Aim:The Enhanced Recovery After Surgery (ERAS®) Society guidelines aim to standardize perioperative care in colorectal surgery via 25 principles. We aimed to assess the variation in uptake of these principles across an international network of colorectal units.Method: An online survey was circulated amongst European Society of Coloproctology members in 2019-2020. For each ERAS principle, respondents were asked to score how frequently the principle was implemented in their hospital, from 1 ('rarely') to 4 ('always'). Respondents were also asked to recall whether practice had changed since 2017.Subgroup analyses based on hospital characteristics were conducted.Results: Of hospitals approached, 58% responded to the survey (195/335), with 296 individual responses (multiple responses were received from some hospitals). The majority were European (163/195, 83.6%). Overall, respondents indicated they 'most often' or 'always' adhered to most individual ERAS principles (18/25, 72%). Variability in the uptake of principles was reported, with universal uptake of some principles (e.g., prophylactic antibiotics; early mobilization) and inconsistency from 'rarely' to 'always' in others (e.g., no nasogastric intubation; no preoperative fasting and carbohydrate drinks). In alignment with 2018 ERAS guideline updates, adherence to principles for prehabilitation, managing anaemia and postoperative nutrition appears to have increased since 2017.Conclusions: Uptake of ERAS principles varied across hospitals, and not all 25 principles were equally adhered to. Whilst some principles exhibited a high level of acceptance, others had a wide variability in uptake indicative of controversy or barriers to uptake. Further research into specific principles is required to improve ERAS implementation.

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The successes of neoadjuvant therapy for locally advanced rectal cancer, which can sometimes achieve significant tumor regression, suggests that the performance of total mesorectumectomy in certain categories of such patients may be excessive. The rapid development of minimally invasive surgical technologies designed to limit the trauma due to the intervention, reduce the risk of postoperative complications, improve the quality of life and increase the proportion of sphincter-preserving operations, initiated several studies investigating the results of local excision of irradiated tumors of rectal cancer. This review article considers the published results of such studies, the problems, and prospects of this surgical strategy. The search of scientific literature was carried out using the PubMed database.

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Оbjective. To assess the sensitivity of CT pneumogastrography in determining the T-stage and yT-stage. Materials and methods. This is a prospective, single-center study that included 267 patients with a histologically diagnosed stomach cancer who received treatment at the N.N. Petrov National Medical Research Center of Oncology from 2015 to 2018. 162 (60.7%) patients underwent preoperative chemotherapy. All patients underwent surgery: 22 in the volume of proximal subtotal gastrectomy, 95 in the volume of distal subtotal resection, 123 in the volume of gastrectomy, and 27 in the volume of endoscopic dissection. All patients underwent staging computed tomography at the preoperative stage according to a single protocol - CT pneumogastrography on a 64-slice X-ray computed tomography. The sensitivity of the method in assessing the depth of invasion was calculated separately for patients without preoperative chemotherapy (T-stage) and for patients who underwent preoperative chemotherapy (уT-stage) by comparison with pathological data. Results. The sensitivity indicators of CT pneumogastrography for patients without preoperative chemotherapy were: for T1a – 80.6%, T1b – 72.7%, T2 – 80.0%, T3 – 88.0%, T4a – 83.3%, T4b –100%. The sensitivity indicators of CT pneumogastrography for patients receiving preoperative chemotherapy were: for уT2 – 65.2%, уT3 – 83.5%, уT4a – 83.9%, уT4b – 75.0%. It is difficult to restore locally advanced gastric cancer with a depth of invasion cT2 – cT4b in the category yT0, yT1a, and yT1b after preoperative chemotherapy due to the persisting pathological tissue with impaired differentiation of all layers of the stomach wall, which is pathomorphologically a large fibrous tissue. Сonclusion. CT-pneumogastrography demonstrates high diagnostic indicators in determining the T-stage and yT-stage of gastric cancer.