Publications by authors named "Sergey Efetov"

15 Publications

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Characteristics of Early-Onset vs Late-Onset Colorectal Cancer: A Review.

JAMA Surg 2021 Jun 30. Epub 2021 Jun 30.

Department of Surgery, Skåne University Hospital, Malmö, Sweden.

Importance: The incidence of early-onset colorectal cancer (younger than 50 years) is rising globally, the reasons for which are unclear. It appears to represent a unique disease process with different clinical, pathological, and molecular characteristics compared with late-onset colorectal cancer. Data on oncological outcomes are limited, and sensitivity to conventional neoadjuvant and adjuvant therapy regimens appear to be unknown. The purpose of this review is to summarize the available literature on early-onset colorectal cancer.

Observations: Within the next decade, it is estimated that 1 in 10 colon cancers and 1 in 4 rectal cancers will be diagnosed in adults younger than 50 years. Potential risk factors include a Westernized diet, obesity, antibiotic usage, and alterations in the gut microbiome. Although genetic predisposition plays a role, most cases are sporadic. The full spectrum of germline and somatic sequence variations implicated remains unknown. Younger patients typically present with descending colonic or rectal cancer, advanced disease stage, and unfavorable histopathological features. Despite being more likely to receive neoadjuvant and adjuvant therapy, patients with early-onset disease demonstrate comparable oncological outcomes with their older counterparts.

Conclusions And Relevance: The clinicopathological features, underlying molecular profiles, and drivers of early-onset colorectal cancer differ from those of late-onset disease. Standardized, age-specific preventive, screening, diagnostic, and therapeutic strategies are required to optimize outcomes.
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http://dx.doi.org/10.1001/jamasurg.2021.2380DOI Listing
June 2021

Superior mesenteric vessel anatomy features differ in Russian and Chinese patients with right colon cancer: computed tomography-based study.

Chin Med J (Engl) 2021 Jun 7. Epub 2021 Jun 7.

Department of Surgery, Clinic of Colorectal and Minimally Invasive Surgery, I.M. Sechenov First Moscow State Medical University, Moscow 119991, Russia Department of Diagnostic Radiology, National Cancer Centre/National Clinical Research Centre for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing 100021, China Department of Colorectal Surgery, National Cancer Centre/National Clinical Research Centre for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing 100021, China.

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http://dx.doi.org/10.1097/CM9.0000000000001566DOI Listing
June 2021

Acute kidney injury in COVID-19: are kidneys the target or just collateral damage? A comprehensive assessment of viral RNA and AKI rate in patients with COVID-19.

Curr Opin Urol 2021 07;31(4):363-368

Institute for Urology and Reproductive Health, Sechenov University.

Purpose Of Review: To investigate the possible effects of severe acute respiratory syndrome-related coronavirus 2 (SARS-CoV-2) on kidney function and assess the rate of viral ribonucleic acid (RNA) shedding/detection in urine.

Recent Findings: Most of the research on the topic suggests that for the moment our ability to estimate whether SARS-CoV-2 is a direct causative agent in acute kidney injury (AKI) or whether it has a cytokine storm effect is limited. During our prospective assessment of 333 patients with COronaVIrus Disease 2019 (COVID-19) it was found that frequency of AKI of 9.6% (32 cases). Despite previous data suggestive of the ability to detect SARS-CoV-2 in urine, we were unable to identify any traces of messenger ribonucleic acid (mRNA) in our group. Both COVID-19 severity (odds ratio, OR = 23.09, confidence interval, CI 7.89-67.57, P < 0.001) and chronic kidney disease (CKD) history (OR = 7.17, CI 2.09-24.47, P = 0.002) were associated with the AKI rate.

Summary: AKI is a relatively frequent condition for patients with COVID-19 and is normally correlated with the severity of the disease and the patient's history of CKD. The available data fail to address whether SARS-CoV-2 mRNA is present in urine, whereas our prospective trial data suggest that mRNA is undetectable in urine irrespective of the severity of the disease.
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http://dx.doi.org/10.1097/MOU.0000000000000901DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8183255PMC
July 2021

A technical guide for everted natural orifice specimen extraction after low anterior resection of the rectum - a video vignette.

Colorectal Dis 2021 Mar 25;23(3):766-767. Epub 2021 Feb 25.

I. M. Sechenov First Moscow State Medical University, Sechenov University, Moscow, Russia.

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http://dx.doi.org/10.1111/codi.15495DOI Listing
March 2021

Screening policies, preventive measures and in-hospital infection of COVID-19 in global surgical practices.

J Glob Health 2020 Dec;10(2):020507

Department of Surgery, Minimally Invasive Unit, Università degli Studi di Roma "Tor Vergata", Rome, Italy.

Background: In a surgical setting, COVID-19 patients may trigger in-hospital outbreaks and have worse postoperative outcomes. Despite these risks, there have been no consistent statements on surgical guidelines regarding the perioperative screening or management of COVID-19 patients, and we do not have objective global data that describe the current conditions surrounding this issue. This study aimed to clarify the current global surgical practice including COVID-19 screening, preventive measures and in-hospital infection under the COVID-19 pandemic, and to clarify the international gaps on infection control policies among countries worldwide.

Methods: During April 2-8, 2020, a cross-sectional online survey on surgical practice was distributed to surgeons worldwide through international surgical societies, social media and personal contacts. Main outcome and measures included preventive measures and screening policies of COVID-19 in surgical practice and centers' experiences of in-hospital COVID-19 infection. Data were analyzed by country's cumulative deaths number by April 8, 2020 (high risk, >5000; intermediate risk, 100-5000; low risk, <100).

Results: A total of 936 centers in 71 countries responded to the survey (high risk, 330 centers; intermediate risk, 242 centers; low risk, 364 centers). In the majority (71.9%) of the centers, local guidelines recommended preoperative testing based on symptoms or suspicious radiologic findings. Universal testing for every surgical patient was recommended in only 18.4% of the centers. In-hospital COVID-19 infection was reported from 31.5% of the centers, with higher rates in higher risk countries (high risk, 53.6%; intermediate risk, 26.4%; low risk, 14.8%;  < 0.001). Of the 295 centers that experienced in-hospital COVID-19 infection, 122 (41.4%) failed to trace it and 58 (19.7%) reported the infection originating from asymptomatic patients/staff members. Higher risk countries adopted more preventive measures including universal testing, routine testing of hospital staff and use of dedicated personal protective equipment in operation theatres, but there were remarkable discrepancies across the countries.

Conclusions: This large international survey captured the global surgical practice under the COVID-19 pandemic and highlighted the insufficient preoperative screening of COVID-19 in the current surgical practice. More intensive screening programs will be necessary particularly in severely affected countries/institutions.

Study Registration: Registered in ClinicalTrials.gov: NCT04344197.
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http://dx.doi.org/10.7189/jogh.10.020507DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7567431PMC
December 2020

Extended Colectomy Followed by Cecorectal Anastomosis as a Surgical Treatment Modality in Synchronous Colorectal Cancer.

Case Rep Oncol 2020 May-Aug;13(2):813-821. Epub 2020 Jul 8.

Coloproctology and Minimally Invasive Surgery Clinic, I.M. Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russian Federation.

Subtotal and extended left colectomies with ileocecal junction preservation represent preferable alternatives in cases of massive involvement of the colon in the pathological process. However, these approaches might be challenging in terms of reconstructive steps. Antiperistaltic cecorectal anastomosis is one of the possible techniques. Still, this type of pouch formation is described mostly in slow-transit constipation surgical management. We report on a patient with synchronous colorectal cancer who underwent extended left colectomy. In the case of compromised vessel anatomy, it was decided to perform antiperistaltic cecorectal anastomosis. We present all clinical and intraoperative patient's data, determining the surgical tactics, and short-term postoperative results. An antiperistaltic cecorectal anastomosis can be considered in nonstandard clinical cases and variable anatomy of the patient.
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http://dx.doi.org/10.1159/000508266DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7443643PMC
July 2020

3D-printed pubic bone for pelvic ring reconstruction after exenteration for anal cancer recurrence.

Br J Surg 2020 10 26;107(11):e512-e514. Epub 2020 Aug 26.

I.M. Sechenov First Moscow State Medical University (Sechenov University), Clinic of Coloproctology and Minimally Invasive Surgery, Moscow, Russia.

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http://dx.doi.org/10.1002/bjs.11982DOI Listing
October 2020

"Multi-faceted" COVID-19: Russian experience.

Br J Surg 2020 Oct 21;107(11):e479-e480. Epub 2020 Aug 21.

I.M. Sechenov First Moscow State Medical University (Sechenov University), Clinic of Coloproctology and Minimally Invasive Surgery, Moscow, Russia.

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http://dx.doi.org/10.1002/bjs.11940DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7461231PMC
October 2020

Surgical Treatment of Sacral Chordoma: The Role of Laparoscopy.

Case Rep Oncol 2020 Jan-Apr;13(1):255-260. Epub 2020 Mar 24.

I.M. Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russian Federation.

Sacral chordoma is a rare tumour that represents the most common malignancy of the sacral region. Its diagnosis can be delayed because of unclear clinical manifestation. This tumour can involve surrounding anatomical structure such as the rectum, and its surgical treatment is still challenging. We report on 3 patients with sacral chordoma. Two of them were successfully treated using a laparoscopic approach and one by open surgery. We present all details of the surgical technique and patients' outcome. Minimally invasive methods in the surgical treatment of chordoma allow to perform a radical dissection of the tumour, minimizing the operative trauma. A laparoscopic approach can be considered safe and radical for sacral chordoma treatment.
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http://dx.doi.org/10.1159/000506441DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7154265PMC
March 2020

Classifications and Clinical Assessment of Haemorrhoids: The Proctologist's Corner.

Rev Recent Clin Trials 2021 ;16(1):10-16

Department of Emergency and Organ Transplantation, University "Aldo Moro" of Bari, Bari, Italy.

Background: Haemorrhoidal disease (HD) is a benign condition affecting a considerable part of adult population. HD can be considered a social and economic burden with high impact on patients' lifestyle. Several new techniques and devices have been proposed for HD treatment; however, preoperative assessment is essential and the use of classification system is recommended.

Methods: In the last two decades many studies described the preoperative assessment and several attempts of classification for HD. This review focuses on the most relevant studies found in literature where classification systems and clinical evaluation with differential diagnosis have been evaluated.

Results: The knowledge of classification systems and differential diagnosis for HD has been shown to play a central role in the clinical assessment and the best treatment choice. Although there are new challenging techniques and devices for HD treatment, a preoperative assessment is always mandatory.

Conclusion: Preoperative clinical evaluation is essential for HD patient treatment and outcome. Classification systems are useful for the therapeutic choice and researches on new medical or surgical treatments. In fact, the international guidelines advise several therapeutic options depending on the severity of the HD.
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http://dx.doi.org/10.2174/1574887115666200312163940DOI Listing
January 2021

International consensus on natural orifice specimen extraction surgery (NOSES) for gastric cancer (2019).

Gastroenterol Rep (Oxf) 2020 Feb 24;8(1):5-10. Epub 2020 Jan 24.

Department of Gastric Cancer, Tianjin Medical University Cancer Institute & Hospital, Tianjin, P. R. China.

At present, natural orifice specimen extraction surgery (NOSES) has attracted more and more attention worldwide, because of its great advantages including minimal cutaneous trauma and post-operative pain, fast post-operative recovery, short hospital stay, and positive psychological impact. However, NOSES for the treatment of gastric cancer (GC) is still in its infancy, and there is great potential to improve its theoretical system and clinical practice. Especially, several key points including oncological outcomes, bacteriological concerns, indication selection, and standardized surgical procedures are raised with this innovative technique. Therefore, it is necessary to achieve an international consensus to regulate the implementation of GC-NOSES, which is of great significance for healthy and orderly development of NOSES worldwide.
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http://dx.doi.org/10.1093/gastro/goz067DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7034234PMC
February 2020

Three-plane Model to Standardize Laparoscopic Right Hemicolectomy with Extended D3 Lymph Node Dissection.

Surg Technol Int 2020 May;36:136-142

Minimally Invasive Surgery, Department of Surgery, Clinic of Colorectal and Minimally Invasive Surgery, I.M. Sechenov First Moscow State Medical, University, Moscow, Russia.

Aim: The purposes of this study were to create a "three-plane model" for laparoscopic right hemicolectomy and to compare short-term outcomes of anterior medial-to-lateral (aM-to-L) and caudal-to-cranial access by retroperitoneal tunneling (Ca-to-Cr), as described based on the three-plane model.

Methods: A three-plane model was developed to clarify the steps of an operation. Consecutive cases of right colon cancer were operated upon with an aM-to-L approach in the earlier period and then with a Ca-to-Cr approach, and postoperative outcomes were evaluated. Short-term results were compared.

Results: Sixty-two patients were divided into aM-to-L (n=29) and Ca-to-Cr (n=33) groups. The two groups did not differ in terms of the patients' baseline characteristics. Median operative time was 220 min (IQR 190-260) for the aM-to-L group and 222.5 min (IQR 180-255) for the Ca-to-Cr group (p=0.73). Estimated blood loss was similar in both groups (p=0.13). Median length of hospital stay was 6 days (IQR 5-8) in the aM-to-L group and 7 days (IQR 6-9) in the Ca-to-Cr group (p=0.17). Median number of harvested lymph nodes was 45.5 (IQR 25-44.9) in the aM-to-L group and 30 (IQR 18-48.5) in the Ca-to-Cr group (p=0.34).

Conclusion: The approach used to reach the superior mesenteric vessels for laparoscopic right hemicolectomy with D3 lymph node dissection does not affect the short-term outcome of the operation. The present three-plane model gives surgeons additional insight to perform this operation.
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May 2020

Perforation of cecum caused by chicken bone under the guise of Crohn's disease.

N Z Med J 2019 10 4;132(1503):100-102. Epub 2019 Oct 4.

Resident, Gastroenterologist, Department of Gastroenterology, Sechenov University, Russia.

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October 2019

A Multicenter Study Evaluating Natural Orifice Specimen Extraction Surgery for Rectal Cancer.

J Surg Res 2019 11 20;243:236-241. Epub 2019 Jun 20.

Department of Colorectal Surgery, National Cancer Center, National Clinical Research Center for Cancer, Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China. Electronic address:

Background: Low anterior resections are increasingly performed laparoscopically for rectal cancer. Recently, natural orifice specimen extraction surgery (NOSES) has been reported as an alternative approach without additional incisions or extensions. In this study, we aimed to evaluate the safety and feasibility of NOSES by comparing the short-term outcomes with those of conventional laparoscopic resection (CLR) in a multicenter retrospective study from China and Russia.

Methods: The retrospective multicenter study was conducted at three centers between January 2015 and December 2017. Relevant collected data included patient demographics, operative parameters, and postoperative complications. All procedures were performed using either a NOSES or a CLR approach.

Results: The data of a total of 768 consecutive patients with rectal cancer were retrospectively analyzed, including 412 CLR and 356 NOSES cases. The two groups were comparable for all demographics and characteristics except for the median tumor size (P = 0.038). No difference was found in the operative time and number of retrieved lymph nodes. Intraoperative complications and positive resection margins were nil in both groups. No difference was found in the time to first flatus (P = 0.150), time to first defecation (P = 0.084), length of postoperative hospital stay (P = 0.152), anastomotic leakage (P = 0.377), and intra-abdominal abscess (P = NA). The CLR group but not the NOSES group had incisional hernia or wound infection events, although the difference between groups was not significant (P = 0.253).

Conclusions: The NOSES procedure is a well-established strategy and may be considered as an alternative procedure to CLR for rectal cancer. However, the long-term benefits of this approach require further evaluation.
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http://dx.doi.org/10.1016/j.jss.2019.05.034DOI Listing
November 2019

International consensus on natural orifice specimen extraction surgery (NOSES) for colorectal cancer.

Gastroenterol Rep (Oxf) 2019 Feb 23;7(1):24-31. Epub 2019 Jan 23.

Department of General Surgery, The Second Xiangya Hospital, Central South University, Changsha, China.

In recent years, natural orifice specimen extraction surgery (NOSES) in the treatment of colorectal cancer has attracted widespread attention. The potential benefits of NOSES including reduction in postoperative pain and wound complications, less use of postoperative analgesic, faster recovery of bowel function, shorter length of hospital stay, better cosmetic and psychological effect have been described in colorectal surgery. Despite significant decrease in surgical trauma of NOSES have been observed, the potential pitfalls of this technique have been demonstrated. Particularly, several issues including bacteriological concerns, oncological outcomes and patient selection are raised with this new technique. Therefore, it is urgent and necessary to reach a consensus as an industry guideline to standardize the implementation of NOSES in colorectal surgery. After three rounds of discussion by all members of the International Alliance of NOSES, the consensus is finally completed, which is also of great significance to the long-term progress of NOSES worldwide.
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http://dx.doi.org/10.1093/gastro/goy055DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6375350PMC
February 2019
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