Vol 23, No 3-6 (2018)

Introduction. Surgical treatment of cancer patients with severe concomitant cardiovascular diseases (CVD) is still a debatable issue. Materials and methods. The study involved 170 cancer patients who had surgical operations. Most patients had coronary heart disease (CHD) as severe concomitant cardiovascular disease -133 cases (78.2%). Simultaneous surgeries were performed in 32 (18.8%) patients; step-by-step tactics was achieved in 138 (81.2%) patients. The study evaluated frequency of complications and mortality. Prophylactic efficiency of surgery for severe concomitant CVDs was determined, as well. The causes of deaths within long-term periods were analyzed, and 3- and 5-year survival was calculated by Kaplan-Meier method. Results. Frequency of complications and mortality in radically operated cancer patients accounted for 55.3% and 4.1%, respectively. A higher rate of complications was registered after simultaneous operations as compared with that after step-by-step tactics - 60% and 52.6% , respectively (р>0.05). Prophylactic efficiency of surgery for severe concomitant CVDs in total accounted for 92.4%. The most effective method for prophylactic myocardial revascularization was coronary bypass (CB) performed at the first step. The main cause of death of radically operated patients in the long-term period was tumor process progression - 31.7%, while CVDs caused much less deaths - 9.8% (р =0,001). 3 and 5-year survival accounted for 59% and 46%, respectively. Conclusions: Surgical treatment of severe concomitant CVDs of cancer patients is a highly effective method for prevention of severe cardiovascular complications. Step-by-step tactics is associated with less frequency of complications. Simultaneous surgery with minimal risk may be performed in a selected group of patient. In the long-term follow up period the main factors, which affected 3- and 5-year survival were the radical type of surgery and the advanced cancer process.

Data from the global oncology statistics shows that pancreatic cancer is at the 4th place in the world for mortality in men and women, having the lowest five-year life expectancy among gastrointestinal tumors with an average median survival of no more than 6 months. Along with it, malignant neoplasms of the biliary tract are rare in the frequency of occurrence of the nosological group of diseases, which, however, are on the second place in terms of the level of malignancy among the neoplasms of the liver. Both nosologies in the vast majority are not subject to radical treatment, being the object of palliative treatment due to late diagnosis. Despite the establishment of new medical technologies, the main method of treating of these nosologies remains surgical. However, at the time of detection and diagnosis less than 20% of patients have a resectable process, and, moreover, even patients with a resectable tumor are often not subjected to radical surgical treatment due to dissemination of the tumor at the time of surgery, which reduces the postoperative five-year survival of this cancer: 25-30% in patients without metastases to regional lymph nodes and about 10% in patients with metastases to regional lymph nodes. Due to the low efficiency of the surgical method, there are searched new methods of complex treatment, new drugs and chemotherapy regimens, as well as radiotherapy regimens, however, with the improvement of methods for diagnosing cancer in the past 20-25 years, neither the prognosis nor survival of patients nor the percentage of early diagnosis of cancer of the pancreas did not significantly improve. A new and promising method for the treatment of malignant neoplasms of the pancreas and the biliary tract is photodynamic therapy, the undoubted advantage of which is low toxicity, selective effect only on cancer cells at the fundamental level, contributing depending on the duration of exposure to their autophagy, apoptosis or necrosis. And, although PDT has drawbacks connected with side effects of PDT, such as gastrointestinal bleeding, obstruction of the duodenum and hemorrhagic pancreonecrosis, and with insufficient knowledge and lack of clear recommendations, but the PDT method is certainly a promising method in both radical and in palliative complex therapy of malignant neoplasms of the pancreas and biliary tract, which requires further study.

It is analyzed the tactics of managing patients with obstruction of bile duct of neoplasmatic etiology in two nosologically comparable groups of patients. The first group of 716 patients underwent complex treatment of complications with the use of minimally invasive interventions in the X-ray angiographic block, while the second group of patients, who made up from 1,301 patients, had complex treatment of complications without the use of minimally invasive interventions. On the background of the active introduction of minimally invasive interventions in the first group of patients both at the diagnostic stage (ante- and retrograde cholangiography) and the implementation at the treatment stage of various minimally invasive procedures for decompression of bile ducts to eliminate complications of malignant neoplasms of the hepatopancreatobiliary zone, both for palliative treatment, and with the purpose of preparation for radical surgical treatment, it is established: a decrease in the number of open biliodigestive anastomosis in order to eliminate obstruction of bile duct, which reduced the incidence of postoperative complications and mortality, improvement of the quality of life of patients who are not candidates to radical surgery; an increase in the number of radical operations to remove malignant neoplasms of the hepatopancreatobiliary zone.

The issues of diagnosis, clinical course, the results of surgical treatment, immunotherapy and combined methods of treatment of patients with metastatic skin melanoma are considered. An attempt has been made to personalize the therapy. Received a complete response to treatment, improving the quality of life while maintaining robustness in a young patient. Methods. Patient B., 30 years old, who was diagnosed with melanoma of the skin of the back in GBUKKOD№1, was operated on in the surgery department of tumors of the skin and soft tissues. After identifying the progression of the disease, the patient was operated on with subsequent adjuvant immunotherapy and radiation therapy. After the progression of the disease was detected, the patient was prescribed a combination of targeted therapy with a full response. When a sustained full response was obtained, the patient was transferred to treatment with PD-1 inhibitors, against the background of which the progression of the disease was revealed, which required a return to the combination targeted therapy, as a result of which a full response was obtained again. Results. Personalized therapy was performed on a patient with progressive MK. The resulting increase in overall duration and quality of life. A full response to the combined targeted therapy with vemurafenib and cobimetinib was obtained twice after surgery, radiation therapy, immunotherapy (interferon-α) and treatment with control point inhibitors (nivolumab).

On the basis of the created robotic complex with a program for a survey with illustrations (by the type of whether there are similar forms of pathology) of major tumors, a portable USB microscope built into a flexible hose and the body of the complex for transmitting to the touch screen pathological changes in visible localizations (skin, oral cavity). The survey was conducted in 38 patients with a certain trajectory for men and women on the touch screen. The use of the robotic complex allowed patients to suspect tumors of the skin, oral cavity, thyroid gland, lymph node enlargement in 39.4%±1.7%, of which 53.4%±1.9 with further examination of cancer was confirmed, including 2 patients with melanoma and 4 basal cell carcinoma. In the presence of complaints from the stomach, heartburn or belching with a smell on an empty stomach, 17 patients underwent a “breathing test” (basal and with a load of urea) on the Helik-Scan of AMA LLC, built into the program of the robotic complex. The color change in the “breathing tubes” was scanned with fixation on the touch screen, 7 of them had Helicobacter pylori above 10 units with load. In 5 patients with FGS, metaplasia (MP-1 and MP-2) was established, in 2 gastric ulcer and one of them with malignancy. After examination of the patient and processing of the results with a robotic complex, recommendations for further tactics were sent via the confidential Internet to the doctor of the prevention Cabinet.