The optimal approach for treating cytology-positive (Cy1) gastric cancer (GC) patients without additional non-curative factors remains uncertain. While neoadjuvant chemotherapy followed by gastrectomy shows promise, its suitability for Western patients is not well supported by existing data. To address this knowledge gap, a cohort study was conducted across four major GC treatment centers in Lithuania, Estonia, and Ukraine. Forty-three consecutive Cy1 GC patients who underwent neoadjuvant chemotherapy between 2016 and 2020 were enrolled. The study evaluated overall survival (OS), progression-free survival (PFS), cytology status conversion, and major pathological response rates, along with the factors influencing these outcomes. All patients underwent surgery post-neoadjuvant chemotherapy, with 53.5% experiencing cytological status conversion and 23.3% achieving a major pathological response. The median OS and PFS were 20 (95% CI: 16–25) and 19 (95% CI: 11–20) months, respectively. Conversion to negative cytology significantly reduced the relative risk of peritoneal progression (RR: 0.11; 95% CI: 0.03–0.47, p = 0.002). The study suggests that neoadjuvant chemotherapy followed by gastrectomy holds promise as a treatment option for Cy1 GC without additional non-curative factors, associating cytology status conversion with improved long-term outcomes and reduced peritoneal relapse risk.

Background: Gastric cancer represents a significant global health burden, necessitating effective multimodal treatment approaches. Neoadjuvant chemotherapy has gained prominence in improving outcomes, with FLOT (5-fluorouracil, leucovorin, oxaliplatin and docetaxel) and XELOX (capecitabine and oxaliplatin) emerging as potential regimens. This study aims to compare the efficacy and safety of neoadjuvant FLOT and XELOX in resectable gastric cancer. Methods: We conducted a prospective randomized open-label clinical trial. Sixty-nine patients with resectable gastric cancer were randomly assigned to perioperative 8 cycles of FLOT and 8 cycles of XELOX and curative surgery. The primary endpoint was the proportion of patients who fully adhered to all the allocated treatment per protocol. Secondary endpoints were pathological regression grade, progression-free survival, overall survival, chemotherapy and surgery complications rates. Results: A total of 69 patients were included in both arms. Thirty-three of 35 (94.3%) patients in the FLOT arm and 23 of 34 (67.6%) in the XELOX arm underwent curative-intent surgery after neoadjuvant treatment. Nineteen (54.3%) and 17 (50%) patients completed the protocol-defined therapy in the FLOT and XELOX arms, respectively (P=0.81). The proportion alive without progression at 2 years was 18.8% [95% confidence interval (CI): 8.9–39.8%] in the XELOX group compared to 45.7% (95% CI: 31.9–65.6%) in the FLOT group. The study was prematurely terminated due to the inferiority of the XELOX regimen in preoperative settings because of the high rate of disease progression. Conclusions: In our study, the rate of protocol completion did not statistically differ between the two groups. Perioperative FLOT chemotherapy exhibits notable efficacy in gastric cancer management, as evidenced by favorable treatment responses and surgical outcomes. The regimen’s safety profile aligns with established expectations. This study supports the continued exploration of FLOT as a valuable component in the perioperative care of gastric cancer patients. Trial Registration: ClinicalTrials.gov ID NCT04937738.

Background Gastric cancer remains one of the leading causes of cancer-related morbidity and mortality. It requires combination of chemotherapy and surgery to achieve the longest overall survival and disease-free survival. However, chemotherapy regimens have a significant toxicity level that prevents patients from completing the entire treatment protocol. Methods This is a prospective randomized clinical trial aiming to assess an intolerance of chemotherapy related adverse effects in patients with resectable gastric cancer receiving perioperative XELOX and FLOT regimen. The primary endpoint is a quantity of patients who complete all the protocol treatment without any deviations. Secondary endpoints are pathological regression rate, chemotherapy toxicity profile, disease-free survival rate and overall survival rate. Results The results of the trial will demonstrate the proportion of patients who are able to complete protocol treatment without any deviations in real world settings and its impact on overall survival and disease-free survival rates. Conclusion The protocol compliance is one the main factors in successful treatment of gastric cancer. In case the compliance of chemotherapy regimen with potentially lower toxicity has bigger impact than application of three-drug scheme, it can play a significant role in real-world settings.

Different laparoscopic hernioplasty techniques provide no significant tissue damage with high effectiveness of procedure that may be feasible for them to achieve some advancements in hernia treatment. It also provides lower postoperative pain level and decreases number of inpatient days. We have performed a retrospective analysis of 147 videolaparoscopic surgery on inguinal hernia in 119 (80.9 %) men and 28 (19.1 %) of women aged 17–84 (57 ± 19,8) with TAPP technique using different mesh implants. The elimination of hernia was started with semi oval incision above lateral and medial inguinal fossae. Meshes were fixed with staplers, the peritoneal defects were closed with monofilament vicryl and the electric union of soft tissues.There were no hematomas, seromas and chronic postoperateive pain syndrome detected while using lightweight meshes, that fixed themselves, and the method of electric union of soft tissues. In other cases, there were some complications as a result of inadequate hemostasis or applying smaller meshes than needed. Using of lightweight self- locking meshes in laparoscopic treatment of hernia with TAPP technique avoids hematoma, reduces the amount of seromas in the operation area and takes off inguinal pain syndrome in the postopera- tive period. It can also reduce transaction costs in 2 times that makes laparoscopic approach a meth- od of choise.

Мета роботи: визначити вплив стентування неспроможності стравохідно-тонкокишкових анастомозів на кількість інвалідизуючих хірургічних інтервенцій. Матеріали і методи. Було проаналізовано дані пацієнтів, які отримали хірургічне лікування раку шлунка за період з 2018 р. до 2022 р. у ДНП «Національний інститут раку». 613 особам виконали гастректомію. Неспроможність стравохідно-тонкокишкового анастомозу виникла у 48 (7,8 %) хворих. Першу групу склали 9 (18,7 %) пацієнтів, які мали лише рентгенологічні ознаки неспроможності. Другу – 19 (39,5 %) хворих із неспроможністю (50 % окружності). Результати. Стентування, як основний метод лікування, проведено у 16 (75 %) пацієнтів, 4 хворих відмовились від процедури. У пацієнтів із третьої і четвертої груп у 6 випадках проведено повторні операції в обсязі операції Торека. У 70 % пацієнтів, яким встановлювали SEMS, досягнуто повного загоєння. Саморозширювальні стенти добре зарекомендували себе як паліативний метод при раку стравоходу з дисфагією III–IV ст. Результати цього дослідження підтверджують їхню ефективність у лікуванні неспроможності стравохідно-тонкокишкового анастомозу (СТА) після гастректомії. Висновки. Використання саморозширювальних металевих стентів (SEMS) дає можливість успішно лікувати неспроможність анастомозу після гастректомії, що свідчить про безпечність методу. Можливість уникнути інвалідизуючих хірургічних втручань свідчить про перевагу перед хірургічними методами лікування. Ендоскопічне стентування потребує подальшого впровадження в клінічну практику та проведення подальших досліджень.