Introduction. The world standard for treating muscle-invasive bladder cancer is radical cystectomy with pelvic lymphadenectomy. Several large studies report significant postoperative complications of radical cystectomy. In 2003, a team of urologists led by Mani Menon performed a series of robot-assisted radical cystectomies (RARC) for the first time. Currently, it is possible to evaluate the survival of patients aft er RARC.

Aim. To determine the indicators of overall (OS), cancer-specific (CSS), and recurrence-free survival (RFS) aft er RARC with pelvic lymphadenectomy in patients with muscle-invasive bladder cancer that were operated at a single center.

Materials and methods. In 2018–2023, 200 patients with muscle-invasive bladder cancer were operated at the Oncology Department of the Bashkir State Medical University Clinic. The operation procedure involved performing RARC with intracorporeal urinary derivation. The maximum follow-up period was limited to 36 months. The survival analysis was performed for the total cohort of patients, as well as following stratification for pN (+/–) status. In order to visualize the obtained results, Kaplan-Meier curves were used.

Results and discussion. After 36 months, the survival indicators of all operated patients were as follows: OS — 48.25%; CSS — 57.49%; RFS — 61.89% (p = 0.0031, χ² = 11.325). Also, a significant decrease in all the survival indicators of pN (+) patients was observed, p < 0.0001. In the pN (+) patient group, patients with advanced pT stage were found to be predominant as compared to the pN (–) group.

Conclusion. The analysis of survival after RARC shows satisfactory longterm oncologic outcomes. After RARC, the leading causes of death are regional lymph node involvement and advanced pT stage.

Introduction. Th e surgical margin status and pathological tumor stage constitute important factors affecting tumor recurrence after partial nephrectomy.

Aim. To assess the role of surgical margin status and pathological tumor stage in tumor recurrence after open partial nephrectomy.

Materials and methods. Th e retrospective study included 904 kidney cancer patients who underwent open partial nephrectomy from 2010 to 2019.

Results. Renal cell carcinoma was found in 796 (88.1 %) patients. A negative surgical margin was detected in 735 (92.3 %) cases. Pathological stages were distributed as follows: pT1aN0M0 — 530 (66.6 %); pT1bN0M0 — 239 (30.0 %); pT2aN0M0 — 22 (2.8 %); pТ3aN0M0 — 5 (0.6 %). Median follow-up was 72 months. Th e recurrence rate amounted to 5.9 % (43/735) for negative surgical margins and 6.6 % (4/61) for positive surgical margins. Positive and negative surgical margins showed no significant difference in the risk of tumor recurrence (p > 0.05). Depending on the pathological stage, the following tumor recurrence rates were observed: pT1aN0M0 — 4,9 % (26/530); pT1bN0M0 — 7.5 % (18/239); pT2aN0M0 — 9.1 % (2/22); pТ3aN0M0 — 20.0 % (1/5). Th e risk of cancer recurrence was significantly higher in pT1b than in pT1a (p < 0.05), as well as in pT2 than in pT1 (p < 0.05).

Discussion. In this study, the presence of a positive surgical margin had no effect on the kidney cancer recurrence rate. However, the retrospective nature of the study and the low incidence of positive margins necessitate further study of this issue.

Conclusions. An increase in pathological tumor stage significantly affects the risk of tumor recurrence. A significant difference in recurrence rates is observed between stages T1a and T1b, as well as between stages T1 and T2.

Introduction. MedInzh-2 is one of Russian mechanical prostheses. Although promising hemodynamic and hydrodynamic characteristics of this prosthesis are reported, only a few studies are available evaluating the implantation of this prosthesis in the aortic position and the maximum follow-up period in these studies does not exceed five years.

Aim. To evaluate the immediate and long-term results of isolated aortic valve replacement with a MedInzh-2 mechanical prosthesis.

Material and methods. The study included data collected from April 2009 to December 2019. During this period, 494 patients were implanted with a MedInzh-2 mechanical prosthesis in the aortic position at the Federal Center for Cardiovascular Surgery. The inclusion criteria were as follows: patient age of 18 years and older and implantation of a MedInzh-2 mechanical prosthesis in the aortic position. The exclusion criteria included the use of other types of mechanical prostheses and combined cardiac surgery. After applying inclusion and exclusion criteria, 224 patients were selected for the study. Th e median age of included patients was 55 (50–59) years. Among the patients who underwent surgery, the percentage of males amounted to 61.6 % (128 patients). The majority of patients (62.5 % or 140 people) were in NYHA class III–IV. Rhythm disturbance in the form of atrial fibrillation (AF) was observed in 11.6 % (26 patients). Th e median follow-up period was 48 (20–80) months.

Results and discussion. In the early postoperative period, three patients died (1.3 %), and perioperative myocardial damage was recorded in 0.9% of cases. Permanent pacemakers were implanted in 2.7 % of cases. The frequency of stroke and acute kidney injury requiring hemodialysis amounted to 0.4 and 0.9 %, respectively. One-year, five-year, and ten-year patient survival rates were 98, 89, and 84 %, respectively. One year, five-year, and ten-year freedom from aortic valve reoperations were 100, 97, and 96 %, respectively. In addition, the ten-year freedom from prosthetic thrombosis reached 98 %.

Conclusion. Th e clinical results and echocardiographic data obtained for the MedInzh-2 mechanical prosthesis implanted in the aortic position confirm its high efficacy in correcting aortic valve pathology.

Introduction. Soft tissue sarcomas of the distal extremities constitute an extremely rare heterogeneous group of malignant mesenchymal tissue tumors, and very few publications are available on this subject. A distinctive feature of hand and foot sarcomas is their small size. Given the rarity of the pathology, survival data vary in the literature.

Aim. To study the clinical and morphological characteristics of soft tissue sarcomas of the hand and foot.

Materials and methods. The clinical observations of 50 patients with soft tissue sarcomas of the hand and foot were retrospectively analyzed. All of the patients were examined and treated at the Moscow Oncology Hospital No. 62 in 2004–2022.

Results. A total of 23 males and 27 females were included in the study, with a mean age of 57 years. Of the 50 sarcoma cases, 12 were localized to the hand and 38 were localized to the foot. Synovial and epithelioid sarcomas were found to be the most frequent histologic subtypes localized to the foot and hand, respectively. Th e most frequent treatment options were surgical and combined treatment (surgery + chemotherapy).

Discussion. The main characteristics of patients do not differ from those reported in foreign studies; however, the sizes of hand and foot tumors were larger in the present study. This group of patients requires closer attention due to the functional significance of areas where such tumors are found, as well as a high prevalence of malignancy according to the observations.

Conclusion. Taking into account the size of distally localized soft tissue sarcomas and the specifics of surgical interventions in these areas, it is recommended to classify them as a separate group to distinguish them from sarcomas arising in other areas of the body. A further study is needed to assess the correlation between treatment volume and recurrence rate in these patients, as well as overall survival.

Introduction. The article describes the first experience of concomitantly using regional endovascular drug administration and vacuum-assisted laparotomy in the combination therapy of widespread purulent peritonitis.

Materials and methods. In 2023 (from January to November 2023), 25 patients with widespread purulent peritonitis were treated at Surgery Unit No. 2 (Septic Surgery Unit) of the G.G. Kuvatov Republican Clinical Hospital.

 Results. The proposed treatment method was applied in three patients. The case fatality rate in the comparator group (n = 22) was 40.9 %. No fatalities were reported among patients who underwent the proposed procedure (n = 3).

Discussion. The clinical picture and dynamics of changes in proinflammatory markers (procalcitonin, blood leukocytes, and C-reactive protein) in the context of endovascular therapy indicate peritoneal inflammation relief and a possible correlation between these events.

Conclusion. We believe that the proposed treatment regimen has a positive effect in the treatment of widespread abdominal inflammatory processes and requires further study.

Vulvar cancer is a fairly rare pathology. One of the factors in its aggressive course is the high metastatic potential of such tumors. The presence of metastases in inguinal lymph nodes constitutes a major prognostic factor. Starting from a 1-mm depth of invasion (FIGO IB), the risk of metastatic lymph node involvement increases to 35%, which makes lymph node examination important. Until 1990, inguinofemoral lymphadenectomy was performed, among other things, to assess the status of inguinal lymph nodes in vulvar cancer. Inguinofemoral lymphadenectomy constitutes a rather extensive operation that is accompanied by a large number of postoperative complications, both in the short- and long-term periods. A study on the role of sentinel lymph node biopsy was published in 2008. Van der Zee et al. provided important evidence that the sentinel lymph node concept can be safely applied in vulvar cancer patients. In the surgical treatment of vulvar cancer, it is essential to assess the sentinel lymph node status in order to reduce the extent of surgical intervention.

One-third of Crohn’s disease patients suffer from isolated small bowel lesions, 10% of whom immediately develop the stricturing form of this disease. In such patients, the diagnosis is often made only on the operating table in the setting of complications. Moreover, following small bowel resection, anastomosis strictures develop in 80% of cases. Of interest are the data of foreign authors on the decrease in the recurrences of small bowel strictures following resection in patients with maximal excision of the associated mesentery. In this connection, research on the possible role of small bowel mesentery in the pathogenesis of Crohn’s disease seems relevant. If this is the case, the optimal surgical treatment consists in performing a resection of the strictured part of the small bowel with the maximal excision of the mesentery of the affected segment and with the creation of a side-to-side antimesenteric anastomosis, excluding the contact of the anastomosis with the remaining part of the mesentery. The article presents a modern literature review on the pathogenesis of the structuring form of small bowel Crohn’s disease, its diagnostic specifics, and the selection of a treatment method, as well as original photo materials.

Cervical cancer, the second most common malignancy in women, poses a serious problem, especially for less developed countries. This results in the suffering of patients and their families, as well as causing social and global consequences. The present review aims to highlight the importance of preventing and treating cervical cancer, outline current problems and challenges, and indicate prospects for improvement. To this end, we analyzed available online data on cervical cancer screening and treatment in Russia (keyword search) and abroad (keyword search in PubMed, http://pubmed. ncbi.nlm.nih.gov/). The study examines the economic and health conditions of various countries, identifying nuances and challenges in implementing screening programs. In spite of significant reductions in cervical cancer incidence and mortality in developed countries due to screening and vaccination initiatives, other regions are still faced with a number of problems. The focus on vaccination and a comprehensive strategy indicates the need for a concerted effort. Further efforts are required in the fight against cervical cancer. While progress has been made in some regions, the health care system of developing countries, including Russia, requires constant improvement of screening and treatment methods, as well as coordination of efforts.

Safety is recognized as a crucial issue of off-label use of anticancer drugs. The potential benefits of such prescriptions in oncology are associated with prevailing the expected clinical benefits over the risks of complications. However, in certain clinical situations with uncertain benefit/risk ratio, an off-label use of drugs may threaten the life and health of the patient. The present paper explores the safety of off-label anticancer drug therapy in real clinical practice. Health care and routine clinical practice are given particular emphasis on systematic recording and careful monitoring of adverse events associated with the off-label use of medicinal products. The creation of a unified registration system for off-label use of drug therapy in oncology along with the creation of large databases (on the sites of institutions with an option to combine the data obtained at the level of districts, regions and the country) enables a significant amount of information on the safety and effectiveness of this approach to be gathered. As a result, a predictable nature of treatment and manageable toxic effects are potentially provided. The study into reasons behind off-label use of drugs in oncology, as well as the study into spectrum and severity of adverse events resulting from the implementation of these prescriptions, will provide detailed information on the safety of off-label use of anticancer agents in patients with malignant neoplasms at different stages of oncological treatment.

Introduction. In the routine practice of a medical oncologist, ganglioneuroma is a rare pathology, and no clearly defined, modern protocols and guidelines for its diagnosis and treatment are available.

Aim. To present a clinical observation on the treatment of retroperitoneal ganglioneuroma in a young female patient, as well as providing a modern perspective and literature review on this problem.

Materials and methods. The article presents the results of treating a patient with retroperitoneal ganglioneuroma at the City Clinical Oncology Hospital No. 1. The review covered three databases: PubMed, SCOPUS, and eLibrary.

Results. The article describes a relatively rare case of a large retroperitoneal ganglioneuroma, as well as a minimally invasive surgical treatment option for this condition.

Conclusion. As a rule, diagnosis of neurogenic neoplasms presents no obvious difficulties only if they are large: they are found incidentally during follow-up checkups and are usually clinically asymptomatic. Radical surgical treatment with laparoscopic removal of non-organspecific retroperitoneal neoplasms offers several obvious advantages and should be used in the treatment of these medical conditions provided clinics have the required technical capabilities and experience in applying minimally invasive technologies in different sections of the abdominal cavity.

Introduction. Stage III and IV hemorrhoids involve the destruction of the ligament of Parks and disruption in the anatomical arrangement of anal canal parts, which makes reconstruction procedures particularly relevant.

 Materials and methods. Patients were assigned to two groups. The first group included 35 patients who underwent hemorrhoidectomy according to the proposed method, while the second included 32 patients who underwent open hemorrhoidectomy (Milligan-Morgan). HDSS and SHSHD questionnaires were used to assess the quality of life.

Results. Complete epithelialization of wounds was observed at day 37.90 ± 9.49 in the first group and at day 47.80 ± 17.40 in the second group, p = 0.022. Group 2 patients exhibited significantly greater persistence of node prolapse symptoms: 0.46 ± 0.51 on the prolapse scale, as compared to 0.05 ± 0.22 in Group 1.

Discussion. Hemorrhoidectomy constitutes a safe and effective procedure; therefore, it is impossible to significantly improve its results; however, we can correct certain aspects of this intervention.

Conclusion. As compared to the conventional method, the proposed method of hemorrhoidectomy allows the wound healing time to be reduced from 47.80 ± 17.40 days to 37.90 ± 9.49 days without affecting the risk of postoperative complications. Three months after conventional hemorrhoidectomy, the number of patients retaining mucosal prolapse phenomena, which lead to a decrease in the quality of life, is 0.46 ± 0.5 on the “prolapse” scale; when applying the developed method, their number is significantly lower and tends to zero (0.05 ± 0.22 on the “prolapse” scale).

Introduction. The present article discusses renal cancer, one of the common malignant diseases. Historical and modern therapies are considered, including tyrosine kinase inhibitors and immune checkpoint inhibitors. The results of clinical studies evaluating the efficacy of combined drug therapy are discussed, including the combination of immune checkpoint inhibitors with angiogenesis of targeted therapy.

Materials and methods. A case is presented of a patient with metastatic clear cell renal cell carcinoma with multiple lung metastases. The diagnosis was established using computed tomography data and was not verified. Various therapy regimens were used during treatment, including pazopanib, nivolumab, and the combination of nivolumab with cabozantinib.

Results and discussion. Follow-up examinations showed disease stabilization and normal tolerance of therapy. Eventually, the patient underwent laparoscopic cytoreductive nephrectomy. The therapy with nivolumab in combination with cabozantinib is still ongoing.

Conclusion. The combined use of cabozantinib and nivolumab currently constitutes a promising strategy for treating renal cell cancer, in which cabozantinib prevents tumor progression, and nivolumab increases immune system activity, promoting tumor cell destruction.