Prediction in colorectal surgery is very useful instrument in managing the health care system in hospitals. Searching for reliable risk factors of postoperative complications allows to identify patients of a high risk of complications group and to discharge earlier from hospital patients with a good prognosis. C-reactive protein is well known as a sensitive and dynamic marker of systemic inflammatory response syndrome. This study evaluated the feasibility of using C-reactive protein as predictor of septic postoperative complications. It was shown that analysis of serum CRP in early postoperative period   allows to predict septic postoperative complications in colorectal cancer patients.

Aim. Study of work motivation and job satisfaction factors among oncologists from a gender perspective. Methods. The survey involved 102 physicians-oncologists of the Republic of Tatarstan - 47% men and 53% women. The study included the following methods: observation, questionnaire, interview. Results. Among all corporate factors, the work content (the functions performed, complexity, diversity, responsibility) was highly evaluated by men - 8.26 points (on a 10-point scale), the style and methods of leadership in the unit - 7.24 points. The highest score (above 8 points) among female doctors was given to organizational culture, training, labor peer review by colleagues, the style and methods of leadership in the unit, as well as standards, rules, regulations, and their implementation. Job satisfaction indicators among male doctors were generally lower than among women in all 16 occupational characteristics. Among the leading motivators oncologists place work content, positive attitude towards their profession, mission and goals of the clinic. They oppose demotivators such as pay rate, moral motivation, career opportunities and provide an acceptable level of work motivation for doctors. Compensation in the form of an award came out on top among the forms of stimulation both in men and in women. Forms of non-cash stimulation are also quite popular with doctors and are approximately equal in men and women: advanced training in the leading domestic and foreign clinics, payment of sports occupations, days off. Women prefer additional vacation, a praise, acknowledgement from the executive management of the clinic. Men appreciate more position increase, awarding of honorary title and especially provision of larger freedom and powers at work. Conclusion. Gender studies of motivation demonstrated the differences in the attitude towards work, in its most important characteristics, labor values among male and female oncologists.

Aim. To improve immediate and remote results of reconstructive restorative procedures in patients with complicated colorectal cancer. Methods. The study is based on clinical experience of treatment of 107 patients who had reconstructive restorative procedures performed in specialized oncology institution after previous Hartmann’s procedure performed in urgent surgical department for complicated colorectal cancer. Reconstructive restorative procedures were performed at different time after the primary operation. To assess functional state of anal sphincter all patients were adminestered sphincteromentry during the preoperative period. Morphological analysis of all tissues removed during the surgery was performed. To evaluate morphological changes of distal end of the stump at different time a histological analysis was performed. Results. According to the results of sphincterometry dynamic reduction of tonic contraction and maximum pressure of anal sphincter is observed. The more the period between Hartmann’s operation and reconstructive restorative surgery, the less pronounced muscle tone of anal sphincter. Histological studies of intestinal wall during the first 3 months after Hartmann’s surgery revealed intact quantity and size of intestinal crypts, non-significant inflammatory infiltration of mucous and submucous layers, during the period of 4 to 6 months - initial signs of diversion colitis, during the period of 7 to 12 months - atrophic changes in mucous membrane (reduction of crypts quantity, their shortening, decreased thickness of mucus), after 1 year - signs of atrophy of its submucous layer. Conclusion. Reconstructive surgery in patients with previous Hartmann’s surgery for complicated colorectal cancer should be performed in specialized departments with all modern methods of surgical, radiation and medical treatment of colon cancer available; based on functional and morphological studies the optimal time frame for reconstructive surgery is 1 to 3 months after the initial surgery.

Aim. To find an optimal way of end colostoma formation in patients with colorectal cancer following abdominoperineal extirpation of the rectum. Methods. Results of surgical treatment (rectum extirpation ended with sigmoidostomy) of 142 patients with malignant tumors of lower part of rectal ampulla treated from 2005 to 2012 are presented. Data of 101 patients (comparison group) were retrospectively analyzed, in whom the same approach of choosing the colostomy technique was applied. The main group consisted of 41 patients in whom the efficacy of authors-introduced technique of colostomy with alloplasty for colostomal wound consolidation from the abdominal cavity side was prospectively defined. Results. The prevalence of early post-operative stomal complications was 18,8% (in 19 out of 109 patients) in comparison group. Ileum volvulus around the stoma causing bowel obstruction was diagnosed in 2 cases, necrosis of stoma wall - in 2 patients, evisceration around stoma site - in 3 patients, perforation of sigmoid stoma - in 1 patient, stoma retraction - in 1 patient, bleeding at stoma site - in 3 patients, paracolostomal mass - in 1 patient. 14 patients from comparison group developed late post-operative stomal complications, including parastomal hernia - 8 patients, stoma prolapse - 3 patients, colostomal fistula - 1 patient, stomal stenosis - 2 patients. Treatment results in the patients from the main group were satisfactory. Early complications included 1 case of bleeding from stoma site, 1 case of partial necrosis of stoma wall. No late complications were registered. The gained data allows to provide successful rehabilitation to patients who underwent colorectal cancer surgery. The described technique is contraindicated in case of infected peritoneal effusion. Conclusion. The use of the method proposed by authors not only significantly improves colostomy results, but significantly decreases the rate of both early and late post-operative complications of stomas compared to standard methods.