Background/Aim. The National Organized Colorectal Cancer Screening Program was conducted in the Republic of Serbia during 2013-2014 covering the population of both genders, aged 50 to 74 years, in 28 municipalities out of 180, with the target population of 651,445 people. This organized colorectal cancer screening aims to reduce mortality from colorectal cancer in the target population. The aim of this study was to show the results of organized screening for colorectal cancer during the first biannual round in Serbia. Methods. General practitioners from the primary health centers, invited target population by letters and by phone to perform immunochemical fecal occult blood test. Persons with a positive test results were referred to the colonoscopy. The database of health insurance and other citizens of the target population was used for invitation for screening in primary health centers. Descriptive statistical analysis of the results in organized colorectal cancer screening in the first round was performed for the key screening indicators. Results. In the first round, a total of 99,592 persons were invited. The participation rate was 62.5%. Colonoscopy was performed in 1,554 persons. Adenomas were found in 586 persons (0.9% of all the tested), e.g. 37.7 % of all colonoscopied. In 129 persons colorectal cancer was diagnosed (0.2% of all the tested), e.g. 8.3% of all the colonoscopied. In the left half of the colon (rectum, sigmoid and descending colon) there were 70.4% diagnosed polyps and 77.3% carcinomas, while 29.6% of polyps and 22.7% carcinomas were found in the proximal parts of the colon. Conclusion. In the first round of the organized colorectal cancer screening in Serbia the participation rate of the targeted population was high and gave encouraging result. It was expected that in the forthcoming rounds even higher coverage of the target population would be accomplished. A positive predictive value of the completed colonoscopies showed that further work on observing the stages of diagnosed adenomas and carcinomas would reach the goals of the expected improvement in early detection of colorectal cancer in Serbia.

In the period 1990 - 2002, 1674 patients with colorectal carcinoma were operated in the First Surgical Clinic, Third Department for Colorectal Surgery. In 1264 cases (75,5%) rectal carcinoma was the indication for surgical treatment. Sphincter saving procedures (SSP) were performed in 824 (65,2%), abdominoperineal resections (APR) in 340 (26,9%) and resections of rectum with definitive stoma (Hartmann procedure) in 100 (7,9%) patients. We analyzed 1095 cases where curative SSP or APR were performed. All cases where curative resection was not possible because of liver metastases or inability to excise all macroscopic disease were excluded. In the group of patients where SSP was performed (767 cases), there were 26,6% high colorectal anastomoses (8cm from anal verge), 65,4% with low (4-8cm from anal verge) and 8,0% with intersphincteric coloanal anastomosis (cm from anal verge). Patohistological exam showed 5,3% Dukes A, 53,1% Dukes B, 36,5% Dukes C and 4,9% Dukes D. In the APR group (328 cases) there were 1,5% Dukes A, 32,4% Dukes B, 62,1% Dukes C and 3,5% Dukes D. In this study we analyzed local recurrence and five-year survival in both groups. Recurrence of the disease was registered in 325 (29,6%) out of 1095 patients. Local recurrence was found in 81 (7,4%) patients. In the SSP group recurrence occured in 215 (28,0%) out of 767 curative resections. Local recurrence alone was found in 53 patients (6,9%). SSP group was also divided into two subgroups; in the first group TME was performed and in second transection of mesorectum was carried out. Analyzing local recurrence in these two groups, in the TME group it was 7,6% and in the transection group 5,6%. In the APR group recurrence was registered in 110 (33,5%) out of 328 patients while local recurrence alone was found in 28 (8,5%) cases. Analyzing mortality we found that 234 (21,4%) out of 1095 patients died during follow-up. In the SSP group 154 out of 767 patients (20,1%) died. In the TME group mortality was 21,7% and in the transection group 16,9%. Mortality in the APR group showed that 80 out of 328 (24,4%) patients died during follow-up. Analysis by the Kaplan-Meier?s test shows cumulative survival of 0,69 for all cases. In the SSP group cumulative survival is 0,72 and in the APR group 0,64 with statistically significant difference (p,001). In the TME group cumulative survival is 0,75 and in the transection group 0,72 with statistically significant difference (p,05). We believe that performing SSP should be encouraged whenever it is possible because there is no difference in local recurrence rates and survival compared to APR. Transection of mesorectum can safely be performed in most cases with tumors located more than 8 cm form anal verge. We believe that exact preoperative staging and preoperative radiotherapy could improve results.

Preoperative radiotherapy with (CRT) or without chemotherapy (RT) in the management of patients with locally advanced rectal carcinoma is increasingly accepted as therapeutic modality to reduce local recurrence and improve survival, decrease tumor size and/or stage, has less toxicity compared to postoperative therapy, improves sphincter preservation and the ability to perform a curative resection. In a brief review of literature we discussed the possible prognostic role of most important pathologic parameters and their clinical implications. At present, predictive value of tumor response to neoadjuvant therapy remains uncertain, whether evaluated as five-point histological tumor regression grade (TRG) or recently proposed three-point rectal cancer regression grade (RCRG). However, most reports emphasize reduced local reccurence rates and disease-free survival advantage in patients with complete tumour regression or tumour down-staging, occuring in up to 20% and 60% of cases, respectively. Patients with advanced post-treatment tumour stage (ypT3/4), positive lymph nodes (ypN1/2), vascular invasion, positive circumferential resection margin, clearance

Introduction. Functional results after low anterior resection for rectal cancer are an issue of increasing attention among colorectal surgeons and others interested in this subject. The consensus on ideal reconstruction type has not been achieved to date, although the number of papers on this subject has been published in recent years. Objective. We conducted a prospective, parallel group study comparing latero-terminal with colonic J-pouch anastomosis in terms of defecatory function in patients undergoing stapled low colorectal/ coloanal anastomosis. Methods. A total of 80 patients were included in this study with either latero-terminal or colonic J-pouch anastomosis. Defecatory function was evaluated using the modified version of MSKCC questionnaire 6, 12 and 24 months after the operation. Fecal continence was evaluated using the Wexner continence score. Results. In both groups, trend towards improvement was registered in all measured variables in all three control intervals. This can apply to bowel frequency, urgency, night soiling, fragmentation and incomplete evacuation. However, the difference was not statistically significant, and when reviewing the trend of results we can note that in the J-pouch group steady state has not been reached even after 24 month control. Conclusion. This trial did not reveal any significant differences in defecatory function 6, 12 and 24 months after low anterior resection (LAR) between patients with a latero-terminal anastomosis and those with colonic J-pouch anastomosis. Our results did not confirm superiority of colonic J-pouch over the lateroterminal anastomosis.

Introduction/Aim: Colorectal cancer is the third most common cancer in men and the second most common cancer in women worldwide and one of the major causes of cancer-related mortality. The aim of this study was to analyze the trends in mortality rates of colorectal cancer in central Serbia in the period 1999-2014. Methods: Mortality data for colorectal cancer, for the period 1999 - 2014, were taken from the of the Institute of Public Health of Serbia " Dr Milan Jovanović - Batut". Joinpoint regression analysis was used to estimate annual percent changes (APCs) in mortality and to identify critical stages in time where significant changes in trend occurred. Results: In central Serbia, in the period between 1999 and 2014, colorectal cancer was the second most common cause of mortality in both men and women. The average standardized mortality rate was 18.2 in men (per 100,000) and 10.5 in women (per 100,000). Rates were 1.7 times higher in men, with a remarkable annual increase of colorectal cancer mortality rate of 1.3% in the period 1999-2014, while in women the mortality rates were steady. In men, a significant increase in mortality rates was present in colon (APC 1.8%) as well as in rectosigmoidal junction cancer (APC 3.3%). Rise of 1.7% was present in colon carcinoma in men 35-74 years of age as well as an increase both in men and women 75 years of age and older in the period 1999-2014. Conclusion: Findings of present study revealed increasing mortality rates of colorectal cancer in Serbia. The implementation of nationally organized screening programmes is of paramount importance and should be conducted with higher efficacy in Serbia. Primary prevention measures should mainly focus on maintaining healthy body weight and a balanced diet as well as smoking and alcohol cessation.

Background/Aim. Rectal cancer is a major health problem throughout the world, despite the great progress in the treatment and control of the disease. The aim of this study was to determine the effect of mesorectal excision type on local recurrence in patients operated on for rectal cancer within a 3- year period. Methods. The clinical retrospective study was conducted at the Clinic for General Surgery at the Clinical Center in Nis, Serbia, and included 225 patients with rectal cancer. Postoperatively, the patients were observed 36 months. Total mesorectal excision (TME) method was used in 129 (57.33%) patients, and partial mesorectal excision (PME) in 96 (42.66%). There were 145 (64.44%) man and 80 (35.55%) women, average age 66.8 years. Results. In 58 (25.77%) of the patients cancer was localized in the proximal third of the rectum, in 99 (44%) in the medium third, in 68 (30.22%) it was 8 cm of the anocutaneous line. In 167 (74.22%) patients rectal cancer was in T3 stadium. TME was performed in all the patients with cancer in the distal third of the rectum and in 61.61% of the patients with cancer in the medium third of the rectum. PME was performed in all the patients with localized cancer in the proximal third and in 38.38% of the patients with cancer in the medium third of the rectum. Local recurrence occurred in 20 (8.88%) patients, 12 (9.30%) in the TME group and 8 (8.33%) in the PME group, which was not a statistically significant difference. In 75% of the cases, relapse occurred in the patients in T3 stage. Relapse occurred in 55% of the cases in the second year after the surgery. The median survival of all the patients amounted to 35 months. The total mortality of all respondents in a 3-year period amounted to 5.3%. Conclusion. There were no statistically significant differences in the incidence of local recurrence and survival among patients who underwent TME and those underwent PME. The type of mesorectal excision does not affect the incidence of local recurrence in node-negative disease stages.