Vol 27, No 2 (2022)

BACKGROUND: The incidence of gastric cancer is still high and holds the leading place in the structure of oncological pathology in the world. Prognostic aspects in the treatment of generalized forms of gastric cancer are currently under revision.

AIM: To study functional status of vascular endothelium in patients with gastric cancer in perioperative period and evaluate its influence on the outcomes of surgical treatment.

MATERIALS AND METHODS: A prospective, randomized study was conducted from 2009 to 2019. Two populations were studied: healthy individuals (control group, n=40); patients diagnosed with gastric cancer (general group, n=122). Patients with gastric cancer underwent gastrectomy with lymphodissection.

The functional state of the vascular endothelium was studied: the volume of circulating endotheliocytes (CCE); the level of von Willebrand factor (VF) and the degree of endothelium-dependent vasodilation (EDV). To study their prognostic significance we calculated a conventional “cut-off point”.

RESULTS: The general group patients were divided into 2 subgroups: the main group — the laparoscopic access (n=54) and the comparison group — the laparotomy access (n=68).

Endothelial dysfunction (EDF) correction with Glutargin 1.0 g per day in combination with Enalapril 2.5 mg per day was additionally used in the main subgroup.

In the main group, the values of CCE and VF were lower (8.3±3.0 and 84.6±21.3, respectively) and the values of EDV were higher (13.7±3.9) in contrast to the comparison group (p <0.0001).

Use of the EDF correction method in the main group resulted in a 4.4-fold and 5.1-fold decrease in CCE and VF concentrations, respectively, and a 4.3-fold normalization of EDV (p <0.0001). Increase of CCE concentration more than 7.0 per 10³ platelets; PV more than 120 μg/ml, as well as decrease of EDV below 14% in the study stages increased the risk of postoperative complications by 2.9; 1.7 and 1.8 times, respectively (p <0.0001).

The incidence of surgical complications was 19.7% and non-surgical complications 31.1%. Hospital mortality was 3.3% and out-of-hospital mortality with up to three years follow-up was 13.1%.

The number of purulent-septic complications in the main group was 2.9 times lower, and the rate of thrombotic complications was 4 times lower than in the comparison group (p <0.05).

CONCLUSION: Combined use of laparoscopic technique by EDF medication correction reduces manifestations of stress reaction and decreases the potential risk of complications development in the postoperative period. Elevation of CCE, as well as EDV decrease beyond the relevant excision points in patients with gastric cancer in the perioperative period are prognostic predictors of the risk of purulent-septic and thrombotic complications development.

BACKGROUND: The duration and accuracy of verification of origin and morphological variant of adenocarcinoma in the cervical smear affect the effectiveness of the treatment of patients. Currently, few publications on the possibility of clarifying the origin of adenocarcinoma in a cervical smear using the traditional cytological method are not sufficient for evidence-based conclusions.

AIMS: To identify patterns of cytological indicators of origin of adenocarcinoma in the biomaterial from the cervix.

MATERIALS AND METHODS: In an observational one-stage retrospective study, a comparative analysis of cytological tests of cervical smears with the conclusion “adenocarcinoma” was carried out with clinical and anamnestic information and the results of histological, immunohistochemical, molecular and genetic examinations. Information about 143 patients in the cancer registry of the Altai Regional Oncological Dispensary (Barnaul) for 2021 was used for analysis. Cytology preparations were prepared by the traditional method, as well as by the method of liquid cytology, staining was carried out by the Papanicolaou (Pap Test) and Pappenheim methods. Testing for human papillomavirus (HPV) was carried out by immunohistochemical method and polymerase chain reaction. PIK3CA and KRAS mutations were detected by polymerase chain reaction.

RESULTS: The cytological conclusion “adenocarcinoma” was confirmed by histology for all 143 women. There were cytology features of the morphological variant of AC, as well as to suggest the primary organ of adenocarcinoma, subsequently verified by visualization methods, histological, immunohistological examinations of biopsy and/or surgical material. The adenocarcinoma elements in the cervical smear was accompanied by adenocarcinoma in the endometrium, cervix, ovary/fallopian tube, colon (68.5, 17.6, 9.8 and 2.8% of cases, respectively; p <0.001). Differentiation of endometrial adenocarcinoma varied. Clear cell adenocarcinoma had specific cellular features. Cellular characteristics of HPV-associated and HPV-unassociated endocervical carcinomas differed from each other. Invasion of intestinal adenocarcinoma into the uterus and cervix was characterized by complexes with a “palisade” arrangement of cells in cervical smears.

CONCLUSION: Cytolodiagnostics of adenocarcinoma in smear from the cervix has prospects for further improvement in the verification of the organ origin of carcinoma. It is assumed that it is rational to assess associations of cytology with histo-, cytochemical, molecular and genetic characteristics of adenocarcinoma.