Brain metastases are the most common intracranial malignancy accounting for significant morbidity and mortality in cancer patients. The current treatment paradigm for brain metastasis depends on patient’s overall health status, the primary tumor pathology and the number and location of brain lesions. Treatment of brain metastases should be individualized for each patient: in case of single brain metastasis surgery or radiosurgery should be considered as first options of treatment; in case of multiple lesions whole-brain radiotherapy is the standard of care in association with systemic therapy or surgery/radiosurgery. Herein, we review the modern management options for these tumors including surgical resection, radiotherapy. In the last decades TKIs or monoclonal antibodies have showed an increase in overall response rate and overall survival in Phase II-III trials. The aim of this paper is to make an overview of the current approaches in management of patients with brain metastases.

Observational study of the postoperative analgesia efficacy with multimodal approach (acetaminophen, NSAIDs, opioids, regional analgesia) in 100 oncological patients has been conducted. On the first day after the surgery maximum pain level was 5 (3-7) points of numeric rating scale (NRS), 38% of patients experienced severe pain (NRS>6 points). After laparo-, thoracoscopic, videoassisted interventions and in cases of epidural analgesia NRS levels were 3 (1-6) and 3 (2-5) points respectively. After the surgeries with high risk of chronic post-surgical pain (thoracic, mammary gland interventions, Phan-nenstiel incision) NRS level was 6 (1-7) points. Patients in this group more often experienced severe pain than in the rest group - 56,7% vs. 32,5% (P.=0.037). Suggesting results of this study and data of current literature the perspectives of further improvement of postoperative analgesia in oncology have been formulated.

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The incidence of postoperative hypothyrosis after subtotal resection of the thyroid for diffuse toxic goiter is rather high, 40-50 % according to many authors. A method is suggested permitting assessment of the share of active zones during surgery. A certain amount of thyroid tissue is left with due consideration for this share, this amount being sufficient to attain an euthyroid state in the postoperative period.

Косюхно Сергій Вікторович, к. мед. н., завідувач відділу малоінвазивної хірургії, ORCID iD: 0000-0002-2950-9279. Потапов Олексій Андрійович, науковий співробітник відділу малоінвазивної хірургії; ORCID iD: 0000-0002-0791-7941. Калашніков Олександр Олександрович, к. мед. н., завідувач хірургічного відділення; ORCID iD: 0000-0002-8224-8039. Плегуца Олександр Іларійович, старший науковий співробітник відділу ендокринної та метаболічної хірургії; ORCID iD: 0000-0002-5695-6111. Щитов О.В., к. мед. н., старший науковий співробітник відділу малоінвазивної хірургії.