Extent of surgical procedure in triple negative breast carcinomas.

INTRODUCTION: Triple negative breast carcinomas (TNBC) account for approximately 15-20% of all breast carcinomas. This subtype is characterised by an unfavourable prognosis with early locoregional recurrence a metastases. Only few studies have focused on the impact of local surgery on the overall therapeutic outcome. However, decisions are difficult to make in the case of TNBC, and no particular molecular subtype or marker exists that would make the decision-making process easier. The aim of our retrospective study was to analyse the TNBC surgical management outcomes at EUC Clinic in Zlin. METHODS: 440 women with breast carcinoma were operated on at EUC Clinic from 2014 to 2016, including 29 patients with TNBC; bilateral carcinoma was present in one case. Neoadjuvant chemotherapy (NAC) was indicated in 6 cases. The tumour centre was marked with a clip. The extent of surgery depended on the residual size of the tumour. Sentinel lymph node biopsy was indicated in clinically negative lymph nodes; further management followed the Z0011 study if the biopsy was positive. Axillary lymph node dissection was performed after NAC. In all cases, surgery was followed by systemic chemotherapy, and by radiotherapy in the case of breast-conserving procedures. RESULTS: The group included 29 women and one patient with bilateral carcinoma, i.e. 30 cases of TNBC. Mean age was 57 years and median age was 55.5 years. Mean follow-up was 62.9 months, with the median of 69.9 month. NAC was indicated in 6 patients; complete pathological response was achieved in one case. NAC was followed by mastectomy in 5 cases including a bilateral procedure in one case, and by breast-conserving surgery in one case. Axillary dissection was performed in all cases. Breast-conserving surgery and sentinel node biopsy predominated in the group (16 cases). Local recurrence was observed in 4 cases, 2 times as an isolated local recurrence after one year and 2 times as part of generalization, always after mastectomy. Six patients died of generalized disease. No regional recurrence was observed. CONCLUSION: TNBC is characterised by a worse prognosis and a higher rate of local recurrence. As confirmed by our study, the results of breast-conserving surgery can be comparable to those of radical procedures, and thus radical surgery should be indicated prudently.

Ductal carcinoma in situ and the extent of surgery.

INTRODUCTION: Ductal carcinoma in situ (DCIS) is a very heterogenous disease. The incidence of DCIS has been increasing with the adoption of mammography screening. This opened new questions concerning surgical and adjuvant therapy.  Methods: We retrospectively observed the incidence of DCIS amongst the patients that underwent surgical resection in EUC clinic Zlín between 2017 and 2019. We also assessed the extent of breast surgery including interventions in axilla and the adjuvant therapy.  Results: There were 616 breast cancer patients, of whom 44 (7.1%) were diagnosed with DCIS. Breast-conserving surgery was performed in 35 (80%) patients. Lumpectomy alone was performed in 21 (47%) patients. Mastectomy was indicated primarily in 9 cases with additional two mastectomies performed to achieve clear margins. All sentinel nodes were negative.  Conclusion: Results confirmed, that the surgical therapy as well as radiotherapy and hormonal treatment are performed according to guidelines at our department. Proportion of sentinel node biopsy is remarkably higher, therefore an improvement in this area is our next goal.

Targeted axillary dissection with preoperative tattooing of biopsied positive axillary lymph nodes in breast cancer.

Sentinel lymph node biopsy (SLNB) has emerged as an alternative to axillary lymph node dissection during breast cancer surgery during the last 2 decades. However, there are several controversies regarding the indication of the sentinel node biopsy after neoadjuvant chemotherapy which can convert positive lymph nodes to negative. The false-negative rate after neoadjuvant chemotherapy is unacceptably high. This high false-negative rate can be decreased by marking of the positive lymph nodes and removal during sentinel lymph node biopsy procedure in addition to the sentinel lymph nodes. The aim of this study was to investigate the possibility of carbon tattooing of the positive sentinel lymph nodes before neoadjuvant chemotherapy. In 2016, a prospective protocol was launched investigating the black carbon tattooing procedure of the suspective and positive axillary lymph nodes by injecting 0.1-0.5 carbon ink in normal saline under ultrasound guidance. All patients underwent black carbon tattooing of the suspected or positive axillary lymph nodes before the chemotherapy or one week before the primary surgery when chemotherapy was not indicated in the neoadjuvant setting. Sentinel lymph nodes together with lymph nodes marked by the black carbon ink were removed and histologically evaluated. So far 27 patients were treated under this protocol. Breast saving surgery was performed in 22 cases and mastectomy in 5 cases. All patients had invasive ductal carcinoma. In 20 patients neoadjuvant chemotherapy was indicated and in 7 patients primary surgery was performed. All lymph nodes marked by black carbon ink were successfully identified and removed. Sentinel lymph node biopsy was performed in 8 cases and sentinel lymph node biopsy followed by axillary dissection in 15 cases. Axillary dissection alone was performed in 4 cases. In 19 cases, the black carbon ink was present in the sentinel lymph node at the same time and in 4 cases carbon dye was present in other lymph nodes than the lymph node identified during SLNB, which corresponds to 17.4%. In the group of patients undergoing primary surgery, in one case from six, the sentinel lymph node was negative and the lymph node marked with carbon ink positive which represents false-negative lymph node and failure of the SLNB procedure. After neoadjuvant chemotherapy, there was no false-negative lymph node identified, but the conversion of the positive lymph nodes to negative was present in 10 cases (50%). There were no complications attributed to carbon ink tattooing. The results of positive sentinel lymph nodes tattooing have confirmed that this method is safe and allows a decrease in the false negativity rate during the sentinel node biopsy procedure.

Surgical treatment of breast carcinoma after neoadjuvant therapy.

INTRODUCTION: Neoadjuvant therapy (NT) applied before breast cancer surgery can lead in favourable cases to regression of the tumor or its total disappearance - pathological complete response (pCR). Due to downstaging after NT, the extent of the surgery can be reduced. pCR represents an important prognostic factor for survival. The aim of this study was to evaluate the effectiveness of NT resulting in pCR on our sample of patients and to assess the frequency of locoregional recurrence (LRR) depending on the extent of the surgery in postoperative care. METHODS: This retrospective study was performed on a sample of 96 patients who underwent breast cancer surgery between 2006 and 2018 after previous NT. On the basis of the histological examination after surgery we evaluated the degree of regression and thus also pCR. In postoperative care we followed the patients for any occurrence of LRR in the breast and axilla. RESULTS: pCR (Chevallier 1) was observed in 26 cases - 27.1%. During follow-up in postoperative care, 8 cases of LRR occurred - 8.3% (5.2% after mastectomy and 2.1% after breast-conserving surgery). Mean follow-up was almost 30 months with the median of 26.5 months. CONCLUSION: With the development of new NT procedures a significant rise in pCR has occurred, predominantly in HER 2+ and triple negative subtypes, thus leading to a decreased incidence of LRR. The number of breast-conserving surgeries with sentinel lymph node biopsy is rising. In a select group of patients breast-conserving surgery is safe and is associated with a low number of LRR events.

Papillary thyroid microcarcinoma and papillary thyreoid cancer at the Department of Surgery, EUC Clinic Zlín.

INTRODUCTION: Papillary thyroid cancer (PTC), especially micropapillary variant (MPTC), is the most common thyroid malignancy. Biological behavior is not aggressive and the patients prognosis is satisfactory. The objective of our comparative retrospective study was to evaluate whether the incidence is rising in the Region of Zlín and if less extensive approach was adopted by Czech endocrinologists. METHODS: We compared 2 groups from years 2005-2008 and 2014-2018. The incidence of thyroid cancer, the PTC and the MPTC, the extent of the surgery and the lymphadenectomy, number of removed lymph nodes and the number of positive lymph nodes were observed. RESULTS: We gathered 1353 patients in group 1. We found 220 malignancies (16.3%), 180 (81.8%) were PTC with MPTC variant in 44.4% (80 patients). All patients underwent a total thyroidectomy. We made 18 central and 10 lateral lymphadenectomies, 280 lymph nodes were collected with meta-stasis in 29,3 %. In group 2 with 1569 patients we found 318 (20.3%) carcinomas, PTC in 302 (94.6%) cases. The MPTC accounted for 215 (67.4%) cases. 10 patients with MPTC underwent hemithyroidectomy only. Numbers of central and lateral lymphadenectomies rose to 52 and 24 respectively. We gathered 376 lymph nodes with proven metastasis in 44.4% of these nodes. CONCLUSION: Both, the incidence and the frequency of PTC and MPTC are rising in our region. However, the number of less invasive procedures is not increasing significantly despite representing a sufficient way of treatment. We need wider adoption of these evidence-based recommendations by indicating endocrinologists in the Czech Republic.

Bipolar radiofrequency-induced thermotherapy of haemorrhoids: a 10-year experience.

INTRODUCTION: Bipolar radiofrequency-induced thermotherapy of advanced stage haemorrhoid disease has been used successfully at the Atlas Hospital in Zlin for ten years. The aim of this study was to evaluate long-term outcomes of the method. METHOD: RFITTH is bipolar radiofrequency-induced thermotherapy of haemorrhoidal diseases. High frequency electric current causes thermal coagulation of tissue. The procedure results in the elimination or significant reduction of prolapse and bleeding of hemorrhoids. RESULTS: 228 RFITTH procedures were performed in 217 patients at the Department of Surgery at the Atlas Hospital from 9/2007 to 1/2017. The group consisted of 134 men and 94 women, the average age was 51 years. 107 operations were performed in stage III and 121 in stage IV. Complications of the procedure involved postoperative fissure occurring in 20 patients (8.7 %). Thrombotic haemorrhoid developed in 6 patients (2.6 %), hyperspasm of the sphincters in 9 patients (3.9 %). Prolapse of the rectal mucosa was diagnosed in 4 patients (1.7 %). The disease recurred in 9 patients and 10 reoperations were performed (3.9 %). CONCLUSION: The method is a safe miniinvasive therapeutic option for advanced stage haemorrhoidal disease. Key words: RFITTH - haemorrhoidal disease - radiofrequency coagulation.

[Is it possible to avoid axillary dissection?] / Muzeme se vyhnout disekci axilárních lymfatických uzlin?

The essential aim of oncology surgery including breast cancer is to remove the malignant tumour and lymph nodes. For many decades, dissection of axillary lymph nodes has been a common part of mastectomy, virtually the only surgical procedure in breast cancer treatment until the 90ies of the previous century. Although mastectomy has been replaced with breast preserving procedures, axillary dissection remained an integral part of the surgery. Sentinel lymph node biopsy (SLNB) has introduced a revolutionary change in breast cancer treatment in the axilla, replacing dissection in clinically negative axillary nodes. As a result, the number of radical procedures in the axilla was significantly limited, as well as the incidence of serious complications that may have a negative impact on the quality of life of the patients. As shown by other studies, the number of dissections can be reduced even further. Subsequent axillary dissection is unnecessary where the sentinel nodes contain only malignant cells, micrometastases and even a limited number of macrometastases. SLNB can also be used in a selected group of patients after neoadjuvant chemotherapy.Key words: breast carcinoma - axillary dissection - sentinel lymph node - micrometastases - macrometastases.

[Microscopic tumor cells in re-excision tissue by conservative surgery in breast cancer]. / Mikroskopické nádorové reziduum v reexcidované tkáni po konzervativních výkonech na prsu pro karcinom.

INTRODUCTION: Conservative procedures in early breast carcinoma are a safe alternative to mastectomy. The resection line is controversial, as well as the presence of residual malignant cells in the breast after excision and their influence on local recurrence. The aim of the study was to assess the presence of residual cells in re-excised tissues near positive resection lines, in the distance up to 2 mm, and 2-5 mm. The distance of more than 5 mm was evaluated as free margin. METHOD: All patients operated on in Atlas Hospital from 2004 to 2008 using conservative surgery were included in study. The resection line and the presence of residual malignant cells were followed in positive margins and in the distance of the resection line from the tumour up to 2 mm, and 2-5 mm. RESULTS: The conservative procedure was indicated 330 times, and 78 patients were re-operated for insufficiently free margins. The conservative procedure was completed 311 times, and mastectomy was done as the final procedure in 19 cases. Positive resection line was found 10 times. Distance up to 2 mm occurred 12 times and 25 mm 56 times. In all re-operated patients, presence of malignant cells in the re-excised tissue was found 31 times (39.7%). Repeated surgery for positive line, i.e. tumour present in the resection line, was done 10 times while malignant cells were found in all patients; for the distance up 2 mm, repeated surgery was done 12 times and 3 cases were positive (25%). For the distance of 2-5 mm, repeated excision occurred 56 times and 18 cases were positive, i.e. 32.1%. CONCLUSION: For the resection line "no tumour in contact with ink", presence of malignant cells in breast tissue must be expected in one third of the cases.Key words: breast carcinoma - conservative surgery - residual malignant cells.

Severe hidradenitis suppurativa.

INTRODUCTION: Hidradenitis suppurativa is a chronic, recurrent inflammatory disease causing significant changes and damage to skin. Predilection sites are the axilla and the anogenital region. Chronic and severe forms of the diseases may cause both physical and psychological injury to the patient. PATIENTS: We present the cases of two female patients with severe hidradenitis suppurativa in the axillae and in the anogenital region. The patients had been unsuccessfully treated for eight and four years respectively with antibiotics and by limited surgery. Different methods of closing the defects following radical surgical excision (local flap reconstruction, healing by granulation) had to be used with respect to the extent of the disease and the site of involved skin. CONCLUSION: Radical wide excision of the skin area involved is the only appropriate surgical procedure which prevents recurrence of the disease. Selection of the therapeutic method must be done very carefully with respect to the individual characteristics of the disease and the patients attitude to therapy.

Correlation among the BRAF gene mutation status, clinicopathological features of primary tumour, and lymph node metastasizing of papillary thyroid carcinoma.

BACKGROUND: Papillary thyroid carcinoma (PTC) is the most common malignant thyroid tumour. A common mutation of papillary thyroid carcinoma (PTC) is the somatic mutation of the BRAF (V600E) gene. AIM: The aim was to 1) determine the association of lymph node metastases of PTC with the BRAF gene mutation of primary tumour; 2) evaluate association of the BRAF mutation in the -primary tumour with clinicopathological para-meters; 3) examine the extent of genetic heterogeneity by monitoring the BRAF mutation in multicentric tumours. SUBJECTS AND METHODS: Retrospective analysis of the BRAF (V600E) mutation in PTC and PTC neck lymph node metastases in 156 patients operated from 2003 to 2012 in Prague and Zlín, the Czech Republic, using a qPCR assay. The results were correlated with clinicopathological factors. RESULTS: DNA was successfully extracted from 137 samples. The BRAF (V600E) mutation was detected in 78 cases (56.9%). The patients with BRAF p.Val600Glu mutation of primary tumour had only non-significantly higher risk of cervical lymph node metastases [OR=2.39 (95%) CI 1.00-5.75, p=0.052]. In the classic papillary variant, the BRAF (V600E) mutation was found significantly more often than in other PTC subtypes (p=0.022). We did not confirm any significant association between the BRAF (V600E) mutation and other clinicopathological findings. CONCLUSION: Except for the higher prevalence in papillary variant of PTC, BRAF p.Val600Glu mutation was not associated with other prognostic clinicopathological factors of PTC. BRAF mutation cannot be regarded as a reliable marker of node metastases in patients with PTC.

[Is thyroid and parathyroid surgery safe? Is it suitable for one-day surgery?]. / Je chirurgie stítné zlázy a prístítných telísek opravdu bezpecná? Je vhodná pro jednodenní chirurgii?

INTRODUCTION: Thyroid and parathyroid surgery is regarded as a safe procedure with minimal complications, especially in high-volume centres. This fact increases the demand to perform thyroid surgery as an outpatient procedure or as a short-stay procedure in selected patients. MATERIAL AND METHODS: From 1995 to 2012, 5346 patients underwent thyroid surgery in the surgical ward of the Atlas Hospital. In a retrospective study we focused on complications that have occurred since 2008 in 1943 patients, especially postoperative hematoma and recurrent nerve palsy, comparing their number with literary data. RESULTS: Postoperative hematoma was diagnosed and revised in 22 cases, that is, in 1.1%. Potentially life-threatening postoperative hematoma, however, occurred also as late as 24 hours after surgery. All these cases were evaluated as emergency situations requiring urgent surgical revision. Definitive unilateral recurrent nerve palsy was diagnosed 15 times, i.e. in 0.77% of patients with complications, and, out of 2633 cases of "nerve at risk", in 0. 56%. Death has occurred in only two patients since 1995. Both of them were elderly and had serious comorbidities. All the other complications were not acute and could also have been managed in an outpatient procedure. CONCLUSION: The number of postoperative complications in the surgical ward of the Atlas Hospital in Zlín in thyroid surgery was similar to literature data, including the time of their occurrence. Outpatient and short-stay hospital procedure can be performed only in a strictly selected group of the patients.

[Minimally invasive video-assisted parathyroidectomy (MIVAP) using primary hyperparathyroidism therapy (pHPT)]. / Miniinvazivní videoasistovaná paratyreoidektomie (MIVAP) v terapii primární hyperparatyreózy (pHPT).

INTRODUCTION: Primary hyperparathyroidism (pHPT) is a general calcium, phosphate and bone metabolism malfunction due to increased secretion of the parathyroid hormone over a substantial period of time. Causal treatment is a surgical procedure - parathyroidectomy. MATERIAL AND METHODS: A retrospective study of patients who underwent surgery was conducted in the department of surgery at the Atlas Hospital in Zlín between 2005 and 2011. In this period, 2555 patients were operated on for thyroid and parathyroid gland disease. 182 of these patients (7.1%) had hyperparathyroidism. There were 80 standard parathyroidectomies, 82 MIVAPs and 20 MIRPs (minimally invasive radio-guided parathyroidectomy). RESULTS: In the study, 82 patients were operated on using the MIVAP technique. 78 (95.1%) had a parathyroid adenoma, 2 (2.4%) had hyperplasia, 2 (2.4%) had a standard body. Using the MIVAP technique, 75 parathyroid gland adenomas were found in 72 patients, 3 patients (3.6%) had a double adenoma. Conversion was performed in 10 patients (12.2%). During standard revision, an adenoma was found intraparenchymatously in 4 cases (4.9%), in 2 cases the adenoma was removed during standard revision. There was no permanent NRL paresis. 4 patients (4.9%) experienced temporary NLR paresis, MIVAP was successful in 72 patients (87.8%), 6 adenomas were removed during conversion; currently, all these patients have normal levels of calcium and parathyroid hormone. No parathyroid gland adenoma was found in 2 patients (2.4%), nor was it removed using persistent pHPT. 2 patients (2.4%) with hyperplasia are being monitored for their borderline calcium and parathyroid hormone levels. CONCLUSION: MIVAP is a complex endoscopic technique which can achieve 90% success rate in patients with the location of a parathyroid gland adenoma confirmed both by ultrasound and MIBI scanning.

Significance of the resection margin and risk factors for close or positive resection margin in patients undergoing breast-conserving surgery.

PURPOSE: While positive resection margin (RM) in women undergoing breast-conserving surgery (BCS) represents a clear indication for re-resection, there is no unequivocal recommendation regarding the extent of the clear RM. The aim of this study was to define the optimal extent of the RM and the risk factors for close or positive RM. METHODS: Patients scheduled for BCS had diagnosis confirmed before BCS (lumpectomy and quadrantectomy) by core biopsy. Sentinel lymph node biopsy followed BCS, and in case of positive findings axillary lymph node dissection followed. According to RM patients were categorized into 4 groups: 1) Patients with positive RM; 2) Clear RM < 2 mm; 3) Clear RM of 2-5 mm; and 4) RM > 5 mm. In the first 3 groups where re-resection was indicated, the presence of tumor cells in the re-resection specimen was determined. All patients were followed for local recurrence. RESULTS: 330 patients undergoing BCS were studied. Median follow up was 39.6 months (range 12-70). Lumpectomy was performed in 111 cases and quadrantectomy in 219. In 19 cases the final procedure was mastectomy due to the impossibility to achieve negative RM. In 78 cases re-resection followed the primary procedure due to close or positive RM. Clear RM was < 2 mm in 12 cases (15%), 2-5 mm in 56 (72%) and positive margin in 10 (13%). Positive re-resection specimen was detected in 31 cases (39.7%) (in 10 cases with positive RM after primary procedure, in 3 with negative margin < 2 mm and in 18 with 2-5 mm margin). The re-resection rate according to the location of the primary tumor was 77% (n=60) in the upper outer quadrant, 8% (n=6) in the lower outer quadrant, 6% (n=5) in the upper inner quadrant, 4% (n=3) in the lower inner quadrant, and 5% (n=4) in centrally located tumors. Multicentric/ multifocal tumor was diagnosed in 16 cases from which re-resection was indicated in 12 cases (75%). The number of re-resection according to tumor size was as follows: Tis 8 cases (30.7%), T1a none, T1b 14 (20.2%), T1c 34 (22.5%), T2 22 (28%). Re-resection was performed in 8 cases (31%) of ductal carcinoma in situ (DCIS), in 53 (22%) of ductal carcinoma, in 10 (37%) of lobular carcinoma, and in 7 (15%) of other histology. Five cases with local relapse were detected during follow up. CONCLUSION: The generally recommended clear RM of 1-5 mm is not sufficient because of the high number of positive specimens in the case of clear RM of 2-5 mm. The risk factors for close or positive RM are multicentric tumors and upper outer location of the primary tumor. Longer follow up will be needed to analyze local relapse rate according to RM status.

Sentinel node biopsy and neoadjuvant chemotherapy in the treatment of breast cancer.

PURPOSE: Sentinel lymph node biopsy (SLNB) has become a safe and accurate alternative to axillary lymph node dissection (ALND) in the surgical management of early breast cancer. The aim of this study was to determine the false negative rate of SLNB in patients with advanced breast cancer after neoadjuvant chemotherapy. METHODS: Forty-eight patients with 49 advanced breast cancers (one patient had bilateral disease) underwent neoadjuvant chemotherapy. All of them had SLNB, followed by standard level I/II ALND. SLNs were identified in 47 out of 49 tumors (detection rate 95.9%). RESULTS: Axillary nodal metastases were detected in 28 patients; SLNs were positive only in 14 patients. Four sentinel internal mammary nodes were removed in 4 patients, while one of them was positive with micrometastasis but axillary nodes were negative. False-negative results occurred in 2 (7.14%) patients. The results of our study confirm that SLNB in patients with advanced breast cancer is not significantly altered by the preoperative chemotherapy. Biopsy results were very similar to those without any neoadjuvant chemotherapy. CONCLUSION: ALND, known for its serious complications, can be replaced in some cases by SLNB.

[Lymphadenectomy in papillary thyroid cancer]. / Lymfadenektomie u papilárního karcinomu stítné zlázy.

INTRODUCTION: Papillary carcinoma is the most frequent malign tumour of the thyroid with rising incidence and metastasising in lymphatic veins. AIM: Diagnosing our patients and comparing the TNM stages to metastases found in lymphatic nodes. MATERIALS, METHODS: A retrospective study of 1,353 patients treated at our department between 2005 and 2008. RESULTS: 220 (16.3%) malign thyroid tumours have been found among 1,353 patients. Papillary carcinoma has been found in 180 cases, according to the TNM classification T1 mic 80x (44.4%), T1 58x (32.2%), T2 29x (16.1%), T3 8x (4.4%), T4 5x (2.8%). Multifocal incidence of papillary carcinoma has been observed in 42 patients (23.3%). Lymphadenectomy cervicocentral 18x, ipsicervicolateral 52x, contracervicolateral 1x. In total, 351 nodes were removed and 113 nodes had metastasis of papillary carcinoma. 2 patients had permanent paresis of the NLR (1.11%), nerve at risk 0.56%, transitory paresis 5.56%. CONCLUSION: The basic surgical treatment of the thyroid with papillary carcinoma is total thyroidectomy with cervicocentral lymphadenectomy. Ipsilateral lympadenectomy is indicated in the case of nodes found sonographically or tumour size T2.

[Locoregional recurrences after conservative surgery in early breast cancer]. / Lokoregionální recidivy po konzervativních výkonech u casného karcinomu prsu.

INTRODUCTION: Conservative surgery is considered as standard and alternative mastectomy in early stage breast cancer but number of local recurrence is higher. Aim of the study was to detect number of local recurrences after conservative surgery and to identify risk factors of local recurrence especially importance of resection margins. MATERIALS AND METHODS: Local recurrences were evaluated in patients after conservative surgery in early breast cancer at department of surgery Atlas hospital in Zlin between January 2004 and December 2008. T1-2 (only one T3) breast cancers were included in study. Diagnostic biopsy, lumpectomy and quadrantectomy were performed. In all patients axillary nodes were examined. Study guidelines required microscopic distance between resection line and tumor margin 5mm. Specimen after surgery was marked with black ink and from June 2006 with six colors ink. Radiotherapy and chemotherapy in additions to character of cancer followed surgery. RESULTS: Conservative surgery was performed in 330 patients. Mean age was 59 years. Follow-up was 39.6 month. Stage of the tumor: 0 19x, I 101x, IIA 163x, IIB 33x, IIIA 5, IIIB 0, IIIC 9. Lumpectomy was made 11 lx including 11 diagnostic biopsies and quadrantectomy 219x. Final conservative surgery was 331x and mastectomy 19x. Positive axillary nodes were 98x. In breast local recurrence appeared in 5 (3.6%) patients and one had regional recurrence without in breast recurrence. Distant metastases were 8x (2.4%) and ten patient died on primary disease without locoregional recurrence. CONCLUSION: Local recurrence appeared only 5x. Clear margins after breast conserving surgery are very important factor in prevention local recurrence. We recommend keeping 5 mm resection distance.

[Lymphatic mapping and biopsy of sentinel lymph nodes using combined methodology of in vivo application of Patentblue and radionuclide and ex vivo detection of metastatic affection of lymph nodes in colorectal carcinoma]. / Lymfatické mapování a biopsie sentinelových uzlin s pouzitím kombinované metodiky in vivo aplikace Patentblue a radiokoloidu a ex vivo detekce metastatického postizení lymfatických uzlin u kolorektálního karcinomu.

AIM OF THE STUDY: to check the new technique of lymphatic mapping and sentinel node biopsy by colorectal cancer surgery and to improve the lymphatic staging. METHOD: combined technique of lymphatic mapping via Patentblue and the radiocolloid in vivo applied in the rectal cancer surgery. The lymphatic-mapping technique with Patentblue in the colon cancer surgery. Radically or palliative tumour resection. Ex vivo detection of sentinel and non-sentinel lymph nodes in the specimen and their division into peritumoral, intermedial and central level. Serial sectioning examination and immunohistochemistry examination of detected lymph nodes. Statistic process. RESULTS: The methods were used for 107 patients. 1985 lymph nodes were examined, out of which 208 was with metastasis. Positive nodes were detected in 56 patients. In average there were 18.5 nodes per patient. 966 sentinel nodes were detected by colouring and radiocolloid marking. Sentinel nodes showed in 97 patients. In 10 patients, the method failed. In 44 patients, sentinel nodes were positive; 117 positive nodes in total. Skip metastases were detected in 6 percent of the patients. The upstaging of metastatic detection was in 3.7 percent. CONCLUSION: The technique of lymphatic mapping and sentinel node detection significantly increases the number of detected nodes and selects the marks the sentinel ones for further examination. The greatest amount of findings of nodal metastases is in the area closest to the tumour, therefore, when sentinel nodes are negative there, these can be examined more closely, by the method of serial insections or immunohistochemically, and staging of the disease can be made more accurate.

[Local recurrences after conservative surgery in breast carcinoma]. / Lokální recidivy po konzervativních výkonech u karcinomu prsu.

BACKGROUND: Local recurrences in breast after conservative surgery are failure of primary therapy. The aim of the study was monitoring of local recurrences after conservative surgery and also relationships of local recurrences with disease free interval and survival. MATERIALS AND METHODS: Between 1.12.1998 and 30.06.2004, 143 patients with breast carcinoma were treated at Department of Surgery Atlas Hospital Zlin by conservative surgery. All patients received radiotherapy and boost in breast. Macroscopic free margins were 10 mm and reexcision were done in all patients with free margins less than 5 mm. Dose of the radiotherapy whole breast and cavity were 50 Gy, interval 5-6 weeks, daily 2Gy. Brachytherapy received all patients, combination of chemotherapy and hormonal therapy were 56x, only chemotherapy 31x, only hormonal therapy 31x and without adjuvant therapy 25x. RESULTS: Median follow-up was 32 month. Tumor size according to TNM classification: TIS 10, pT1a 1x, pTb 28x, pTc 55x, pT2 44x, pT3 5x. Stage: 0 1x, I 58x, IIA 56x, IIB 24x, IIIA 4x. Local recurrences in breast were 5x, (3.49%), distant metastases 6x, (4.1%) and 3x (2.09%) appeared distant metastases and death at breast carcinoma without local recurrence. Only in one patient local recurrence were followed by distant metastases and death. Interval from local recurrence and death was 12 month. Size of the original tumor with local recurrences was from 10mm to 45 mm. Interval from the time of initial treatment to local recurrences was from 12 to 42 month. Surgical treatment of local recurrences included mastectomy 4x and conservative surgery 1x. CONCLUSION: Number of local recurrences is in correspondence with international guideline and results of modern multimodal therapy.

[Sentinel lymph node biopsy in the breast carcinoma in clinical practice]. / Biopsie sentinelové uzliny u karcinomu prsu v klinické praxi.

AIM: In the management of early breast carcinoma, biopsy of sentinel lymph nodes has gradually replaced dissection of Level I and II axillary nodes. The aim of the study is to assess feasability and reliability of the method in our conditions. METHOD: From June 1998 to June 2007, a total of 458 sentinel node biopsies (SLNB) were performed. Originally, patent blue sentinel node mapping was used. Since 2000, a combination of radiocolloid application and a gamma- probe (detector), as well as the patent blue, has been used. Originally, SLNBs were followed by axillary dissections, however, in 2002, the procedure was waived in cases of negative sentinel nodes findings. RESULTS: Out of the total of 458 SLNB patients, 382 female patients were included in the study. SLNB, without concomitant axillary dissection, was performed in 170 subjects. In 70 subjects, the sentinel node was positive and they were indicated for axillary dissections. Positive non-sentinel nodes were detected 17 times. In total, 899 sentinel nodes were examined in the study group of 382 biopsies. The mean was 2.35. False negative nodes were recorded in three cases in female patients with SLNB and axillary dissection (4.6%). No local relapses in the axilla were recorded in negative sentinel node findings without subsequent axillary dissections. CONCLUSION: Sentinel node biopsy is a safe alternative to axillary dissection in the surgical management of early breast carcinoma.

[Benefits of intraoperative n. laryngeus recurrens neuromonitoring in thyroid surgery]. / Prínos peroperacního neuromonitoringu n. laryngeus recurrens v tyreoidální chirurgii.

INTRODUCTION: N. laryngeus reccurens injury is a serious complication in thyroid surgery. Nerve visualization is a procedure preventing its traumatization. The visualization with additional intraopertive neuromonitoring results in further reduction of the n. laryngeus reccurens injury rates. AIM: Verification of the intraoperative neuromonitoring effects on reduction of the n. laryngeus reccurens injury rates. MATERIAL, METHODOLOGY: 309 operated patients were included in the intraoperative neuromonitoring prospective study. A total of 295 patients were included in the study and intraoperative monitoring was performed per protocol. RESULTS: Out of the total of 295 subjects, 1 patient sufferred from permanent paresis, ie. 0.33%, nerves at risk 0.2%. 6 subjects sufferred from transient pareses, i.e. 2.03%, nerves at risk 1.2%, with a prevailing 8-week recovery period of the ORL findings. CONCLUSION: Intraoperative neuromonitoring in thyroid surgery is yet another option for reduction of the n. laryngeus reccurens intraoperative injury rates.