Ultralow anterior resection with implantation of gentamicin-collagen sponge and no defunctioning stoma: anastomotic leakage and local cancer relapse.

Background Anterior resection with total mesorectal excision (TME) of ultralow rectal cancer may result in the increased risk of the anastomotic leakage (AL). The aim of this study was to evaluate the usefulness of the gentamicin-collagen sponge (GCS) for the protection against symptomatic AL and investigate association between AL and local relapse (LR). Patients and methods A series of 158 patients with ultralow rectal cancer was studied. All the patients underwent R0 sphincter-saving TME with anastomosis wrapping using GCS. In none of the cases a temporary protective stoma was constructed. Results AL rate was 3.2% (5/158) while median time to AL diagnosis was 5 days following surgery (range 3-15). There was no postoperative and leakage-related mortality. Patient age > 75 years and smoking were independent risk factors related to significantly increased AL rate: 12.5% vs. 0.8% (P = 0.0004) and 5.7% vs. 0% P = 0.043), respectively. LR was observed in 12% of cases. It was highly significantly more common and developed earlier in patients who have had AL when compared with non-AL group: 80% vs. 9% (P = 0.00001) and 8.5 vs. 17 months (P = 0.014), respectively. Conclusions Anastomosis wrapping with GCS after anterior resection with TME is a safe procedure resulting in the low incidence of anastomotic leakage which may be also associated with decreased risk of local relapse.

Breast segmentectomy with rotation mammoplasty as an oncoplastic approach to extensive ductal carcinoma in situ.

BACKGROUND: The aim of this study was to assess the usefulness of the breast segmentectomy with rotation mammoplasty (BSRMP) in conserving therapy for an extensive ductal carcinoma in situ (DCIS) with or without an invasive component. METHODS: Thirty-six women with DCIS visible as large area of microcalcifications distributed out of the retroareolar area regardless of the quadrant were studied prospectively. All the patients underwent BSRMP and axillary procedure (31 sentinel node biopsy, 5 axillary dissection) followed by radiotherapy. In each case, follow-up was carried out carefully and special effort was made to identify postoperative complications. Cosmetic result was judged 6 months after radiotherapy by the patient herself and two surgeons being rated as poor, mediocre, medium, good or excellent. RESULTS: Operation was completed without any difficulties in all the cases. Appropriate BSRMP was easily done after the skin marking. Regardless of the type of axillary approach, it was conveniently performed. Wound was healed by primary adhesion; skin or breast tissue necrosis did not develop. Neither haematoma nor surgical site infection was observed. In none of the patient, centralisation of the nipple-areola complex (NAC) was needed. Three patients (8.3%) with close margins (1 mm or less) successfully underwent subsequent re-excision. The scar did not result in any impairment of arm movement. Cosmetic outcome was evaluated by the women as excellent and good in 55 (87%) and 8 (13%) cases, respectively, while by the surgeons as excellent, good and medium in 52 (82%), 8 (13%), and 3 cases (5%), respectively. CONCLUSIONS: BSRMP is a simple and safe technique achieving good cosmetic results without NAC centralisation and giving the wide and easy access to axilla for both sentinel node biopsy and lymphadenectomy. It can be helpful in cases of extensive, radially spreading tumours (in particular DCIS or invasive cancers with intraductal component), eccentric lesions, or superficially located cancers when the neighbouring skin is excised. However, due to its limitations (long incision, difficult subsequent mastectomy, possibility of scar placement in the visible area of decollete), a careful patients' selection should be done. Further studies are needed to assess long-term cosmetic outcomes including delayed post-radiotherapy effects.

Multidisciplinary management in Merkel cell carcinoma.

Herein, the authors describe the experience with the treatment of Merkel cell carcinoma (MCC) and review the literature regarding MCC treatment regimens. Nine patients underwent treatment due to stage I, II, or III MCC. The median follow up was 39 months. In five cases, tumors were excised with skin margins of >2 cm, and skin margins were <2 cm in four patients. Local adjuvant radiotherapy (RT) was given to four patients, while three patients underwent local lymphadenectomy (LAD). Local recurrence occurred in four patients who did not undergo RT (among them three patients had excision margins <2 cm) after a mean time of 9 months. Despite retreatment, two of those patients developed metastases. Recurrence-free survival after primary therapy was achieved: (a) in three patients with stage I and II MCC treated surgically with excision margins <2 cm combined with RT or wide excision >2 cm alone and (b) in two patients with stage III MCC treated with wide excision and LAD combined with local and regional RT. A review of the literature supports the following recommendations: (a) excision with adequate margins combined with RT; (b) LAD with regional RT in cases of lymph node involvement; and (c) sentinel lymph node biopsy in patients without clinically suspicious lymph nodes.

Batwing mastopexy as oncoplastic surgical approach to periareolar tumors in upper quadrants.

AIMS AND BACKGROUND: Batwing mastopexy (BWM) is an oncoplastic technique most commonly used in the treatment of 12 o'clock periareolar tumors. The aim of this study was to assess the early cosmetic results of BWM performed for periareolar lesions located in the upper quadrants, i.e. from 10 to 2 o'clock position. METHODS AND STUDY DESIGN: A prospective analysis of a preliminary group of 35 women with periareolar intraductal or invasive breast cancer in the upper quadrants was done. All patients underwent wide lumpectomy with clear margins followed by BWM in order to obtain favorable cosmesis. For invasive cancers axillary biopsy or dissection was performed by separate incision. Cosmetic outcome was assessed 4 weeks after surgery by the patient with reference to breast shape, nipple-areola complex (NAC) position and scar arrangement. The result was rated as poor, medium or good for each parameter. RESULTS: There were no poor ratings of cosmetic outcome. The result was rated as medium by 5 women (14%) regarding breast shape and by 3 regarding NAC position (9%). The remaining women evaluated these parameters as good (86% and 91%, respectively). In contrast, scar arrangement was assessed as good by 26 patients (74%), medium by 8 (23%), and poor by 1 (3%). All women rating scar arrangement as other than good had a lesion located in the upper lateral quadrant. Considering the reasons for the relatively low scar acceptance by these women, the only important cause of disappointment was the placement of one of the radial parts of the scar in the area of decolletage in the upper medial quadrant. CONCLUSIONS: BWM allows to achieve favorable breast shape and NAC position for lesions located in the upper quadrants regardless of the medial or lateral side. However, when performed in the lateral quadrant it produces a scar that can be hard to accept for some women.

Urinary complications in rectal cancer patients are related to the dissection tool.

BACKGROUND/AIMS: To assess the incidence and risk of urinary complications after anterior rectal cancer resection with regard to the surgical device used for total mesorectal excision (TME). METHODOLOGY: During the years 2004-2009 we operated 374 rectal cancer patients with TME and the intent of autonomic nerves sparing intent. Seventeen patients underwent mesorectal dissection with ultrasound scalpel (US). They were compared to the control series of 35 cases selected from the patients for whom electrocautery was used. Selection was done in the manner to eliminate any other significant differences between groups. RESULTS: Intraoperative complications, postoperative mortality, anastomotic leakage and infectious complications did not occur. Urinary bladder disturbances developed in US group in 1 patient (6%) while in 12 patients (34%) in EC group (p<0.05). In US group the character of complication was transient stress incontinence with symptoms being significantly reduced during six postoperative months. In EC group two patients had dysuria, two nycturia, one had both. Stress incontinence occurred in six patients, complete incontinence requiring catheterization in one. CONCLUSIONS: When compared to EC, TME with US is related to lower risk of urinary complications and facilitates autonomic nerve preservation due to minimized thermal lateral tissue damage.

Lobular neoplasia found on breast biopsy: marker of increased risk of malignancy or direct pre-cancerous lesion?

The aim of this study was to compare the imaging symptoms and microscopic findings in females with lobular neoplasia (LN) found on biopsy. 1,478 women who underwent primary open biopsy or surgical excision after percutaneous biopsy were reviewed. In 24 of them (1.6%), LN was found. In four patients, excisional biopsy with hook-wire localization was done primarily due to the radial scar. In 20 females, surgical excision of BIRADS 4 lesion was performed because of the presence of LN in specimens from the vacuum-assisted or core-needle percutaneous biopsy. Postoperative pathologic findings were compared to the radiological symptoms. In 13 women, LN did not produce any radiological symptoms and was an additional histologic finding existing near the other lesion: fibroadenoma and radial scar. In none of these lesions was an invasive cancer noticed. In one single patient, ductal carcinoma in situ was observed in the other segment of the breast. Invasive ductal cancer developed in the contralateral breast in one patient. In 11 patients, LN was diagnosed due to radiological symptoms produced by itself. In this group, the invasive lobular cancer was found in seven lesions (64%). Our finding suggests that LN producing suspicious radiological symptoms can be a different biologic type of this lesion when compared asymptomatic LN diagnosed which is usually found on biopsy as additional microscopic pathology. Symptomatic LN is probably associated with a higher potential of malignant transformation.

Duration time of vacuum-assisted biopsy for nonpalpable breast masses: comparison between stereotactic and ultrasound-guided procedure.

AIMS AND BACKGROUND: Minimally invasive biopsy should be a standard practice in the non-operative diagnosis of breast lesions that are suspicious for or highly suggestive of malignancy. The aim of this study was to compare the procedure duration time for different methods of minimally invasive image-guided vacuum-assisted breast biopsy (VABB). METHODS: Six hundred and ninety-one women with nonpalpable breast masses classified as BI-RADS IV or V were studied. All of them underwent minimally invasive percutaneous VABB with an 11-gauge needle. In 402 patients an ultrasound-guided procedure with a hand-held device was performed while in 289 women stereotactic biopsy was carried out using a dedicated prone table unit with digital imaging. In each case the duration of biopsy was measured in terms of the total procedure time, room time and physician time. RESULTS: There were no significant differences between the stereotactic and ultrasound-guided groups with regard to patient age, body mass index, menopausal status, history of parity, hormone replacement therapy, breast parenchymal pattern (according to Wolfe's classification), family history of breast cancer, mass size and number of samples. Ultrasound-guided biopsy was found to take significantly less time than prone stereotactic biopsy in every aspect of procedure duration. Mean total procedure time, room time, and physician time in minutes were 26.7 ± 8.2 vs 47.5 ± 9.4 (P <0.01), 23.1 ± 8.5 vs 36.5 ± 9.2 (P <0.05), and 12.3 ± 5.6 vs 18.6 ± 5.9 (P <0.05), respectively. CONCLUSIONS: Ultrasound-guided breast biopsy is less time-consuming than the stereotactic procedure for both the patient and the physician. Because of the shorter procedure time (as well as other well-known advantages: real-time imaging, lower cost), ultrasound-guided biopsy should be considered the method of choice for sampling suspicious nonpalpable breast masses.

Association between histological type of tumour growth and patient survival in t2-t3 lymph node-negative rectal cancer treated with sphincter-preserving total mesorectal excision.

For rectal cancer patients without nodal metastases the identification of unfavourable factors can be helpful for the better selection for adjuvant therapy and multimodality treatment. The aim of this study was to evaluate the impact of clinico-histological parameters on prognosis in node-negative rectal cancer patients. One hundred and thirty-nine consecutive node negative rectal cancer patients with complete five-year follow-up were studied prospectively. All of them underwent curative anterior resection with total mesorectal excision technique. Seventy-eight patients with tumour penetration beyond the bowel wall received neo-adjuvant short-course radiation (25 Gy) followed by surgery within 1 week and postoperative chemotherapy with 5-fluorouracil and folinic acid in six cycles or adjuvant radiochemotherapy: irradiation (50.4 Gy) combined with chemotherapy (as above). Cancer-specific survival was calculated according to the Kaplan-Meier method. Variables significant in univariate analysis by log-rank test (P < 0.05) entered the Cox proportional hazard model. Survival was decreased for males, older patients (>60 years) with extraperitoneal, poorly differentiated cancers, tumours with mucinous histology and with the absence of lymphocytic infiltration but with the lack of statistical importance. Prognosis was significantly improved for patients with T2 tumours versus T3 (P < 0.01) and with cancers with expanding growth comparing to diffusely infiltrating ones (P < 0.01). In multivariate analysis these parameters significantly and independently influenced survival (P < 0.01 and P < 0.05, respectively). Diffusely infiltrating growth of tumour can reflect the more aggressive cancer behaviour and unfavourable course of disease despite the optimised local control. Apart from the extent of tumour penetration the type of invasive margin can be an additional parameter helpful for the optimal treatment planning and better patient selection for postoperative chemotherapy.

Mastectomy approach with Y-shaped incision: a technique designed for women with obesity.

OBJECTIVE: To evaluate the access to axilla, postoperative complications, and cosmetic results of the modified radical mastectomy with a Y-shaped approach especially designed for women with obesity. METHODS: One hundred seventeen consecutive women with obesity with infiltrating breast cancer were studied. All of them were not eligible for breast-conserving therapy and underwent modified radical mastectomy. Operation was performed using a surgical technique designed to improve the axillary clearance and to eliminate the lateral dog ear deformity. Two oblique incisions were added to the traditional transverse Stewart incision at the lateral part forming the Y-shaped approach. After lateral flap retraction, the axillary dissection was done. Before closing the wound, the triangular flap was advanced medially, whereas superior and inferior areas of redundant skin overlying the latissimus dorsi muscle were excised. RESULTS: No intraoperative complications were observed. In each case, the axillary dissection (with level 3 node clearance when needed) was performed with ease. The wound was healed by primary adhesion, giving an excellent cosmetic result without lateral dog ear deformity. Skin flap necrosis was found in 2 elderly patients. Wound hematoma and surgical site infection developed in 1 patient each. Necrosis of the apex of axillary triangle occurred in one woman with diabetes. These rare complications were managed successfully in all the cases. CONCLUSIONS: The Y-shaped approach for modified radical mastectomy is a simple and safe technique. It facilitates the wide access to axilla and improves cosmesis in women with obesity by eliminating lateral dog ear deformity.

[The effectiveness of population-based breast cancer screening programme]. / Skutecznosc populacyjnego programu wczesnego wykrywania raka piersi.

UNLABELLED: Well-organised mammography screening programme can significantly reduce the breast cancer mortality However, changes in mortality rates take a long time thus some early indicators are usually used to monitor the effectiveness of the programme. If these operational objectives are accomplished then the programme can replicate the mortality reduction achieved in randomised trials. THE AIM OF THIS STUDY: To evaluate the quality of breast cancer screening programme in the region of Lower Silesia during the first year of its operating. MATERIAL AND METHODS: Centrally organised breast cancer screening has been introduced since the beginning of the year 2007. This population-based programme is designed for women aged 50-69. Females undergoing treatment or being followed-up due to breast cancer are not invited. Screen-film two-view mammography without clinical examination is used as a screening test which is to be performed every two years. The second level diagnostic tools are breast clinical examination and additional imaging (mammography and ultrasound). Following further assessment women are referred to the examination at the routine round length of the programme, at the less interval (short-term recall) or biopsy procedures. Quality assessment was done via early indicators according to the European guidelines. RESULTS: The attendance rate was 41% (79,143 women screened within 192,613 eligible population for one year). Technical repeat rate, further assessment rate, and short-term recall rate were: 0.26%, 6.85%, and 0.91%, respectively. Pathologically confirmed breast cancer was revealed in 364 women giving the detection rate 4.59 for 1000. Cancer detection rate to expected incidence ratio was 3.35. CONCLUSIONS: Mammography service performed during the first year of breast cancer screening programme in the region of Lower Silesia conforms to quality assessment parameters recommended by the European guidelines at the acceptable level. The main problem at the start of this programme is too low coverage. Invitation process must be strongly intensified to improve long-term effectiveness and to significantly reduce breast cancer mortality.

Combined-modality therapy with sphincter-preserving total mesorectal excision for locally advanced rectal cancer: patient's age and long-term outcome.

BACKGROUND: In rectal cancer patients anterior resection with total mesorectal excision (TME) results in good functional outcomes, optimal local control and improved survival. However, patients with locally advanced tumours still have a high risk of oncological relapse and may benefit from neo- or adjuvant therapy. AIM. The purpose of this study was to identify the clinico-pathological features related to poor prognosis after sphincter-saving curative combined-modality therapy for rectal cancer. MATERIAL AND METHOD: Forty-eight consecutive patients with UICC stage II and III rectal carcinoma operated on with TME were studied prospectively. Fifteen patients received neoadjuvant radiotherapy and postoperative chemotherapy; for the remainder combined adjuvant chemoradiotherapy was given. RESULTS: Five-year cancer-specific survival rate was 49%. Patient's gender, tumour location, grade, mucinous histology, direct tumour spread, type of growth margin and lymphocytic tumour infiltration were revealed to be factors without statistical importance. Only the positive nodal status (31.6 +/- 11.0 vs 61.5 +/- 9.7) and the patient's advanced age (38.5 +/- 9.7 vs 63.2 +/- 11.4) were significantly related to decreased survival rate (p=0.038 and 0.048, respectively). In multivariate analysis both parameters independently influenced poor prognosis (p=0.045 and 0.038; Relative Risk 2.26 and 2.13; Odds Ratio 4.21 and 1.07, respectively). CONCLUSIONS: An elderly patient's age seems to be an independent prognostic factor associated with poor survival after curative treatment for locally advanced rectal cancer even when non-cancer causes of death are excluded. Thus, for older patients adjuvant therapy should be an integral part of treatment with the careful benefit-toxicity analysis.

Hepatitis C virus infection and locally advanced splenic marginal zone lymphoma.

Splenic marginal zone lymphoma (SMZL) is a rare malignant B-cell neoplasm, usually with an indolent clinical course and favorable prognosis. Treatment options include chemotherapy, surgery, radiation and immunotherapy. In some recent studies an increased incidence of hepatitis C virus (HCV) infection in patients with SMZL was reported and its possible role in lymphomagenesis was emphasized. A 66-year-old woman with twelve-year history of HCV infection was admitted due to locally advanced abdominal tumor involving the spleen and the left part of the diaphragm. Transaminase serum levels were not elevated. Neither peripheral lymphadenopathy nor bone marrow pathology was found. Absolute blood lymphocyte, erythrocyte and platelet counts were normal. A splenectomy with partial diaphragm resection in one block was performed. Recovery was uneventful. Pathologic examination with immunohistochemistry revealed SMZL and confirmed a neoplastic infiltration of the resected diaphragm. Following surgery, chemotherapy (CHOP regimen) and immunotherapy (anti-CD20 antibody) were given. At the last follow-up 15 months after surgery, the patient was free of any symptoms of lymphoma. Surgical resection of even locally advanced SMZL with involvement of adjacent tissues can be performed as a diagnostic and therapeutic procedure. Splenectomy is especially indicated in symptomatic patients without other sites of the disease. HCV infection may result in increased risk of SMZL due to the induction of B-cell lymphoproliferation. Because of possible lymphoma regression following anti-viral therapy, a systematic screening for HCV in patients with SMZL seems to be valuable and helpful for treatment planning.

Sphincter-preserving R0 total mesorectal excision with resection of internal genitalia combined with pre- or postoperative chemoradiation for T4 rectal cancer in females.

AIM: To evaluate the impact of chemoradiation admi-nistered pre- or postoperatively on prognosis in females following R0 extended resection with sphincter-preserving total mesorectal excision (TME) for locally advanced rectal cancer and to assess the association between chemoradiation and intra- and postoperative variables. METHODS: Twenty-one females were treated for locally advanced but preoperatively assessed as primarily resectable rectal cancer involving reproductive organs. Anterior resection with TME and excision of internal genitalia was combined with neo- or adjuvant chemoradiation. Two-year disease-free survival analysis was performed with the Kaplan-Meier method and log-rank test. The association between chemoradiation and other variables was evaluated with the Fisher's exact test and Mann-Whitney test. RESULTS: Survival rate decreased in anaemic females (51.5% vs 57.4%), in patients older than 60 years (41.8% vs 66.7%) with poorly differentiated cancers (50.0% vs 55.6%) and tumors locatedor=1 L, rate of postoperative bladder and anorectal dysfunction, and minimal distal resection margin. It significantly influenced minimal radial margin (mean 4.2 mm vs 1.1 mm; P<0.01). CONCLUSION: Despite involving internal genitalia, long-term disease-free survival and sphincter preservation may be achieved with combined-modality therapy for females with T4 locally advanced rectal carcinoma. Neoadjuvant chemoradiation does not compromise functional results and may significantly improve oncological outcomes probably due to enhanced radial clearance.

Clinical factors in prediction of prognosis after anterior resection with total mesorectal excision for carcinoma of the rectum.

The aim of the study was to estimate the long-term results and the prognostic value of clinical and pathological factors following R0 anterior resection with total mesorectal excision (TME). Ninety-eight consecutive patients with histologically confirmed rectal cancer were studied prospectively with five-year follow-up. Survival was calculated using the Kaplan-Meier method and differences between curves were tested by the log-rank test. Multivariate analysis was performed using the Cox regression model. Recurrence-free survival (RFS) was 63.6%. Mean time of recurrence was 13.8 months (range 3-38). Local recurrence rate was 7.8% with the mean time of 12.7 months (range 3-25). In univariate analysis Dukes' stage (RFS for stage: A=93.2%; B=53.8%; C=26.3%) and preoperative CEA serum level (s-CEA) (for s-CEA5 ng/ml RFS=5.9%) significantly influenced survival (P<0.005 and P<0.00001). These parameters were also found to be independent prognostic factors in multivariate analysis (P<0.05 and P<0.00001). Survival was worse in older female patients with low-localised poorly differentiated tumors; however, those variables had not significant impact on prognosis. Neither symptom duration nor mucinous histology was significantly related to survival. Using TME technique a low local recurrence rate resulting in improved survival can be achieved. Apart from clinicopathological staging, elevated s-CEA can identify patients with poor prognosis. In addition to TME adjuvant therapy for this high-risk group should be considered.

[Postoperative complications of curative treatment for rectal cancer in males with sphincter-preserving total mesorectal excision]. / Powiklania leczenia u mezczyzn raka odbytnicy metoda calkowitego wyciecia mezorektum z zaoszczedzeniem zwieraczy.

UNLABELLED: Cancer of the rectum is an important problem for public health in Poland due to increasing incidence rate and still not satisfying treatment outcomes. Surgical management remains the mainstay of therapy. Because of introduction of the total mesorectal excision technique (TME) better locoregional control can be achieved. The value of the treatment method for clinical practice is associated with oncological effectiveness but it is also related to the risk of mortality and morbidity. THE AIM OF THIS STUDY: To assess the risk of mortality and morbidity of the curative anterior resection with TME in male patients and to evaluate the association between the incidence of postoperative complications and patient-, tumour- and treatment-related variables. MATERIAL AND METHODS: Consecutive 65 patients with histologically confirmed rectal cancer operated on with sphincter-saving TME method were studied prospectively RO resection was achieved in all cases. All anastomoses were constructed with end to end double-stapling technique. Adjuvant therapy was administered for 54% patients (in stages UICC II i III). 19% of patients received preoperative radiation with high-dose fractions to 25 Gy (5 x 5 Gy) and postoperative chemotherapy with 5-fluorouracil and leucovorin in six courses. In 35% of patients combined adjuvant radiotherapy to the total dose 50.4 Gy and chemotherapy scheduled as above was used. RESULTS: There was no postoperative mortality. Early complications were noticed in 23% of patients: in 9.2% prolonged wound healing caused by superficial infection, in 6.9% anastomosis leakage (surgical treatment was performed in one patient), in 4.6% prolonged bowel paralysis, in 2.3% acute postoperative bleeding requiring relaparotomy. Late complications occurred in 16% of patients: in 6.9% anterior resection syndrome with bowel dysfunction (in one case defunctioning stoma was constructed), in 4.6% bladder dysfunction (nycturia with dysuria and urinary incontinence in 2.3% each), in 2.3% moderate benign anastomosis stricture and also in 2.3% complete sexual impotence. In patients with postoperative complications following factors were present: older age (> 75 years), obesity (BMI > 30), diabetes, preoperative radiotherapy and ultra low site of tumour (< 6 cm from the anal verge). CONCLUSIONS: Anterior resection with TME technique is a safe procedure in male patients. The incidence of early and late postoperative complications seems to be acceptable especially considering the oncological advantages of this method. The risk of morbidity increases in older patients with obesity, diabetes, ultra low-sited tumours and after preoperative radiation therapy

[Prognostic value of Jass classification of rectal cancer compared to original Dukes system]. / Skutecznosc prognostyczna klasyfikacji raka odbytnicy wedlug Jassa w porównaniu z klasycznym systemem Dukesa.

UNLABELLED: The aim of this study was to assess the prognostic value of Jass and Dukes classification of rectal cancer. MATERIAL AND METHOD: The impact of these staging systems on five-year disease-free survival has been estimated in univariate and multivariate analysis for the group of ninety-two curatively treated patients. RESULTS: In univariate analysis a relationship between survival and stage of disease has been found with a high degree of statistical significance for both Jass (I: 89.3 +/- 5.9; II: 54.2 +/- 10.2, p< 0.005; III: 14.3 +/- 9.4, p< 0.001; IV: 12.0 +/- 6.5, p < 0.001) and Dukes (A: 88.1 +/- 6.4; B: 41.0 +/- .9, p < 0.001; C: 15.4 +/- 7.1, p < 0.001) classifications. Cox regression model has identified Jass system as the best predictor of prognosis (II: p < 0.05; III: p < 0.001; IV: p < 0.001) and has shown the lack of significance for Dukes classification. In multivariate analysis of specific pathological features constituting Jass scale a significant and independent influence on survival (p < 0.05) has been noticed for the depth of penetration through the bowel wall, type of tumour growth and lymphocytic infiltration but not for the number of positive lymph nodes. CONCLUSION: Jass classification of rectal cancer is a prognostically effective modification of Dukes system as the result of addition of histological parameters significantly affects the prognosis.

[Prognostic significance of clinical and pathomorphological factors in colorectal cancer: a uni- and multivariate analysis]. / Ocena wartosci prognostycznej czynników klinicznych i patomorfologicznych w raku okreznicy i odbytnicy metoda analizy jedno- i wielowariantowej.

The aim of this study was to estimate the prognostic value of clinical and pathomorphological factors in cancer of the colon and rectum. We studied seventy-seven patients subjected to a radical surgery with a five-year follow-up. Survival was calculated using the Kaplan-Meier method and compared by log-rank test. Multivariate analysis was performed using Cox's regression model. Overall 5-year survival was 68%. Primary tumour spread beyond the bowel wall and regional lymph node involvement appeared to be independent prognostic factors, significantly influencing the survival of patients. Other variables including patient's age and sex, tumour location, symptom duration before treatment onset, grade of differentiation and mucinous histology had no significant impact on prognosis. Tumour spread beyond the bowel wall and metastases to regional lymph nodes are the most useful prognostic factors in patients with colorectal carcinoma. In routine practice the clinical stage of cancer should remain a reference against which other clinical and pathomorphological variables are assessed.