The effect of preoperative biliary stent on postoperative complications after the resection of pancreatic head tumour / A preoperatív biliáris sztent hatása a posztoperatív szövodményekre hasnyálmirigyfej-daganat miatt végzett reszekciós mutéteink kapcsán

Introduction. A preoperative biliary stent is often inserted because of obstructive jaundice due to pancreatic head tumour. However, it can also be the source of complications too. Aim and method. We retrospectively analyzed our operations which were performed between 01.10.2017 and 31.12.2019 for pancreatic tumour in association with stent related mortality and morbidity. The multiresistant bacteria and the spectrum of microorganism of intraoperative bile samples were investigated. Results. 82 patients were operated on with pancreatic tumour. There were 63 pancreatic head resections, and 19 palliative operations. 63 pancreatic head resections were analyzed. There were 36 open and 27 laparoscopic operations. Extended operation was needed in 12 cases (5 portal vein resections, 2 splenectomies, 1 right hepatolobectomy, 1 right hemicolectomy, 2 liver metastasectomies and 1 hepatic artery resection). The average age of 36 stented patients of which 24 were men and 12 women were 65 and 64 years respectively. The average age of 27 non-stented patients of which 14 were men and 13 were women, were 67.9 and 58 years respectively. The bile culture proved to be positive 30/36(83%) in the stented group and 13/27(48%) in the non-stented group (P = 0.005). The 3 most common bacteria were E coli, Enterococcus fecalis and Klebsiella pneumoniae in both groups followed by the yeast of Candida. 8 multiresistant bacteria were noticed in the stented group. 6 were ESBL producing (P = 0.033) and 2 vancomycine resistant (P = 0.5) bacteria. 3 patients of the stented group and 2 patients of the non-stented group were lost during the first 30 days. There were 4/0 wound infections, 6/2 haemorrhages, 2/2 pancreatic fistulas, and 2/3 abdominal abscesses in the stented vs. non stented groups. The average length of stay was 19.47 days in the stented and 14.62 days in the non-stented groups (P = 0.14). Conclusion. With regard to the fact that biliary stent changes the bacterial flora it is important to choose the proper antibiotic prophylaxis to reduce morbidity. On the basis of our own results and the literature an effective antibiotic therapy is suggested against enterococcus and ESBL producing bacteria. The prophylaxis against yeast in particularly in immunocompromised cases should also be considered. Regular antibiotic resistance check-up is essential.

Readmission indicated by severe fluid-electrolyte disturbances as a complication of ileostomy / A kórházi visszavételt igénylo súlyos folyadék-elektrolit zavar mint az ileosztóma egyik szövodménye

Introduction: After the operations of rectal tumours following neoadjuvant chemo-radio therapy it is a common practice to create a defunctioning ileostomy in order to prevent complications due to anastomotic leak. The ileostomy itself can be the source of complications with 20­60% incidence rate, while dehydration causes 16.9­40% of readmissions. Aims: Our goal was to review our own cases on the basis of complications of ileostomy particularly with regard to dehydration and its consequences. We wanted to develop a therapeutic protocol to help prevent these severe complications. Results: We retrospectively analyzed the morbidity data of our patients who had defunctioning ileostomy for different indications between 01.09.2017­31.12.2019. During this period, 252 rectosigmoid resections and 33 abdominoperineal resections of the rectum were performed. Ileostomy was created for 110 patients. 27 patients (24.5%) were readmitted with severe renal impairment and electrolyte disturbances. 24 patients were readmitted once, 1 patient twice and 2 patients 3 times. Readmission happened an average of 49.6 days (1­343) after the operation. At admission and readmission the average of GFR (glomerular filtration rate) of patients was 54.66 (38­60) ml/min/1.73 m2 ­ 22.8 (5­51) ml/min/1.73 m2 (p = 0.001), the average of serum Na level was 140.7 (133­145) mmol/l ­ 131.4 (111­144) mmol/l (p = 0.001), the average of serum K level was 4.6 (3.2­5.6) mmol/l ­ 5.37 (3.6­7.6) mmol/l (p = 0.005) and the average of serum creatinine level was 89.6 (54­149) µmol/l ­ 33.3 (107­877) µmol/l (p = 0.001). Conclusion: With regard to the short and long term severe complications of dehydration and the high risk of readmission caused by ileostomy, it is important to estimate the risk of patients, to educate the inpatients as early as possible, to commence the prevention of dehydration, and regularly monitor in the outpatient setting. Provided the conditions are given, the early closure of ileostomy should be considered.

[Laparoscopic and open complete mesocolic excision in right-sided colon cancer compared with open and laparoscopic surgery]. / Laparoszkópos és nyitott komplett mezokólikus excízió összehasonlítása nyitott és laparoszkópos konvencionális mutéttel jobb oldali vastagbéldaganatoknál ­ retrospektív feldolgozás, kezdeti tapasztalatok.

Introduction: In 2009, Hohenberger translated the concept of total mesorectal excision to colon cancer surgery and he named it complete mesocolic excision (CME). The principle of CME is based on wide mesenteric excision in the embriologic plane to remove mesenteric lymph nodes, central vascular ligation without damage of the peritoneal layer. CME can be performed by laparoscopic and open methods. Aim: To make sure that we are capable of performing right laparoscopic hemicolectomy with similar results to the open method. Results: A cohort of 156 consecutive patients were operated on with malignant right-sided colon tumours from 01.09.2016 to 30.06.2019. 143 curative resections were performed in 63 men and 80 women. The average age of men and women were 71.5 and 72.75 years, respectively. 84 laparoscopic and 59 open operations were performed. 84 patients underwent CME surgery and 56 conventional resections. The average length of the specimen was 22.34 cm in the conventional and 24.97 cm in CME surgery (p = 0.18) and the average lymph node number were 15.4 and 16.9, respectively (p = 0.24). The average duration of the operation was 111 minutes for the conventional and 136 minutes for the CME group (p = 0.0014), while the average length of stay were 7.47 days and 5.65 days (p = 0.0004) respectively for the cases without complications. Conclusion: We are yet in the learning period, but based on the early results, it might be concluded that the operation can be performed by laparoscopic methods as well with similar results to the open operation but with shorter length of stay.

[Breast care nurse. A new specialist in the multidisciplinary care of breast cancer patients]. / Az emlorák-terápiás novér. Új szakember az emlorák multidiszciplináris ellátásában.

The uniform European structure and professional standards for high quality breast cancer care were established in conjunction with the European Organisation for Research and Treatment, the European Society of Mastology and the European Breast Cancer Coalition with the support of the European Parliament. Well-prepared professional teams including a new member called the breast care nurse serve as ground for special breast cancer centers with international accreditation that provide modern, evidence based, patient centered multidisciplinary oncological care. The responsibilities of the new qualified professional staff member include the psycho-social support of the patient and carers from the moment of diagnosis throughout the whole oncological treatment, the fostering of delivering information and communication between patients and specialists. As a result of the curriculum founded by the European Oncology Nursing Society, breast care nurses have become key members of the practice of holistic breast cancer care in countries where the European recommendations have already been implemented. Considering the expected rearrangement of national oncological care, the new sub-specialty is outlined for the first time in the light of the experiences gained at the National Institute of Oncology, Budapest, a comprehensive cancer center.