Palliative treatment of the advanced gastric cancer by means of surgery and HIPEC.

OBJECTIVES: We demonstrate a case report of the patient who suffered from advanced gastric cancer and was treated by means of surgery and HIPEC. BACKGROUND: Gastric cancer is a therapeutic challenge in the European countries due to late diagnosis, advanced stages of the disease in time of diagnosis and early recurrence in cases where a radical surgery is possible. METHOD: The patient with an advanced gastric cancer (pT3N2M1 - peritoneal and ovarian metastases) was treated by means of radical surgery in combination with hyperthermic intraoperative intraperitoneal chemotherapy (HIPEC) and early postoperative intraperitoneal chemotherapy (EPIC). Surgical treatment was followed by a standard chemotherapy. Due to recurrence, there was the second look surgery one year later again with HIPEC procedure. RESULTS: Patient survived 32 months after diagnosis and despite intraperitoneal recurrence she never developed clinically significant ascites and she never suffered from intestinal obstruction. CONCLUSION: This case demonstrate a potential benefit of new oncosurgical approach -radical surgery + HIPEC + EPIC in the treatment of gastric cancers (Tab. 2, Fig. 6, Graph 4, Ref. 18). Text in PDF www.elis.sk.

[Fascial closure of the abdominal wall by dynamic suture after topical negative pressure laparostomy treatment of severe peritonitis--results of a prospective randomized study]. / Uzáver steny brisní po laparostomii s pouzitím negativníiho tlaku pro tezkou peritonitidu pomocí dynamické fasciální sutury--výsledky prospektivní randomizované studie.

INTRODUCTION: Severe peritonitis is a frequent condition characterized by high morbidity and mortality rates. Topical negative pressure (TNP) laparostomy could improve the results of the treatment, provided that the adverse events of this method are reduced. The aim of our study was to prove, in a prospective randomized study, that the primary use of TNP laparostomy reduces morbidity and mortality when compared to primary abdominal wall closure after the index surgery for severe peritonitis. The possibility of the abdominal wall fascial closure significantly influencing morbidity was the main topic of this study. MATERIAL AND METHODS: Between 9/2009 and 9/2011,57 patients with severe peritonitis were included in the study at the Department of Surgery of the Bulovka Faculty Hospital; 28 of them were randomized to the TNP laparostomy group and 29 to the primary closure group. The two groups did not differ in age, gender, polymorbidity and severity of peritonitis. RESULTS: The length of hospital stay was similar in both groups (median: 22 days; range 10-171 days) in the intervention group and 23 days (range 3-71) in the control group (p = 0.89). The mortality rate was significantly lower in the TNP laparostomy group in comparison with the primary closure group (3 patients, 11% vs. 12 patients, 41%; p = 0.01). A complete closure of the abdominal wall including fascia and complete abdominal wall healing was achieved in 80% of survivors in the TNP group, compared to 29% in the primary closure group (p = 0.01). No enteral fistula occurred in any surviving patients from both groups. The overall length of abdominal wall healing was significantly shorter in the TNP group (median: 7; 7-94 days, versus 30; 7-223; p = 0.04). CONCLUSIONS: Primary TNP laparostomy is an effective and safe method in the treatment of severe peritonitis. Keeping good clinical practice, especially using dynamic suture as early as after the index surgery and the timely closure of laparostomy as soon as the indication disappears (according to relevant criteria) leads to a significantly higher abdominal wall healing rate, icluding fascial closure, than after peritonitis treatment without laparostomy.

[Antibiotic prophylaxis in acute surgical procedures--the current praxis in Czech Republic]. / Antibiotická profylaxe u akutních chirurgických výkonu--soucasná situace v CR.

INTRODUCTION: Surgical site infections (SSI) are currently one of the most frequent postoperative complications. Emergent surgery is generally subject to a higher risk of SSI. Antibiotic prophylaxis is one of many measures that should be taken to prevent postoperative infection. However, due to possible adverse effects it must be applied only in indicated cases. Many guidelines have been published abroad, but still missing in Czech Republic. Standard use of prophylaxis can be currently followed due to compliance with SCIP (Surgical Care Improvement Project) measurements and reflects the quality of surgical care. OBJECTIVES: The aim of our study was to evaluate the current clinical praxis of prophylactic antibiotic administration in Czech Republic in emergent surgery for diagnosis: acute appendicitis, small bowel obstruction and perforated gastroduodenal ulcer and evaluate the SCIP criteria adherence. METHOD: The survey was sent to 149 surgical departments. The questionnaire included 7 questions and feedback was considered to be anonymous. The compliance with 3 main SCIP measurements (INF-1, INF-2, INF-3) was evaluated by the patients with acute appendicitis as a indication for emergent surgery. RESULTS: Overall, 85 (57%) completed questionnaires were received back. According to a survey results, antibiotic prophylaxis is always administered in 15% of patients operated for acute appendicitis, 27% operated for small bowel obstruction and 47% of patients with gastroduodenal perforation. No prophylaxis is given in 11 (13%) hospitals for either of the mentioned diagnoses. Antibiotics are mostly (46%) administered at induction of general anesthesia and extended to 24 hours. The SCIP measurements adherence was as follows: INF-1--4.7%; INF-2--86%; INF-3--81% of evaluated departments. All of 3 (all-or-none) criteria were fulfilled only at 3 (3.5%) surgical departments. CONCLUSION: The clinical praxis of antibiotic prophylaxis in urgent surgical procedures in Czech Republic is highly variable and mostly ignores the current international guidelines (SCIP). There is a need of local specific guideline concerning antibiotic prophylaxis guaranteed by scientific company.