Hand Assisted Laparoscopic Surgery for Colorectal Cancer: Surgical and Oncological Outcomes from a Single Tertiary Referral Centre.

The aim of this study was to report overall experience, perioperative and long-term survival results in a single tertiary referral center in Lithuania with hand assisted laparoscopic surgery (HALS) for colorectal cancer. A prospectively maintained database included 467 patients who underwent HALS for left-sided colon and rectal cancer, from April 2006 to October 2016. All those operations were performed by three consultant surgeons and nine surgical residents, in all cases assisted by one of the same consultant surgeons. There were 230 (49.25%) females, with an average age of 64 ± 9.7 years (range, 26-91 years). The procedures performed included 170 (36.4%) anterior rectal resections with partial mesorectal excision, 160 (34.26%) sigmoid colectomies, 81 (17.35%) left hemicolectomies, 45 (9.64%) low anterior rectal resections with total mesorectal excision, and 11 (2.25%) other procedures. Stage I colorectal cancer was found in 140 (29.98%) patients, 139 (29.76%) stage II, 152 (32.55%) stage III and 36 (7.71%) stage IV. There were five conversions to open surgery (1.1%). The mean postoperative hospital stay was 6.9 ± 3.4 days (range, 1-30 days). In total, 33 (7.06%) patients developed postoperative complications. The most common complications were small bowel obstruction (n = 6), anastomotic leakage (n = 5), intraabdominal abscess (n = 4) and dysuria (n = 4). There were two postoperative deaths (0.43%). Overall, 5-year survival for all TNM stages was 85.7%, 93.2% for stage I, 88.5% for stage II and 76.3% for stage III. Hand assisted colorectal surgery for left-sided colon and rectal cancer in a single tertiary referral center was feasible and safe, having all the advantages of minimally invasive surgery, with good perioperative parameters, adequate oncological quality and excellent survival.

Changing epidemiology and age-specific incidence of cutaneous malignant melanoma in Lithuania: an analysis of national cancer registration data by gender and anatomical site, 1991-2015.

Introduction: The purpose of this study was to investigate the gender-specific and anatomical site-specific incidence of cutaneous melanoma. Material and methods: All cases of primary skin melanoma reported to the Lithuanian Cancer Registry during the period 1991-2015 were included. For the analyses, patients were categorized by sex and melanoma site. Results: Overall age-standardized rate (ASR) of melanoma in the trunk increased 0.8-3.3, while in limbs the ASR increased 1.0-3.4. The highest increase in new cases per 100,000 population (in both sexes) was detected in limbs and it increased over time (from 2.01 per 100,000 in 1991 to 3.65 per 100,000 in 2015). The highest increase in the number of new cases was in limbs with ASR, with a more than 3-fold increase from 1991-2015 (1.4-4.6). A statistically significant increase was observed in mortality of skin melanoma between 1991 and 2015, with the highest annual percentage change (APC) of 5.5 in the trunks of men (95% CI: 5.2-5.9; p < 0.05) and women with APC 3.9 (95% CI: 3.5-4.4, p < 0.05). Conclusions: In our study, we found higher incidence rates of skin melanoma in females. Melanoma was more commonly diagnosed in the trunk of males and limbs of females, with the highest mortality increase in trunk melanoma in both genders.

The Impact of the COVID-19 Pandemic on Cancer Patient's Management-Lithuanian Cancer Center Experience.

The pandemic spread of the COVID-19 virus significantly affected daily life, but the highest pressure was piled on the health care system. Our aim was to evaluate an impact of COVID-19 pandemic management measures on cancer services at the National Cancer Institute (NCI) of Lithuania. We assessed the time period from 1 February 2020 to 31 December 2020 and compared it to the same period of 2019. Data for our analysis were extracted from the NCI Hospital Information System (HIS) and the National Health Insurance Fund (NHIF). Contingency table analysis and ANOVA were performed. The COVID-19 pandemic negatively affected the cancer services provided by NCI. Reductions in diagnostic radiology (-16%) and endoscopy (-29%) procedures were accompanied by a decreased number of patients with ongoing medical (-30%), radiation (-6%) or surgical (-10%) treatment. The changes in the number of newly diagnosed cancer patients were dependent on tumor type and disease stage, showing a rise in advanced disease at diagnosis already during the early period of the first lockdown. The extent of out-patient consultations (-14%) and disease follow-up visits (-16%) was also affected by the pandemic, and only referrals to psychological/psychiatric counselling were increased. Additionally, the COVID-19 pandemic had an impact on the structure of cancer services by fostering the application of modified systemic anticancer therapy or hypofractionated radiotherapy. The most dramatic drop occurred in the number of patients participating in cancer prevention programs; the loss was 25% for colon cancer and 62% for breast cancer screening. Marked restriction in access to preventive cancer screening and overall reduction of the whole spectrum of cancer services may negatively affect cancer survival measures in the nearest future.

Immunophenotype Rearrangement in Response to Tumor Excision May Be Related to the Risk of Biochemical Recurrence in Prostate Cancer Patients.

BACKGROUND: Prostate cancer (PCa) is known to exhibit a wide spectrum of aggressiveness and relatively high immunogenicity. The aim of this study was to examine the effect of tumor excision on immunophenotype rearrangements in peripheral blood and to elucidate if it is associated with biochemical recurrence (BCR) in high risk (HR) and low risk (LR) patients. METHODS: Radical prostatectomy (RP) was performed on 108 PCa stage pT2-pT3 patients. Preoperative vs. postoperative (one and three months) immunophenotype profile (T- and B-cell subsets, MDSC, NK, and T reg populations) was compared in peripheral blood of LR and HR groups. RESULTS: The BCR-free survival difference was significant between the HR and LR groups. Postoperative PSA decay rate, defined as ePSA, was significantly slower in the HR group and predicted BCR at cut-off level ePSA = -2.0% d-1 (AUC = 0.85 (95% CI, 0.78-0.90). Three months following tumor excision, the LR group exhibited a recovery of natural killer CD3 - CD16+ CD56+ cells, from 232 cells/µL to 317 cells/µL (p < 0.05), which was not detectable in the HR group. Prostatectomy also resulted in an increased CD8+ population in the LR group, mostly due to CD8+ CD69+ compartment (from 186 cells/µL before surgery to 196 cells/µL three months after, p < 001). The CD8+ CD69+ subset increase without total T cell increase was present in the HR group (p < 0.001). Tumor excision resulted in a myeloid-derived suppressor cell (MDSC) number increase from 12.4 cells/µL to 16.2 cells/µL in the HR group, and no change was detectable in LR patients (p = 0.12). An immune signature of postoperative recovery was more likely to occur in patients undergoing laparoscopic radical prostatectomy (LRP). Open RP (ORP) was associated with increased MDSC numbers (p = 0.002), whereas LRP was characterized by an immunity sparing profile, with no change in MDSC subset (p = 0.16). CONCLUSION: Tumor excision in prostate cancer patients results in two distinct patterns of immunophenotype rearrangement. The low-risk group is highly responsive, revealing postoperative restoration of T cells, NK cells, and CD8+ CD69+ numbers and the absence of suppressor MDSC increase. The high-risk group presented a limited response, accompanied by a suppressor MDSC increase and CD8+ CD69+ increase. The laparoscopic approach, unlike ORP, did not result in an MDSC increase in the postoperative period.

Oxidant/Antioxidant Status of Breast Cancer Patients in Pre- and Post-Operative Periods.

BACKGROUND AND OBJECTIVES: The purpose of this study is to evaluate the level of oxidative stress before and after breast cancer surgery. MATERIALS AND METHODS: Malondialdehyde (MDA) level was tested using a thiobarbituric acid (TBA) assay based on the release of a color complex due to TBA reaction with MDA. The glutathione S-transferase (GST) activity was evaluated by enzymatic conjugation of reduced glutathione (GSH) with 1-chloro-2,4-dinitrobenzene. The level of total glutathione (reduced GSH and oxidized GSSG) was detected using a recycling system by 5,5-dithiobis(2-nitrobenzoic acid). The levels of the indices were determined in the serum of 52 patients before surgery, two hours and five days after surgery, and in 42 healthy women. RESULTS: In the patients over 50 years old the level of MDA was higher after surgery in comparison with before surgery, and GST activity was lower in comparison with the control. The GSH + GSSG level in both ages groups after surgery was lower than in the control. Significant differences of MDA level were detected in patients with stage III after surgery compared to the control. The level of GSH + GSSG was significantly lower in the patients with I-III stages compared to the control. CONCLUSION: The most expressed changes demonstrate the significance of MDA as a marker to evaluate oxidative stress in breast cancer patients. The degree of oxidative stress depends on the patient's age and stage of disease.

Outcomes of surgical management of iatrogenic colonic perforation by colonoscopy and risk factors for worse outcome.

PURPOSE: To assess outcomes of surgical management for iatrogenic colonic perforations and risk factors of worse outcome. METHODS: We reviewed the medical records of patients with colonic perforations during colonoscopies 2007 - 2016 at the National Cancer Institute. We collected patient demographic data, colonoscopic reports, perforations treatment and outcome. RESULTS: Perforation rate was 0.14% (23 of 16 186). Twenty were managed surgically. The most common location of perforation was the sigmoid colon in 12 cases (60%). The most used surgical technique was simple suture (11 cases - 55%), followed by resection with anastomosis (6 - 30%), and Hartman's procedure in 3 cases (15%). Postoperative morbidity and mortality rates were 45% and 15% - three patients died. No significant relationship between time to surgery (p=0.285), American Society of Anaesthesiologists (ASA) score (p=0.642) or patient age (p=0.964) and postoperative complication were found. CONCLUSIONS: Patients need to be informed of the complications of colonoscopy. We could not determine strong risk factors for worse outcomes.

Surgery for triple-negative breast cancer- does the type of anaesthesia have an influence on oxidative stress, inflammation, molecular regulators, and outcomes of disease?

Breast cancer is the most frequently diagnosed cancer in females. Triple negative breast cancer (TNBC) is a molecular subtype of breast cancer which has a high mortality rate because of aggressive proliferation, quick occurrence of metastasis, and lack of effective treatment. New data show evidence that the type of anaesthesia can affect breast cancer recurrence and long-term outcome. Because TNBC lacks targets for modern specific therapy, a perioperative period could be the field of investigations for the long-term outcomes in TNBC influence. We reviewed the literature on research focusing on the influence of anaesthetics to oxidative stress, inflammation, molecular regulators, and TNBC oncological outcomes.

Hybrid transanal and total mesorectal excision after transanal endoscopic microsurgery for unfavourable early rectal cancer: a report of two cases.

Completion total mesorectal excision (TME) is a rare but complex procedure after transanal endoscopic microsurgery for early rectal cancer with unfavourable final histology. Two cases are reported when completion TME was performed after upfront transanal partial mesorectal dissection. Intact non-perforated TME specimens with negative and adequate distal and circumferential margins were created. The quality of both total mesorectal excisions was complete and distal margins were sufficient. We believe that our technique might be a way of approaching completion TME after TEM, especially in cases of low rectal cancer.

The functional results of radical rectal cancer surgery: review of the literature.

Introduction For more than the last 20 years, low anterior resection with total mesorectal excision (TME) is a gold standard for rectal cancer treatment. Oncological outcomes have improved significantly and now more and more reports of functional outcomes appear. Due to the close relationship between the rectum and pelvic nerves, bowel, bladder, and sexual function are frequently affected during TME. Methods A search for published data was performed using the MEDLINE database (from 1 January 2005 to 31 January 2015) to perform a systematic review of the studies that described anorectal, bladder, and sexual dysfunction following rectal cancer surgery. Methodological quality of the included studies was assessed using the MINORS criteria. Results Eighty-nine studies were eligible for analysis. Up to 76% of patients undergoing sphincter preserving surgery will have changes in bowel habits, the so-called "low anterior resection syndrome" (LARS). The duration of LARS varies between a few months and several years. Pre-operative radiotherapy, damage of anal sphincter and pelvic nerves, and height of the anastomosis are the risk factors for LARS. There is no evidence-based treatment available for LARS. Sexual function is more commonly affected after rectal surgery than after urinary function. The main cause of dysfunction is damage to pelvic nerves. Sexual and bladder functional outcomes in females are less well reported. Laparoscopic and robotic surgery allows better visualization of autonomic nerves and, therefore, more precise dissection and preservation. Conclusions It is important that rectal resection is standardized as much as possible, and that new functional outcome research use the same validated outcome questionnaires. This would allow for a high-quality meta-analysis.

Prevalence of paraneoplastic rheumatic syndromes and their antibody profile among patients with solid tumours.

The aims of this study were to assess the prevalence of paraneoplastic rheumatic syndromes in a cohort of patients with newly diagnosed solid tumours and to describe their autoimmune profile, comparing it to the controls. Screening questionnaires (3,770) were distributed, and during a three-step study, 94 patients were confirmed to have both paraneoplastic syndrome and oncology diagnoses. Three control groups-patients with undifferentiated arthritis, Raynaud's phenomenon for non-malignant causes and solid tumours only-were designed to compare with the paraneoplastic cases and their immunology profile. The prevalence of paraneoplastic rheumatic syndromes was 2.65% (95% CI 0.21-3.20). The group of patients with arthritis and the group of patients with Raynaud's syndrome were found to prevail among other clinical presentations of paraneoplastic rheumatic syndromes. Both paraneoplastic syndromes were linked to malignancies of the urogenital system. Antinuclear antibodies were found to be similarly frequent in the paraneoplastic arthritis, paraneoplastic Raynaud's phenomenon and the solid tumour groups. No differences were observed when comparing paraneoplastic arthritis and undifferentiated arthritis, except that the patients with paraneoplastic arthritis were older. Comparing paraneoplastic Raynaud's to Raynaud's phenomenon, male preponderance in the paraneoplastic Raynaud's phenomenon group was observed, and the patients were obviously older. Paraneoplastic rheumatic syndromes are rare and more often occur in older patients. Among them, paraneoplastic arthritis and Raynaud's syndrome were the most frequent. The immunology profile does not help in discriminating between arthritis and paraneoplastic arthritis patients and is of limited use in Raynaud's differential diagnosis.

Epidural and general anesthesia versus general anesthesia in radical prostatectomy.

Induced hypotension with epidural anesthesia influences the intraoperative blood loss in prostate cancer patients undergoing radical prostatectomy. The aim of this study was to evaluate intraoperative blood loss and need of blood transfusions in patients who underwent radical prostatectomy under epidural/general anesthesia and general anesthesia. Two groups were selected: epidural/general anesthesia group (study group, 27 patients) received epidural anesthesia in association with general anesthesia, and general anesthesia group (control group, 27 patients) received general anesthesia alone. Epidural/general anesthesia was performed using 0.5% solution of bupivacaine and maintained by volatile anesthetic sevoflurane. General anesthesia was performed with endotracheal ventilation using sevoflurane and intravenous fentanyl. The present study showed that the mean blood loss in epidural/general anesthesia group was significantly lower in comparison with that of general anesthesia group (740+/-210 mL versus 1150+/-290 mL, P<0.001). In addition, less allogeneic blood was transfused in epidural/general anesthesia group: 0.19 blood units transfused versus 0.52 blood units in general anesthesia group (P=0.007). Our study proved that induced hypotension with epidural/general anesthesia reduced intraoperative blood loss and need of allogeneic blood transfusions in cancer patient undergoing open radical prostatectomy.

[Intercostal nerve blockade with alcohol during operation for postthoracotomy pain]. / Potorakotominio skausmo gydymas tarpsonkauliniu nervu blokadomis.

OBJECTIVE: Purpose of this study was to evaluate the effectiveness of intraoperative intercostal nerve blockade with alcohol in addition to epidural analgesia with morphine for control of postthoracotomy pain syndrome. MATERIAL AND METHODS: 57 oncological patients undergoing antero-axillary thoracotomy were randomized to receive intraoperative intercostal nerve blockade with alcohol plus postoperative epidural analgesia with morphine (n=27) and postoperative epidural analgesia with morphine only (n=30). 31 patients had lobectomy, 10 bilobectomy, 9 pulmonectomy and 7 segmentectomy. There were 42 right sided and 15 left sided procedures. Objective and subjective assessment was carried out at 10 and 30 days postoperatively. Pain was assessed by using a subjective visual pain scale ranging from 1 (no pain) to 10 (worst pain) during coughing. RESULTS: Postsurgical pain was significantly lower in intraoperative intercostal nerve blockade patients group. The mean pain score on the 10 postoperation day was 2.1 and 6.5 accordingly in intraoperative intercostal nerve blockade and epidural analgesia with morphine patients group. The mean pain score on the 30 day was accordingly 1.5 and 4.2. CONCLUSION: Additional intraoperative intercostal nerve blockade with alcohol provides an additional benefit for postthoracotomy pain relief, especially for at least one month following the thoracotomy.

[Controlled hypotension in transthoracic esophageal resection]. / Kontroliuojama hipotenzija atliekant transtorakaline stemples rezekcija.

PURPOSE: This study was performed in order to evaluate effectiveness of controlled hypotension decreasing blood lose in transthoracic esophageal resection. PATIENTS AND METHODS: Thirty-six patients were enrolled in this randomized study. The patients were divided in to two groups. We used controlled hypotension induced by thoracic epidural anaesthesia for the group T (n=18/50%). For the group K (n=18/50%) we used only endotracheal anesthesia. The median arterial pressure was about 50 mmHg in group T and 80-110 mmHg in group K. We investigated intra-operative and post-operative blood loss, the average operating time, opioid and inhaled anesthetic use and stay in intensive care unite. RESULTS: The intra-operative blood loss was less for 45.7% in group T than in group K but post-operative blood loss was the same in groups. The mean operation time was 14.2% shorter in group T. We used 80% less fentanyl and 43% less inhaled anesthetics in group T. The stay in intensive care unit was 2.6 days in group T and 3.9 in group K. There were no significant complications caused by controlled hypotension. CONCLUSION: We conclude that controlled hypotension is an effective method to decrease blood loos and blood transfusions. It creates better conditions for surgery and reduces operation time. There were no serious cardiac, neurological and renal intra-operative and post-operative complications resulting from the use of controlled hypotension.

[Prognostic factors for resectable esophageal cancer]. / Stemples vezio chirurginio gydymo prognoziniai veiksniai.

UNLABELLED: Objective was to evaluate prognostic factors influencing the postoperative mortality after esophagectomy. MATERIAL AND METHODS: The results of surgical treatment of 106 patients suffering from esophageal cancer were analyzed retrospectively. The presurgical risk factors in the surviving patients (group I, n=94) and in those patients, who died within the postoperative period (group II, n=12), were compared. The following indicators were analyzed: patients' age, body mass index, preoperative loss of body mass, tumor location, type and duration of operation, amount of blood transfused, ECG changes, changes in the lungs visible on chest X-ray, and spirometry indices. We examined the volume of forced expiration within the first second (FEV1), forced expiratory vital capacity (FVC), peak expiratory flow (PEF), Gaensler index (FEV1/FVC), Tiffeneu index (FEV1/VC) and amount of PaCO(2)in arterial blood. RESULTS: Postoperative mortality was 11.3%. The following statistically reliable differences in the indices of group I and group II patients were established: FEV1 (82.3% and 65.4%), Gaensler index (75.2% and 68.5%), PaCO(2)(37.4 mmHg ir 42 mmHg), radiographic changes in the lings (13.6%l and 61.2%), loss of body mass within the preoperative period (11.2% and 18.3%), lower albumin values (39.9 g/l and 30.5 g/l) and tumor localization within the upper third of the esophagus (22% and 68.8%). The leak of anastomosis - 11.8% and 82.8%. CONCLUSION: The postoperative mortality after esophagectomy mostly depends on the status of pulmonary function during the postoperative period, inadequate nutrition during the preoperative period and tumor localization in the upper third of the esophagus. Main complications after esophagectomy are pulmonary insufficiency and leak of anastomosis.

[Hypotensive epidural anesthesia in thoracic surgery]. / Hipotenzine epidurine anestezija torakaliniu operaciju metu.

OBJECTIVE: This study evaluated effectiveness of hypotensive epidural anesthesia in decreasing blood loss, operation and extubation time, opiates use and stay in intensive care unit. MATERIAL AND METHODS: Fifty-eight patients were enrolled in the study. Right (n=16) or left (n=42) pneumectomy was performed for the study patients. We used the hypotensive anesthesia induced by thoracic epidural anesthesia for the group T (n=29/50%) and normotensive anesthesia for the group K (n=29/50%). The epidural catheter was introduced into the epidural space at the level Th4-5. Arterial pressure was reduced using bupivacaine into epidural space. In the group T median arterial pressure was about 50-60 mmHg. For the group K we used only general anesthesia and median arterial pressure was 80-120 mmHg. RESULTS: The average intra-operative blood loss was 534+/-198 ml in the group T and 1287+/-380 ml in the group K (p<0.001). Post-operative blood loss was the same in both groups. The average operation time was 10% shorter in the group T (p=0.078). Fentanyl use in the T group was 203+/-91 microg and 1266+/-601 microg in the K group (p<0.001). Patients in the T group were safely extubated after 66+/-17 min (p<0.001) and discharged from intensive care unit after 2+/-1.1 days (p<0.05). The patients in the group K were extubated after 138+/-37 min and discharged from intensive care unit after 3.27+/-1.3 days. CONCLUSION: Hypotensive epidural anesthesia is an effective method to decrease blood loss and blood transfusions in thoracic surgery. It creates better conditions for surgery and reduces stay in intensive care unit. Also there were no serious cardiac, neurological and renal intra-operative and post-operative complications that could be conditioned by the use of hypotension.

[Principles of anesthesia for pulmonary surgery]. / Anestezijos ypatybes atliekant plauciu operacijas.

The aim of the article is to review principles of thoracic anesthesia for pulmonary surgery. This article is divided into three sections. Preoperative considerations include pulmonary evaluation and optimal pulmonary preparation. Intraoperative period considerations are monitoring requirements, choice of anaesthesia and the indications for providing one-lung ventilation. Postoperative problems of immediate life-threatening complications, management of mechanical ventilation and control of pain are discussed in the third part.

[Bronchoplastic operations for lung cancer]. / Bronchoplastiniu operaciju galimybes kompleksiskai gydant plauciu vezi.

UNLABELLED: Objective of our work was to evaluate efficacy of bronchoplastic operations for lung cancer and time to progression in combined treatment. From 1997 till 2001, 57pts were operated for early I-IIB stages of lung cancer. Operations were: tracheal resections in 3pts (5.2%), window right pneumonectomies in 5pts (8.7%), window left pneumonectomies in 2pts (3.5%), window right upper lobe in 22pts (38.5%), bifurcation resections 2pts (3.5%), sleeve right upper lobe resections 7pts (12.2%), sleeve left upper lobe resections in 11pts (19.2%). We had complications: in 7pts (12.2%) suture failure, 26pts (45.6%) obstructive pneumonia, 3pts (5.2%) kinking of anastomosis, 2pts (3.7%) bronchial bleeding, 6pts (10.5%) covered bronchial fistulas, 5pts (8.7%) died after operations. RESULTS: 32pts (56%) underwent radiation after surgery, 13pts (22.8%) radiation and chemotherapy. Three-year survival was in 82.4% (47pts), in 10pts (17.4%) disease progressed. CONCLUSIONS: 1. Bronchoplastic operations are sufficient for early lung cancer treatment. 2. Three-year was in survival 82.7% of pts. Seventeen percent of patients failed after combined treatment.

[Stair climbing test in prediction of postoperative complications after lung cancer surgery]. / Lipimo laiptais meginys prognozuojant komplikacijas po plauciu vezio operaciju.

Preoperative physical state of a patient is very important for adaptation of the patient after lung resections. Purpose of this work is to evaluate an information factor of a stair-climbing test while predicting of postoperative complications after lung cancer surgery. Fifty two patients were examined, who passed lung surgery of different volume. The patients are distributed to two groups: I(st) group included the patients able to climb 1-44 footsteps (n=22/42.3%) and the II(nd) group included the patients able to climb more than 44 footsteps at a moderate speed without stopping for rest (n=30/57.7%). One flight of stairs made up to 22 footsteps with 15 cm of height each. Postoperative myocardial ischemia, disorders of heart rhythm, pneumonias, atelectasis, prolonged artificial ventilation of lungs, sanative bronchoscopy, duration of treatment, and cases of death were registered. It was established that postoperative cardiac and lung complications occurred in 17 patients (32.7%), two patients died (3.8%). Rate of complications between the patients of the I(st) and II(nd) group was 82.4 ir 17.6 percent. Postoperative course was normal for those patients (n=11) who were able to climb five or more flights of stairs. It was noticed that duration of postoperative period has an inverse proportion to a number of the climbed up footsteps. The stair-climbing test is a simple, safe, cheap and informative enough for prediction of postoperative cardiopulmonary complications after lung cancer surgery.

[Characteristics of postoperative course in cancer patients]. / Senyvo amziaus onkologiniu ligoniu pooperacines eigos ypatumai.

UNLABELLED: Objective of our work was to analyze postoperative care peculiarities in elderly cancer patients over 80 years. A retrospective analysis is made in connection with postoperative course in 152 cancer patients. The I(st) group included patients over the age 80 years (8.7 years in average), and the II(nd) group included patients of 60 years. Distribution of the patients into groups was equivalent as per volume and duration of operations. We have established that postoperative complications in patients of the I(st) and II(nd) group were noticed as 46.0 and 12.5 percent accordingly, that included 22.5 and 2.8 percent of lung complications, 23.7 and 4.2 percent of cardiovascular complications. Episodes of disorientation (delirium) were noticed in every fifth patient over the age of 80 years. Postoperative death-rate made up to 13.7 percent in the I(st) group, and 2.8 per cent in the II(nd) one. Results of the performed work showed that surgical treatment of cancer patients over the age of 80 years is related to a higher risk. Therefore, indications for operation and its volume has to be defined strictly taking into consideration preoperative functional status of the patients. CONCLUSIONS: 1. Postoperative complications three times and mortality five times are higher in cancer patients over 80 years to compare to 60-year-old patients. 2. Preoperative live functions status influence more to postoperative mortality than age as independent risk factor.

[Combined anesthesia for esophageal resection operations]. / Misrus anestezijos budas atliekant stemples rezekcines operacijas.

OBJECTIVE: To view combined anesthesia benefits versus general anesthesia and to compare postoperative epidural analgesia and patient-controlled analgesia with intravenous morphine. MATERIAL AND METHODS: Twenty four patients scheduled for elective thoracoabdominal esophagectomy were randomized to T (n=12) and K (n=12) groups. Group T patients received epidural analgesia with 0.125 percent bupivocaine and morphine after combined general-epidural anesthesia and group K patients received intravenous patient-controlled analgesia with morphine after general anesthesia. The patients were monitored for operation and extubation time, for postoperative pain and length of intensive care unite (ICU) stay. RESULTS: T group patients received 79 percents less narcotics than K group. At rest there were no differences in pain relief between the groups. Pain scores at mobilization showed a significantly lower value in the T group. Patients in T group were tracheally extubated earlier (mean 210 minutes vs 380 min.) after admission to the ICU and discharged from the ICU earlier (mean 2.3 vs 4.3 days). CONCLUSIONS: Combined anesthesia and epidural analgesia improve overall outcome, provide better postoperative pain relief, shorten the intubation time and intensive care stay in patients undergoing esophageal resection operations.