MRI­based neoadjuvant therapy indication in middle and low rectal cancer.

OBJECTIVE: The aim of this study was to evaluate the indication of neoadjuvant therapy in patients with middle and low rectal cancer based on MRI examination. BACKGROUND: In spite of noticeable advances in the diagnosis of rectal cancer, the optimal treatment remains highly debated. Current guidelines advise the use of neoadjuvant therapy in UICC stage II patients or higher. However, in clinical praxis, there is gradual implementation of new criterions and variables used in rectal cancer stage evaluation, the fact of which influences the treatment choice. The most important emerging variables taken currently into account are the distance from mesorectal fascia, circumferential resection margin, extramural venous invasion and intersphincteric plane, all of which can be evaluated using the MRI examination. METHODS: The accuracy of MRI staging was compared with definite histopathological results from resected tumors. Patient data were prospectively collected between the years 2013 and 2018 at 3rd Surgical Clinic, Faculty of Medicine, Comenius University in Bratislava, Slovakia. Data from 101 patients were gathered and divided into two groups, according to the localization of tumor within rectum, while 9 patients were excluded from the study because of benign lesion diagnosis based upon final histopathologic evaluation. RESULTS: In 92 evaluated patients, no significant change was noted between MRI and histopathological T-staging. However, in N-staging, significant differences were noted between preoperative MRI staging and postoperative histopathological staging. CONCLUSION: The results of this study demonstrate inefficient preoperative lymph node staging, suggesting overtreatment of rectal cancer patients. Although the use of neoadjuvant therapy has led to great advances in modern cancer treatment, it is connected with a number of side effects and therefore should be indicated only for patients who can benefit from this treatment (Tab. 1, Fig. 3, Ref. 16).

[Optimal timing of laparoscopic cholecystectomy in treatment of acute cholecystitis]. / Optimálne nacasovanie laparoskopickej cholecystektómie v liecbe akútnej cholecystitídy.

INTRODUCTION: Acute cholecystitis is one of the most frequent diseases occurring in developed countries of the world. Laparoscopic cholecystectomy is a treatment option for acute cholecystitis. Since the advent of laparoscopic cholecystectomy there has been a lack of agreement regarding the timing of the operation in the treatment of acute cholecystitis. METHOD: From September 2012 to August 2015 we carried out a prospective randomized trial at the IIIrd Surgical Department of University Hospital Milosrdní bratia in Bratislava. We compared two basic approaches to the treatment of acute cholecystitis. During the trial, 64 patients with acute cholecystitis were admitted to the surgery department. 32 patients were treated with early laparoscopic cholecystectomy within 72 hours from the appearance of the symptoms. The other 32 patients were primarily treated with antibiotics and subsequently underwent delayed cholecystectomy after 68 weeks. RESULTS: Our results suggest several advantages of early laparoscopic cholecystectomy such as shorter operation time, lower conversion rate, shorter length of hospital stay, shorter postoperative convalescence and lower cost of hospitalisation. CONCLUSION: Based on these results we believe that immediate laparoscopic cholecystectomy (within 24 hours from the patients admission to hospital) should become a preferred method of treatment of patients with acute cholecystitis. KEY WORDS: acute cholecystectomy early and delayed laparoscopic cholecystectomy prospective randomized trial.

Laparoscopic versus open appendectomy in treatment of acute appendicitis.

INTRODUCTION: The authors present the results of a retrospective study comparing the laparoscopic and open procedures of appendectomy for the diagnosis of acute appendicitis.Material and methods. Retrospective analysis of the results of both methods on a set of 161 patients in period 2006-2010. RESULTS: Regarding the intraabdominal complications and hospitalization periods, results confirm the equivalence of both methods. A significantly lower incidence of wound complications as well as shorter hospital stay were experienced in the laparoscopy-treated group of patients. CONCLUSION: Based on the results of this study, the laparotomic appendectomy would be reserved for appendicitis with diffuse peritonitis. The laparoscopy is positively preferred in obese patients (Tab. 3, Ref. 16).

Thymic tumours associated with Myasthenia gravis: a long term observation study of operated patients.

Primary tumours of thymus, thymoma and thymic carcinoma, are very rare, they represent less than 1 % of all neoplasms. The most common manifestation of thymoma with appearance of 40 to 50 % of the neuromuscular autoimmune disease is myasthenia gravis (MG). The performance of a complete resection is the most predictive indicator for long-term survival of patients with thymic tumour, also important prognostic factors are the histological type of thymic tumour and its invasiveness. The aim of our study is to study the long-term survival of patients after the resection of the tumour, as well as enhanced efficiency of radical thymectomy in the complex treatment of myasthenia gravis. From 1989 to 2010 we operated on 369 patients with MG. Out of 49 patients (13.7 %) 38 cases (76.6 %) were thymomas and 11 cases (23.4 %) thymic carcinomas. Complete removal of tumours (stage I, II, and III) were performed in 45 (92 %) cases. Of the 41 living patients (83.7 %), three (7.3 %) were diagnosed with metastatic thymic carcinoma or thymoma, and treated with adjuvant therapy. In one case, the patient died due to generalization of the thymic carcinoma. Statistical analysis with Kaplan-Meier method showed better overall survival of patients with thymoma than patients with thymic carcinoma. The difference in survival curves was not significant. (Mantel-Cox p = 0.479, Generalized Wilcoxon p = 0.326). In terms of treatment of Myasthenia gravis associated with thymoma, we achieved 70 % successful clinical and pharmacological remission. On the other hand, paraneoplastic MGAT has the worst prognosis of all the other forms of MG. The difference between MGAT to every other form of MG was statistically significant (Tab. 6, Fig. 1,Ref. 28).

[Laparoscopic repair of incisional hernias - our first experience]. / Laparoskopická plastika hernií v jazve po laparotómii - nase prvé skúsenosti.

INTRODUCTION: The authors present their first experience with the laparscopic hernioplasty of the incisional hernias appearing after laparotomy. MATERIAL AND METHODS: In the period from January 2008 to June 2012, 29 patients underwent hernioplasty by the IPOM technique (Intra Peritoneal Onlay Mesh) using Teflon mesh. The patients were followed up prospectively for the mean time of 29 months. The mean age of the patients was 57 years, the average size of the hernias was 6.5 cm, and the average time of the operation was 75 minutes. RESULTS: In the early postoperative period in 3 patients (11%) occurred pseudoperitonitis caused by the irritation of the peritoneum in the area of the attached mesh. In one patient (3%) severe paralytic ileus developed, and 22 patients experienced seroma in the left hernial sac. All seroma was absorbed except for one patient. In the mentioned case, seroma absorbed completely after repeated aspiration within 3 months. During the period of follow-up no patient showed any signs of recurrence. CONCLUSION: Since the first method of choice in the treament of incisional hernias after laparotomies is still unclear, laparoscopic repair seems to be a promising option. Results of laparoscopic repair are comparable with the conventional hernioplasty using mesh.

[Relapsing urinary tract infections as a single symptom of a foreign body within the GIT in a diverticulosis patient]. / Recidivujúce infekcie mocových ciest ako jediný príznak cudzieho telesa gatrointestinálneho traktu pri divertikulóze.

Recidiving urinary tract infections and pneumaturia are the cardinal symptoms of colovesical fistula. The authors present a case of rare complication of diverticulosis and gastrointestinal foreign body, that only had urological symptomatology.

Surgical treatment of pulmonary metastases in germ-cell testicular cancer patients--long-term results.

OBJECTIVES: The aim of this prospective clinical study is to evaluate our 20-year experience with surgical treatment of pulmonary metastases in germ-cell testicular cancer and discuss the optimal therapeutical approach. BACKGROUND: Authors presents 63 patients who were surgically treated in the period from 1988 to 2008 for pulmonary metastases in germ cell testicular cancer. All patients were allocated for surgical treatment after undergoing cisplatin-based combination chemotherapy. METHODS: In a group of 63 patients, 57 thoracotomias and 27 sternotomias were performed. In pulmonary procedures small atypical resections prevailed--84%. Postoperative mortality was 1.2%. Decision for follow-up treatment was made on basis of histological investigation of metastases. In some cases when viable tumor tissue was found (16% patients), further chemotherapy was administered. The rest of patients were monitored intensively. RESULTS: In a long-term follow-up, remission was achieved in almost 60% of patients. CONCLUSION: We suggest that lung metastasectomy as the secondary treatment in generalized germ cell testicular cancer should be fully warranted (Fig. 3, Ref. 16). Full Text (Free, PDF) www.bmj.sk.

[Long-term results of surgical treatment of pulmonary metastases in germ cell testicular cancer patients]. / Dlhodobé výsledky chirurgickej liecby pl'úcnych metastáz u pacientov s germinatívnymi nádormi testis.

BACKGROUND: Lung metastasectomy as a treatment option in pulmonary metastases has been discussed for a long time.Testicular cancer belongs to a group of tumours primarily treated with chemotherapy because of the high efficacy of anticancer chemotherapy. Surgical treatment plays only a secondary role in the removal of residual pulmonary metastases. Decision-making in the treatment of pulmonary metastases requires histological investigation.The aim of this prospective clinical study is to evaluate 20 years of experience with the surgical treatment of pulmonary metastases in germ-cell testicular cancer. PATIENTS AND METHODS: In the period 1988-2008, 63 patients were surgically treated for residual pulmonary metastases of testicular germ-cell tumours. All of the patients were indicated for surgery--pulmonary metastasectomy after the anticancer chemotherapy had been carried out.The survival rate of patients was evaluated according to the Kaplan-Meier method. RESULTS: In total, 57 thoracotomies and 27 sternotomies were performed. 9 patients underwent repeated thoracotomy due to recurrent metastases. In the case of primary resection of pulmonary metastases, minor procedures dominated--atypical partial resections were performed in 84% of all patients. Postoperative mortality was 1.2%. The histological result of metastasis determined a further procedure. Patients in whom vital tumorous tissue was detected (16% of patients) were subsequently treated by second-line chemotherapy, while the rest of the patients were strictly followed-up. In long-term survival, where the mean duration of follow-up was 8.9 years, an almost 60% remission rate was achieved. CONCLUSION: Based on the long-term results, the authors consider surgical treatment of pulmonary metastases of testicular germ-cell tumours as the treatment fully indicated.

[Ventral hernia associated with morbid obesity--when is surgery indicated?]. / Ventrálna hernia spojená s morbídnou obezitou--kedy operovat'?

The authors refer results of surgical treatment of incarcerated ventral hernias in patients with morbid obesity. In the 3rd Department of Surgery of the Comenius University Medical Faculty in Bratislava, 4 obese patients (BMI over 40) were operated for incarcerated ventral hernias in 2007. Based on a follow up analysis, the authors recommend a proactive approach to elective surgical therapy.

[Scar hernia repairs using a mesh--the sublay technique]. / Operácie hernií v jazve pomocou siet'ky--technikou sublay.

In this work, the authors evaluated a group of patients operated on the III. Surgery Clinic FNsP MB in 2004 to 2006 for incisional hernias using the sublay technique--he mesh is implanted preperitoneally and covered by the fascia. The evaluation was done using a questionnaire, with a return rate of 65.5%. After an average of 24.8 months, 8.3% of patients report recurrence. Based on this data we further use this technique, but put more emphasis on minimalizing postoperative complications. From today's perspective, we consider retromuscular hernia repair using a mesh to be a standard procedure in incisional hernia management with best results in preventing recurrences.

[Laparoscopic appendectomy in acute appendicitis]. / Laparoskopická apendektómia pre akútnu apendicitídu.

Laparoscopic appendectomy has not yet become a stable part of surgical armamentary as has laparoscopic cholecystectomy. The authors on the basis of their own experience show its benefit for the surgeon and for the patient. The conversion rate (7.7%) in the study group is comparable with literature data. The indication for operation was always periappendical mass, in combination with retroceocal position of the appendix. Minimum complication rate in the study group (one case of subfebrile fever in 5 days), very good overview in operation field with the possibility to treat also another pathologic findings concern the authors together with short hospital stay a clear advantages of laparoscopic appendectomy. On the basis of this experience their advocate the routine use of this operation. (Ref. 19.)