Survival prognostic factors in patients with resection of liver metastasis from colorectal cancer.

BACKGROUND AND AIM: Case selection criteria for resection of liver metastasis after colorectal cancer are still incompletely elucidated and represent a subject of great interest recently. Our aim was to evaluate 2-year survival after resection and to identify the survival risk and prediction factors in those cases. METHODS: 63 patients diagnosed and undergoing liver resection for colorectal metastatic disease to the liver at the Surgical University Hospital No.3 (Cluj-Napoca, Romania) between 01.01.2002 and 31.12.2005 were included in the study. Exclusion criteria were: palliative treatment as well as surgical treatment performed in a different surgical centre. After the surgical treatment, patients were followed regularly using clinical assessment on a 3 monthly basis with abdominopelvic ultrasound or computerised tomography annually. The following variables were recorded: age, gender, coexisting medical diseases, blood tests results, tumour site, maximal tumour diameter after resection, duration of surgery, surgical procedure and the clinical outcome until last follow-up, including date of death where appropriate. RESULTS: 2-year post-operative survival was 65.1%. In univariate analysis: age (< 65 vs > = 65 years, p = 0.041), metastasis number (< 3 vs > = 3 tumors, p = 0.049), maximal tumor dimension (< 3 vs > = 3 cm, p = 0.047), glutamine-oxaloacetic transaminase (GOT) preoperative level (< 42 vs > = 42 mg/dl, p = 0.018) were significant factors correlated to median survival time. However, non of the above mentioned factors presented independent prediction power in multivariate analysis (Cox regression, p < 0.05). CONCLUSIONS: Our results support liver metastasis resection without prior case selection except for technically-operative criteria selection.

[Late reinterventions after the surgical treatment of gastric and duodenal ulcer]. / Reinterventii tardive dupa tratamentul chirurgical al ulcerului gastric si duodenal.

A number of 87 reinterventions performed during a 5-year-period for late complications of the gastric and duodenal ulcer surgery are analysed. In most of them (64 cases), the cause of the reintervention was a postoperative ulcer. A long afferent loop (6 cases), the dumping syndrome (4 cases), the stenosis of the anastomosis opening (6 cases) and the primitive neoplasm of the gastric stump (7 cases) represented other causes of reintervention. The immediate postoperative results were very good and good in 69 cases. The risks related to the specific character of this surgery materialized themselves in 14 postoperative complications (anastomotic fistulas, haemorrhages from the anastomosis, stress ulcers etc.), which required iterative operations; the postoperative death rate attained 3.4%. The analysis of these postgastrectomy syndromes is an opportunity to discuss about the failure factors in the surgery of the gastric and duodenal ulcer, the possibilities of exploration and the principles which should guide the reparative therapy.

Roux-en-Y gastrectomy: early and late results.

Results obtained in 16 patients by Roux-en-Y gastrectomy (Moskowicz procedure) are presented. According to Langhans a high gastrectomy ascending on the lesser curvature to 2 to 3 cm below the cardia and unaccompanied by a sectioning of the vagal branches was performed. The Roux-en-Y resection was used only in exceptional situations, being preferred to the standard Billroth II operation in order to avoid the biliopancreatic reflux into the gastric remnant. It was performed as a primary intervention in 13 cases (penetrating gastric or duodenal ulcers, gastritis due to biliar reflux) and as a revisional surgery in three patients with disturbances of the operated stomach. The best results were obtained in gastritis due to biliar reflux, in gastric ulcers Johnson I type, and when the method was used as a revisional surgery. When it was used as a primary operation in duodenal ulcers, the main risks depend of two things: the duodenal fistula and the ulcerous recurrence. Duodenal stump disruption has not specific causes and as well as in all the Billroth II resections may results from less than satisfactory duodenal closure. This complication was noted in one patient. Concerning the risk of the anastomotic ulcer, it is particularly increased in the Billroth II-Roux gastrectomy compared with the other types of gastric resections. When the operation is unaccompanied by vagotomy, the risk has maximum values. In this clinical material the ulcerous recurrence was noted in four patients.