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<article article-type="research-article" dtd-version="1.3" xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" xml:lang="ru"><front><journal-meta><journal-id journal-id-type="publisher-id">oncotomsk</journal-id><journal-title-group><journal-title xml:lang="ru">Сибирский онкологический журнал</journal-title><trans-title-group xml:lang="en"><trans-title>Siberian journal of oncology</trans-title></trans-title-group></journal-title-group><issn pub-type="ppub">1814-4861</issn><issn pub-type="epub">2312-3168</issn><publisher><publisher-name>Tomsk National Research Medical Сепtеr of the Russian Academy of Sciences</publisher-name></publisher></journal-meta><article-meta><article-id pub-id-type="doi">10.21294/1814-4861-2023-22-1-101-109</article-id><article-id custom-type="elpub" pub-id-type="custom">oncotomsk-2436</article-id><article-categories><subj-group subj-group-type="heading"><subject>Research Article</subject></subj-group><subj-group subj-group-type="section-heading" xml:lang="ru"><subject>ОПЫТ РАБОТЫ ОНКОЛОГИЧЕСКИХ УЧРЕЖДЕНИЙ</subject></subj-group><subj-group subj-group-type="section-heading" xml:lang="en"><subject>ONCOLOGY PRACTICE</subject></subj-group></article-categories><title-group><article-title>Особенности хирургического лечения рака желудка и пищеводно-желудочного перехода после неоадъювантной терапии: опыт МРНЦ и обзор литературы</article-title><trans-title-group xml:lang="en"><trans-title>Surgical management of cancer of the stomach and gastroesophageal junction after neoadjuvant therapy: the experience of the MRRC and literature review</trans-title></trans-title-group></title-group><contrib-group><contrib contrib-type="author" corresp="yes"><contrib-id contrib-id-type="orcid">https://orcid.org/0000-0002-2136-1994</contrib-id><name-alternatives><name name-style="eastern" xml:lang="ru"><surname>Скоропад</surname><given-names>В. Ю.</given-names></name><name name-style="western" xml:lang="en"><surname>Skoropad</surname><given-names>V. Yu.</given-names></name></name-alternatives><bio xml:lang="ru"><p>Скоропад Виталий Юрьевич, доктор медицинских наук, ведущий научный сотрудник, заведующий отделом торакоабдоминальной онкологии</p><p>г. Обнинск, 249031, ул. Жукова, 10</p><p>SPIN-код: 2283-1111,</p><p>Researcher ID (WOS): E-2200-2018</p></bio><bio xml:lang="en"><p>Vitaliy Yu. Skoropad, MD, DSc, Leading Researcher, Head of the Department of Thoracoabdominal Oncology</p><p>10, Zhukov St., 249031, Obninsk</p><p>Researcher ID (WOS): E-2200-2018</p><p> </p></bio><email xlink:type="simple">skoropad@mrrc.obninsk.ru</email><xref ref-type="aff" rid="aff-1"/></contrib><contrib contrib-type="author" corresp="yes"><contrib-id contrib-id-type="orcid">https://orcid.org/0000-0003-0406-0046</contrib-id><name-alternatives><name name-style="eastern" xml:lang="ru"><surname>Кудрявцев</surname><given-names>Д. Д.</given-names></name><name name-style="western" xml:lang="en"><surname>Kudryavtsev</surname><given-names>D. D.</given-names></name></name-alternatives><bio xml:lang="ru"><p>Кудрявцев Дмитрий Дмитриевич, научный сотрудник</p><p>г. Обнинск, 249031, ул. Жукова, 10</p><p>SPIN-код: 1680-5735,</p><p>Researcher ID (WOS): С-8505-2018</p></bio><bio xml:lang="en"><p>Dmitry D. Kudryavtsev, Researcher</p><p>10, Zhukov St., 249031, Obninsk</p><p>Researcher ID (WOS): С-8505-2018</p></bio><xref ref-type="aff" rid="aff-1"/></contrib><contrib contrib-type="author" corresp="yes"><contrib-id contrib-id-type="orcid">https://orcid.org/0000-0002-5050-7868</contrib-id><name-alternatives><name name-style="eastern" xml:lang="ru"><surname>Соколов</surname><given-names>П. В.</given-names></name><name name-style="western" xml:lang="en"><surname>Sokolov</surname><given-names>P. V.</given-names></name></name-alternatives><bio xml:lang="ru"><p>Соколов Павел Викторович, врач-хирург, заведующий операционным блоком, врач-онколог отделения хирургического и лучевого лечения заболеваний абдоминальной области</p><p>г. Обнинск, 249031, ул. Жукова, 10</p><p>SPIN-код: 8527-6278</p></bio><bio xml:lang="en"><p>Pavel V. Sokolov, MD, Surgeon, Head of Surgery Unit, Oncologist, Surgery and Radiation Therapy Department</p><p>10, Zhukov St., 249031, Obninsk</p><p> </p></bio><xref ref-type="aff" rid="aff-1"/></contrib><contrib contrib-type="author" corresp="yes"><contrib-id contrib-id-type="orcid">https://orcid.org/0000-0001-7689-6032</contrib-id><name-alternatives><name name-style="eastern" xml:lang="ru"><surname>Иванов</surname><given-names>С. А.</given-names></name><name name-style="western" xml:lang="en"><surname>Ivanov</surname><given-names>S. A.</given-names></name></name-alternatives><bio xml:lang="ru"><p>Иванов Сергей Анатольевич, доктор медицинских наук, профессор РАН, директор, Медицинский радиологический научный центр им. А.Ф. Цыба – филиал ФГБУ «Национальный медицинский исследовательский центр радиологии» Минздрава России (г. Обнинск, Россия); профессор кафедры онкологии и рентгенорадиологии им. В.П. Харченко, ФГАОУ ВО «Российский университет дружбы народов»</p><p>г. Обнинск, 249031, ул. Жукова, 10,</p><p>117198, г. Москва, ул. Миклухо-Маклая, 6</p></bio><bio xml:lang="en"><p>Sergey A. Ivanov, MD, Professor of the Russian Academy of Sciences, Director, A. Tsyb Medical Radiological Research Centre – branch of the National Medical Research Radiological Centre of the Ministry of Health of the Russia (Obninsk, Russia); Professor of the Department of Oncology and Radiology, V.P. Kharchenko Medical Institute, RUDN University</p><p>10, Zhukov St., 249031, Obninsk,</p><p>6, Miklukho-Maklaya St., Moscow, 117198</p><p> </p></bio><xref ref-type="aff" rid="aff-2"/></contrib><contrib contrib-type="author" corresp="yes"><contrib-id contrib-id-type="orcid">https://orcid.org/0000-0001-8784-8415</contrib-id><name-alternatives><name name-style="eastern" xml:lang="ru"><surname>Каприн</surname><given-names>А. Д.</given-names></name><name name-style="western" xml:lang="en"><surname>Kaprin</surname><given-names>A. D.</given-names></name></name-alternatives><bio xml:lang="ru"><p>Каприн Андрей Дмитриевич, доктор медицинских наук, профессор, академик РАН, член-корреспондент РАО, генеральный директор, ФГБУ «Национальный медицинский исследовательский центр радиологии» Минздрава России (г. Обнинск, Россия); заведующий кафедрой онкологии и рентгенорадиологии им. В.П. Харченко, ФГАОУ ВО «Российский университет дружбы народов»</p><p>249036, г. Обнинск, ул. Королева, 4,</p><p>117198, г. Москва, ул. Миклухо-Маклая, 6</p><p>Researcher ID (WOS): K-1445-2014</p><p> </p></bio><bio xml:lang="en"><p>Andrey D. Kaprin, MD, Professor, Academician of the Russian Academy of Sciences, Director, National Medical Research Radiological Centre of the Ministry of Health of the Russia (Obninsk, Russia); Head of the Department of Oncology and Radiology, V.P. Kharchenko Medical Institute, RUDN University</p><p>4, Koroleva St., 249036, Obninsk,</p><p>6, Miklukho-Maklaya St., Moscow, 117198</p><p>Researcher ID (WOS): K-1445-2014</p></bio><xref ref-type="aff" rid="aff-3"/></contrib></contrib-group><aff-alternatives id="aff-1"><aff xml:lang="ru"><institution>Медицинский радиологический научный центр им. А.Ф. Цыба – филиал ФГБУ «Национальный медицинский исследовательский центр радиологии» Минздрава России</institution><country>Россия</country></aff><aff xml:lang="en"><institution>A. Tsyb Medical Radiological Research Centre – branch of the National Medical Research Radiological Centre of the Ministry of Health of the Russia</institution><country>Russian Federation</country></aff></aff-alternatives><aff-alternatives id="aff-2"><aff xml:lang="ru"><institution>Медицинский радиологический научный центр им. А.Ф. Цыба – филиал ФГБУ «Национальный медицинский исследовательский центр радиологии» Минздрава России;&#13;
ФГАОУ ВО «Российский университет дружбы народов»</institution><country>Россия</country></aff><aff xml:lang="en"><institution>A. Tsyb Medical Radiological Research Centre – branch of the National Medical Research Radiological Centre of the Ministry of Health of the Russia;&#13;
RUDN University</institution><country>Russian Federation</country></aff></aff-alternatives><aff-alternatives id="aff-3"><aff xml:lang="ru"><institution>ФГБУ «Национальный медицинский исследовательский центр радиологии» Минздрава России;&#13;
ФГАОУ ВО «Российский университет дружбы народов»</institution><country>Россия</country></aff><aff xml:lang="en"><institution>National Medical Research Radiological Centre of the Ministry of Health of the Russia;&#13;
RUDN University</institution><country>Russian Federation</country></aff></aff-alternatives><pub-date pub-type="collection"><year>2023</year></pub-date><pub-date pub-type="epub"><day>22</day><month>02</month><year>2023</year></pub-date><volume>22</volume><issue>1</issue><fpage>101</fpage><lpage>109</lpage><permissions><copyright-statement>Copyright &amp;#x00A9; Скоропад В.Ю., Кудрявцев Д.Д., Соколов П.В., Иванов С.А., Каприн А.Д., 2023</copyright-statement><copyright-year>2023</copyright-year><copyright-holder xml:lang="ru">Скоропад В.Ю., Кудрявцев Д.Д., Соколов П.В., Иванов С.А., Каприн А.Д.</copyright-holder><copyright-holder xml:lang="en">Skoropad V.Y., Kudryavtsev D.D., Sokolov P.V., Ivanov S.A., Kaprin A.D.</copyright-holder><license xml:lang="ru" license-type="creative-commons-attribution" xlink:href="https://creativecommons.org/licenses/by/4.0/" xlink:type="simple"><license-p>Данная работа распространяется под лицензией Creative Commons Attribution 4.0.</license-p></license><license xml:lang="en" license-type="creative-commons-attribution" xlink:href="https://creativecommons.org/licenses/by/4.0/" xlink:type="simple"><license-p>This work is licensed under a Creative Commons Attribution 4.0 License.</license-p></license></permissions><self-uri xlink:href="https://www.siboncoj.ru/jour/article/view/2436">https://www.siboncoj.ru/jour/article/view/2436</self-uri><abstract><sec><title>Введение</title><p>Введение. Показатели заболеваемости и смертности от рака желудка (РЖ) остаются весьма высокими и занимают ведущие позиции как в мире, так и в Российской Федерации; при этом доля местнораспространенного РЖ достигает 50 % [<xref ref-type="bibr" rid="cit1">1</xref>]. Применение периоперационной/адъювантной химиотерапии является стандартом в лечении данной категории больных. Перспективным признается применение неоадъювантной химиолучевой терапии.</p></sec><sec><title>Материал и методы</title><p>Материал и методы. Представлен анализ результатов хирургического этапа лечения рака желудка и кардиоэзофагеального перехода после различных вариантов неоадъювантной терапии: химиотерапии, химиолучевой терапии и их комбинации. Проанализирован опыт МРНЦ, включающий 5 клинических проспективных исследований, в том числе одно исследование являлось рандомизированным многоцентровым. В исследования были включены 237 пациентов с морфологически подтвержденным диагнозом местнораспространенного рака желудка и кардиоэзофагеального перехода, из них 202 пациента на первом этапе лечения получили неоадъювантную терапию. Полученные нами данные проанализированы также в сравнительном аспекте с результатами лечения больных раком желудка и кардиоэзофагеального перехода по данным рандомизированных исследований, опубликованных за последние 15 лет.</p></sec><sec><title>Результаты</title><p>Результаты. Из 202 пациентов, которым на первом этапе лечения была проведена неоадъювантная терапия, были оперированы 190 (94 %); из них радикально (R0-операции) – 184 больных (98 % от всех оперированных больных, 91 % – от включенных в исследование). В раннем послеоперационном периоде зарегистрированы осложнения у 62 (32,6 %) пациентов (варьировало от 19 до 37 %). Хирургические вмешательства по поводу осложнений были выполнены повторно у 11 (5,8 %) пациентов. Послеоперационная летальность составила 1,6 % (3 пациента). Многоцентровые рандомизированные исследования и метаанализы, а также многолетний опыт МРНЦ им. А.Ф. Цыба показали, что добавление неоадъювантной терапии не приводит к увеличению показателей послеоперационных осложнений и летальности; и в то же время увеличивает число R0 резекций, а также улучшает отдаленные результаты лечения у пациентов с резектабельными местнораспространенными опухолями указанных локализаций.</p></sec><sec><title>Заключение</title><p>Заключение. Анализ многолетних клинических исследований, проведенных в МРНЦ им. А.Ф. Цыба, а также результаты, опубликованные зарубежными авторами, свидетельствуют, что неоадъювантная терапия у ряда пациентов приводит к изменениям мягких тканей в области операции и, соответственно, может усложнять ее выполнение. Тем не менее значимого негативного влияния на показатели послеоперационных осложнений и летальности не зафиксировано.</p></sec></abstract><trans-abstract xml:lang="en"><sec><title>Itroduction</title><p>Itroduction. Gastric cancer incidence and mortality rates remain very high worldwide, including the Russian Federation. More than 50 % of gastric cancers are locally advanced at presentation [<xref ref-type="bibr" rid="cit1">1</xref>]. Perioperative or adjuvant chemotherapy is a standard treatment for gastric cancer patients. The use of neoadjuvant chemoradiotherapy is considered very promising.</p></sec><sec><title>Material and Methods</title><p>Material and Methods. We present the analysis of the results of surgical treatment of cancer of the stomach and gastrooesophageal junction after various options of neoadjuvant therapy: chemotherapy, chemoradiotherapy, and their combinations. The experience of the Medical Radiological Research Centre (MRRC), including 5 clinical prospective studies and one randomized multicenter clinical trial, was analyzed. A total of 237 patients with histologically proven locally advanced cancer of the stomach and gastro-oesophageal junction were included into the study. Of these patients, 202 received neoadjuvant therapy. Our treatment outcomes were compared with those of randomized trials published over the last 15 years.</p></sec><sec><title>Results</title><p>Results. Of 202 patients who received neoadjuvant therapy, 190 (94 %) underwent surgery (R0 resection: 184 patients). In the early postoperative period, complications were observed in 62 patients (32.6 %). Re-surgery was performed in 11 (5.8 %) patients. Postoperative mortality was 1.6 % (3 patients). Multicenter randomized studies and meta-analyses, as well as the long-term experience of MRRC, have shown that neoadjuvant therapy does not increase the number of postoperative complications and mortality, increases the rate of R0 resections and improves long-term treatment outcomes in patients with resectable locally advanced cancer of the stomach and gastro-oesophageal junction.</p></sec><sec><title>Conclusion</title><p>Conclusion. Analysis of long-term clinical studies conducted at the MRRC as well as the treatment results published by other authors show that in some cases neoadjuvant therapy can lead to soft tissue changes in a surgical area and may complicate surgical management; however, it does not have a negative impact on the rates of postoperative complications and mortality.</p></sec></trans-abstract><kwd-group xml:lang="ru"><kwd>рак желудка</kwd><kwd>неоадъювантная терапия</kwd><kwd>комбинированное лечение</kwd><kwd>хирургическое лечение</kwd><kwd>послеоперационные осложнения</kwd></kwd-group><kwd-group xml:lang="en"><kwd>gastric cancer</kwd><kwd>neoadjuvant therapy</kwd><kwd>combination treatment</kwd><kwd>surgical treatment</kwd><kwd>postoperative complications</kwd></kwd-group></article-meta></front><back><ref-list><title>References</title><ref id="cit1"><label>1</label><citation-alternatives><mixed-citation xml:lang="ru">Каприн А.Д., Старинский В.В., Петрова Г.В. 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