Sergey A. Domrachev

Improved surgical outcomes in patients with pancreatic cancer are largely associated with atraumatic and precise surgical technique. In this context, the most accurate determination of tumor localization, size, and metastases is particularly important. This can be achieved through fluorescence imaging (FI). It allows not only for specifying the localization of tumor foci and mapping lymphatic collectors, but also for a fairly accurate assessment of organ and tissue perfusion. Objective. Systematic review aims to determine the feasibility of using FI in pancreatic surgery (PROSPERO ID: CRD42023475963). Material and methods. The literature search was conducted using the MEDLINE, Embase, and e-Library databases from 31 of October, 2023 y., to 30 of June, 2024 y. This systematic review included all studies describing the use of FI during pancreatic surgery. Results. A total of 383 patients from 32 studies meeting the inclusion criteria were included in the review. The most commonly used fluorescent agent was indocyanine green (ICG), utilized in 28 studies. The authors cite the following important advantages of FI: more accurate determination of tumor and metastatic lesion localization, reliable assessment of organ blood supply and viability before and after resection, and a reduction in the risk of intraoperative injury to the common bile duct during pancreatic surgical interventions. Conclusion. FI in pancreatic surgery has a definite potential for detecting metastatic lesions not identified by radiological imaging methods, providing more precise visualization of tumors and resection margins, reducing the risk of intraoperative complications, and enabling reliable assessment of perfusion and viability of the pancreas, stomach, duodenum, spleen, and liver. This method may also be used to evaluate the effectiveness of neoadjuvant therapy in patients with pancreatic cancer.

Objective. To compare outcomes of redo laparoscopic and robot-assisted surgeries at the esophagogastric junction in patients with prior antireflux procedures. Material and methods. Between 2016 and 2024, 30 patients underwent redo antireflux surgery at the Loginov Moscow Clinical Scientific and Practical Center. Seventeen patients received robot-assisted surgery using the Da Vinci system (main group), while 13 underwent conventional laparoscopic procedures (comparison group). Initial surgeries included Nissen fundoplication (22 cases), Toupet fundoplication (3 cases), and the A.F. Chernousov technique (5 cases). Redo procedures included Toupet fundoplication (11 cases), the Chernousov method (16 cases), posterior cruroplasty with gastropexy (1 case), proximal gastrectomy with double-tract reconstruction (1 case), and Kanashin-type gastroplication combined with Toupet fundoplication (1 case). Results. Median operative time was 180 (105–305) minutes for robotic and 200 (130—340) minutes for laparoscopic surgeries; proximal gastrectomy required 300 minutes. Average intraoperative blood loss was 25 (20—50) mL in the robotic group and 20 (5—70) mL in the laparoscopic group. Median hospital stay was 5 (1—16) days in the robotic group and 6 (2—11) days in the laparoscopic group. No deaths occurred. Conclusion. Redo surgery at the esophagogastric junction using minimally invasive techniques is safe and effective for patients with complicated gastroesophageal reflux disease. Robot-assisted surgery is technically comparable to laparoscopy, with low complication rates and slightly shorter hospitalization durations.

AIM OF THE STUDY was to present a case of combined, staged surgical treatment for locally advanced cardioesophageal cancer complicated by esophageal stenosis in a comorbid patient with a significant lesion of the internal carotid artery, and to summarize the data of scientific literature on the methods for its diagnosis and treatment.MATERIAL AND METHODS A 65-year-old patient came to the Moscow Clinical Research and Practice Center named after A.S. Loginov in August 2020 with complaints of difficulty in passing solid food through the esophagus. During the examination at the Center, Siewert II cType 3 T4bN2M0 G3 cardioesophageal junction cancer was diagnosed. Taking into account the results of comprehensive diagnostics, the patient was found to have asymptomatic stenosis of the internal carotid artery up to 75%. Step-by-step surgical treatment of the patient was performed.DISCUSSION In the presented clinical observation for prevention of intraand postoperative ischemic complications, at the first stage the patient underwent carotid endarterectomy followed by surgical treatment for the underlying pathology. The presented observation is of interest due to the rare occurrence of such a combination of surgical interventions and the lack of consensus regarding the treatment tactics for this category of patients.CONCLUSION Combined staged treatment of a patient with cardioesophageal cancer and internal carotid artery stenosis reduces the risk of perioperative complications and improves the prognosis of further treatment for the underlying disease.

Aim: to present the results of an Expert Consensus on standardization of indications for surgical treatment of gastroesophageal reflux disease (GERD). Materials and methods. The issues of standardization of indications for surgical treatment of GERD were discussed by 39 experts – leading gastroenterologists and surgeons from 7 cities of Russia, representing 17 institutions. The list of questions for discussion was formed by the initiative group and sent to the experts. The experts reviewed recent literature, including existing clinical guidelines and consensuses, assessed the evidence base and suggested statements for voting based on the analysis of relevant provisions of foreign consensuses, high-level scientific publications, which set out information obtained in the course of studies that meet the criteria of evidence-based medicine, positions on this issue in the Russian Federation, and suggested statements for voting. Delphi method was used to reach the consensus.Results. GERD is the most common benign esophageal disorder. Surgery is considered one of the treatment methods for GERD. In real clinical practice, selection of patients who may benefit from surgery is challenging. The results of surgical and conservative treatment of GERD are comparable. Surgical treatment should be performed in a specialized hospital only after a joint examination with a gastroenterologist confirming the diagnosis of GERD. An appropriate volume of preoperative diagnostic workup, matters related to surgical interventions in case of incomplete response to proton pump inhibitors (PPIs) and when extraesophageal manifestations of GERD are present were discussed. The consensus reviews the indications, contraindications and possible results of antireflux operations in patients with GERD. The value of endoscopy, esophageal manometry, pH monitoring/pH-impedance monitoring and X-ray polypositional examination of the upper gastrointestinal tract as a preoperative examination of the patient is analysed. Conclusions. The experts reached the consensus on 20 statements on standardization of indications for surgical treatment of GERD.

Objective. To evaluate the outcomes of surgical treatment for epiphrenic (supradiaphragmatic) and bifurcational (mid-esophageal, epibronchial) esophageal diverticula. Material and methods. Between 2015 and 2022, 12 patients with epiphrenic and bifurcational esophageal diverticula were treated at the Loginov Moscow Clinical Research Center. Thoracoscopic diverticulectomy was performed in 7 cases (5 bifurcational and 2 epiphrenic), while 5 patients underwent laparoscopic transhiatal diverticulectomy. In 3 patients, surgery was supplemented with fundoplication (Toupet, Dor), and in 1 patient with cardiomyotomy. Results. No fatal outcomes were recorded. One patient developed a pneumothorax in the postoperative period, requiring pleural drainage. At follow-up, one patient continued to experience dysphagia, retrosternal pain, and regurgitation. Two patients showed negative dynamics: one experienced a recurrence of the diverticulum, and the other had worsened dysphagia. Conclusions. Diverticulectomy for bifurcational diverticula is effective in alleviating clinical symptoms without the need for additional myotomy. Surgical treatment of epiphrenic diverticula involving diverticulectomy without fundoplication and/or cardiomyotomy does not always lead to satisfactory postoperative results, warranting further investigation.

ЦЕЛЬ ИССЛЕДОВАНИЯ Оценить результаты и определить целесообразность повторных антирефлюксных операций с применением роботической системы Da Vinci. МАТЕРИАЛ И МЕТОДЫ С 2019 по 2022 г. в ГБУЗ «МКНЦ им. А.С. Логинова ДЗМ» у 10 больных выполнены повторные антирефлюксные операции с использованием роботической системы Da Vinci. Ранее в других клиниках этим больным была выполнена фундопликация в связи с безуспешностью консервативной терапии. В нашей клинике сделаны следующие операции: 4 пациентам — рефундопликация по Toupet, 3 больным — повторная фундопликация по методике А.Ф. Черноусова; 1 пациенту ввиду выраженного укорочения пищевода выполнена гастропликация по Н.Н. Каншину с фундопликацией, 1 больному — задняя крурорафия с гастропексией и еще 1 пациенту — проксимальная резекция желудка с double track-реконструкцией. РЕЗУЛЬТАТЫ Медиана времени операции составила 160 (105—305) минут, из них 20 минут во всех случаях занимал «докинг». Средняя кровопотеря составила 25 (20—100) мл. У 1 больного послеоперационный период осложнился явлениями гастростаза, который разрешен консервативными методами. Средняя длительность послеоперационного лечения составила 5 (1—11) койко-дней. Летальных исходов не было. ЗАКЛЮЧЕНИЕ Применение робота Da Vinci при повторных операциях на кардии сопровождается хорошими послеоперационными результатами и, безусловно, является целесообразным.

Esophageal cancer ranks 8th in incidence and 6th in mortality among oncological diseases in the world. To date, interest in the analysis of oncological patients’ quality of life is steadily growing. The majority of the questionnaires for evaluating patients quality of life with esophageal cancer, however, have not been validated and translated into Russian. Objective. To study the world’s experience of using patient-reported outcome measures (PROMs) that assess the quality of life in patients with esophageal cancer. Key points. We examined the most popular PROMs for esophageal cancer patients. The techniques and potential applications of these questionnaires throughout different stages of treatment in clinical settings, along with the influence of esophageal cancer treatment on quality of life, were explored. Conclusions. While evaluating outcomes and contrasting diverse treatment approaches, it is crucial to consider not only clinical data but also the subjective evaluations made by patients regarding their quality of life. Modern PROMs not only provide a comprehensive assessment of patients’ quality of life but also facilitate comparisons between different treatment modalities, including those for esophageal cancer patients. Clearly, there is a requirement to customize and validate the existing pertinent quality of life questionnaires for individuals with esophageal cancer in the context of Russia.

PRO (patient reported outcomes) is a patient's subjective assessment of health and quality of life, without interpretation by a specialist. PROM (patient reported outcomes measure) questionnaires are used to analyzing this data. Assessment of the quality of life is a perspective direction, which allows to improve the quality of medical care and treatment results. Today, there are many questionnaires PROM, their reliability and validity has been proven in numerous studies. Unified standards and methods for developing and evaluating questionnaires have been developed. Interest in the use of quality of life questionnaires is increasing constantly. However, studies analyzing the data of the PROM questionnaires are rarely found in the national literature. Quality of life is also poorly researched in clinical practice. The aim of the literature review is to present modern methods for assessing the quality of life of patients, especially with cancer. A review of the most widespread and reliable questionnaires and assessment instruments for the quality of life of a patient has been carried out. The analysis of world experience of their use in clinical practice, for patients with cancer has been performed. Examples of both general and specific questionnaires are given. PROM questionnaires are widely used among patients with cancer. However, incorrect use of PROMs is found in the literature, and in patients with certain nosologies PROM data studied poorly. Further analysis of the potential of PROM questionnaires implementation is required, as well as their translation and adaptation for use in Russian health care.

ЦЕЛЬ ИССЛЕДОВАНИЯ Анализ результатов торакоскопической эзофагэктомии у пациентов с доброкачественными заболеваниями пищевода. МАТЕРИАЛ И МЕТОДЫ В ретроспективное когортное исследование включены 78 пациентов, которым выполнена минимально инвазивная эзофагэктомия по поводу доброкачественных заболеваний пищевода в отделении высокотехнологичной хирургии и хирургической эндоскопии МКНЦ им. А.С. Логинова и в отделении торако-абдоминальной хирургии и онкологии РНЦХ им. Б.В. Петровского с 2011 по 2021 г., в том числе у 53 по поводу пептических и ожоговых стриктур пищевода и у 24 по поводу ахалазии кардии или кардиоспазма. В 68 случаях минимально инвазивная эзофагэктомия дополнена пластикой пищевода изоперистальтической желудочной трубкой с формированием эзофагогастроанастомоза на шее, у 1 пациента выполнена операция Льюиса и у 9 больных сделана пластика пищевода толстой кишкой. У 58 пациентов анастомоз формировали ручным способом, у 19 — с использованием механических сшивающих аппаратов. В 1 случае операция завершилась выведением эзофаго- и гастростомы. РЕЗУЛЬТАТЫ Медиана объема кровопотери составила 200 мл (10—1200 мл), длительность операции — 450 мин (245—765 мин). В ближайшем послеоперационном периоде у 37 больных отмечены осложнения, в том числе несостоятельность швов эзофагогастро- и эзофагоколоанастомоза у соответственно у 17 и 4 пациентов. В отдаленном периоде у 9 больных развилась стриктура анастомоза. Летальных исходов не было. ЗАКЛЮЧЕНИЕ Применение минимально инвазивных технологий при резекции или экстирпации пищевода по поводу доброкачественных заболеваний позволяет достигнуть благоприятных результатов. Тем не менее трудности с внедрением данной методики определяются отсутствием единого мнения при выставлении показаний и выборе тактики лечения, малым числом больных, различием взглядов в отношении выбора ручного или аппаратного способа формирования анастомоза на шее и варианта оперативного доступа при торакоскопической эзофагэктомии.

ЦЕЛЬ Обзора — изучить современные возможности выполнения рефундопликаций. Представлен мировой опыт проведения повторных антирефлюксных вмешательств, в частности рефундопликаций с использованием роботической системы Da Vinci. Проведен анализ причин, приводящих к неудовлетворительным результатам первичных операций. Рассмотрены показания к рефундопликации и результаты роботических повторных антирефлюксных операций.