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Контактная информация: Андрей Евгеньевич Зотиков, профессор, д.м.н., ведущий научный сотрудник отделения хирургии сосудов Института хирургии им. А.В. Вишневского, Москва, Россия, e-mail: zotikov@ixv.

Objective Pancreatic neuroendocrine tumour (pNET) is a rare type of tumour with different malignant potential. Nowadays there is no universal approach for treatment of small and benign‐looking pNETs throughout the world. Methods There were 137 patients with pNETs surgically treated in our department between 2007 and 2017. Most of them were female ‐ 96 cases with median age 42 years old. Organ‐preserving procedures (OP) were performed in 44 (32%) cases and were compared with standard procedures 93 (68%) cases. Results Main intraoperative characteristics were comparable in groups. There was significantly less estimated blood loss volume in the OP group: less than 1 dL. Postoperative length of stay and drainage placement time were less in the OP group. There were less pancreatic fistulas and no delayed gastric empties in the OP group. 90‐day postoperative mortality rate was the same in both groups: four cases of severe postoperative pancreatitis with acute respiratory distress syndrome. Conclusion As the “wait‐and‐see” policy can be not useful due to uncontrolled disease progression, choice of organ‐preserving treatment first can become the first line of decision taking in small benign pNETs. Our experience shows that organ‐preserving treatment is more comfortable for the surgeon and for the patient. However, it is not the universal position. The long‐term survival data still has to be estimated.

Objectives: ERAS has prompted changes to practice across the surgical, anaesthetic and nursing professions that have minimised the surgical stress response and reduced length of hospital stay. The next goal for ERAS teams is to return patients to normal function as quickly as possible following discharge. Occupational therapists support patients to recover and overcome any barriers that prevent them from doing activities (occupations) that matter to them. This study examines the current role of occupational therapy (OT) in ERAS. Methods: A broad literature search was conducted on 26 th January 2016 as described in Table 1. Results: 68 peer reviewed abstracts, in English, from 2000, were identified. This reduced to 17 once the abstracts had been filtered for duplicates and relevancy, and reduced to 4 once the full papers had been studied. The 4 remaining papers comprised a cohort study with some OT input described, but no OT specific outcome (Dawson-Bowling et al, 2014); and 3 comparative cohort studies (Husted et al, 2011; Pape et al, 2013; Petersen et al, 2008), 2 describing some OT input but no OT specific outcome, and 1 with an OT outcome, but little description of input. Conclusion: There is very little research describing the explicit role of OT in ERAS even though OTs work routinely within surgical MDTs. The skills of an OT would appear to be very useful in helping to accelerate return to full function post discharge. Further work is needed to evaluate whether OT input can help accelerate return to normal activities of daily living.

An analysis of the immune status in 53 patients that underwent coronary artery bypass grafting under cardiopulmonary bypass was carried out in the preoperative period and on day 1 and 7 after the surgical intervention. Significant changes in innate and adaptive immunity were revealed. In the first case, they were expressed as an inflammatory process developed throughout the postoperative period; it was confirmed with an increase in leukocytes, total and stab granulocytes, monocytes, oxidative stress of phagocytes, CD64+ and CD40+ granulocytes, endogenous intoxication with the developed significant deficiency in CD4+ monocytes, and regulatory NK cells; while immediately after the surgery, it was confirmed by IgG and IgM levels.Some changes in adaptive immunity manifested through its activation, confirmed by an increased CD4+, CD11b+, HLA-DR+, and CD4+CD25+lymphocyte content, together with a deficiency noted in total lymphocytes and CD8+ lymphocytes.