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The modern principles of surgical treatment in non-organ retroperitoneal tumors
The analysis of DNA polymorphisms distribution of two genes involved in the regulation of the functional activity of cytokines found:
- Frequency distribution of alleles IL-1p and IL- 6, consistent with the law of the expected Hardy-Weinberg equilibrium (P > 0.05);
- Among the examined patients with keloid scars in the presence of genotype-national function allele and genotype polymorphism S3953T gene IL-1p detected in 12.5 % and 25.0 %, respectively, compared with 6.0 % and 12.0 % in the control group, and is associated with a than 2-fold increased risk of diseases associated with collagen remodeling. However, these differences were not significant article cally (x2 = 1.3; P = 0.3; OR=2.4; 95 % CI 0.5062, 11.8); The genotype homozygous for the allele C/C, on the contrary, was protective against such states (x2 = 1.2; P = 0.2; OR = 0.4; 95 % CI 0.50, 8.11). However, its frequency was statistically insig-nificant-telno lower in the group of patients with keloids (75.0 %) than in controls (88.0 %). In the studied group of people with homozygous genotype were found;
- incidence functionally inactive alleles and genotypes of G-174C polymorphism in the gene IL-6 in patients with keloids significantly higher than in control group con (6 % and 25.0 % versus 4.0 % and 8.0 %, respectively).
Heterozygous for the presence of allele G/C in the group of patients with keloids met insignificantly more frequently than in the control group (20.0 % vs. 8.0 %, P > 0.05). A combination of two rare allelic variants not significantly more common also in the group of patients (25.0 %) compared with the control group (2.0 %). According to remodeling odds ratio, risk of collagen remodeling in patients in the presence of genotype — G/C + C/C is increased by more than 3.5 times (x2 = 2.4; P = 0.1; OR = 3.8; 95 % CI 0.6569, 22.37).
Conclusion
The association between the polymorphic variants of genes IL-1^ second IL-6 and the development of pathological conditions involving remodeling call gene. According to preliminary results of polymorphisms of genes S3953T gene IL-1^ and G-174C IL-6 gene is a marker of increased risk of disease development, it is clearly expressed with homozygous genotype polymorphism G-174C IL-6 gene. The results reveal some aspects of the genetics of pathological process in keloid scars and indicate the advisability of continuing the first study of polymorphisms of genes involved in the pathogenesis of diseases involving the degeneration of collagen.
References:
1. Адаскевич В. П., Мяделец О. Д., Тихоновская И. В. Алопеция. - М.: Медицинская книга; Н. Новгород: Изд-во НГМА, 2010. -Вып. 2. - 192 с.
2. Божченко А. А. Рубцовые и нерубцовые алопеции: вопросы классификации, этиологии, патогенеза, клинической картины и терапии//Журн. дерматовенерологии и косметологии. - 2005. - № 2. - С. 45-54.
3. Зарецкая Ю. М. Клиническая иммуногенетика. - М.: Медицина, 2003. - 208 с.
Ulmasov Firdavs Gayratovich, Djuraev Mirjalol Dehkonovich, Yusupbekov Abrorbek Ahmedjanovich, National research center of oncology of Uzbekistan E-mail: [email protected]
The modern principles of surgical treatment in non-organ retroperitoneal tumors
Abstract: The article provides a data of immediate and long term results of surgical treatment in 208 patients with locally spread nonorganic retroperitoneal tumors. Malignant tumors constituted 152 (71.3 %) while benign tumors 56 (26.9 %). Radical operations were performed to 64.8 % of patients, palliative — 26.7 % and in 8.3 % of cases operations were cytoreductive. From these, in 52.8 % of cases operations had combined character. General, Intra- and postoperative complications constituted 16.4 %, meanwhile postoperative lethal outcomes — 2.4 %. 5-year survival rate of patients with benign tumors reached 83.3 %, and malignant — 12.6 %. The same index after radical operation constituted 41,3 %, and after non radical — 9.6 %. Relapses within 5 years after surgery for a malignant tumor occurred in 73.7 %, and after a benign tumor — 26.3 % of patients.
Kaywords: retroperitoneal, non-organ, tumor, operation, radical, surgical, size, combined, anastomosis.
Relevance
Non-organ malignant retroperitoneal tumors according to WHO (2013) is 0.3-0.4 % in the structure of cancer pathology [4].
According National cancer research center (NCRC) of Uzbekistan recorded annually 80-86 cases of retroperitoneal tumors with non-organ origins representing 0.4 % of all cancer.
Statistical analysis of the last 5 years shows that more than 50 % of tumors are locally advanced character that required conducting combined operations [1; 2].
Due to the inaccessibility of the region and since these tumors often give no or non-specific symptoms until they have reached a substantial size, they are usually large at presentation. Sarcomas
comprise a third of retroperitoneal tumors, with two histological subtypes predominating, namely liposarcoma (70 %) and leiomyosarcoma (15 %). Other retroperitoneal neoplasms include primary lymphoproliferative tumors (Hodgkin's and non-Hodgkin lymphoma) and epithelial tumors (renal, adrenal, pancreas) or might represent metastatic disease from known or unknown primary sites (germ cell tumors, carcinomas, melanomas). Benign tumors can cause concern and are often an incidental finding during an investigation for unrelated symptoms [3].
They may be referred on suspicion ofbeing a sarcoma. The most common benign pathologies encountered in the retroperitoneum include benign neurogenic tumors (schwannomas, neurofibromas),
Section 5. Medical science
paragangliomas (functional or non-functional), fibromatosis, renal angiomyolipomas and benign retroperitoneal lipomas [6; 10].
Operations in occasion of retroperitoneal tumors are very complicated among the surgeries. Treatment of these tumors demands from the surgeon deep knowledge of anatomy and possessing the high technical skills as well as the creativity and professional courage [4; 7]. However, the operability ofretroperitoneal tumors remains quite low. For example, in a large clinical material various reputable researchers have shown that at the time of treatment of such patients for medical assistance only half of them are subject to surgical treatment, and in 21-26 % of cases of the operation is palliative or completed with trial laparotomy [9; 11]. The radical surgical interventions manage to perform according to different authors from 35 to 70 % [5; 8].
Materials and methods
Studies were conducted in 254 patients with retroperitoneal tumors who were in the department of abdominal surgery of NCRC. All patients had the surgery interventions, 208 of them (81.9 %) had removing of the tumor, 46 (18.1 %) patients had exploratory laparotomy. Among patients who had surgery, malignant tumor were in 152 (73.1 %) caces, benign — 56 (26.9 %). From them radical surgery had 64.8 % patients, 26.7 % palliative — 26.7 %, cytoreductive — 8.3 % patients. 52.8 % of them had combined operation. Men were- 144 (69.2 %), women — 64 (30.8 %). The age of patients ranged from 16 to 76 years. The diagnosis is established on the basis of comprehensive studies using diagnostic laparoscopy and MSCT angiography.
Radical surgery involves the removal of a single block of primary retroperitoneal tumor and surrounding structures affected by the mobilization of tissue outside the tumor pseudocapsule.
With the involvement in the process of tumor adjacent organs (kidney, spleen, pancreas, adrenal glands, stomach, duodenum, small intestine, colon, rectum, bladder, uterus, uterus, vagina), or their feeding vessels, during radical surgery are performed combined intervention with the removal or resection of the said bodies. In our study, in 52.8 % of cases have been made combined surgical interventions. The main components of the combined intervention were: small and large intestine and mesentery, liver, spleen, kidneys, ureters, front and side walls of the abdomen, great vessels, ovaries, bladder, pancreas and others. Among the combined operations is considered to be the most relevant in the germination of retroperitoneal great vessels and ureters. These operations accounted for 16 % (22) among patients with combined operations.
In 12 (16 %) cases was detected invasion to the great vessels, in 3 cases invasion to the iliac arteries and veins, in 4 cases to the abdominal aorta, and in 5 cases to the inferior vena cava, in which 2 patients had invasion to above and in 3 patients below the renal veins. In all 3 cases with invasion into the iliac artery was made resection of common and the external iliac artery with iliac-femoral prosthetic repair.
In 2 cases of 3 during the germination the aorta was made resection of the aorta with a prosthetic repair, and 1 case of resection margins with the plastic of wall of the aorta. In all five cases, the tumor invasion into the inferior vena cava had been made resection and plastic of vessel walls. 10 (4.8 %) of patients had resection of the ureter as element of combined operation, length of resection was from 2 to 10 cm, on the right — 6, left — 4. In 5 cases it was possible due to the mobilization of the ureter urethra to overlay
urethra-urethro anastomosis. In 3 other cases, when the defect of the ureter, is from 8 to 10 cm., we have developed unique ways to restore the defect of appendicular appendage from the cecum with preservation of the mesentery, a similar operation is performed on the right at 2 and left at 1 patient. In 2 cases with 6 cm. defect was performed the full mobilization the left kidney with renal artery, vein and the proximal end of the ureter, due to this has been bring down the left kidney as a whole by 6 cm. and to form urethra-urethra anastomosis with nephropexy.
Results
General intra- and postoperative complications were in 16.4 % (34 patients). The intraoperative complications were in 24 (11.5 %), and the postoperative complications were in 10 (4.8 %) patients. The intraoperative complications: in 16 patients there was diffuse bleeding from the tumor bed during the mobilization and removal of the tumor, in 2 patients was massive bleeding as a result of damage to major vessels, in 3 cases — the damage of the integrity of the intestine, in 2 — bladder and 1 — spleen. During the postoperative period complications structure directly related to the operation itself was as follows: bleeding from the resected tumor bed — 3, external colonic fistula was formed from colo-colo anastomosis — 1, paralytic ileus in 2, pancreatitis in 2 in 1 thromboembolism, acute cardiovascular failure in 1 patient. Intraoperatively died 1 (0.4 %) patient from the acute cardiovascular failure, due to the continuous bleeding and disseminated intravascular coagulation syndrome. During the postoperative period died 5, 2 cases from the intra-abdominal bleeding, 1 — from thromboembolism, 1 — from myocardial infarction, and 1 patient after relaparotomii to close the intestinal fistula. Postoperative mortality was 2.4 %.
Postoperative complications associated with plastic urethra were observed: in 1 (3.5 %) patient after the formation of urethra, urethra anastomosis with the defect to 3.0, long-term period of up to 3 years in 2 (11.4 %) patients had slight narrowing in the anastomosis area with the development of I-degree hydronephrosis. In the remaining patients urethral patency of anastomoses was estimated very well.
Relapses of not organ tumors after radical surgery revealed within five years in 60.8 % cases: respectively, in 26.3 % of patients with benign tumors and 73.7 % — with malignant, and in most patients (52 %) tumor recurrence occurred within the period of 18 months after surgery. The five-year survival in retroperitoneal tumors after radical surgery was 41.3 %, after non-radical — 9.6 %.
Conclusion
Among the expansion-combined operations, special place is occupied resection and prosthetic large major vessels, and the replacing throughout of the defect of the ureter. When the defect of the urethra was up to 3 cm., continuity can be restored through the mobilization of the distal and proximal urethra. When the defect up to 5.0 cm. can be performed through the kidneys mobilization. When the defect constituting more than 5.0 cm. on the right side can be used appendix with the preservation of mesentery. These methods are aimed at preserving the anatomical and functional features of the body. Contemporary surgical techniques in contrast to traditional methods of treatment have a great advantage in restoring the health of patients, reducing the frequency of complications, reducing the amount of disability, improvement in 3- and 5-year survival and quality of life.
References:
1. Echenique-Elizondo M., Amodarain-Arratibel J. A. Liposarcoma retroperitoneal gigante//Cir. Esp., - 2005. - V. 77: 293-295.
2. Yoshida Y., Inoue K., Ohsaco T. et al. Weekly paclitaxel therapy is curative for patients with retroperitoneal liposarcoma//GanTo-KagakuRyoho. - 2007. - V. 34: 465-467.
Analysis of the surgical treatment of the pulmonary metastatic lesions
3. Hassan I., Park S. Z., Donohue J. H. et al. Operative management of primary retroperitoneal sarcomas. A reappraisalofaninstituteex-perience//Ann. Surgery. - 2004. - V. 239: 244-250.
4. Stauffer J. A., Fakhre G. P., Dougherty M. K. et al. Pancreatic and multiorgan resection with inferior vena cava reconstruction for retroperitoneal leiomyosarcoma//World journal Surgery Oncology. - 2009. - V. 6, № 7: 3.
5. Raut C. P., Swallow C. J. Are radical compartmental resections for retroperitoneal sarcomas justified?//Ann Surgery oncology. -2010. - 17: 1481-1484.
6. Morandeira A., Prieto J., Poves I. et al. Giant retroperitoneal sarcoma//Can. Journal. Surgery. - 2008. - V. 51, № 4: 79-80.
7. Lopez-FandoLavalle L., Burgos Revilla J., Saenz Medina J. et al. Renal autotransplantation: a valid option in the resolution of complex cases//Arch. Esp. Urol. - 2007. - V. 60, № 3. - P. 255-265.
8. Teo M. C., Chow P. K., Soo K. C. Surgery for retroperitoneal sarcoma requiring major vascular resection and reconstruction//Asian. Journal. Surgery. - 2005. - V. 28, № 4: 312-315.
9. Bolling T., Janke K., Wolters H. H. et al. Kidney-autotransplantation before radiotherapy: a case report. Anticancer Res., - 2009. -V. 29, № 8: 3397-3400.
10. Iida T., Kawa G., Matsuda T. A case of preserving renal function by renal autotransplantation for bilateral urothelial carcinoma of the ureter//Int. Journal. Urolog. - 2009. - V. 16, № 6: 587.
11. Lopez-Fando Lavalle L., Burgos Revilla J., Saenz Medina J. et al. (2007) Renal autotransplantation: a valid option in the resolution of complex cases. Arch. Esp. Urolog., 2007. - V. 60, № 3. - P. 255-265.
Usmanov Bekzod Baymatovich, Doctor of oncology, Department of Thoracic Oncology, National Cancer Research Center, Republic of Uzbekistan E-mail: [email protected] Yusupbekov Abrorbek Axmedjanovich, MD, deputy director of the National Cancer Research Center Khairutdinov Rafik Vakhidovich, MD, Senior Researcher, of ThoracicOncology, National Cancer Research Center Ismailova Umida Abdullaevna, Postgraduate Student, Department of General Oncology and Radiation Diagnosis, Tashkent Medical Academy
Analysis of the surgical treatment of the pulmonary metastatic lesions
Abstract: In he department of thoracic oncosurgery of the Republican Oncological Research Center of the Ministry of Health of the Republic of Uzbekistan from 2000 to 2013 the surgical treatment at metastatic pulmonary lesions was performed in 45 patients. The surgeries were performed by thoracotomic approach in 29 (64.4 %) and with videothoracoscopic method — in 16 (35.6 %) patients. The volume of surgeries depended on the character of metastatic pulmonary lesions (size, number of metastases located in the zones in the lungs). There were performed atypical resections — 39 (86.7 %), lobectomies — 4 (8.9 %), bilobectomies — 1 (2.2 %), pulmonectomies — 1 (2.2 %). The patients were made analysis of the postoperative development in thoracotomic and thoracoscopic approaches in the patients with similar volume of operation. On the basis of this there were made conclusions that thoracoscopy seemed to be more preferable, than thoracotomy due to less traumaticity and more favourable postoperative development. The role of videothoracoscopy was determined as diagnostic and therapeutic method at solitary character of the metastatic pulmonary lesion.
Keywords: metastases in the lungs, videothoracoscopy, toracotomy, lung atypical resection.
Introduction
According to the data of literature the morbidity of high level of patients due to result of progressing looking-like metastazing of the malignant tumors is one of the most important problem of the modern oncology [1].
The term "metastasis" was introduced, for the first time, by Recamier in 1829. Metastazing (from the Greeth metastasis -transmission of the malignant tumors into the lungs depended on the common rules, being studied in details in experiment and oncological clinic and together with autonomic growth and invasiveness appeared to be sign of the tumor progression. It is well known that hematogenous way appeared to be the main way of metastazing into the lungs [2; 3; 4].
Metastases in the lungs were defined at the primary examination or in the different time after treatment of malignant neoplasms in 6-30 % of patients with tumors of any localization [4; 5; 6].
According to the autopsies, intrapulmonary metastases were revealed in 20-54 % of patients, having extrapulmonary tumors [7; 8].
Frequency of the metastazing of the malignant tumors into the lungs, according to the data of various authors, varied from 1.6 to 55.4 %, dependently on the localization and histological structure of the primary tumor. Mostly of all metastatic lung lesions occurred in trophoblast disease (55.4 %), of the malignant kidney neoplasms (37.7 %), of the locomotor apparatus (18.6 %), the colon (16.8 %), mammary gland (15.7 %), more rarely — in uterine cancer and sarcoma (4.2 %), gastric cancer (1.6 %) [9; 10; 11]. In 70-90 % of
