Introduction. Radical nephrectomy is considered as a common operation associated with significant changes in the topography of the upper abdominal cavity which appear in the postoperative period. Analysis of the literature fails to provide sufficient information about functional changes in the parenchymatous abdominal organs that occur after nephrectomy. Aim. To investigate a number of liver and pancreatic enzymes in the blood of patients at the pre­ and post­ operative stages of the radical nephrectomy. Materials and methods. The study involved a retrospective analysis of medical records of 111 patients after radical nephrectomy. The patients underwent biochemical examination at the pre­operative stage, on day 1, and day 7 after the operation: ALT, AST, amylase, diastase. The examination was performed by means of biochemistry analyzers Bio Systems BA 400 and Beckman Coulter AU 480. Statistical data processing was carried out using Statistica 10.0. Results. The analysis of the obtained materials shows that the level of liver and pancreatic enzymes increases after radical nephrectomy. A side of the operation was revealed significant: left­sided nephrectomy leads to an increase in the level of blood amylase and diastase, right­sided nephrectomy results in an increase in the level of ALT and AST. No dependence on the sex of patients was determined. No increase in the level of the studied enzymes was found in a number of patients in the postoperative period; however, almost half of patients were detected with a significant, 1.5–2 times and higher, increase in the level of enzymes, thus requiring special control and correction. The maximum level of ALT reached 245 U/L (norm 0–35 U/L), the maximum level of AST comprised 184 IU/L (norm 0–35 IU/L). Discussion. The obtained results indicate the interrelation of functional disorders of the liver and pancreas and changes in their topography after radical nephrectomy. Conclusion. Radical nephrectomy is associated with significant functional disorders of the liver and pancreas depending on the side of the operation: the level of blood amylase and diastase increases after left nephrectomy, the level of ALT and AST grows after right nephrectomy. The level of enzymes exceeds the norm by 1.5–2 times in almost half of patients.

Introduction. Metastatic squamous cell carcinoma from an unknown primary focus accounts for less than 5 % of malignant tumors in the head and neck. Improving the methods of diagnosis can reduce the incidence of this pathology. Materials and methods. A retrospective analysis of the results of diagnosis and treatment of 59 patients with metastasis to the lymph nodes of the neck without an identified primary focus was performed. The proportion of male patients was 86 % (51/59), female — 14 % (8/59). The average age of patients is 61 years. Squamous cell carcinoma prevailed — 79 % (47/59). Results. Metastatically affected lymph nodes were localized in 92 % of cases at levels II and III. The proportion of patients with stages N2, N3 prevailed — 55 % (abs. 26), 32 % (abs. 15), respectively. Overexpression of the P­16 protein in metastatically affected lymph nodes was detected in 70 %, PD­L1 in 48 %, and Epstein­Barr virus (EBV) in 6 %. Ipsilateral diagnostic palatine tonsillectomy of an apparently unchanged tonsil was performed in 15 % (9/59) of cases, revealing the primary site in one instance. Of the special treatment methods, complex and combined treatment prevailed — 55 % (abs. 26). Radiation therapy in an independent version was performed by 48 % of patients, while 76 % received the full course (abs. 16). Combined treatment (a course of Radiation therapy followed by chemotherapy) — in 7 % (abs. 3) 20 % of patients received polychemotherapy. Palliative immunotherapy (pembrolizumab 200 mg IV — 5 courses) was given to 1 patient. The average life expectancy was higher with complex treatment — it was 60 months (95 % CI 43.5–76.4), the median survival is 60 months. Discussion. The main methods of treatment of patients with metastases of squamous cell carcinoma without were radiation therapy in an independent version, as well as complex treatment. Ipsilateral diagnostic palatine tonsillectomy of an apparently unchanged tonsil was performed in 15 % (abs. 9), and allowed to identify the primary focus in 1 case.

Conclusion. Metastasis to the lymph nodes of the neck without remains an urgent interdisciplinary problem. Prospective multicenter studies are required to improve and optimize the algorithms for diagnosis and treatment of these patients.

Introduction. Patients with varicose disease of the lower extremities may suffer from subcutaneous vein thrombophlebitis with an incidence of more than 50%. However, saphenous vein thrombophlebitis occurs against the background of varicose veins in 80% of patients. Aim. To improve the efficacy of phlebectomy in patients with varicose veins complicated by saphenous vein thrombophlebitis. A modified method of total stripping of the great saphenous vein was developed and introduced into clinical practice in City Clinical Hospital No. 21 (Ufa, Russia). The modified surgical technique is aimed at reducing the severity of postoperative hematomas, increasing the cosmetic effect and reducing the incidence of damage to the cutaneous nerve located near the large saphenous vein. The surgery technique was patented (Patent No. RU2812293C1). Materials and methods. From 2022 to 2023, total stripping of the great saphenous vein was performed in 26 patients with varicose veins of the lower extremities and thrombophlebitis of the great saphenous vein in Cardiac Surgery Department of City Clinical Hospital No. 21. The examined patients were divided into a control group (18 patients) and a comparison group (8 patients). The quality of life of all patients was assessed before and after surgical intervention using the Visual Analog Scale (VAS). Results and discussion. All patients underwent total stripping of the great saphenous vein. Prior to surgery, no statistically significant difference was reported in the assessment of quality of life between the groups. The group of the modified stripping technique demonstrated positive clinical and aesthetic results after surgery. Performing total stripping of the great saphenous vein using the modified technique statistically significantly improved the quality of life in the postoperative period. Control points of examinations were on days 1, 7, 30, 90 after surgery. Conclusion. The comparative analysis of the treatment results proved the efficacy of the modified technique of total stripping in varicose vein patients with thrombophlebitis, including a higher level of quality of life, better clinical and aesthetic result of surgical treatment.

Introduction. Reducing the aggressiveness of surgical tactics is currently considered a promising trend in medicine that is widely supported due to its better safety profile. However, a large percentage of patients need more intervention. In the treatment of breast cancer, the main difficulties in postoperative management are associated with lymphatic surgery. Aim. To perform a comparative analysis of techniques for intraoperative control of lymphorrhea in patients during lymph node dissection for breast cancer in Yaroslavl Regional Oncologic Hospital. Materials and methods. Case histories of 660 patients after axillary subclavian subscapular lymphadenectomy were analyzed. In the postoperative period, patients revealed prolonged lymphorrhea. Magnifying techniques (binocular lenses, microscope) were used during the interventions to detect and isolate lymphatic vessels in 108 patients. A double coagulation technique was used to ligate the lymphatic vessels. Sufficient coagulation surface was achieved by forming suture lines of an angle greater than 90°. When performing a mastectomy, the technique was supplemented by circular bandaging of the chest. Results and discussion. Analysis of case histories showed that lymphadenectomy proved to be the main significant factor influencing lymphorrhea. Sparing techniques reduced the risk of postmastectomy syndrome. Comparing the study group with the control group revealed a statistically significant reduction in the severity of lymphorrhea without an increase in the risk of other complications. Conclusion. The combination of these techniques demonstrated statistically significant advantages in controlling postoperative complications. The techniques are easy to perform, therefore, they can be introduced into practice with minimal costs. The economic benefits are associated with the absence of additional costs for surgery, as well as with a reduction in the duration of hospital stay for patients. All this significantly increases patient satisfaction with the treatment performed.

Introduction. Indications for radiation therapy after mastectomies with/without reconstruction at T1­2N0­1M0 remain unclear; treatment standards contain references to the possible administration of radiation therapy for factors that increase breast cancer recurrence. Materials and methods. A retrospective single­center, non­randomized study enrolled 984 breast cancer patients treated at P.A. Gertsen Moscow Cancer Research Institute from 2014 to 2022. Patients were divided into 2 groups: a radiotherapy group and a non­radiotherapy group. Results and discussion. The paper presents an analysis of patients’ age, the histological structure of the tumor, immunohistochemical characteristics, tumor grade, multicentricity, presence of lymphovascular invasion, tumor cells, the state of R1 and R0 margins, and the tumor stage at risk of recurrence. Overall survival in the recurrence group accounted for 95.1%, in the non­recurrence group – 98.4%. In the radiotherapy group (group I), the overall survival comprised 98.4%; metastases were diagnosed in 4.9% of cases. In thenon­radiotherapy group (group II), the overall survival amounted to 98.2%; metastases were revealed in 5.9% of cases. Conclusion. Univariate analysis in the study groups showed that radiation therapy reduced the risk of relapse by 3.5%. In case of positive R1 margin, radiotherapy is recommended, which was confirmed in our study, the difference accounted for 14.5%, and in the presence of R1, radiotherapy is claimed to be necessary in the postoperative period. When analyzing the stage of breast cancer and the risk of recurrence, the statistical difference was revealed only at stage IIA (T1N1M0); radiation therapy reduced the risk of breast cancer recurrence. The statistical difference in groups I and II was detected at Grade 2 tumor, Ki­67 level less than 50%, presence of tumor embolism and age of patients under 40 years. Radiation therapy after subcutaneous/skin­sparing mastectomy reduces the recurrence risk by 3.2%; however, the overall survival in group I and group II accounted for 98.4 and 98.2%, respectively; the difference is not statistically significant. In our study, the criteria for prescribing radiation therapy in the postoperative period include: young age of the patients, R1 resection margin, luminal/non­luminal HER2 positive type, cN1, presence of tumor embolism.

Primary spinal tumors appear to be much less common than metastatic lesions, but their surgical treatment comprises a complex and multifaceted task. Numerous factors influence indications and timing of surgical intervention, including neurological status of the patient, histological characteristics of the tumor, its localization, stability of the spinal column, and comorbidities. Significant spinal cord compression, rapid progression of neurologic deficits, or pronounced instability of the spinal column may require urgent surgical intervention. When the spinal canal is not affected, treatment should start with a biopsy to accurately determine the histology of the tumor. Some tumor types, such as giant cell tumors, osteoblastomas, chordomas, and chondrosarcomas, require complete removal of the tumor. However, performing a wide resection in a single block is often found difficult due to compression of vascular and nerve structures. Current approaches to surgical management of primary spinal tumors involve minimally invasive techniques that significantly improve postoperative recovery and reduce the risk of complications. These techniques were originally used to treat degenerative spinal diseases and trauma; however, they have also demonstrated their effectiveness in tumor surgery. Adapting surgical strategy based on histology and tumor location, as well as integrating minimally invasive techniques, can improve patient survival and quality of life. The present paper describes the latest advances in the surgical treatment of primary spinal tumors, discusses current techniques and strategies, and prospects for further research in this area.

Stress urinary incontinence refers to a multifactorial disease characterized by involuntary urination associated with a sudden increase in intra­abdominal pressure. Millions of females around the world suffer from stress incontinence each year. Conservative methods of treatment and physical rehabilitation are considered to be ineffective, thereby driving the need for surgical treatment. Sling surgeries comprise a widely used surgical technique for the treatment of stress urinary incontinence due to their affordability and minimal time investment. Introduction of synthetic polypropylene mesh prostheses in the treatment of stress incontinence made them the most common material. However, the accumulated experience and complications associated with the use of mesh grafts contribute to the recent decline in the popularity of synthetic slings and give rise to the search for and development of alternative materials for the surgical treatment of stress urinary incontinence. Since the need for treatment of urinary incontinence remains high, fascia autograft surgeries have been proposed, even though they require an additional surgical procedure and expose the patient to complications at the donor site of the graft. In addition, surgeons use allografts and xenografts, and regenerative technology is developing in this field. Considering high social significance of this problem, the present paper is aimed at reviewing the scientific literature concerning grafts for the treatment of stress incontinence.

Renal cell carcinoma (RCC) has previously been considered as a single disease. However, it is currently characterized as a heterogeneous group of tumors that differ in histological features, genetic abnormalities, and variable clinical course. In normal cells, energy is produced by the cleavage of chemical bonds in nutrients through the oxidation of fats, proteins, or carbohydrates. Mutational alterations in genes associated with RCC, including VHL, FLCN, PTEN and SDH, lead to abnormal cellular adaptation to changes in oxygen status, iron metabolism and nutrients. The present paper reviews the known genetic abnormalities observed in RCC and their impact on metabolic alterations. Understanding the genetic and metabolic mechanisms underlying RCC is crucial for the development of effective therapies. Targeting specific genetic abnormalities or metabolic pathways represents a promising approach to the RCC treatment. In addition, studies into the metabolic basis of RCC contribute to the development of new biomarkers for early diagnosis and monitoring of the disease. Moreover, investigating the role of VHL, FLCN, PTEN, and SDH genes in the development of RCC provides valuable information on the molecular mechanisms behind the disease. As a result, it may lead to the development of new treatment strategies aimed at restoring the normal function of these genes or compensating for their abnormalities. Overall, an integrated approach to the study of RCC that considers genetic, metabolic, and clinical aspects will ensure that more effective treatments are developed and prognosis for patients with this disease are improved.

Introduction. Splenic artery aneurysms refer to the most common visceral artery aneurysms. However, they are diagnosed quite rarely, since about 80% of them appear asymptomatic. Clinically, splenic artery aneurysms manifest themselves through their complications, including hemorrhage into pancreatic cysts or intra­abdominal bleeding due to their rupture, leading to lethality up to 8.5%. Other complications of splenic artery aneurysms appear extremely rare. The gold standard for the diagnosis of splenic artery aneurysms refers to digital subtraction angiography that enables their exact localization to be determined and aneurysm embolization to be performed. Materials and methods. In the period from 2015 to 2023, we observed 51 patients who underwent endovascular interventions on the splenic artery for hypersplenism (n = 32) and aneurysms (n = 19). In most cases, the aneurysms were asymptomatic. The paper presents a rare clinical case of splenic artery aneurysm complicated by recurrent intestinal bleeding. Results and discussion. Examination (EGD, CS) did not detect the source of recurrent intestinal bleeding. Contrast CT revealed a splenic artery aneurysm. Celiac angiography detected a large aneurysm (52×41 mm) of the splenic artery, closely adjacent to the lower horizontal branch of the duodenum. Endovascular embolization of the splenic artery was performed proximal to the aneurysm, resulting in complete occlusion of blood flow through the splenic artery and aneurysm. No repeated episodes of intestinal bleeding were observed after the intervention, thereby indicating the effectiveness of hemostasis. No signs of splenic ischemization were detected by clinical and examination data due to the preservation of blood flow through short splenic vessels. Conclusion. Endovascular embolization of the splenic artery is found to be an effective treatment for its complicated aneurysms.

Introduction. Incidence of ovarian cancer remains high in the overall prevalence of oncological pathology. Adjuvant chemotherapy refers to its treatment options. Patients with oncological pathology are faced with a high risk of thrombosis and thromboembolism, with up to 30% lethal outcome within a month of its development. A number of cancer cells are known to induce platelet aggregation, contributing to thrombosis and metastasis as a result of this interaction. Accordingly, the paper is aimed at presenting a clinical case for demonstrating the role of P-selectin expression in the complications in a patient with ovarian cancer. Materials and methods. The present paper evaluates platelet activation marker in a patient undergoing chemotherapy courses after cytoreductive surgery. Following the case conference and in accordance with the clinical recommendations of the Russian Oncology Association (AOR) and Russian Society of Clinical Oncology (RUSSCO), cytoreduction (CC-0), radical hysterectomy, transverse colectomy, left hemicolectomy with rectum resection were performed. The interventions included ascendostomy, pelvic, lateral right-sided and left-sided peritonectomy, pelvic lymphoadenectomy, total omentectomy, Renape-French HIPEC (hyperthermic intraperitoneal chemotherapy), abdominal and pelvic drainage. Expression of P-selectin on the platelet surface was measured as a marker of platelet activation. Results and discussion. At the time of admission, the patient had high CD62 expression activity compared to healthy volunteers (CD62 ADP^- — 11.2%, CD62 ADP — 24.7% vs CD62 ADP^- — 1.3%, CD62 ADP — 17.2%). During the complex treatment of ovarian cancer, the platelet activation increased (CD62 ADP^- — 21.8 %, CD62 ADP⁺ — 30.1 %). At discharge, CD62 expression values reached the conditional norm, presumably indicating thrombosis development. Conclusion. Tumor microenvironment influences the hemostasis system. Detailed study into this issue obtains a high potential for the prevention of primary and secondary thromboembolic complications in oncologic patients.

Introduction. Cardiovascular diseases occupy a leading position in the structure of mortality in the world. In particular, coronary heart disease causes mortality in 48% of cases among cardiovascular diseases. Surgical treatment of patients with coronary heart disease is aimed at eliminating stenotic or occlusive lesions in the coronary arteries by heart bypass and/or percutaneous coronary intervention with stenting. The success rate of the procedure accounts for about 85%. In the remaining 15%, revascularization fails to achieve its goal, which may be caused, among other things, by a pronounced calcification of the occlusive segment of the coronary artery. Aim: to demonstrate the development of one of complications after revascularization of chronic coronary artery occlusion and a method for its elimination. Materials and methods. The paper demonstrates a clinical case of an 86­year­old patient with coronary heart disease treated in a non­emergency hospital. Coronary angiography revealed a multivessel lesion. Coronary artery bypass grafting was recommended after an intraoperative consultation with a cardiologist and a vascular surgeon. The next day, the patient underwent emergency coronary angiography in order to revascularize chronic occlusion. Results and discussion. The patient underwent attempted revascularization of chronic calcified occlusion, which resulted in such a complication as deformities and “detachment” of the distal tip of the guidewire. This complication was resolved with the help of a trifold snare and the creative and cold­blooded thinking of the operating surgeon. Conclusion. The clinical case shows that, despite any encouraging statistical success rate, the operating surgeon should be ready for possible intraoperative complications. The key to solving this problem lies in the availability of modern medical tools for coronary interventions, as well as in relevant experience of an operating surgeon and creativity in making certain decisions.

Introduction. Phytobezoar refers to a foreign body accumulated in the stomach when swallowing substances of natural or synthetic origin. Phytobezoar is formed in the stomach and small intestine, its etiopathogenesis is yet to be investigated. It causes obturation intestinal obstruction, which requires emergency surgical intervention. The paper presents a clinical case in surgical practice of phytobezoar in the small intestine which was complicated by a recurrent obturation intestinal obstruction. Aim: to present a clinical case of phytobezoar in the form of recurrent obturation intestinal obstruction. Materials and methods. 66­years old female patient Kh. underwent surgical treatment for obturation intestinal obstruction caused by phytobezoar twice within a short period of time. The gastric resection and consumption of bezoar-dangerous products due to a dried­fruit diet were considered to be the prerequisite for the formation of phytobezoar. According to the pathomorphologic examination, the intervention included laparotomy, enterotomy and phytobezoar extraction. Results and discussion. A complete revision of the abdominal cavity organs was performed during the first laparotomy with no other fragments of phytobezoar found. Following the first surgery and before discharge, the patient underwent ultrasound, CT scan of abdominal cavity organs, fibrogastroscopy — no volumetric pathologic formations in the abdominal cavity were detected. Therefore, the phybobezoar was assumably formed again in a relatively short period of time and led to the development of reobstruction. The patient was discharged with recovery.Conclusion. The clinical case shows that in surgical practice phytobezoar can get formed repeatedly in a short period of time and lead to the development of recurrent intestinal obstruction.