Vol 47, No 8 (2019)

Background: Thoracic tumors involving the superior vena cava (SVC) are common in the practice of a thoracic surgeon treating cancer patients. Extended combined procedures that allow for complete removal of the tumor improves overall and disease-free survival and as such are justified from an oncologist’s perspective. In some patients, due to a long-standing SVC syndrome, the development of venous collaterals would increase the early postoperative risk of thrombus formation in the prosthesis. In such a case, it is possible to perform circular SVC resection without subsequent prosthetic replacement. 

Aim: To evaluate the short-term results of SVC resection in patients with chest tumors, to develop an algorithm and to identify the patient group in whom circular SVC without prosthetic replacement is feasible.

 Materials and methods: Twenty eight (28) patients were included into the study (22 men and 6 women, with the mean age of 55 [range, 21 to 70 years]; all of them had undergone SVC resection within the intervention for a lung or mediastinal malignancy for 10 years (from 2008 to 2018) in the Department of Thoracic Surgery, Moscow Research Institute of Oncology named after P.A. Herzen. We analyzed their short-term results of the procedures, the postoperative course, and technical particulars of the procedures. 

Results: Locally advanced lung cancer was diagnosed in 19 (67%) of the patients, thymoma in 3 (10%), lung metastatic disease in 2 (7%), germ-cell mediastinal tumors in 2 (7%), thymus cancer in 1 (3%), and residual lymphoma in 1 (3%) patient. In the majority of the patients (15 cases, 53%), the complicated clinical course had been diagnosed before surgery. In 4 patients with protracted SVC syndrome, we performed circular resection without any prosthetic replacement. In 22 patients (78%), the postoperative course was uneventful. Postoperative mortality was 7%. 

Conclusion: SVC resection can be safely performed in patients with primary mediastinal and lung tumors. With a long-standing SVC syndrome, the newly developed cava-caval anastomoses can provide significant functional support; in such patients with compensatory collateral blood flow, the circular SVC resection without prosthetic replacement is relatively safe.

Rationale: For many years, breast cancer has been leading in the cancer structure in women, accounting for 21% from the total number of newly diagnosed cases of malignancies in Russia. The literature on the prevalence of the BRCA-associated breast cancer is heterogeneous, which might be related to the specifics of the frequentist analysis. 

Aim: To assess the prevalence of BRCA-associated breast cancer and the probability of sporadic breast cancer in women of the Moscow region by Bayesian statistics. 

Materials and methods: The literature search in the E-library.ru database from January 2010 to March 2019 identified 13 original studies and 8 literature reviews with the data on hereditary breast cancer in the territories of the Russian Federation, Republic of Belarus and Ukraine. The assessment of the prevalence of BRCA gene mutation based on the Bayesian statistics and the full probability equation for incompatible events was performed on the data obtained in one study based on molecular genetic tests of 3826 female patients with breast cancer living in the Moscow Region, aged from 22 to 90 years (Russian Scientific Center of Roentgenoradiology). This was the most comprehensive study among those performed in Russia, covering almost all age ranges, with detailed description of the study design, diagnostic methods and the mutations spectrum analyzed.

 Results: The prevalence of BRCA1-associated breast cancer in Moscow among women is about 0.037%. The general population prevalence of the most frequent mutations of the BRCA1 gene (5382insC, 185delAG, 300T>G, 2080delA, 3819delGTAAA, 4153delA) in the female population in Moscow is about 0.05%, or about 0.1% from the total population. The probability of sporadic breast cancer in the female population of Moscow without any gene dominant mutations associated with breast cancer is about 1%. Conclusion: For the first time, the Bayesian statistics was used to analyze the prevalence of mutations in the BRCA1/2 genes in Russia. The results obtained are in good agreement with similar data for the Belgorod region and the Siberian region of Russian Federation, and the Grodno region of Belarus.

It is known that multivisceral resections (MVR) are associated with significant numbers of post-operative complications. However, the effectiveness of MVR in increasing the patients' life expectancy remains a matter of debate. Are the risks of extended volume resections justified? It has been previously assumed that the removal of adjacent organs could improve the prognosis of the disease, even in the absence of direct invasion. However, in the era of the big potential of chemoand radiation therapy, the implementation of an over-extensive surgical volume in the absence of tumor invasion is doubtful. In the presence of regional lymphatic nodes metastases, MVR do not improve prognosis, compared to that after palliative resections. If the patient has distant metastases, or the operation has been obviously not radical enough, MVR worsen the prognosis. In grade T4b invasion and with the absence of life threatening complications, it is optimal to start with neoadjuvant or perioperative chemotherapy. In the case of intraoperative suspicion of adjacent anatomical structures involvement, with no distant metastases, en bloc resection in combination with D2 lymphodissection is indicated. In approximately 30–60% of cases, invasion is not confirmed by histology. The only way to improve the results of surgical treatment of gastric cancer patients is to carefully assess the extension of the disease at the preoperative stage, select patients and team work of surgeons with chemotherapists, radiologists and specialists in diagnostics.

Anemia is a frequent systemic complication and extra-intestinal manifestation of inflammatory bowel diseases (IBD). Despite significant progress in IBD treatment, late diagnosis and insufficient correction of concomitant anemia remain a problem in routine clinical practice. The review describes the main pathophysiological mechanisms of IBD-associated anemia, such as iron deficiency, chronic inflammation (anemia of chronic disease) and B₉ and B₁₂ deficiencies. The authors highlight the main diagnostic principles of these conditions, present the strategy for their differential diagnosis, describe the state-of-theart approaches to the correction of iron-deficient anemia in IBD, and delineate the role of oral and parenteral medications for replacement therapy. Optimal treatment goals and prevention methods of an iron-deficient condition are given. Special attention is focused on the principles on red cell mass transfusions in acute massive blood loss. The authors describe the main differentiating features of anemia of chronic disease and its treatment in IBD patients with various grades of the inflammation. The paper contains the indications and treatment regimens for B₁₂ and foliate-deficient anemia with consideration of the IBD course. The authors of the article are members of the Working Group of the Russian Society on the study of IBD and believe that the literature analysis performed would allow for its use to issue the Russian clinical guidelines on the management of patients with anemia in ulcerative colitis and Crohn's disease.