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One of the most serious complications after low anterior resection is the failure of sutures of colorectal anastomosis, which is the most common surgical complication that results in patient’s death. Promptly diagnosed anastomotic leakage in postoperative period is challenging. Nevertheless, elimination of risk factors in preoperative period can significantly reduce complication rates.The purpose of this review article is to analyze possible risk factors and methods for preventing colorectal anastomosis leakage.An important area of prevention and optimization of treatment options for anastomotic leakage is the development of prognostic measures to eliminate risk factors. We see the prospects for this direction in the introduction of a nomogram, which allows the surgeon to assess the possible outcomes of the operation, to choose the optimal tactics with a minimum risk of complications, as well as the introduction of methods to avoid or prevent the development of complications of colorectal anastomosis.

Breast Cancer is the most common type of cancer worldwide. Scientific advances and new ways of treating have significantly improved the prognosis of breast cancer in recent decades. The emergence of modern cyclin-dependent kinase (CDK) inhibitors has changed the treatment paradigm for metastatic hormone receptor (HR)-positive breast cancer. In the past four years, the CDK4/6 inhibitors, ribociclib, palbociclib and abemaciclib, received their first FDA approval for the treatment of Hormone Receptor (HR)- positive and Human Epidermal growth factor Receptor 2 (HER2)-negative breast cancer after showing significant improvements in progression-free survival in the PALOMA, MONALEESA and the MONARCH randomized clinical trials, respectively. In the Russian standards for the treatment of metastatic HR positive and HER2-negative breast cancer are included two inhibitors of CDK4/6 – ribociclib, palbociclib. This review summarizes the background of clinical efficacy and potential toxicities seen with the use CDK4/6 inhibitors with endocrine treatment in pre- or postmenopausal women with hormone receptor–positive, HER2-negative advanced or metastatic breast cancer. Despite the similar toxicities, inhibitors of cyclin-dependent kinases differ in their severity and some types of adverse events. Most hematologic abnormalities seen with CDK4/6 inhibitors are not complicated and are adequately managed with standard supportive care and dose adjustments when indicated. This review focuses on the practical management of adverse events associated with CDK4/6 inhibitors.

Aromatase inhibitor (AI) combined with Gonadotropin-releasing hormone agonist (GnRH-a) have been recognized as an effective approach to adjuvant endocrinotherapy for breast cancer (BC) in premenopausal patients with adverse predictive factors. However, the risk of non-optimal suppression of the ovaries due to the mechanism of action of aromatase inhibitors has been proven. Recently published SOFT-EST studies showed that the blood estradiol (E2) level in 37% of patients was above the level that was permissible for the purpose of this group of drugs. And although today there is no enough scientific justification to interpret this result, the introduction of aromatase inhibitors in adjuvant therapy in young women requires the search for tactics to reduce the risk of mediated increase in estradiol against the background of such therapy. Alertness occurs when the E2 serum level exceeds the menopause limit by the time the aromatase inhibitors are prescribed. Objective of the study. Determine the tactics for minimizing the risk of increasing estradiol against the background of aromatase inhibitors in combination with GnRH-a in adjuvant therapy for breast cancer in premenopausal patients. Material and methods. 47 patients of ≤ 50 years old with GR + HER2- Stages I-III Breast Cancer and a regular menstrual cycle before the start of neo-/adjuvant chemotherapy were studied. E2 and FSH levels were assessed at the stage prior to chemotherapy and immediately prior to administering adjuvant endocrinotherapy. After the completion of chemotherapy, only 7 out of 47 women had the menstrual cycle - patients without clinical and biochemical suppression of ovarian function (SOF). 86% of cases had cytostatic amenorrhea (n = 40), of which 23 cases (58%) showed that this condition was not combined with the biochemical response of sex hormones, i.e. there was no biochemical SOF. Thus, the study group included 30 patients, who were supposed to be treated with aromatase inhibitors + GnRH analogues, and had no clinical or biochemical menopause by the time adjuvant endocrinotherapy was prescribed. In order to reduce the risk of mediated increase in estradiol, even with pharmaceutical “switching off” ovarian function, the patients were prescribed the GnRH analogue (Buserelin Depot) before starting aromatase inhibitors therapy. Results and conclusion. A progressive decrease in E2 level was determined after each subsequent administration of Buserelin Depot. The median values remained low only after the third injection. Following the chemotherapy, a decrease in estradiol was accompanied by a physiological increase in the FSH levels in 73% of women. The administration of Buserelin Depot led to a significant decrease in FSH median (p

The randomized clinical trials showed the effectiveness of the addition of ovarian suppression to tamoxifen or to aromatase inhibitors after adjuvant chemotherapy in women younger or older than 35 years, but with at least one high-risk factor for recurrence.However, the lack of clear criteria for evaluating the ovarian function after gonadotoxic chemotherapy, especially in women in the perimenopause, significantly complicates the choice of the right tactics for endocrine therapy. Despite proven efficacy of aromatase inhibitors as part of the adjuvant breast cancer therapy in women with preserved ovarian function in SOFT and TEXT trials, this tactic requires a more differentiated approach, according to many experts.The relative factors (STRAW criteria, age, gonadotoxicity of chemotherapy) for determining the probability of restoration of ovarian function after the chemotherapy were determined using the characteristics of the menstrual cycle in women with hormone-sensitive breast cancer based on the international trials available in the literature. The introduction of these methods for evaluating the ovarian function after chemotherapy in premenopausal women into the clinical guidelines for the adjuvant management of early breast cancer may make the choice of ovarian suppression more appropriate not only from the clinical, but also from the physiological point of view.