Introduction. Thoracic epidural analgesia or thoracic epidural anaesthesia (TEA) and opioid-based intravenous multimodal analgesia (MMA) provide adequate control of perioperative pain, however, comparative data are still to be gathered. Aim. To compare both anesthesia techniques in terms of stress response during and after robotic-assisted pelvic exenteration (PE). Materials and methods. 112 patients were divided into 2 equal groups A level of serum cortisol was measured at induction of anesthesia and in 2, 24, and 48 hours. The efficacy of analgesia was compared using a 10-point numeric pain scale. Analgesic administration and side effects were reported for 1–3 postoperative days. Results. Cortisol levels increased 2 hours after skin incision in the MMA group and only in 24 hours in the TEA group (p < 0.050). Postoperative cortisol levels were significantly lower in the TEA group (p = 0.001). Numeric pain scores were significantly lower in the TEA group (1.7 [1.0–3.2] vs. 2.7 [2.1–4.2]; 1.9 [1.0–3.3] vs. 3.5 [3.5–5.0]; 3.7 [3.0–4.8] vs. 4.2 [3.7–4.7], respectively; p < 0.050). Patients in the TEA group received less opioid administration (4.3 mg vs. 13.9 mg; 7.0 mg vs. 19.9 mg; 10.9 mg vs. 16.5 mg, respectively; p < 0.050). The two groups of patients were detected with no significant difference in the incidence of respiratory depression. Discussion. According to the study results, perioperative stress response was reduced with TEA being added to the anesthesia protocol. Patients in the TEA group received lower doses of analgesics. Both groups produced similar short-term postoperative outcomes. Conclusion. As compared to opioid-based MMA, TEA provided more effective analgesia and similar side effect profiles. Therefore, TEA appears to be an acceptable method for stress response suppression and pain management in patients undergoing robotic-assisted PE.

Introduction. Cervical cancer (CC) remains the most common cancer in women worldwide. However, effective and specific biomarkers for the diagnosis and prognosis of cervical cancer are yet to be found. In recent years, the potential of circular RNAs (circRNAs) as new diagnostic, prognostic and therapeutic tools has received much attention. The current study involved an in-depth bioinformatics research to explore the circRNA-microRNA (miRNA)-messenger RNA (mRNA) regulatory network in order to identify important molecular processes and biological pathways supposedly associated with CC. Materials and methods. The study collected data on the expression of circRNA (GSE102686), miRNA (GSE30656) and mRNA of target genes (GSE9750), based on the Gene Expression Omnibus (GEO) database, in squamous cell carcinoma of the cervix samples and normal squamous epithelium of the cervix, dividing them into study and control groups. Protein-protein interaction (PPI), Gene Ontology (GO) analysis, and Kyoto Encyclopedia of Genes and Genomes (KEGG) analysis were performed to further understand the function of circRNAs for their target genes. Results. A total of 105 differentially expressed circular RNAs (DECs), 144 differentially expressed microRNAs (DEMs), and 539 differentially expressed target genes (DEGs) were identified for cervical cancer. Concurrently, functional enrichment analysis of GO and KEGG pathways was performed for DEGs. Subsequently, searching databases for circRNA, miRNA and mRNA target genes, as well as PPI network analysis and functional enrichment revealed 3 DECs with significantly high expression levels (hsa_circ_0000745, hsa_circ_0084927 and hsa_circ_0002762), 6 DEMs with reduced expression levels (hsa -miR-145, hsa-miR-876-3p, hsa-miR-1229, hsa-miR-182, hsa-miR-520h and hsa-miR-1252) and 9 key genes such as ANGPT2, COL11A1, MEST, KIF20A, CLN6, FNDC3B, USP18, DLGAP5 and CXCL9, suggesting a potentially significant role in cervical cancer. Conclusion.Understanding the circRNA-miRNA-mRNA regulatory network is of great importance for evaluating the oncogenesis of CC, as well as discoverying new circRNAs as the main regulatory molecules in this network. This is considered to be a new direction in the diagnosis and targeted therapy of cervical cancer.

Introduction. The choice of treatment between extracranial stereotactic radiotherapy and surgery for metastatic vertebral body tumors with minimum or no epidural compression of the dura mater is yet to be clearly defined. Materials and methods. The study enrolled 41 patients who received treatment at the National Medical Research Centre for Oncology (Rostov-on-Don, Russia) from January 1, 2014 to December 31, 2022. The inclusion criterion was the presence of a metastatic vertebral tumor, with minimal or no epidural compression of the dura mater and the radicular infundibulum (ESCC 0–1b). Patients were divided into two groups: 21 patients (SBRT group) received only extracranial stereotactic radiation therapy and 20 patients who underwent surgery followed by adjuvant extracranial stereotactic radiation therapy 1 month after surgery (Op.+Аd.SBRT). Results. The early postoperative period revealed no deterioration in the neurological status of patients in the SBRT group, no improvement in the Karnofsky performance status and no regression of pain syndrome, in contrast to patients in the Op+Аd.SBRT group. In a month after the surgery, tumors continued to grow in 3 patients (21%) of the SBRT group and only in 1 patient (6%) of the Oр.+Аd.SBRT group. Discussion. In the early postoperative period, the Op.+Аd.SBRT group showed an improvement in the functional status and a significantly more pronounced regression of the pain syndrome in the patients of the SBRT group, which can be explained by direct decompression of the compressed spinal root and elimination of increasing instability of the spinal column. Conclusion. Surgical treatment complemented by adjuvant extracranial stereotactic radiation therapy constitutes the preferred treatment for patients with metastatic spinal lesion with minimal epidural spread, without epidural compression of the spinal cord, with severe pain syndrome and signs of increasing instability of the spinal column.

Introduction. Recent decades indicate a significant increase in the incidence of skin cancer. Aim. To upgrade the specialized device and to improve the quality of skin neoplasm diagnostics. Materials and methods. The study mainly involved the method of non-invasive differential diagnostics of skin neoplasms. The method relies upon optical research methods, including Raman spectroscopy, a spectroscopic technique. A 10-year study, conducted by the Department of Oncology, the Samara Regional Clinical Oncology Dispensary (SOKOD), included more than 500 observations. The study used samples of various skin neoplasms obtained during surgical treatment of patients. Experimental tests provided a certain spectrum of various benign and malignant human skin neoplasms, including melanoma. Results. A series of experimental tests resulted in an experimental setup that is absolutely safe to use. Discussion. The study involved comparison of individual characteristics of the Raman spectra, obtained in the examination of neoplasm and healthy skin for each patient, thereby individualizing the method. The study revealed a high accuracy rate of 92% (with sensitivity of 89%, specificity of 93%), thus minimizing risks of false negative results, which is essential for mass examination. Conclusion. Since the proposed device setup does not require consumable products and different reagents, the method is marked with lower time costs and maintenance burden. Raman spectroscopy obtains a significant potential, thus, can be widely used for skin neoplasms in various medical and preventive institutions.

Introduction. New COVID-19 coronavirus infection negatively influenced the surgical service. Clinical recommendations for the treatment of surgical patients were adjusted to the new conditions of unfavorable epidemiologic conditions with reorientation to urgent minimally invasive surgical care. Therefore, the generally accepted diagnostic and treatment programs could not be applied due to the overwhelming admission of patients in extremely severe condition. Such programs embrace treatment and prevention of intra-abdominal hypertension and abdominal compartment syndrome. Aim. To analyze the treatment results of patients with COVID-19 infection in covid hospitals, complicated by abdominal surgical pathology and associated with abdominal surgical disease, in terms of diagnosis, treatment and prevention of pathological conditions leading to increased intra-abdominal pressure. Materials and methods. The study analyzed the treatment results of 1900 patients in covid hospitals with different surgical capabilities, where they were provided with diagnostic, therapeutic and preventive measures in order to prevent abdominal compartment syndrome, i.e. management of intra-abdominal hypertension and abdominal compartment syndrome was performed according to the diagnostic and treatment program. Results and discussion. 67 patients (3.5%) in the clinical group developed an abdominal surgical complication, or covid infection was associated with an acute abdominal surgical disease. In case of indications for emergency surgery, surgical tactics consisted in minimally invasive techniques and regional anesthesia; a development of compartment syndrome was managed with emergency decompressive laparotomy. Conclusion. The implementation of the diagnostic and treatment program of intra-abdominal hypertension and abdominal compartment syndrome management in the clinical group of COVID-patients enabled compartment syndrome to be prevented in 3.5% of patients and early decompressive laparotomy to be performed in 1.5% of patients in case of its development. The mortality associated with abdominal complications of COVID-19 comprised 1.3% in the clinical group.

Introduction. Glioblastoma refers to a neuroepithelial malignant brain tumor with an aggressive course and extremely unfavorable prognosis. The median overall survival comprises 14.6 months. Standard treatment demonstrates relatively poor efficiency due to high recurrence rate associated with the high repopulation rate of tumor cells as well as impossibility of eradication of primary tumor. Simultaneous integrated boost is recognized as a technique to enhance local control in gliomas. Materials and methods. The study analyzed data of 25 patients who received chemoradiotherapy for grade 4 glioblastoma in the Radiotherapy Unit No 1. Day hospital lasted from September 2021 to March 2023 (data were analyzed over a year). In group 1, 15 patients received chemoradiation treatment, including simultaneous integrated boost volumetric modulated arc therapy (SIB-VMAT). In group 2, 10 patients received standard fractionated radiation therapy. Results and discussion. Treatment tolerability appeared satisfactory: the target dose was administered in 100% of patients without forced interruptions, toxicity was comparable in both groups; 1-year locoregional control comprised 46.7% in the group with simultaneous integrated boost, 50% in the group of standard fractionated therapy; 1-year overall survival accounted for 66.7% in the group with simultaneous integrated boost, and 70% in the group of standard therapy. The follow-up period revealed no cases of radiation necrosis. The results obtained in the present study appear comparable with the data of relevant scientific publications on the issue. Conclusion. Radiation therapy using simultaneous integrated boost in the postoperative treatment of grade 4 glioblastoma is considered as an acceptable and safe method with moderate toxicity and satisfactory overall survival rate.

Introduction. Sarcopenia refers to a clinical syndrome characterized by progressive skeletal muscle disease, loss of muscle mass and strength resulting in impaired physical performance. The prevalence of sarcopenia in the population ranges from 5% to 13% in people aged 43.0 ± 11.1 years and reaches 50% in those over 70. Various methods have been used to diagnose sarcopenia, which, however, have their limitations. Currently, CT scanning is considered the most accurate method for the detection of sarcopenia. Therefore, the development of new methods for early diagnosis of sarcopenia appears relevant. Aim. To investigate different methods of diagnosing sarcopenia in morbidly obese patients. Materials and methods. The study presents an analysis of various methods for diagnostics of sarcopenia in morbidly obese patients, including a patented method based on the research conducted in the BSMU Clinic (Utility Patent No. 2815157 dated 11.03.2024). Results and discussion. Doctors used the suggested method of diagnosis, defined the value of sarcopenia index equal or less than 15, and diagnosed sarcopenia. Conclusion. The prevalence and severity of sarcopenia vary depending on the classification criteria and thresholds used. Since a unified diagnostic method is yet to be developed, it is necessary to continue research into this issue, and introduce sarcopenia detection, prevention, and correction techniques into widespread clinical practice. Indices of sarcopenia and obesity, obtained during an additional preoperative study, provide significant prognostic information superior to body mass index, thereby enabling the direction and scope of surgical interventions to be determined and survival outcomes to be improved.

Metastases are considered to be a key mechanism for the spread of malignant tumors, whereby tumor cells separate from the primary site and form new tumor nodes in various parts of the body. Bone tissue, including the spine, is often affected by metastases, which can significantly worsen the prognosis and quality of life of patients. Metastasis comprises a complex multistep process during which tumor cells undergo molecular and phenotypic changes enabling them to migrate and adapt to new conditions in the body. Bone metastases can be osteolytic, causing bone destruction, or osteoblastic, stimulating excessive bone formation. Tumor cells enter the bone and activate osteoclasts or osteoblasts, thereby leading to remodelling of bone tissue and formation of a closed cycle of bone destruction and tumor growth. The characteristics of tumor cells are determined by their genetic and epigenetic changes, as well as interaction with the environment. Understanding the molecular and pathophysiological aspects of spinal metastasis is essential to developing effective treatments and improving therapeutic approaches. The paper considers new therapeutic approaches aimed at overcoming spinal metastasis in order to improve the prognosis and quality of life of patients.

Intra-abdominal hypertension and abdominal compartment syndrome remain a challenging problem in abdominal surgery. Due to various etiological factors leading to increased intra-abdominal pressure (inflammatory, destructive processes, trauma, sepsis, postoperative complications, etc.), and the negative impact of increased IBP on the functions of the gastrointestinal, respiratory, cardiovascular systems, kidneys, central nervous system, timely diagnosis and treatment play an important role. Gradually elevated intra-abdominal pressure can cause persistent organ dysfunction and be potentially fatal. To date, the pathophysiological mechanisms, methods for determining intra-abdominal pressure, the frequency of its measurement, and methods of conservative and surgical treatment have been studied in sufficient detail. The paper presents a literature review on the problem of intra-abdominal hypertension and abdominal compartment syndrome. The study considers issues of epidemiology, mortality rates, methods for measuring intra-abdominal pressure, including advanced innovative technologies. The authors present the basics of clinical diagnosis, the significance and informativity of additional biochemical blood tests, radiation methods, mainly computed tomography, and ultrasound examination. Advanced methods of conservative treatment are considered, which, when used early, significantly minimize target organ damage, organ dysfunction, and indications for emergency decompressive laparotomy. Finally, recommendations are given for the postoperative management of patients with an “open” abdomen, and for the optimal timing of laparostoma closure.

Cancer is recognized as the second leading cause of mortality in the Russian Federation. Prolonging the life of oncology patients involves treatment with toxic drugs, causing multiple side effects. Today, scientists around the world are striving to find non-toxic drugs. The present study explores phytosterols. Phytosterols refer to a class of steroids widely distributed in plants as an essential component of plant cell membranes. They include stigmasterol, beta-sitosterol, and campesterol. Stigmasterol has been found to increase the expression of proapoptotic genes (Bax, p53) and decrease the expression of the antiapoptotic gene Bcl-2 in HepG2 liver cancer cells. Stigmasterol is able to induce cell arrest in G0-G1 phase (stationary phase), resulting in fewer cells in the G2/M phase (division phase). It induces apoptosis and protective autophagy in gastric cancer cells while inhibiting the Akt/mTOR signaling pathway. β-sitosterol exhibits growth inhibitory and cytotoxic effects against a number of established cancer cell lines in vitro and in vivo, and remains free from acute/subacute toxic effects. β-sitosterol is widely used to treat chronic prostate diseases. In 2020, spendings on dietary supplements rich in beta-sitosterol accounted for $24 827 065 in the USA. Campesterol induces cell apoptosis via the mitochondrial pathway. It appears cytotoxic to U937 hepatocellular cancer cells. Campesterol induces cell apoptosis and activates proapoptotic signaling in ovarian cancer cell lines of a person. The present literature review demonstrates that specific substances in this group, beta-sitosterol, stigmasterol, and campesterol, provide pronounced antitumor effects.

Introduction. Peritoneal carcinomatosis, one of the most aggressive forms of metastasis, is recognized as a serious clinical problem. Conventional therapies, including cytoreductive surgery and systemic chemotherapy are limited in their efficacy. New approaches, involving photodynamic therapy and fluorescence diagnostics, obtain great potential for improving the outcomes of complex treatment for this category of patients. Materials and methods. The paper presents a clinical case of a female patient with peritoneal metastases of ovarian cancer complicated by small intestinal obstruction and tumor necrosis. The case demonstrates the results of implementing photodynamic technologies in combination with staged cytoreductive surgical treatment. The first stage of cytoreductive surgical intervention was mainly focused on elimination of life-threatening complications and involved fluorescence diagnostics and photodynamic therapy in order to control the completeness of cytoreduction as well as to assess the nature of suspicious tumor foci and to treat the residual tumor. The second stage of surgical treatment included completing cytoreduction under fluorescence diagnostics, and intraabdominal hyperthermic chemoperfusion. The paper evaluates the results of using fluorescence diagnostics for determining the tumor lesion of the peritoneum in order to objectify the choice of the peritonectomy volume. Results and discussion. The implementation of the described approach resulted in increased efficiency of cytoreductive intervention due to intraoperative diagnostics and targeted antitumor treatment of residual tumor foci. Assessment of the quality of life using the SF-36 survey in the postoperative period demonstrated a significant improvement in both physical and psychological components of health during three months of follow-up. Conclusion. The innovative approach, involving integration of phototheranostics into the cytoreductive surgical treatment of patients with peritoneal carcinomatosis, can potentially improve the accuracy of intraoperative diagnostics of tumor prevalence in the peritoneum and, moreover, enhance the efficiency of cytoreductive interventions. However, further clinical studies are required to fully evaluate the therapeutic potential and prove the efficacy of the proposed treatment.

Introduction. Extraorgan cysts of the retroperitoneal space (ECRS) remain a challenge in terms of determining therapeutic and diagnostic tactics. In most cases, ECRS are asymptomatic, which explains their detection as an incidental finding during examinations or surgical interventions in the abdominal cavity and/or retroperitoneal space. The main method for treatment of true and formed false ECRS consists in surgery with both laparotomy and laparoscopic accesses. Materials and methods. Clinical case: patient M., female, 39 years old, addressed to one of the clinics in Ufa with complaints of periodic lower left abdominal pain. Based on the results of the examinations, a diagnosis was made of a large tumor of the left ovary, complicated by pain. Concomitant diagnosis: multinodular uterine myoma. Surgical treatment — conservative myomectomy — with laparotomy access was performed due to the large size of the neoplasm. Intraoperatively, in the left iliac region, a volumetric liquid formation measuring 20×15 cm, not associated with the ovary, was discovered retroperitoneally. After further examination, the patient was referred for surgical treatment for retroperitoneal tumor in the City Clinical Hospital No 21. Results and discussion. The surgery was performed laparoscopically. The duration of the surgical intervention accounted for 39 minutes. The postoperative period was reported to be uneventful. Drains were removed on the second day. The patient was discharged from hospital on the fifth day after surgery. Histological examination of the cyst wall revealed no epithelial lining; the wall consisted of fibrous tissue. In this clinical case, according to the results of histological examination, the structure of the cyst wall corresponds to the secondary type or false cysts due to no epithelial lining. Conclusion. In cases of extraorgan retroperitoneal cysts, laparoscopic excision is considered to be a safe and effective method with less postoperative pain and a shorter recovery period compared to open interventions.

The textbook “Oncology 2.0” by K.Sh. Gantsev, Sh.R. Kzyrgalia, F.V. Moiseenko, and R.S. Yamidanov, under the editorship of Professor Sh.Kh. Gantsev follows the history of the authors’ publications for more than 20 years, revealing the mechanisms of the modern concept of carcinogenesis as one of the conditions for successful diagnostics and treatment in oncology. This is particular relevant under contemporary conditions, when oncology is becoming an increasingly knowledge-intensive discipline and requires competence in various fields of science to be synthesized for its successful development. The textbook successfully accomplished the task of academic presentation of complex material in a simple form, combining extensive knowledge of molecular biology, genetics, clinical and experimental oncology, anatomy, lymphology, as well as with own unique scientific developments.