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Introduction. Despite the advances in the modern pharmacopoeia, a significant place is given to surgical methods of treating benign prostatic hyperplasia (BPH) and prostate cancer (PCa). In the postoperative period in men, sexual function usually deteriorates.Purpose of the study. To study the needs of men after prostate surgery and their sexual partners in restoring their previous sexual life.Materials and methods. The pilot open-label prospective randomized non-comparative study included 50 patients in the age range of 53 – 74 years (average 58.3 years). All patients were consistently admitted and operated on at the “Avicenna” Medical Centre, Ltd. (Novosibirsk) from January to December 2020. Upon admission, all patients completed the International Index of Erectile Function (ICEF) questionnaire; one month later, this questionnaire was re-completed, supplemented with five questions.Results. Twenty-one patients were admitted with a diagnosis of PCa T1c – T2N0M0, all of them underwent laparoscopic prostatectomy with lymphadenectomy. Twenty-nine patients were operated on for BPH. They underwent transurethral resection with a bipolar resectoscope. Only 6 patients (12%) had no comorbidities. Surgical intervention worsened sexual function in all patients, while in men aged 50 – 59 years, the IIEF score decreased by 61.0%, at the age of 60 – 69 years by 39.0%, in patients over 70 years old by 55.2%. Eighteen (36.0%) patients showed interest in restoring sexual function. Thirty-two (64%) patients were against the continuation of sexual activity with the following motivation: 19 (59.4%) – lack of desire for a sexual partner, 8 (25.0%) – lack of desire of the patient himself, 5 (15.6%) – unwillingness to re-operated. Nineteen women out of 36 stable couples (52.8%) objected to the restoration of the sexual function of their sexual partners.Conclusion. Prostate surgery affects male sexual function more severely in younger patients. Thirty-two patients after surgery refused to restore sexual activity, in more than half of cases (59.4%) due to the unwillingness of the sexual partner to resume sexual relations.

Introduction. Penile cancer (pc) is a rare cancer. The standardized incidence rate of pc in russia is 0.82 cases per 100,000 males. On average, 58 % of patients (20–96 %) with pc have a local infection process: tumor decay, the presence of erosion, tumor ulceration, inflammatory changes in regional lymph nodes, etc. During hospitalization nosocomial pathogens may be possible causes of infection in ulcerative lesions.The aim of the study was to present the results of the treatment of tumor ulcer in a patient with penile cancer infected with multiresistant acinetobacter baumannii and klebsiella pneumoniae.Material and methods. We present a clinical observation of 54-year-old patient diagnosed with penile cancer pt4n3m0, with ulceration of the tumor, localized at the root of the penis and ulceration of metastatic lymph nodes in the left inguinal region and subsequent infection with highly resistant nosocomial microorganisms.Results. The patient received 6 courses of paclitaxel, ifosfamide and cisplatin with clinical effect, such as significant reduction of the tumor and therapeutic pathomorphosis of 3-rd degree. Then ileo-inguinal lymphadenectomy was performed on the left. A few months later the tumor continued to grow in the left groin area. During the 2nd line of chemotherapy (cisplatin, docetaxel and capecitabine), the patient had grade iii–iv neutropenia, febrile neutropenia. High fever and localized infection in the area of tumor ulceration with multiresistant hospital microorganisms was detected. Combined antibiotic therapy had temporary effect. After isolation of multiresistant carbapenemresistant k. Pneumoniae from the ulcer, the patient was prescribed ceftazidim/avibactam 2.5 g 3 times a day. Clinical effect, such as defervescence and significant reduction of the ulceration zone was seen subsequently.Conclusion. Etiotropic antibacterial therapy of the infected tumor ulcer resulted in a significant reduction in the manifestation of the infection process, allowing antitumor therapy to be continued, as well as surgery to be performed.

Introduction. Secondary upper-extremity lymphedema is most commonly caused by lymphadenectomy and radiotherapy (RT) of regional lymph nodes. Lymphatic edema differ in the fact that they lead to fibrotic changes in tissues, as the lymph contains up to 2–4% of protein, which causes a specific histopathological response. Proteins, as well as tissue protein-polysaccharide complexes, undergo transformations leading to pathological collagenization, and then to hyalinization and sclerosis. A vicious circle of pathological processes stemming from biophysical and chemical changes in proteins and polysaccharides with metabolic disorders occurs. Compression therapy is the most important component of the fight against both upper- and lower-extremity edema of various origins at any stage of the disease.The aim is to assess the postoperative stabilization of the upper-extremity edema state due to the patient’s self-bandaging using inelastic bandages and the possibility of personalized adjustment of pressure to be applied at the required level. The article provides indications for the use of an adjustable inelastic compression bandage to stabilize edema, and reviews a clinical example of its postoperative use in a patient with grade 4 secondary right upper-extremity lymphedema. Particular emphasis is placed on the versatility of adjustable inelastic compression bandage and the expediency of its widespread use in clinical practice.Conclusion. Simplicity and ease of use with an option to self-adjust and maintain the stable level of therapeutic pressure throughout the entire period of medical rehabilitation, as well as minimization of doctor’s involvement, allow us to recommend the adjustable inelastic compression bandage for effective use in wide clinical practice.

Squamous cell carcinoma of the breast is a rare, aggressive tumor with a poor prognosis. To date, due to the low incidence of morbidity, there is no single concept in the complex treatment of this pathology. The article describes the case of a 49-year-old patient after surgical treatment of squamous cell carcinoma of the left breast from 2019 on the anamnesis. A year later after the progression of the disease the patient underwent removal of a chest wall tumor with resection of IIIV ribs, allo- and autoplasty, axillary lymphadenectomy on the left. In most cases, the treatment of squamous cell carcinoma of the breast is surgery, but the role of adjuvant chemotherapy, radiation therapy and endocrinotherapy are still unambiguous.

Subungual melanoma is a rare malignant tumor, little known to practitioners. Its location makes diagnosis difficult and requires differentiation with conditions such as onychomycosis, panaritium, hematoma, etc. Unsymptomatic onset brings more problems, the error level during visual examination even among experienced oncologists reaches 25–40%, and the average life expectancy of patients with fully manifested melanoma is limited to 3–4 years.So we present a clinical case to emphasize the need for oncological alertness during an outpatient examination of the subungual lesions. A 32-year-old woman came to the reception complaining of a non-healing bleeding, relatively painless wound of the left little toe. The condition was associated with trauma, for about a month she treated the wound herself, “cauterizing” it with antiseptics.After outpatient treatment of a granulating wound, the material was sent for histological diagnosis, which showed the presence of pigmentless melanoma in the stage of active growth. The woman was urgently hospitalized in the oncology department, where 5th finger exarticulation and inguinal-iliac lymphadenectomy were performed successfully. After this, the condition remained stable, but 14 months later there was a formation in the area of the postoperative scar. A study of a new surgical material confirmed the recurrence of malignant melanoma with Clark invasion level 2.In our opinion, outpatient surgeons should not delay histological examination for all ulcerative and granulomatous lesions of the feet, which will improve the differential diagnosis.

Introduction. Lymphatic cysts (LC) are the accumulation of free lymphatic fluid in a limited space (between tissues and organs), in the place where the lymphadenectomy was performed. They are the most frequent complications in pelvic oncourology. LC are divided into symptomatic and asymptomatic.Purpose of the study. To assess the influence of the anatomical localization of symptomatic lymphatic cysts (sLC) on the clinical appearance.Materials and methods. 203 radical prostatectomies (RPE) and 42 radical cystectomies (RC) were performed with pelvic lymph node dissection (PLND) in the N.I. Pirogov City Clinical Hospital № 1 from January 2017 to March 2020. Of 203 patients, 13 (6.4%) developed SLC, and of 42 patients, 6 (14.3%). All patients who developed complications underwent complex ultrasound studies and multispiral computed tomography (MSCT) of the retroperitoneal space, abdomen, and pelvic area to assess the localization and volume of the sLC.Results. Four anatomical localizations of the sLC can be distinguished after analyzing the clinical picture of 19 patients with sLC and comparing the obtained data with MSCT: paravasal-iliac, paravesical, prevesical, and pelvic-retroperitoneal. The frequency of paravasaliliac sLC was higher, they developed in 13 (68.5%) patients. The clinical picture included: pain in the pelvic area, lymphedema of the lower limb, body temperature ≥ 39.0 °C, due to LC infection and compression of the iliac vessels. Paravesical sLC were found in 2 (10.5%) patients. There was a failure of the urethrovesical anastomosis, according to retrograde cystography, due to displacement of the bladder. Prevesical sLC were found in 2 (10.5%) patients. Patients noted progressive urinary incontinence and pain above the pubic symphysis. Pelvic-retroperitoneal sLC was observed in 2 (10.5%) patients, with the clinical appearance of nagging pain in the lumbar region, body temperature ≥ 38.0 °C, due to ureteral compression and the development of obstructive pyelonephritis, as well as compression of the inferior vena cava by a lymphatic cyst. The repeated intervention was performed in 18 cases: percutaneous drainage of the LC under ultrasound guidance in 12 (63.2%) patients, laparoscopic marsupialization of the LC in 3 (15.7%) patients, an open technique in 3 (15.7%). In 1 patient (5.4%) the treatment was conservative.Conclusion. Symptomatic LC can be classified according to 4 anatomical locations, which define their clinical symptoms. Most sLC require reoperation.

Introduction. DPatients diagnosed with T4b bladder cancer represent a relatively limited group of patients presenting to the urology clinic. Besides, this category of patients is rarely selected for cystectomy. patients with T4b should be referred for chemotherapy and/or radiation therapy and only later, ultimately, for cystectomy. However, there are currently no studies on the real impact of various organ invasions in terms of survival and complications associated with surgery in T4b patients. Also, in this subgroup of patients, cystectomy helps alleviate current or future symptoms of bladder cancer, and it is suggested that surgery after chemotherapy may improve survival compared to chemotherapy alone.Purpose of the study. To evaluate the effectiveness of consolidating the surgery for bladder cancer cT4b, given the experience of cystectomy in terms of clinical and oncological results.Materials and methods. The study included 29 patients with bladder cancer who underwent palliative cystectomy (pc) and 404 patients after radical cystectomy (RcE) with lymphadenectomy and various methods of urine diversion in the period 1995 - 2019. Palliative treatment was determined by the extreme stages of the oncological process (the presence of stage T4b).Results. Preoperatively, the PC was planned to be performed in only 10 patients, whereas after the RCE it was palliative in 29 cases. According to our study, differences in the main treatment outcomes were not in favour of patients with PC. During the observation period, the overwhelming majority of patients — 24 of 29 (82.8%) died, while in the group after RCE, only 34.0% of patients died (p 0.05). It was comparable with the data of modern literature in both cases (3.4% and 3.0%). This reflects the equal degree of safety of performing cystectomy in patients with bladder cancer at stage T4b in comparison with patients undergoing RCE, to a certain extent. The duration of the survivors' follow-up in the PC group ranges from 3 to 51 months with a median of 25.7 ± 13.9 months versus 73.9 ± 3.9 months in the RCE group in surviving patients (p

Objective: to provide various methods for sentinel lymph node detection considering their advantages and disadvantages.Material and Methods. The search of the relevant articles published in Pubmed, MedLine, RINTs, etc. database was conducted. 49 publications from 1970 to 2018 were analyzed.Results. Currently, sentinel lymph node biopsy (SLN biopsy) has become a worthy alternative to traditional lymphatic surgery for early breast cancer. SLN biopsy significantly decreases the number of postoperative complications caused by lymphadenectomy and improves the quality of life of cancer patients. So far, a large number of SLN detection techniques have accumulated. Each of these techniques has its own advantages and disadvantages.Conclusion. Despite a large number of SLN detection methods, the question of the optimal technique is currently debatable.

Изучены пути распространения и метастазирования у 122 больных первичным раком маточных труб, все они прооперированы, и диагнозы подтверждены гистологически. Распространение опухолевого процесса за пределы первичного очага выявлено у 88 (72,1%) больных. Из них прорастания опухоли в другие органы – у 43 (35,2%) и метастазы – у 67 (54,9%) больных. Метастазы преимущественно в лимфатические узлы – 32 (26,2%) больных. У 30 больных первичным раком маточных труб, кроме пангистерэктомии и резекции сальника, были удалены тазовые, а у 15 из них – и поясничные лимфатические узлы. При I клинической стадии по FIGO метастазы в лимфатические узлы выявлены у 27,3% (11/3), при II стадии – 41,6% (12/5), а при III-IV стадиях – у всех больных. Метастазы в парааортальные лимфатические узлы выявлены в 60,0% (15/9) оперированных больных первичным раком маточных труб. В итоге из 30 больных раком маточных труб всех стадий метастазы в лимфатические узлы выявлены у 46,6% (30/14). Почти каждая третья больная, даже при I клинической стадии, имела метастазы в лимфатические узлы. Прожили свыше 5 лет 68,4%(19/13) из этой группы больных, что на 16,2% больше, чем в группе оперированных без лимфаденэктомий. Uşaqlıq borularının xərçəngi olan operativ müalicə edilmiş və diaqnozu histoloji üsulla təsdiq edilmiş 122 xəstədə prosesin yayılma və metastazvermə yolları öyrənilmişdir. 88 xəstədə (72,1%) şiş prosesinin ilkin ocaqdan kənara yayılması aşkar edilmişdir. Onlardan 43 (35,2%) nəfərdə şiş ətraf orqanlara sirayət etmiş, 67 nəfərdə (54,9%) yaxın və uzaq metastazlar aşkar edilmişdir. Metastazlara əsasən limfa düyünlərində rast gəlinmişdir – 32 (26,2%) xəstədə. Uşaqlıq borularında ilkin xərçəng olan 30 xəstədə panhisterektomiyadan və piyliyin rezeksiyasından əlavə, çanaq lіmfa vəziləri, onlardan 15 nəfərdə isə həm də bel limfa vəziləri çıxarılmışdır. FİGO təsnifatı üzrə I klinik mərhələdə olan xəstələrdən 27,3%-də (11 nəfərdən 3-də), II mərhələdə 41,6%-də (12 xəstədən 5-də), III-IV mərhələdə isə bütün xəstələrdə lіmfa düyünlərində metastazlar aşkar edilmişdir. Uşaqlıq borularının ilkin xərçənginə görə operativ müalicə edilmiş xəstələrdən 60,0%-də (15 xəstədən 9 nəfərdə) paraaortal limfa vəzilərində metastaz olmuşdur. Ümumiyyətlə, uşaqlıq boynu xərçənginin bütün mərhələləri üzrə 30 xəstədən 14 nəfərdə (46,6%) limfa vəzilərində metastazlar aşkar edilmişdir. Demək olar ki, hətta I mərhələli şişi olan xəstələrdən hər 3 nəfərdən birində limfa vəzilərində metastazlar olmuşdur. Bu qrupdan olan xəstələrdən 68,4%-i (19 nəfərdən 13-ü) 5 ildən artıq yaşamışdır, bu, limfadenektomiya edilməyən xəstələrin 5-illik yaşama göstəricisinə nisbətən 16,2% çoxdur.

Aim of investigation. To analyze the data of patients with gastrointestinal stromal tumors (GIST) in the retrospective study that was carried out in hospitals of Chita and central regional hospital of Transbaykal region. Material and methods. In original study overall 116 patients with stromal tumors of gastrointestinal tract according to the records of Chita and Transbaikal Regional pathological bureau were analyzed Results. Nine (7,7%) patients had tumor location in the esophagus, 69 (59,4%) - in the stomach, 3 (2,5%) - in duodenum, 16 (13,7%) - in jejunum and ileum, 10 (8,6%) - in the colon, 3 (2,5%) - in the rectum. Retroperitoneal location of the GIST was revealed in 3 (2,5%) patients, pancreatic - in 2 (1,7%), liver - in 1 (0,8%) patient. The tumor was complicated by development of gastro-intestinal bleeding in 51 (44,8%) patients, in 3 cases (2,5%) it was lethal. Patients underwent organ-preserving operations without lymphadenectomy. In the remote period after surgery one patient died due to tumor metastasis, in 7 patients GIST was primarily diagnosed at the autopsy. Targeted therapy by tyrosine kinase inhibitors was carried out for 14 patients. Histological investigation of tumors revealed the mixed type in 8,62% of patients, and approximately equal proportion for spindle-cell and epithelioid (46,4 and 44,8%) variants. Extraorgan tumor growth especially in the cases of gastric location, commonly led to diagnostic errors when GIST was misdiagnosed for pancreatic pseudocyst, leiomyoma, schwannoma and other tumors. Conclusions. GIST can develop in any segment of gastrointestinal tract and features extraorgan growth in most of the patients, intraluminal growth of pedunculated tumor is rarely diagnosed. Bleeding from a tumor is the most frequent complication which can which can be lethal.

The present review is devoted to the concept of sentinel lymph node biopsy, which is an increasingly recognized method that was included into the guidelines for surgical treatment of various tumors developed by the European Organisation for Research and Treatment of Cancer (EORTC). Since the implementation of organ preservation surgeries, lymph node biopsy is considered the second most significant achievement in surgical treatment of breast cancer, because it reduces the frequency of complications (which often occur after axillary-subclavian lymphadenectomy), duration of hospital stay and treatment expenditures .

This article describes a rare clinical case of prostate cancer with a high baseline PSA level of 1407 hg/ml. In the course of diagnosis, hormonal and surgical treatment there was a successive dynamics of PSA decline: 07.08.2015–1407 ng/ ml, 14.09.2015–43,61ng/ml; 17.11.2015–0,326 ng/ml; 13.02.2016 (end of hormone therapy) — 0,084 ng/ml. After the operation of radical prostatectomy with enlarged lymphadenectomy, on 20.04.2016 (with prolonged hormone therapy up to 9 monthes) gradual decrease of PSA level continued: 05.05.2016–0,008 ng/ml; 17.06.2016–0,008 ng/ml; 08.09.2016–0,039 ng/ml; 30.11.2016–0,002 ng/ml; 07.09.2017 (total PSA) — 0,008 ng/ml. In parallel, there was a consistent improvement in the clinical picture, up to the MRI data of 19.10.2017, when there were no significant neoplastic changes at the level of the study (in the projection of the prostatic bed).

Endometrial cancer (EC) typically is treated surgically. Because of the adjuvant treatment implications, complete surgical staging including lymphadenectomy is recommended for high-risk ECs. Sentinel lymph node mapping has the potential to provide information about lymph node metastasis while avoiding potential complications of extended lymph node dissection.

Background. Metastatic involvement of the internal mammary chain lymph nodes (IMN) is associated with poor prognosis for breast cancer (BC) patients. However, parasternal radiation therapy is still a subject for debate. Methods. Results of 1144 consecutively treated patients with primary BC, who underwent one-stage videothoracoscopic (VATS) parasternal lymphadenectomy from 1998 to 2009, were retrospectively studied. Results. Surgical complications associated with thoracoscopic procedure did not exceed 2%. IMN metastases were detected in 211 (18.4%) patients, 6.0% of these cases did not have axillary invasion. In a wide analysis, the frequency of metastasis was statistically more influenced by: tumor localization (different from external quadrants), primary tumor size (T), level of involved axillary lymph nodes (N) and lymphovascular invasion. Patients with IMN metastases showed significantly poorer long-term outcomes: 5-year overall - OS and disease-free survival - DFS (OS 79.0±3.1% vs 91.4±1.0%, p

The article presents an analysis of domestic and foreign literature on the diagnosis and treatment of stomach cancer complicated by bleeding. The absence of unanimity in the choice of treatment strategy, timing and extent of surgical intervention, the feasibility and scope of lymphadenectomy

Objective: improve results of the treatment of patients with malignant salivary gland neoplasm (MSGN). Materials and methods. Analysis of 417 patients suffering from MSGN treated in the Federal State Budgetary Institution “N.N. Blokhin Russian Cancer Research Center” from 1988 to 2014. All the subjects were divided into 4 main groups according to the treatment assigned: group of the surgical treatment – 27.3 % (n = 114), group of the combined treatment (surgery and radiotherapy (RT)) – 54.0 % (n = 225), group of the complex treatment (surgery, radiotherapy and chemotherapy) – 10.5 % (n = 44), group of conservative treatment (radiotherapy and/or chemotherapy) – 8.2 % (n = 34). Results. Best 5-year disease-free survival (DFS) was observed in patients with localization of the tumor process in the minor salivary glands (MSG), mucosal tunic (MT) of mouth (73.2 ± 5.5%) and parotid gland (62.3 ± 3.3 %), while the lowest survival rate was observed in tumors of sublingual salivary gland (0%) (median was not achieved, p = 0.07). Depending on the morphological variants the best 5-year DFS was observed in groups of myoepithelial carcinoma, and acinar cell carcinoma: 81.3 ± 9.8 and 79.1 ± 8.4 %, respectively (median was not reached, p > 0.05); the worst survival rate was observed in patients with squamous cell carcinoma, carcinoma of the salivary ducts and adenocarcinoma: 45.7 ± 15.5; 50.3 ± 12.7 and 53.0 ± 5.5 %, respectively (median was not reached). In poorly differentiated tumors (G3 ) 5-year DFS was lowest and was equal to 32.7 ± 4.1 %, while in G1 tumors – 83.6 ± 3.1% (p = 0.000001). In G3 tumors addition of radiotherapy to the surgery significantly reduces the incidence of local recurrence - from 51.4 % (surgical treatment alone) down to 33.8 % (combined treatment) (p = 0.08). There was a significant decrease in 5-year disease-free survival rate from 74.2 ± 2.6 % without any adverse pathological signs down to 37.9 ± 5.4% in the presence of these signs (p = 0.000001). Cervical lymph node dissection is absolutely indicated for tumor localization in submandibular salivary gland, as it reduces an incidence of local recurrence: 15.8 % versus 25.9 % in the group without lymph node dissection, p> 0.05. In case of other MSGN localizations, prophylactic lymphadenectomy does not improve long-term outcomes. Radiotherapy in the post-op period significantly improves long-term results of treatment in comparison with a group of preoperative radiotherapy (local recurrence rates are 29.5 and 9.7 %, respectively, p = 0.0002). The use of chemotherapy can be justified in case of neoplasms with poor differentiation (G3 ) since this significantly reduces an incidence of distant metastases (17.6 and 9.1 % in groups of the combined treatment and in the group of conservative chemoradiotherapy respectively, p > 0.05).

Представлен обзор данных литературы о тактике лечения больных раком желудка. Тактика хирургического вмешательства при раке желудка пересмотрена с учетом концепции сторожевых лимфоузлов., A review of literature data on the treatment of patients with early gastric cancer has highlighted the tactics of surgical intervention in gastric cancer focused the sentinel lymph nodes concept., Представлено огляд даних літератури щодо тактики лікування хворих з раннім раком шлунка. Тактику хірургічного втручання при раку шлунка переглянуто з урахуванням концепції сторожових лімфовузлів.

The experience of the central performance of lymphadenectomy (TSLA) with primary thyroid cancer in 224 patients. All patients were divided into groups based on preoperative and intraoperative diagnosis of thyroid cancer and the vol- ume of operational benefits. Taking into account the frequency of metastasis to lymph nodes VI level TSLA should be performed in all patients with primary thyroid cancer regardless of the incidence of the primary tumor