[Aspirin withdrawal in high risk cardiac patients before the operation of total colectomy with resection of ileum--case report].

Coronary artery disease is one of the risk factors for myocardial infarction and it is present in 40% of patients who are undergoing noncardiac surgery. Despite evidence of the benefit of the antiplatelet therapy in patients at risk of cardiac complications, aspirin treatment is often discontinued before surgery due to the risk of perioperative bleeding. In many studies and meta-analysis it is shown that aspirin withdrawal in perioperative period was associated with three-fold higher risk of major adverse cardiac events. Perioperative continuation of aspirin increase the rate of bleeding by 1.5, but it doesn't increase the level of the severity of bleeding complications. In perioperative periode aspirin is discontinued only if it is estimated that the bleeding risk is higher than the risk of thrombosis. In the paper authors present a case report of patient who developed a perioperative myocardial in-farction as a consequence of aspirin withdrawal before total colectomy.

Surgery for colorectal liver metastases: expanding the boundaries but where have all the patients gone.

AIM: To review and discuss the current strategies and controversies in the surgical management of colorectal cancer liver metastases. METHODS: An analysis of indications, contraindications and scoring systems and concepts for expanding the indications for resection are discussed. The findings and discussion are related to our own experience, especially with radiofrequency assisted liver resection for colorectal cancer liver metastases. RESULTS: Resection is the only management strategy that can potentially cure the patient. Certain controversies still exist, such as contraindications for surgery, timing of treatment of synchronous metastases, significance of extra-hepatic disease etc. Strategies that can improve respectability are discussed. Parenchyma oriented, tissue sparing surgery facilitates reresection should it become necessary. CONCLUSION: The management of colorectal cancer liver metastases is still a confusing issue for general oncologists and general surgeons. A multidisciplinary approach that tailors the management strategy to the individual patient is the only option that provides optimal results for patients with advanced disease.