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Introduction. The most pressing problems in abdominal oncology surgery are the development of obstructive jaundice as a complication in patients with malignant tumors in the hepatobiliary and pancreatoduodenal area, and the ways to eliminate it and to reduce the risk of adverse events. Our earlier research revealed 14 predictors that together are more likely to cause undesirable postoperative complications, including deaths during minimally invasive biliary tract decompression. On the basis of the data obtained, a computer program “Risk Assessment of Treatment Methods for Obstructive Jaundice” was created.Materials and methods. The program was introduced into clinical practice in Yaroslavl Regional Clinical Oncology Hospital and was tested on 144 patients from 2019 through 2022. Th e program issued a conclusion on the risk of adverse events and assigned the patient to one of the groups where drainage or stenting were recommended for the first stage of biliary tract decompression.Results and discussion. Following a collegial decision based on the results obtained via the program, 58 patients (40.28 %) underwent endoscopic stenting and 86 patients (59.72 %) underwent percutaneous transhepatic biliary drainage. In the study group, adverse events developed in 10 patients (6.94 %), while in the control group — in 50 patients (22.94 %), and 134 patients (93.06 %) had no complications, as compared to 168 patients (77.06 %) in the control group.Conclusion. Application of the program based on reliable and practically significant 14 predictors results in a decline in general complications induced by minimally invasive biliary tract decompression from 22.94 % to 6.94 % and a 3.5-fold decrease in mortality from 5.05 % to 1.39 % in patients with malignant neoplasms in the hepatobiliary and pancreatoduodenal area, complicated by obstructive and mixed jaundice.

Введение. Проблема поиска наиболее оптимальной тактики диагностики и лечения злокачественных неорганных забрюшинных опухолей является актуальной по сей день. Это связано с рядом особенностей, к которым относятся: отсутствие единого подхода к лечению злокачественных неорганных забрюшинных опухолей, отсутствие эффективных способов профилактики прогрессирования заболевания, малое количество публикаций, посвященных этой проблеме. Все это ставит перед онкологами, занимающимися лечением больных с данной патологией, задачу накопления и анализа результатов лечения каждого больного. Материалы и методы. Основу работы составил анализ данных 32 пациентов с неорганными забрюшинными опухолями, из которых 26 находились на лечении в Ярославской клинической онкологической больнице с 2016 по 2021 г. с диагнозом «злокачественная неорганная забрюшинная опухоль». Результаты и обсуждение. Основная масса пациентов, включенных в исследование, имела Т4N0M0 и составила 13 (50 %) больных. 3 В стадия была выявлена у 73,08 %. Гистологически верифицированы: липосаркома -19,23 %, лейомиосаркома и миксоидная липосаркома -по 15,38 %, остальные образования составляли 3,8 % каждая и являлись различными типами сарком из мезодермальных зачатков. Опухоли высокой степени злокачественности имелись у 22 больных (84,62 %), низкой степени злокачественности -у 4 (15,38 %). 22 больным было проведено радикальное хирургическое лечение. Изолированное удаление опухоли было выполнено 11 (50 %) больным, 11 (50 %) операций сопровождались комбинированным или сочетанным удалением опухоли. Послеоперационные осложнения отсутствовали. Гистологически подтвержденная инвазия опухоли у оперированных больных была выявлена в 50 %, наиболее частым органом, вовлеченным в процесс, являлась почка. Заключение. Полученные данные указывают на высокие показатели резектабельности образований данной локализации. При анализе объема удаленной опухоли выявилась прямая взаимосвязь со степенью злокачественности образования. Высокие показатели одно-, трех-и пятилетней выживаемости пациентов свидетельствуют об эффективности радикальной хирургической резекции как при изолированном удалении, так и при сочетанной или комбинированной резекции. Однако частое развитие рецидивов и в связи с этим повторные оперативные вмешательства приводят к регрессивному снижению выживаемости.

Introduction. The incidence of gastric cancer remains high, despite the increase in the share of stage I–II cancers — 37.1% in 2019. Surgical treatment remains relevant even in patients with “early” forms of gastric cancer (EGC). Therefore, the reliable means for determining the surgeon volume in such patients are to be urgently developed.Aim. To estimate the probability of building a stable predictive model for patients with EGC in order to choose the proper surgical intervention.Materials and methods. Th e research involved the data obtained from “Database of patients with gastric cancer, reflecting statistics of patients with a particular variant of surgical intervention, treated at Yaroslavl Regional Clinical Oncological Hospital during the period from 2009 to 2019”. All patients (n = 266) received different volume of surgery: intraluminal surgery (n = 128), wedge gastric resection (n = 36), classical gastrectomy or subtotal gastric resection (n = 102). According to the volume of intervention, the patients were ratified into several study groups. Statistical analysis involved case records of three groups of patients and was conducted using MedCalc Statistical Soft ware version 20.022 and Statistica 12.5.Results. Ten factors were identified to form a patient model corresponding to each method of surgical treatment. Th e fairness of the division of patients into groups was checked by ROC-analysis in order to determine sensitivity and specificity of the set of criteria for the division. Th e following characteristics of the mathematical model were obtained by means of ROC analysis: concordance coefficient = 88.24%, AUC = 0.893; index J = 0.811; Se = 87.92; Sp = 89.04; +LR = 3.27; -LR = 1.31.Conclusion. Introduction of this approach into clinical practice decreased the rate of gastrectomies and gastric resections by 15% for the last three years.

Introduction. Sentinel node biopsy is the gold standard in the diagnosis of lymph node basin lesions in breast cancer. Although the method has got a long history of its application, some practical issues related to its economic and social advantages and disadvantages remain unresolved.Aims. To consider the efficiency of approaches to the diagnosis and minimally invasive treatment in breast cancer, following the experience of sentinel node biopsy in Regional Clinical Oncological Hospital, Yaroslavl.Materials and methods. Th e present paper involves the analysis of 942 histories of breast cancer patients who have undergone surgical treatment at Regional Clinical Oncological Hospital, Yaroslavl. According to the study results, 16% of stage I and II patients had a change in the initial status of lymph node basins aft er pathoanatomical examination of the removed lymph nodes. Th is prompted a change in preoperative examination and appointment of MRI of breast and lymph regional outflow for 64 patients prior to planning a sentinel lymph node biopsy.Results and discussion. Magnetic resonance imaging data correlated with the results obtained aft er histological examination and served to determine the extent of surgical treatment, reducing the risks of reintervention and locoregional recurrence.Conclusion. Sentinel node biopsy is a method that combines high informativity, safety and economic benefits. However, in order to achieve greater patient focus, a comprehensive approach to preoperative examination and principle of cooperation in the choice of treatment strategy should be observed in all cases.