RESUMO
Oesophageal achalasia is a serious cause of dysphagia. Therapeutic options for achalasia include endoscopic and surgical methods. Indications for individual methods overlap to a certain extent and require careful diagnosis. The review article describes individual methods, focusing particularly on the issues of indications of pneumatic dilatation, peroral endoscopic myotomy (POEM) and laparoscopic or robotic Hellers myotomy. Special attention is paid to revision procedures after Hellers myotomy. The main added value of POEM is the treatment of spastic disorders of the oesophagus and re-do myotomy. Type 2 achalasia can be treated with dilatation, POEM and HM; type 1 achalasia can be treated using the same modalities. For type 3, POEM is the current method of choice. Despite the current emphasis on endoscopic myotomy, surgical therapy, especially laparoscopic or robotically assisted Hellers myotomy, remains a safe therapeutic option. It is indicated especially in patients who are not suitable for endoscopic therapy or those with advanced achalasia findings. In the future, identification of the risk of postoperative complications (perforation, reflux) should lead to differentiation of the indication of the laparoscopic (robotic) approach and POEM, or it may lead to a synchronous or metachronous indication of the cuff construction.
Assuntos
Acalasia Esofágica , Refluxo Gastroesofágico , Acalasia Esofágica/diagnóstico , Acalasia Esofágica/cirurgia , Esfíncter Esofágico Inferior/cirurgia , Esofagoscopia/métodos , Refluxo Gastroesofágico/cirurgia , Humanos , Resultado do TratamentoRESUMO
INTRODUCTION: Arterial aneurysms of the pancreaticoduodenal arcade (PDA) represent approximately 2% of all aneurysms of visceral arteries. Despite a low incidence, this group of aneurysms is clinically significant due to its high risk of rupture. CASE REPORT: A 45 years old patient presented with a pancreaticoduodenal arcade aneurysm rupture along with a tight stenosis at the origin of the coeliac trunk. Retrograde blood flow from the superior mesenteric artery (SMA) to the hepatic artery (HA) via PDA limited our therapeutic options due to the necessity to maintain liver perfusion. The patient was indicated for an interventional radiology procedure, which consisted of percutaneous transluminal angioplasty (PTA) with stent placement at the origin of the coeliac trunk and subsequent transarterial embolisation (TAE) - trapping of the aneurysm using coils. Due to clinical signs of the intra-abdominal compartment syndrome, within 24 hours of the radiological treatment, the patient was indicated for surgical revision (laparotomy). During the surgery, no signs of active bleeding were found; coagula were evacuated from the abdominal cavity (800 ml) and laparostomy was performed with a temporary closure using a grid. Final closure of the abdominal cavity was performed on postoperative day 20 from the initial procedure. Follow-up abdominal CT performed 22 months after TAE showed no recurrence of the aneurysm. CONCLUSION: Aneurysm rupture represents a serious case of acute abdomen which requires urgent treatment. The preferred method of treatment for ruptured PDA aneurysms is the endovascular intervention using TAE, which is associated with lower morbidity and mortality than the surgical intervention. Concurrent coeliac trunk stenosis requires consideration given the need to maintain sufficient liver perfusion after TAE of the PDA aneurysm, acting up to this point as a collateral circulation of the liver. The choice of the therapeutic approach should be individualised taking into account the above mentioned recommendations.
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Aneurisma Roto , Embolização Terapêutica , Aneurisma Roto/complicações , Aneurisma Roto/diagnóstico por imagem , Aneurisma Roto/cirurgia , Artéria Celíaca , Hemoperitônio/etiologia , Hemoperitônio/cirurgia , Humanos , Artéria Mesentérica Superior , Pessoa de Meia-Idade , Pâncreas , Resultado do TratamentoRESUMO
Oesophageal diverticula represent a relatively rare pathology of the oesophagus requiring a specific diagnostic and therapeutic approach. Interventional therapy is indicated for symptomatic diverticula, diverticula with other pathologies (tumour in the diverticulum, gastroesophageal reflux disease, low-malignancy gastroesophageal junction tumours). The open surgical approach is being increasingly replaced by minimally invasive surgical, endoscopic and combined methods. Surgical mini-invasive methods use transaxillary, thoracoscopic or transhiatal laparoscopic approach, often with endoscopic assistance. Endoscopic and transoral surgical procedures include various diverticulotomy techniques and submucosal tunnelling techniques (variants of peroral endoscopic myotomy). The primary concern in therapy is the reduction of symptoms, improvement of the quality of life and the patient´s safety. The resulting quality of life is affected by the frequent presence of functional diseases of the oesophagus (achalasia, hypercontractile oesophagus). Although surgical minimally invasive therapy using the laparoscopic or thoracoscopic approach is safe, it nevertheless does not exclude serious risk of complications. Randomized and observational studies comparing endoscopic and surgical methods are still missing. It is, therefore, necessary to extend the records in order to update the indication algorithm of intervention therapy, focusing mainly on safety with a clear imperative for patient centralization.
Assuntos
Divertículo Esofágico/diagnóstico por imagem , Divertículo Esofágico/cirurgia , Refluxo Gastroesofágico , Laparoscopia , Humanos , Qualidade de VidaRESUMO
INTRODUCTION: This case report describes bleeding from an iatrogenic thoracic aortic injury in minimally invasive thoracoscopic esophagectomy. CASE REPORT: A 53-year-old man underwent neoadjuvant radiochemotherapy for adenocarcinoma of the esophagus with positive lymph nodes. PET/CT showed only a partial response after neoadjuvant therapy. Minimally invasive thoracoscopic esophagectomy in the semi-prone position with selective intubation of the left lung was performed. However, massive bleeding from the thoracic aorta during separation of the tumor resulted in conversion from minimally invasive to conventional right thoracotomy. The bleeding was caused by a five millimeter rupture of the thoracic aorta. The thoracic aortic rupture was treated by suture with a gore prosthesis in collaboration with a vascular surgeon. Esophagestomy was not completed due to hypovolemic shock. Hybrid transhiatal esophagectomy was performed on the seventh day after the primary operation. Definitive histological examination showed T3N3M0 adenocarcinoma. CONCLUSION: Esophagectomy for cancer of the esophagus is one of the most difficult operations in general surgery in which surgical bleeding from the surrounding structures cannot be excluded. Aortic hemorrhage is hemodynamically significant in all cases and requires urgent surgical treatment.
Assuntos
Neoplasias Esofágicas , Esofagectomia , Doença Iatrogênica , Neoplasias Esofágicas/cirurgia , Esofagectomia/efeitos adversos , Humanos , Masculino , Pessoa de Meia-Idade , Tomografia por Emissão de Pósitrons combinada à Tomografia Computadorizada , Decúbito Ventral , ToracoscopiaRESUMO
INTRODUCTION: Diffuse peritonitis is a serious disease with rather poor therapeutic results. Management traditionally consists in the surgical treatment of its etiology, combined with targeted antibiotic therapy and complex intensive care of the patient. The basic procedure includes the identification and treatment of the origin of peritonitis, followed by thorough abdominal cavity toilet, lavage and drainage. There are currently two major procedures for carrying out complex surgical care of a patient suffering from diffuse peritonitis. The first one is primary sanation of the abdominal cavity, in which toilet, peroperative lavage and postoperative drainage is performed. The second procedure involves similar steps, but postoperative irrigation with saline or another solution is performed, usually over 2448 hours - continuous lavage. Both procedures, albeit often modified, are still used in most surgical departments in the Czech Republic; therefore, we decided to compare them in terms of morbidity, mortality and hospital length of stay. METHOD: We conducted a prospective randomized study involving 55 patients with peritonitis operated on from 10/2012 to 4/2014. Whenever possible, we tried to use both methods alternately method regularly to enable randomization and ensure presentable outcomes. RESULTS: No statistically significant difference related to morbidity, mortality and hospital length of stay was recorded in our group. CONCLUSION: Based on our results, we can state that both methods are equal and suitable for all types of diffuse peritonitis without any impact on mortality, morbidity and hospital length of stay. Key words: peritonitis - drainage peritoneal lavage.
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Lavagem Peritoneal , Peritonite , Cuidados Pós-Operatórios , República Tcheca , Drenagem , Humanos , Peritonite/terapia , Estudos ProspectivosRESUMO
A single-center retrospective study the complication and mortality of surgical treatment of esophageal cancer 2006 to 2015 is presented. A total of 212 patients with esophageal cancer were operated at the First Department of Surgery University Hospital Olomouc, Czech Republic in the period between 2006 and 2015. Adenocarcinoma was histologically described in 127 patients (59.9%), squamous cell carcinoma in 82 patients (38.7%), and other types of carcinoma were described in 3 cases. According to the preoperative staging of esophageal cancer, the patients with early stage disease (T1-2N0M0) had primary surgery, while the patients with advanced stage (T3-4N0-2M0) were indicated for neoadjuvant chemoradiation with the surgery being performed subsequently. Transhiatal laparoscopic esophagectomy was performed in 183 patients, and Orringer esophagectomy in 4 patients. Thoracoscopic esophagectomy was performed in 17 patients and thoracotomy in 30 patients. Respiratory failure with the development of ARDS syndrome accompanied by multiple-organ failure occurred in 21 patients. Statistically significant association between mortality and ASA (p = 0.009) and between respiratory complications and ASA (p = 0.006) was demonstrated. The majority of patients who died were under 60 years of age (p = 0.039). Further, significant association between 30-day mortality and tumor stage (p = 0.021), gender (p = 0.022) and age (p = 0.018) was evident. A significant association between tumor stage and fistula in anastomosis, (p = 0.043) was observed. Esophagectomy is a procedure, which should be performed in specialized high-volume centers experienced in treatment of this serious malignancy and by certified oncology surgeons with long time experience in esophageal surgery.
Assuntos
Neoplasias Esofágicas/mortalidade , Neoplasias Esofágicas/cirurgia , Esofagectomia/efeitos adversos , Adenocarcinoma/mortalidade , Adenocarcinoma/cirurgia , Carcinoma de Células Escamosas/mortalidade , Carcinoma de Células Escamosas/cirurgia , Humanos , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Estudos RetrospectivosRESUMO
The authors present a review article evaluating the use of the colon as a replacement for the esophagus. We present current indications for both benign and malignant conditions and compare the advantages and disadvantages of the technical possibilities of esophageal reconstruction. The surgical technique utilizing the vascular bundle of the left colic artery and retrosternal location of the colonic conduit is discussed and documented in detail. Furthermore, we describe both early and late complications, including their management. We conclude that the colon is a safe technical possibility for esophageal replacement with satisfactory early and long-term results in cases where gastric conduit is not available. Key words: esophageal replacement with colonic interposition - esophageal replacement complications - colon interposition for esophageal replacement technique - coloplasty - esophageal replacement surgery.
Assuntos
Colo , Esôfago , Anastomose Cirúrgica , Colo/transplante , Esôfago/cirurgia , Humanos , Complicações Pós-OperatóriasRESUMO
INTRODUCTION: Post-oesophagectomy leakage occurs in 1-30% of cases as a significant factor in postoperative morbidity and mortality, accounting for 40% of postoperative deaths. Endoscopic vacuum therapy (EVAC) is, besides stent therapy, clips and surgical therapy, a new endoscopic thera-peutic modality. CASE REPORT: A 72-year-old polymorbid female patient with Siewert type II adenocarcinoma of the distal esophagus (T1b, N0, M0) was indicated for resection of the upper stomach and lower thoracic esophagus from laparotomy and thoracotomy with reconstruction using double-stapling anastomosis. On postoperative day 12, a 3rd degree leakage with propagation into the right pleural cavity was proven on CT. Endoscopy showed a defect affecting 30% of the circumference with a 7×3×3 cm cavity. Because of the leak morphology, EVAC was indicated. The therapy comprised 12 sessions with 3-4-day intervals for a total duration of 40 days with 5 extraluminal and 7 intraluminal applications and negative pressure of 100-125 mmHg. The condition was complicated by global respiratory failure due to severe pneumonia. Artificial ventilation was terminated on the 58th postoperative day. The patient was discharged to a rehabilitation facility on the 90th postoperative day. The follow-up 3 months after discharge confirms satisfactory performance results with full replenishment. CONCLUSION: The therapy of complications of intrathoracic anastomoses after oesophagectomy has shown a trend toward reduced invasiveness and wider implementation of endoscopic methods. In spite of its shortcomings, the use of EVAC is a safe and highly effective therapeutic option even for extensive anastomotic defects. The future use, indications as well as relation to other therapeutic options require further evaluation. Key words: endoscopic vacuum therapy - esophageal leakage - esophagectomy complications - intraoperative endoscopy.
Assuntos
Neoplasias Esofágicas , Esofagectomia , Tratamento de Ferimentos com Pressão Negativa , Idoso , Anastomose Cirúrgica , Fístula Anastomótica , Endoscopia , Neoplasias Esofágicas/cirurgia , Feminino , HumanosRESUMO
The authors present the results of surgical treatment of esophageal cancer at Department of Surgery I, University Hospital Olomouc between 20062016. The aim of the study was to use retrospective analysis to evaluate the results of patients operated for esophageal cancer and statistically evaluate the results based on the type of surgical approach (transhiatal, transthoracic). Method: A total of 240 patients with esophageal cancer were operated at Department of Surgery I between the beginning of 2006 and the end of 2016. We evaluated respiratory complications, the incidence of anastomotic fistula and complications based on the Clavien-Dindo classification of complications, based on the type of surgical approach selected (transhiatal or transthoracic esophagectomy). Results: The patient set included 207 men (86.3%) and 33 women (13.7%). The mean patient age was 60.4 years. The histological type was adenocarcinoma in 145 (60.4%) and squamous cell carcinoma in 90 (37.5%) patients; another type of carcinoma was observed in 5 cases. Transhiatal esophagectomy was performed in 194 patients (80.2%) (transhiatal laparoscopic in 190 and classic Orringer in 4 patients). Transthoracic approach was used in 46 patients (19.2%), thoracoscopic in 16, and thoracotomic in 30 patients. A gastric conduit was used in 236 patients and coloplasty was performed in 4 patients. The mean duration of surgery was 217 min for the transhiatal approach, 239 min for the thoracoscopic approach and 277 min for the thoracotomic approach. Total blood loss per patient was 562 ml on average for all the operated patients. Peri- or postoperative blood transfusions were administered to 148 patients. Lymphadenectomy was performed as part of the procedure in all patients; the mean of 16.1 lymph nodes were removed. The average hospital stay was 20.7 days. In the patient set, 30-day mortality included 12 patients (respiratory complications 10, MI 1, conduit necrosis 1) and 90-day mortality included 4 (multi organ failure during ARDS). Based on statistical analysis, the incidence of respiratory complications significantly correlated with ASA classification (p=0.0001) and Clavien-Dindo classification (p.
Assuntos
Adenocarcinoma , Neoplasias Esofágicas , Esofagectomia , Adenocarcinoma/cirurgia , Neoplasias Esofágicas/cirurgia , Feminino , Hospitais Universitários , Humanos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias , Estudos RetrospectivosRESUMO
Extended tracheo-bronchoplastic resection for lung cancer with carinal involvement ranks among technically demanding procedures. Despite certain progress in oncological therapy, this type of resection remains the only potentially curative treatment of NSCLC in this localization. However, given the severity of complications postoperative mortality is relatively high (711%). The main cause of death is tracheobronchopleural fistula complicated by thoracic empyema, bronchopneumonia and septic shock. If ARDS (acute respiratory distress syndrome) develops, the mortality rate rises up to 70%. The treatment of tracheobronchopleural fistula is arduous, long-term and essentially multidisciplinary. In this case report, the authors present the case of a 58 years old patient developing the tracheobronchopleural fistula early after carinal resection and sleeve pneumonectomy for a centrally localised squamous cell carcinoma of the right lung. The fistula was primarily sutured and secured using a muscular flap. For recurrence of the fistula, tissue adhesive glue was applied in combination with the introduction of a plastic stent, which resulted in healing of the tracheobronchopleural fistula.Key words: sleeve pulmonectomy carinal resection tracheobronchopleural fistula tracheobronchial stenting.
Assuntos
Carcinoma Pulmonar de Células não Pequenas , Fístula , Neoplasias Pulmonares , Pneumonectomia , Carcinoma Pulmonar de Células não Pequenas/cirurgia , Fístula/etiologia , Fístula/cirurgia , Humanos , Neoplasias Pulmonares/cirurgia , Pessoa de Meia-Idade , Recidiva Local de Neoplasia , Pneumonectomia/efeitos adversos , Complicações Pós-OperatóriasRESUMO
Extranodal lymphomas are quite rare, and they usually present as non-Hodgkin lymphomas. The most common localization is the gastrointestinal tract, mainly the stomach - primary gastric lymphoma; histologically, diffuse large B-cell lymphoma (DLBCL) is the most frequent type. The diagnosis is established based on endoscopic examination with biopsy of the tumor. It is an aggressive tumor, highly chemosensitive, which is why primary systemic chemotherapy is indicated in early, as well as late, stages of the disease. Surgery is indicated to treat complications such as perforation, bleeding or gastrointestinal obstruction. The authors present the case of a chemoresistant patient with hemodynamically significant bleeding, indicated for surgical revision after unsuccessful endoscopic treatment. Multiple organ resection was performed due to the large size of the tumor in the abdominal cavity.Key words: gastric lymphoma - surgical treatment.
Assuntos
Linfoma Difuso de Grandes Células B , Neoplasias Gástricas , Cavidade Abdominal/cirurgia , Adulto , Biópsia , Criança , Hemorragia/etiologia , Humanos , Linfoma Difuso de Grandes Células B/complicações , Linfoma Difuso de Grandes Células B/cirurgia , Neoplasias Gástricas/complicações , Neoplasias Gástricas/cirurgiaRESUMO
INTRODUCTION: Solid pseudopapillary neoplasm (SPN) is a very rare neoplasm that occurs in girls and young women in 90% of cases; the range is 779 years of age, and the median is 28 years of age. This tumour was first described by Virginia Frantz in 1959 as a papillary cystic tumour of the pancreas. METHODS: The aim of this retrospective study was to analyse the incidence of SPN in all patients with a pancreatic tumour operated at the 1st Dept. of Surgery, University Hospital Olomouc between years 2006 and 2015. Clinical symptoms, imaging methods used, tumour marker positivity, histological findings, postoperative complications and disease-free interval were all evaluated. RESULTS: Of the 454 patients operated on between 20062015, the diagnosis of SPN was made in five female patients. The following imaging methods were used in the preoperative diagnostic process: CT, MRI, PET/CT and endosonography. In four patients the tumour was localised in the tail of the pancreas; these women underwent left-sided pancreatectomy. In one patient, the tumour was located in the pancreatic head and a pylorus-preserving pancreaticoduodenectomy was performed. Complications were seen only in one patient who underwent revision on the first postoperative day for bleeding from the pancreatic cut surface. Pancreatic fistula was not observed in any of the patients. The procedures were considered as sufficient from the oncological viewpoint due to the radical resection procedure and negative resection margin, and therefore no adjuvant oncological treatment was indicated in any of the patients. During the follow-up period, recurrence was not observed in any one of the patients. CONCLUSION: Solid pseudopapillary neoplasm of the pancreas is a rare disorder with a low malignant potential occurring primarily in young women. Generally, SPN has a good prognosis; however, advanced stages of the disease with distant metastases may be encountered in rare cases. The only curative treatment is radical surgical resection.Key words: solid pseudopapillary neoplasm Frantzs tumour pancreas.
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Neoplasias Pancreáticas , Pancreaticoduodenectomia , Tomografia por Emissão de Pósitrons combinada à Tomografia Computadorizada , Adulto , Feminino , Humanos , Recidiva Local de Neoplasia , Pancreatectomia , Neoplasias Pancreáticas/diagnóstico por imagem , Neoplasias Pancreáticas/cirurgia , Estudos RetrospectivosRESUMO
INTRODUCTION: The authors present the results of surgical resection in the form of proximal gastrectomy in a selected set of patients with adenocarcinoma of the gastroesophageal junction. The selection criteria included: ASA III-IV, internal comorbidities and elderly patients. METHODS: Between 2007 and 2015, 28 patients with adenocarcinoma of the gastroesophageal junction underwent proximal gastrectomy at the 1st Department of Surgery. The patient set consisted of 19 (67.8%) men and 9 (32.3%) women aged 5289 years with the median age of 72.5 years. Endoscopic examination revealed a tumour of the gastroesophageal junction, which was evaluated according to the Siewert classification: type I was present in 4 (16.7%) cases, type II in 12 (42.3%), and type III in 12 (42.3%). Histological analysis revealed adenocarcinoma in all cases. Proximal gastrectomy with lymphadenectomy was performed in all patients. Splenectomy was performed in eleven patients. The continuity of the gastrointestinal tract was ensured by esophagogastroanastomosis, and pyloromyotomy was performed as a standard procedure. Cryostatic examination revealed positive resection margins in the esophagus in five patients, which led to the resection of the distal esophagus from the right-sided thoracotomy. RESULTS: Injury to the biliary tract was observed in one case in the perioperative period, which was treated by hepaticojejunoanastomosis onto an excluded jejunal loop. The following complications were observed postoperatively: bleeding, respiratory complications, anastomotic dehiscence, laparotomy wound dehiscence, and inflammatory infiltration in the abdominal cavity. Thirty-day mortality was 10.7% in our patient set. CONCLUSION: Proximal gastrectomy with lymphadenectomy is an appropriate alternative for polymorbid patients with adenocarcinoma of the gastroesophageal junction and provides good short- and long-term results.Key words: cancer of gastroesophageal junction proximal gastrectomy complications of therapy.
Assuntos
Adenocarcinoma/cirurgia , Neoplasias Esofágicas/cirurgia , Junção Esofagogástrica/cirurgia , Gastrectomia/métodos , Neoplasias Gástricas/cirurgia , Idoso , Idoso de 80 Anos ou mais , Sistema Biliar/lesões , Esofagectomia/efeitos adversos , Esofagectomia/métodos , Feminino , Secções Congeladas , Gastrectomia/efeitos adversos , Humanos , Excisão de Linfonodo/métodos , Masculino , Margens de Excisão , Pessoa de Meia-Idade , Mortalidade , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/etiologia , Hemorragia Pós-Operatória/epidemiologia , Piloro/cirurgia , Esplenectomia/métodos , Deiscência da Ferida Operatória/epidemiologiaRESUMO
INTRODUCTION: Pancreatic cancer (PDAC) is one of the most aggressive malignancies. Its poor prognosis is due to a combination of various factors, mainly aggressive biology of the tumour, non-specific symptoms in early stages, their underestimation, prolonged time to diagnosis and late onset of treatment. The majority of patients are diagnosed in an advanced stage of the disease. Median survival of these patients ranges from 211 months. The most common consequences of locally advanced disease that require intervention include obstruction of the duodenum and biliary obstruction. The purpose of our study was to analyze the survival of patients with radically inoperable PDAC undergoing palliative surgery or exploration with biopsy, and to evaluate the influence of patient and tumour factors and treatment modalities on survival. METHODS: In our retrospective study we included all patients with radically inoperable PDAC undergoing a non-radical surgical intervention between 01 January 2006 and 31 December 2014. Patient age, histopathological findings, surgical and oncological treatment and survival were included in the analysis. The results were statistically processed and evaluated using IBM SPSS Statistics software version 22 (USA). RESULTS: 184 patients with radically inoperable PDAC, 105 males and 79 females, were included in our study. Mean age of the patients was 64 years and most patients presented with stage IV of the disease. Mean survival time was 7.04 months and median 4.7 months. CONCLUSION: We determined a statistically significant influence of the following factors on patient survival: sex, stage, presence of distant metastases at the time of surgery and oncological treatment administration. Mean and median survival of patients with radically inoperable tumours matches global statistics. KEY WORDS: pancreatic cancer - radically non-resectable - palliative surgery - survival.
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Carcinoma Ductal Pancreático/mortalidade , Cuidados Paliativos , Neoplasias Pancreáticas/mortalidade , Idoso , Biópsia , Carcinoma Ductal Pancreático/terapia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Neoplasias Pancreáticas/terapia , Estudos Retrospectivos , Taxa de SobrevidaRESUMO
INTRODUCTION: The investigation of prognostic and predictive factors for early diagnosis of tumors, their surveillance and monitoring of the impact of therapeutic modalities using hybrid laboratory models in vitro/in vivo is an experimental approach with a significant potential. It is preconditioned by the preparation of in vivo tumor models, which may face a number of potential technical difficulties. The assessment of technical success of grafting and xenotransplantation based on the type of the tumor or cell line is important for the preparation of these models and their further use for proteomic and genomic analyses. METHODS: Surgically harvested gastrointestinal tract tumor tissue was processed or stable cancer cell lines were cultivated; the viability was assessed, and subsequently the cells were inoculated subcutaneously to SCID mice with an individual duration of tumor growth, followed by its extraction. RESULTS: We analysed 140 specimens of tumor tissue including 17 specimens of esophageal cancer (viability 13/successful inoculations 0), 13 tumors of the cardia (11/0), 39 gastric tumors (24/4), 47 pancreatic tumors (34/1) and 24 specimens of colorectal cancer (22/9). 3 specimens were excluded due to histological absence of the tumor (complete remission after neoadjuvant therapy in 2 cases of esophageal carcinoma, 1 case of chronic pancreatitis). We observed successful inoculation in 17 of 28 tumor cell lines. CONCLUSION: The probability of successful grafting to the mice model in tumors of the esophagus, stomach and pancreas is significantly lower in comparison with colorectal carcinoma and cell lines generated tumors. The success rate is enhanced upon preservation of viability of the harvested tumor tissue, which depends on the sequence of clinical and laboratory algorithms with a high level of cooperation.Key words: proteomic analysis - xenotransplantation - prognostic and predictive factors - gastrointestinal tract tumors.
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Carcinoma/cirurgia , Neoplasias Gastrointestinais/cirurgia , Camundongos SCID , Transplante de Neoplasias/métodos , Transplante Heterólogo/métodos , Animais , Biomarcadores , Cárdia , Linhagem Celular Tumoral , Neoplasias Colorretais/cirurgia , Neoplasias Esofágicas/cirurgia , Humanos , Camundongos , Neoplasias Pancreáticas/cirurgia , Prognóstico , Proteômica , Neoplasias Gástricas/cirurgiaRESUMO
INTRODUCTION: Postpancreatectomy haemorrhage (PPH) is considered to be the most severe specific postoperative complication following pancreatic resections and its treatment is difficult and requires coordinated interdisciplinary collaboration. PPH causes 11-38% of all post-pancreatectomy deaths. The aim of this study was to determine the prevalence of PPH in a set of patients operated on within the last 10 years, and to analyze the diagnostic methods, treatment modalities and the outcomes. METHODS: A retrospective analysis of patients undergoing pancreatic resections between 2006 and 2015. Clinically relevant PPH (types B and C) were the subject of interest. The onset, location and severity of PPH were analysed. Other factors analysed included operation diagnosis of PPH, diagnostic methods along with signs of sentinel bleeding, treatment options undertaken including the number of transfusions. 30-day, 90-day and in-hospital mortality, as well as the length of hospital stay and readmission rate were calculated. A descriptive statistical method was used. RESULTS: A total of 449 patients were operated on. Pancreatoduodenectomy (DPE) or pylorus-preserving pancreatoduodenectomy (PPPD) was done in 76.4%, left sided pancreatectomy (LPE) in 19.8% and total pancreatectomy (TPE) in 3.8%. 190 of the patients (42.3%) were women and 259 (57.7%) men, with the mean age of 61.5±11.1 years. A total of 23 (5.1%) PPH cases were identified, 21 (4.7%) were clinically relevant. Eight patients (35%) developed early PPH with direct reoperation, late PPH was seen in 14 patients after DPE and in one after LPE. Sentinel bleeding was present in 53.3% of late PPH cases. CT/CTA was performed in four patients with subsequent DSA performed in three. DSA identified a gastroduodenal artery stump pseudoaneurysm in one patient, which was resolved using a stent. Surgical intervention for late PPH was required in 10 patients in total, six of whom needed direct surgery due to the rapid development of circulatory instability and 3 due to inconclusive radiological management. One patient needed surgical drainage of both an abscess and haematoma. In two patients the origin of bleeding was due to a gastric ulcer, which was proven and solved endoscopically and 2 patients required conservative treatment only. The specific mortality for PPH was 17.4%. In the group of patients that suffered with any PPH following DPE and PPDPE the mortality rate was 22.2%, and 28.6% for late PPH. If late PPH developed coincidentally with postoperative pancreatic fistula (POPF), the mortality was 44%. In the early PPH group, an average of 10.1±2.5 transfusion units (TUs) were used with an average length of hospital stay 17.5±4.8 days and zero mortality in comparison to an average of 11.7±10 TUs and 29.9±14.6 days in hospital and 26.6% mortality in the late PPH group. CONCLUSION: PPH is a severe complication, which has a high mortality rate. It also often coincidentally develops with POPFs. Early clinical diagnosis with identification of its cause plays a key role in management. The use of interventional radiology in the treatment of PPH has begun to dominate other treatment modalities due to a very high success rate, and close collaboration with interventional radiologists is necessary in order to reduce the rate of surgical intervention required in PPH. KEY WORDS: haemorrhage - pancreas - resection - complications - mortality.
Assuntos
Pancreatectomia/efeitos adversos , Pancreaticoduodenectomia/efeitos adversos , Hemorragia Pós-Operatória/epidemiologia , Hemorragia Pós-Operatória/etiologia , Idoso , Estudos Transversais , República Tcheca , Feminino , Mortalidade Hospitalar , Humanos , Comunicação Interdisciplinar , Colaboração Intersetorial , Tempo de Internação/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Pancreatectomia/mortalidade , Pancreaticoduodenectomia/métodos , Hemorragia Pós-Operatória/mortalidade , Hemorragia Pós-Operatória/terapia , Reoperação , Taxa de SobrevidaRESUMO
INTRODUCTION: The aim is to map the current situation in the surgical treatment of pancreatic cancer in the Czech Republic. This information has been obtained from surgical treatment providers using a simple questionnaire and by identifying the so called high volume centres. The information has been collected in the interest of organizing and planning research projects in the field of pancreatic cancer treatment. METHOD: We addressed centres known to provide surgical treatment of pancreatic cancer. A simple questionnaire formulated one question about the total number of pancreatic resections, also separately for the diagnoses PDAC - C25, in the last two years (2014 and 2015). Other questions focused on the use of diagnostic methods, neoadjuvant therapy, preoperative assessment of risks, the possibility of rapid intraoperative histopathology examination, Leeds protocol, monitoring of morbidity and mortality including long-term results, and the method of postoperative follow-up and treatment. ÚZIS (Institute of Health Information and Statistics of the Czech Republic) was addressed with a request to analyze the frequency of reported total numbers for DPE, LPE, TPE and to do the same with respect to diagnosis C 25 for the last two years, available for the entire Czech Republic (2013, 2014). RESULTS: Altogether 19 institutions were identified by the preceding audit, which reported more than 10 pancreatic resections annually; these institutions were addressed with the questionnaire. Sixteen institutions responded to the questions, 13 of them completely. CONCLUSION: The majority of potentially radical surgeries for PDAC in the Czech Republic are carried out at 6 institutions. All of the institutions that participated in the survey collect data about morbidity and mortality and monitor their results. KEY WORDS: pancreas cancer outcomes surgery.
Assuntos
Carcinoma Ductal Pancreático/cirurgia , Hospitais com Alto Volume de Atendimentos , Pancreatectomia , Neoplasias Pancreáticas/cirurgia , Padrões de Prática Médica , República Tcheca , Humanos , Inquéritos e QuestionáriosRESUMO
BACKGROUND: Sarcomatoid carcinoma (SARC) of the lung is a very rare and aggressive type of nonsmall cell lung cancer. It belongs to a group of poorly differentiated carcinomas with partial sarcomatoid differentiation or with a direct sarcoma component. Characteristic findings include a large tumor with an invasive tendency, early recurrence and systemic metastases. CASE: The authors present a case of SARC in the 77-year-old patient. Preoperative staging confirmed sarcomatoid carcinoma of the lower lobe of the left lung without generalization on PET/CT. However, an infiltration of more than 2/3 of the diaphragm was ascertained. A resection was performed -â a left lower lobectomy with resection of the diaphragm and its replacement by a muscle flap made from the latissimus dorsi muscle with vascular pedicle. Histological findings confirmed the dia-gnosis of sarcomatoid (pleomorphic) carcinoma pT3N0M0. The patient underwent adjuvant chemotherapy; recurrence and systemic dissemination of the disease occurred after 20 months; the patient died 21 months after the surgery.
Assuntos
Carcinoma Pulmonar de Células não Pequenas/terapia , Neoplasias Pulmonares/terapia , Idoso , Carcinoma Pulmonar de Células não Pequenas/patologia , Quimioterapia Adjuvante , Diafragma/patologia , Diafragma/cirurgia , Evolução Fatal , Humanos , Neoplasias Pulmonares/patologia , Recidiva Local de Neoplasia/tratamento farmacológico , Pneumonectomia , Sarcoma/patologiaRESUMO
INTRODUCTION: Breast cancer is the most common malignancy in women. It affects mostly women between the ages of 60 and 70; however, in the past years, the number of younger female patients has been increasing. The incidence of breast cancer has been rising worldwide, especially in the United States and Western Europe. Breast carcinoma mortality, on the other hand, has shown a slight decrease due to early screening programmes and advanced treatment methods. METHODS: We included patients who had undergone surgery for breast carcinoma in the 1st Department of Surgery at Teaching Hospital in Olomouc between 1 January 2008 and 31 December 2012. In each patient, her age at the time of diagnosis/surgery was calculated. All patients were divided into 10-year age groups. At the same time, a sub-group of breast cancer patients younger than 45 years was created. We compared the numbers of patients in the respective groups and sub-groups in every year. The mean age and the median of age were also calculated. To evaluate the benefit of mammary screening, we compared the staging of operated tumours in the different years studied. The results were statistically processed and evaluated. RESULTS: The total number of 980 patients underwent surgery for breast carcinoma at our department between 2008 and 2012 with age ranging from 20 to 88 years. 101 of them were younger than 45 years. The mean age of the patients was 59 years, the median was 60 years. The total number of patients increased from 153 in 2008 to 240 in 2012. There was no significant increase in the number of patients younger than 45 years. There were more patients diagnosed with stage II carcinoma and fewer patients with stage III carcinoma in 2012 than in 2010. CONCLUSION: The analysis of our group of patients confirmed the increasing tendencies of breast cancer incidence in total. We did not prove a statistically significant increase in the number of patients in pre-screening age (i.e., younger than 45 years). More frequent diagnosis of early-stage disease was detected, especially during the last three evaluated years.Key words: breast cancer - age - stage screening.
Assuntos
Neoplasias da Mama/epidemiologia , Detecção Precoce de Câncer , Hospitais Universitários , Programas de Rastreamento/métodos , Adulto , Distribuição por Idade , Idoso , Idoso de 80 Anos ou mais , Neoplasias da Mama/cirurgia , República Tcheca/epidemiologia , Feminino , Humanos , Incidência , Mastectomia , Pessoa de Meia-Idade , Estudos Retrospectivos , Taxa de Sobrevida/tendências , Adulto JovemRESUMO
INTRODUCTION: Although generally uncommon, pancreatic metastases are increasingly encountered in clinical practice. The benefit of pancreatic resections in this setting is unclear and still being discussed. Renal cell carcinoma is the most frequent primary tumour metastasing to the pancreas--R0 resections in cases of solitary metastases can be performed. Resections in malignant melanoma and ovarian cancer are rather considered as palliative. The aim of this study is to analyse our own set of patients operated on for metastases into the pancreas and evaluate the results of their surgical treatment. METHODS: We identified the patients operated on for metastases to the pancreas. Patient and tumour characteristics were summarized using descriptive statistics. RESULTS: A total of 9 patients (out of 312 patients undergoing resection for malignancy in the period of 2006-2014) with pancreatic metastases were analysed. All but one were asymptomatic; the symptomatic patient suffered from GI bleeding. All patients had a metachronous lesion with a median length of 12 years (421 years) between the initial operation and pancreatic resection. The most common metastasing tumour was renal cell carcinoma (77%) with the highest incidence occurring at the head of the pancreas (44%). The most frequent procedure used was the pylorus-preserving pancreatic head resection (44%). The median operating time was 247 min, (126375 min). Six patients were complication free, the median of their hospital stay was 9.5 days (812 days). Complications included PPH type C and PF type B both of which required surgical intervention; however, PF type A required no intervention. No postoperative deaths occurred, multiple metastases were found in 4 patients with renal cell carcinoma metastases. The median of follow-up has been 11.5 months, (334 months). CONCLUSION: Survival after pancreatic resections due to renal cell carcinoma is favourable. Mortality is low and morbidity is similar to that associated with pancreatic resections due to other aetiologies, making surgery a valid and safe treatment option. Lifelong follow-up of patients after nephrectomy is advised. Resections in pancreatic metastases of malignant melanoma or ovarian carcinoma are considered as palliative, their indication being individual following interdisciplinary consultation.