Single centre experience with surgical treatment of hilar cholangiocarcinoma.

UNLABELLED: BACKGROUND /AIMS: Surgical resection is a radical treatment option for hilar cholangiocarcinomas. However it is still difficult to cure and patient prognosis is poor. An evaluation of the surgical options and results may elucidate effective treatments. METHODOLOGY: We retrospectively examined the demographic characteristics, surgical records and outcome in 64 patients with hilar cholangiocarcinoma undergoing surgical resections or palliative surgical procedures for the period of 2004-2012. RESULTS: The patients included 43 males and 17 females with a mean age of 61.4 ± 10.4 years (±SD, range 35-81 years). Forty four resections were done - R0-22 cases (34.4%), R1 - 10 (15.6 %) cases, R2 -12 cases (18.7%) and 20 palliative (31.3%) operations were performed. R0 - resection of common bile ducts with right hepatectomy with Sg 1 was done in 8 cases, resection of common hepatic duct with left hepatectomy with Sg 1 in 9 cases and resection of common hepatic duct in 5 cases. The total percentage of postoperative morbidity is 51.5 %. The types of complications are as follows: intra abdominal bleeding 31.25 %, temporary biliary leakage - 26.56 %, leakage of hepatico-jejunostomyâ7.81 %, biliary fistula 7.81%, liver insufficiency 17.18 %, pleural effusion 48.13 %, intraabdominal abscess 28.13 %, surgical site infection 48.3 %. The mean five-year overall survival for R0 - resection is 32%, for R1 - and R2 - resection is 12% and for the palliative operations - 0%. The mean overall survival for R0-resection is 37 months, for R1 - and R2 - resection is 19 months and for the palliative operations 7 months. CONCLUSIONS: Radically extended surgical resection for hilar cholangiocarcinoma is necessary to obtain improved patient survival.

[The effect of intraperitoneal levobupivacain (Chirocaine) application on postoperative pain in laparoscopic cholecystectomy--a prospective study].

BACKGROUND AND OBJECTIVE: A prospective comparative trial was performed to evaluate the effect of intraperitoneal Ievobupivacaine administration on postoperative pain in patients undergoing laparoscopic cholecystectomy. MATERIAL AND METHODS: Patients received a standardized procedure and were allocated to receive either (I) 0.25% 20 ml levobupivacaine or (II) normal saline 20 mL to the bed of the gall bladder and to the subdiaphragmal region above the liver at the end of the operative intervention. VAS (0-10) on 2-nd, 6-th, 12-th and 24-th hour as well as postoperative analgesia requirements were evaluated. RESULTS: Mean abdominal pain in the levobupivacaine group was significantly lower than that in the 0.9% Na Cl group on the 2nd (p = 0.038) and 6-th (p = 0.028) postoperative hour. There was reduction in postoperative analgesia requirements in levobupivcaine group, but no statistically significant difference between the two groups was detected. CONCLUSIONS: Intraperitoneal administration of levobupivacaine is associated with modest analgesia following laparoscopic cholecystectomy.

[Multiple primary carcinomas of the colon and associated extracolonic primary malignant tumors].

Adenocarcinoma of the colon is the most common visceral cancer. The incidence of multiple primary colorectal carcinoma varies from 0.6% to 7.6%. A review of 837 cases of colorectal carcinoma showed 32 cases (3.8%) of colorectal multiple primary malignant tumors and 11 cases (1.3%) of colorectal primary malignant tumor associated with extracolonic primary malignant tumor. A total of 78 tumors were involved: 24 in the sigmoid, 12 transverse colon; four in the cecum; 30 in the rectum; 3 in the ascending and 5 in descending colon; 2 each in the bladder, prostate; two each in the breast, cervix, and one each in the skin, nasopharynx, lungs. If synchronous carcinomas are located in the same anatomic region, a conventional resection should be performed. When the carcinomas are widely separated, a subtotal colectomy is the operation of choice. Survival of patients with synchronous carcinomas is not significantly different from survival of patients with same-stage solitary carcinomas.

[Gastrointestinal stromal tumors (GIST) - clinical experience and current therapeutical aspects].

Gastrointestinal stromal tumors (GIST) are specific, generally Kit (CD117) - positive, mesenchymal tumors of the gastrointestinal tract encompassing a majority of tumors previously considered gastrointestinal smooth muscle tumors. They are believed to originate from interstitial cells of Cajal or related stem cells. Diagnosis is based on histological and immunohistochemical examination, and these rare tumors are characterized by c-kit (CD117) staining. We present an analysis of clinical presentation and course, surgical management and pathological features of 11 patients with gastrointestinal stromal tumors treated in our institution from 2002 to 2007. 2 patients with malignant retroperitoneal GIST had disease progression/recurrence and died. They received adjuvant imatinib therapy. 9 patients are disease free on the 3-d year of the follow-up. Our results confirm that in stromal tumors complete surgical resection remains the mainstay of treatment in localized gastrointestinal stromal tumors. Complete removal of the tumor is often curative in localized gastrointestinal stromal tumors and is always recommended. Clinically, their behavior is difficult to predict, and mitotic count and tumor size seem to be the most effective prognostic factors. It is conceivable that treatment and prognosis of metastatic and non - resectable gastrointestinal stromal tumors, as well as the adjuvant treatment of high-risk, radically excised gastrointestinal stromal tumors will be strongly impacted by the c-kit target therapy.

[Combined and extended radical operations in colorectal cancer patients].

This is a report on radical operative interventions performed in 513/755 patients presenting complicated colorectal carcinoma, covering the period 2000 through 2007. One hundred and four patients are subjected to combined and extended operations, distributed as follows: 61 combined and 43 extended. In thirty three patients with abdominoperineal extirpation the combined interventions include: hysterectomy (7), ovariectomy (9), resection of vagina (8), prostate gland resection (5) and bladder resection (4). In case of resection of rectum after Hartmann, combined intervention is done in seventeen patients - small intestine resection - 7, ovariectomy - 2, appendectomy - 3 and cyst extirpation from lethality amounts to 12.9 per cent of patients with complicated colorectal carcinoma undergoing combined and extended surgical interventions.

[Obstructive ileus of the large intestine caused by ischemic colitis--literature review and report of 7 cases].

Ischemic colitis is the most common form of intestinal ischemia. The damage produces ulcers in the lining of the large intestine. Ischemic colitis affects primarily people who are 50 or older. The disease was first described by Boley and associates [1] as a "reversible vascular occlusion" of the colon, and Marston and colleagues [2] went on to detail the gangrenous, stricturing, and transient forms. Two mechanisms may cause bowel ischemia: The first and most common is diminished bowel perfusion due to low cardiac output often seen with in patients with cardiac disease or in prolonged shock of any etiology. The second mechanism is occlusive disease of the vascular supply of bowel due to atheroma, thrombosis, or embolism in which the collateral circulation is not adequate to maintain bowel integrity.

[Retroperitoneal endoscopic adrenalectomy for cavernous adrenal hemangioma].

Adrenal cavernous hemangiomas are rare non-functional tumors. This article describes the case of a patient with a cavernous adrenal hemangioma. Prior to surgery, the mass was diagnosed as an incidentaloma. It was successfully removed by means of endoscopic retroperitoneal adrenalectomy without any intraoperative, nor postoperative complications and histologycally verified as "adrenal cavernous hemangioma".

[Clinical experience and current aspects of treatment of abdominal actinomycosis].

Actinomycosis is an uncommocn inflammatory entity caused by the universally distributed anaerobic bacterium, Actinomyces Israeli. The most common sites of the abdominal form of the disease are the transverse colon and the cecum with the appendix. Actinomycosis can mimic other abdominal diseases as diverticulitis, abscesses, inflammatory bowel disease and malignant tumors, presenting a diagnostic challenge. In most cases surgical intervention is performed. Antibiotic administration should be a part of the complex treatment of the disease.

[Medullary thyroid carcinoma--current surgical aspects. Overview and retrospective analysis of 22 cases].

BACKGROUND: Medullary thyroid carcinoma (MTC) accounts for 5% to 10% of all thyroid malignancies. Approximately 75% of cases are sporadic. Familial forms of medullary thyroid carcinoma account for the remaining 25% of cases--MEN IIa, MEN IIb and FMTC. METHODS: Retrospectively 22 cases of medullary carcinoma of thyroid gland were analysed. Total thyroidectomy with selective lymph dissection was performed in all patients. RESULTS: 18 patients were with sporadic form of medullary thyroid carcinoma, 4--with FMTC; 21 were with primary carcinoma, 1--with recurrent carcinoma Mean age--32 years (22-59). At the follow-up control (max 10 years) there is no evidence of disease recurrence. CONCLUSION: Recent advances in genetic testing allow early diagnosis and treatment of familial MTC syndromes. Despite some advances in treatment, optimal management is still controversial. Total thyroidectomy with selective lymph dissection remains the choice of surgical treatment. In the familial forms medullary carcinoma is associated with well-characterized, germline mutations in the RET protooncogene. Both genetic and biochemical screening are of essential significance for early diagnosis and adequate and optimal surgical treatment.

[Retroperitoneal endoscopic adrenalectomy vs. conventional adrenalectomy in treatment of benign adrenal lesions--comparative analysis].

BACKGROUND: Miniinvasive adrenalectomy is considered to be the standard of care for the surgical treatment of the adrenal gland's pathology. Since the initial report of laparoscopic adrenalectomy in 1992 and of retroperitoneal endoscopic adrenalectomy in 1994, it has evolved into a feasible and safe minimally invasive procedure for benign adrenal tumors. METHODS: Clinical characteristics and outcomes of 63 retroperitoneal endoscopic adrenalectomies (REAs) and 45 conventional adrenalectomies (CAs) from 1996 to 2004 were evaluated. RESULTS: 61 patients underwent 63 REAs. Tumor size varied from 2 to 8 cm. Median age was 48.6 years. Mean operative time was 135 min (45-240), mean intraoperative blood loss - 85 ml (30-550). The complication rate was 17.77%. Median postoperative hospital stay was 5 days (2-10). 44 patients underwent 45 conventional adenalectomies. Median age was 44.5 years (16-71). Intraoperative complication rate was 17.77%, postoperative - 22.22%, Mean operative time was 120 min (75-240). Median postoperative hospital stay was 10 days (6-21). CONCLUSION: No statistically significant difference was established between mean operative times of REA- and CA-groups (p=0.91). Conventional adrenalectomy was associated with a significantly increased complication rate (p=0.009). Hospitalization was also longer after the open technique (p < 0.0001). Introduced in 1994 and displaying all advantages of minimal access surgery REA has become the standard of care for benign adrenal tumors.