A. Lukashenko

BACKGROUND: Colorectal cancer is one of the most common cancers worldwide and is associated with high mortality when detected at a later stage. There is a paucity of studies from low and middle income countries to support the cost-effectiveness of colorectal cancer screening. We aim to analyze the cost-effectiveness of colorectal cancer screening compared to no screening in Ukraine, a lower-middle income country. METHODS: We developed a deterministic Markov cohort model to assess the cost-effectiveness of three colorectal cancer screening strategies [fecal occult blood test (FOBT) every year, flexible sigmoidoscopy with FOBT every 5 years, and colonoscopy every 10 years] compared to no screening. We modeled outcomes in terms of cost per quality-adjusted life-years (QALYs) over a lifetime time horizon. We performed sensitivity analyses on treatment adherence, test characteristics and costs. Analyses were conducted from the perspective of the Ministry of Health of Ukraine. RESULTS: The base-case lifetime cost-effectiveness analysis showed that all three screening strategies were cost saving compared to no screening, and among the three strategies, colonoscopy every 10 years was the dominant strategy compared to no screening with standard adherence to treatment. When decreased adherence to treatment was modeled, colonoscopy every 10 years was the most cost-effective strategy with an incremental cost-effectiveness ratio of $843 per QALY compared with no screening. CONCLUSION: Our findings indicate that colorectal cancer screening can save money and improve health compared to no screening in Ukraine. Colonoscopy every 10 years is superior to the other screening modalities evaluated in this study. This knowledge can be used to concentrate efforts on developing a national screening program in Ukraine.

BACKGROUND: Intraoperative ultrasound examination (IOUS) is indispensable part of modern surgical interventions in tumors of hepatopancreatobiliary zone. In this study retrospective analysis of IOUS efficiency in surgical treatment of pancreatic tumors was provided. MATERIALS AND METHODS: In the period from January 2013 till November 2015 in the National Cancer Institute IOUS was applied during 76 surgical interventions: for pancreatic head tumors--in 46 (60.5%) patients, for body/tail pancreatic tumors--in 20 (26.3%) patients, in 10 (13.2%) patients--for periampullary zone neoplasms. In IOUS we performed primary tumor assessment (localization, degree of tumor spreading to superior mesenteric vessels, hepatoduodenal ligament vessels, additional foci occurrence in pancreas), and liver metastases detection. Surgical interventions were performed: pancreatoduodenectomy in 52 (68.4%) patients, radical antegrade modal pancreatosplenectomy--in 14 (18.4%) patients. RESULTS: IOUS allowed determining additional tumor foci in pancreas in 2 (2.6%) patients, in 8 (10.5%) observations tumor invasion into portal or superior mesenteric vein was determined. In 21 (27.6%) patient additional hepatic neoplasms were detected (in half of cases--11.8%, metastases). These findings resulted in change of surgical intervention extent in 23 (30.3%) patients: expansion to combined resections in 14 (18.4%) patients, reduction to symptomatic operations in 5 (6.6%) cases, organ-preserving operations were performed in 4 (5.3%) patients. Variant anatomy of hepatic arterial blood supply was determined in 41 (53.9%) patients that necessitated performance correction of resection stages for preservation of adequate hepatic blood supply. CONCLUSIONS: IOUS is a highly-precise diagnostic method substantively influencing operation course in pancreatic tumors, enabling surgeon to provide adequate staging and permanent correction of operation course.

Since the first attempts at resecting parts of diseased livers in the late nineteenth century, hemorrhage has been the main obstacle for surgeons. One of the first hemostasis techniques in liver resection was liver suture. The idea of suturing the liver in order to perform resection was proposed by a team of Russian and Polish surgeons from Kharkiv University in today's Ukraine. The liver suture became widely popular and has been used in various forms throughout the surgical world. Further into the twentieth century, it has lost much of its popularity; however, over more than 100 years of existence it has seen several peaks in interest. Currently, it is still being used by some liver surgeons as it is one of the cheapest ways of obtaining a bloodless liver parenchyma transection.

The modification of the reconstructive stage of gastropancreatoduodenal resection aims to increase the security of the pancreatojejunoanastomosis by minimizing the impact of such aggressive substances as bile and pancreatic juice. The modification represents the isolated pancreatojejunoanastomosis on the Roux-en-Y intestinal loop and gastro- and hepaticojejunoanastomoses on the second intestinal loop, separated with the use of the stub. Thus, the method allows the separate passage of pancreatic juice, bile and gastric contents, excluding their impact on other anastomoses. The described modification was performed in 6 patients. There were no cases of the anastomotic insufficiency. The mean hospital stay was 10,5 days. Thus. The method proved to be effective and safe, providing good initial results.