (according to the tumor mutation status) were also included in the study.Results. Objective response was observed in 32 out of 42 patients (76 %) (in 17 out of 20 participants (85 %) with potentially resectable metastases), whereas progressive disease was registered in 2 patients (5 %). Radical resection of organs affected by metastasis was performed in 19 out of 42 patients (45 %): 15 out of 20 (75 %) in the group with potentially resectable metastases and 4 out of 22 (18 %) in the group with non-resectable metastasis (р

Objective: to identify factors associated with efficacy of an aflibercept-chemotherapy combination in patients with metastatic colon cancer.Materials and methods. This retrospective multicenter study was conducted in 20 clinics from 15 regions of the Russian Federation. The main efficacy outcome was progression-free survival (PFS). We performed univariate and multivariate analysis to assess the impact of various factors of PFS.Results. Two hundred and fifty-seven patients received aflibercept-containing chemotherapy; of them, 175 participants (68.1 %) received it as a second-line therapy. The objective response rate and median PFS were 18.7% and 5 months (95% confidence interval (CI) 4.2—5.8) respec -tively. The following factors were found to have a positive effect of PFS at multivariate analysis: grade I—II adverse events to aflibercept therapy (hazard ratio (HR) 0.58; 95 % CI 0.38—0.89; p = 0.01), therapy for concomitant diseases (HR 0.47; 95 % CI 0.29—0.76; p = 0.002), and ECOG performance status of 0 (HR 0.53; 95 % CI 0.34—0.81; p = 0.004). Patient with all 3 factors present had median PFS of 9 months, whereas patients without them demonstrated PFS of only 3 months (HR 1.9; 95 % CI 1.5—2.6; p

Objective: to determine the minimum number of lymph nodes (LN) required for accurate prediction of overall survival in patients with stage II colon cancer and to assess the prognostic value of criteria used in the MOSAIC trial.Materials and methods. This retrospective study included patients with stage II colon cancer that underwent surgical treatment in the Department of Proctology and received adjuvant chemotherapy (if needed) in the Department of Clinical Pharmacology and Chemotherapy of N.N. Blokhin National Medical Research Center of Oncology between 2004 and 2013. Overall survival was considered as the main criterion of treatment efficacy.Results. A total of 445 patients met the inclusion criteria; of them, 60 (13.5 %) patients received adjuvant chemotherapy. The receiver operating characteristic (ROC) analysis was employed to evaluate the predictive value of the number of removed LN for disease progression and death in patients with stage II colon cancer. We found that specificity of >80 % was achieved by removing/examining at least 12 LN. The examination of 13 LN increases specificity by another 6 %. Further increase in the number of removed/examined LN (>13) did not significantly improve prognostic accuracy for death from the moment of disease progression. Only the removal of 13 or more LN ensured a significant impact on overall survival (hazard ratio (HR) 0.12; 95 % confidence interval (CI) 0.02—0.91; p = 0.04). At multivariate analysis, the following factors were found to affect overall survival: postoperative complications (HR 2.4; 95 % CI 1.4—4.3; p

Aim. The aim of the work is to develop the tactics for the treatment of complicated colon cancer (tumor perforation, tumor bleeding, acute obturation obstruction).Materials and methods. The clinical development included 324 patients with urgent complications of colon cancer. 269 patients were operated urgently and immediately, 56 operations were deferred. The diagnosis was based on anamnesis, clinical, laboratory and special research methods (ultrasound, CT, EGD, colonoscopy, histological examination). Results. Postoperative mortality in urgent complications of colon cancer was 3.5%.Conclusion. The rationale for the choice of method and volume of surgery, depending on the location and nature of complications of colon cancer, is provided.

Colon cancer is the 3rd most common malignant neoplasm and the 4th leading cause of mortality from them. The majority of patients are diagnosed at stages II–IV, which indicates the need for markers that can predict disease progression, especially after surgical treatment. Recently, there has been a growing interest in exploring circulating tumor DNA as a marker of residual tumor in colon cancer. In 2018, the N.N. Blokhin National Medical Research Center of Oncology together with the Institute of Chemical Biology and Fundamental Medicine under the coordination of the Center for Strategic Planning and Management of Biomedical Health Risks initiated a research project entitled “Development of an assay for the diagnosis of various malignant tumors and treatment efficacy monitoring based on the analysis of circulating tumor DNA from patient blood”. This article provides a theoretical background for the project and a report on its progress made so far.

Introduction. Colon and rectal cancer (CC, RC) are different entities from a clinical and tumor biological point of view. Up to now, both, CC and RC, are synonymously called “Colorectal Cancer” (CRC). With our experience in basic and clinical research and routine work in this field we now have come to the opinion, that the term “CRC” should definitely be questioned, and if justified, be abandoned.Materials/Methods. We analyzed the actual available data from the literature and our own results from the Ulm based study group FOGT to proof or reject our hypothesis.Results. The following evident differences were recognized: Anatomically, the risk to develop RC is 4× higher than for CC. Molecular changes in carcinogenesis in CC are different from RC. Physical activity helps to prevent CC, not RC. Pathologically there are differences between RC and CC. In addition, there are also major clinical differences between CC and RC, such as in surgical topography and– procedures, multimodal treatment (MMT) approaches (RC in MMT is less sensitive to chemotherapy than CC), and prognostic factors for the spontaneous course and for success of MMT (e.g. TS or DPD ). Discussion. CC ´sand RC´s definitely are different in parameters of causal and formal carcinogenesis, effectivity of primary prevention by physical activity, conventional and molecular pathology.According to our findings we can demand from the preclinical point of view that CC and RC are two different tumor entities in terms of various representative biological characteristics.CC and RC are also differing substantially in many clinical features, as outlined in a separate paper from our group.Conclusion. “CRC” should no longer be used in basic and clinical research and other fields of cancer classification as a single disease entity. CC is not the same as RC. CC might even be divided into right and left CC.

A new anti-angiogenic drug aflibercept has been authorized as a second-line therapy in patients with metastatic colon cancer. The use of this drug as part of FOLFIRI regimen significantly reduces the risk of disease progression (RR = 0.758, p = 0.00007). At the same time, the additional use of aflibercept in the VELOUR study led to the development of side effects of 3-4 degrees of severity in 83.5% of patients. In this case, the use of aflibercept in combination with FOLFIRI is not only associated with complications that are typical for anti-angiogenic drugs, but also with a high percentage of cases of diarrhea and neutropenia. In this regard, the oncologist should understand the pathogenesis, the methods for prevention and treatment of complications associated with the use of aflibercept. These particular aspects are highlighted is this review.

Objective: to assess the efficacy of anti-angiogenic agents incorporated into second-line chemotherapeutic regimens for metastatic colon cancer depending on the KRAS gene mutation status.Materials and methods. We selected completed prospective randomized controlled phase III clinical trials evaluating the efficacy of antiangiogenic agents (bevacizumab, ramucirumab and aflibercept) added to second-line chemotherapy for metastatic colon cancer with subanalysis of treatment efficacy depending on the KRAS gene mutation status. Meta-analysis was performed using the ReviewManager (RevMan) v. 5.3 (The Cochrane Collaboration, Denmark).Results. Three studies (ML18147, RAISE, VELOUR) involving 2165 patients (1137 with KRAS wild-type tumors and 1028 with KRAS-mutant tumors) met the inclusion criteria and were included into this meta-analysis. The majority of patients (84 %) received bevacizumab in the first-line treatment. The results of our meta-analysis suggest that adding an anti-angiogenic drug to chemotherapy in patients with KRAS wildtype colon cancer significantly improved both progression-free survival (hazard ratio (HR) 0.71; 95 % confidence interval (CI) 0.62–0.80; р

Objective: to assess short-term and long-term outcomes of right hemicolectomy with extensive lymph node dissection using the experience of one clinic.Materials and methods. This retrospective study analyzed data from a prospectively collected database containing information on all patients with right-sided colon cancer that underwent laparoscopic right hemicolectomy with D3 lymph node dissection between 2013 and 2018. We estimated intraoperative blood loss, surgery duration (taken from anesthetic records), frequency of postoperative complications, length of in-hospital stay, duration of lymphorrhea, time to gastrointestinal recovery, integrity of the mesocolon, number and location of removed lymph nodes.Results. A total of 50 underwent laparoscopic right hemicolectomy with D3 lymph node dissection. No cases of surgical conversion were registered. Median surgery duration was 185 min; median blood loss was 30 mL. No postoperative mortality was observed in the study cohort. Twelve (24 %) patients had postoperative complications; 2 (4 %) patients underwent repeated surgery. Median number of lymph nodes examined was 26; high-quality specimens (G ) were obtained in 48 (96 %) patients. At a median follow-up of 19.5 months, 2 (4 %) patients had disease progression (developed liver metastases).Conclusion. Our results confirm safety of laparoscopic approach for right colon resection with D3 lymph node dissection

Colon cancer is known to be resistant to immunotherapy; however, during the last few years, researchers managed to identify a subgroup of patients that response to anti-PD-1 therapy. This encouraged molecular biologists, immunologists, and clinical oncologists to reconsider the role of immunotherapy for colon cancer. A substantial number of studies devoted to this problem have been published so far, which allowed us to prepare a literature review. This review covers the main trends in immunotherapy of colon cancer, including prognostic value of tumor-infiltrating lymphocytes, efficacy of immune checkpoint inhibitors, bispecific monoclonal antibodies, and antitumor vaccines, as well as transformation of non-inflammatory cancer phenotype into the inflammatory one.