Influence of donor age on renal graft function in first seven post transplant days.

Increasing gap between demand and availability of human kidneys for transplantation has forced a re-evaluation of the limits on donor age acceptability. The present study included 74 patients who underwent kidney transplantation in University Clinical Centre Tuzla. In an observational cohort study we assessed impact of donor age on post transplant renal function by analyzing following parameters: 24 hour urine output, creatinine clearance (Cr Cl) and glomerular filtration rate (GFR). Depending on donor age recipients were allocated in to two groups. Group I included patients who received renal graft from donors age up to 55 years, and Group II encountered recipients who received renal graft from donors older than 55 years. Our goal was to determine whether donor age over 55 years significantly diminishes renal graft function in first seven post transplant days. No statistically significant difference was found between Group I and II regarding 24 hour urine output. From second to fifth postoperative day creatinine clearance values were higher in the group of patients who received kidney from donors older than 55 years (47+/-19, 1 vs. 44, 4+/-20, 8). On the fifth, sixth and seventh post operative day GFR was significantly higher in patients who received renal graft from donors age up to 55 years (p<0, 0161). Our data showed no significant difference in observed variables between the two groups, thus indicating that utilization of renal grafts from donors' age > 55 years is acceptable and may considerably expand the donor pool.

Micophenolat Mofetil versus Azathioprine: effects on renal graft function in early posttransplant period.

All conventional immunosuppressive tree drugs-protocols are based on Cyclosporine; consisting of low doses of Cyclosporine (CsA), Azathioprine (AZA) or Mycophenolate Mofetil (MMF) and Prednisolone. AZA has been used in clinical transplantation for more than 30 years and was the first immunosuppressive agent to achieve widespread use in organ transplantation. MMF was introduced in clinical practice in 1995 after several clinical trials proved that it was more efficient than AZA for prevention of acute rejection episodes. Our aim was to evaluate influence of AZA and MMF on renal graft function in early post-transplant stage. Study recruited 74 patients who underwent kidney transplantation in University Clinical Centre Tuzla. All patients received CsA and corticosteroid-based immunosuppression, as a part of triple immunosuppressive regiment, 40 patients received AZA and 34 MMF. In order to assess renal graft function, following parameters were evaluated: glomerular filtration rate GFR (ml/min) creatinine clearance (CrCl) (ml/min), 24 h urine output (ml/day), and from the serum potassium, sodium, urea and creatinine (mmol/dm3). Significantly higher average values of 24 hour urine output were recorded during first seven postoperative days in patients receiving MMF compared to those treated with AZA. Serum creatinine values showed statistically significant decrease, starting with the second postoperative day, in MMF vs. AZA group (168,7+/-70,5 vs. 119,9+/-42,6; p<0,0007). GFR was significantly higher in MMF compared to the AZA group of patients. On the first post-transplant day CrCl was higher in AZA group (24,3+/-10 vs. 17,5+/-7,3; p=0,01), next six days situation is reversed CrCl is significantly higher in the MMF group (43,7+/-15 vs. 53, 4+/-22, 8 p=0,006). MMF vs. AZA therapy was associated with protective effect against worsening of renal function in first seven post-transplant days.

Surgical treatment and complications of treating pancreatic tumor.

UNLABELLED: Pancreatic tumor is one with the worst prognosis of all cancers, and the tenth most frequent cancer in Europe, making the 3% of all cancers affecting both sexes. Most patients seek treatment when the disease is in its advanced stage and the level for possible resectability is low. Late presentation of the disease is responsible for the short survival period of 6 months and a five-year survival of 0.4 to 5% of patients. At the Clinic for Surgery in Tuzla during period from January 1st 1996, to January 1st 2011, a total of 127 resection surgeries were performed due to malignant tumors. The goal of this study was to show that adequate assessment of operability, proper surgical strategy and modern techniques of creating anastomoses reduces morbidity and mortality, results in fewer postoperative complications and contributes to better surgical results. In our study sample the most common place of tumor location was the head of pancreas, in 69 (59.7%) patients. Men develop this type of cancer more often than women in the ratio of 2:1, while the median age of patients was 62 years. We faced postoperative complications in 37 (29.1%) patients, pancreatic fistula being the most prevalent complication, occurring in 16 (12.6%) patients. Overall early and late postoperative mortality was observed in 12 (9.8%) patients. CONCLUSION: Patients with chronic and hereditary pancreatitis are at a higher risk for developing pancreatic cancer and should be screened for the purpose of early diagnosis. The staging of pancreatic cancer has improved, with the accuracy of 85-90%. Postoperative complications, morbidity, and mortality are significantly reduced (p < 0.05) if the standardized operational procedure is applied and if modern techniques are used to create pancreaticojejunal anastomosis as the anastomosis carrying the highest risk.

Daily hospice: Depression and anxiety after mastectomy for breast cancer.

The aim of the study was to define the effects of daily hospice team's activities on depression and anxiety in breast cancer patients having undergone mastectomy after three-month therapy. This prospective study included 35 patients that underwent mastectomy for breast cancer, followed by 3-month treatment at daily hospice, Tuzla University Clinical Center. Control group consisted of 35 mastectomized patients that did not visit daily hospice. Depression and anxiety were estimated by use of Zung's scale. Patients were tested initially and retested at 12 weeks. On initial testing, the mean value of depression was 59.85 +/- 6.97 in the study group and 55.65 +/- 7.91 in the control group. On three-month retesting, the level of depression was lower in the study group, with a mean value of 48.57 +/- 7.06 (P<0.0001) (steam T-test and Wilcoxon's test) and higher in the control group, with a mean value of 60.45 +/- 7.47 (P=0.0001) (steam T-test and Wilcoxon's test). On initial testing, the mean value of anxiety was 54.97 +/- 6.35 and 52.20 +/- 6.03 in the study and control group, respectively. On three-month retesting, the level of anxiety was lower in the study group, with a mean value of 43.43 +/- 5.97 (P<0.0001), showing improvement from initial testing, but was higher in the control group, with a mean value of 55.68 +/- 7.47 (P=0.0002). In conclusion, daily hospice team's treatment had favorable effects on lowering the levels of depression and anxiety in patients undergoing mastectomy for breast cancer.

Video-assisted thoracoscopic surgery for spontaneous pneumothorax.

Primary spontaneous pneumothorax (PSP) is a benign disease frequently found in younger and healthy-looking persons. It requires a surgical treatment in about 30-40% of cases. Video-assisted thoracoscopic surgery (VATS) has been recently introduced as a reliable alternative method to the classic thoracotomy. The aim of this paper is to establish and compare the length of surgical procedure, pain intensity, number and kind of postsurgical complications during the procedure for the patients with PNTX treated by VATS in relation to the patients with PNTX treated by thoracotomy. This is a retrospective study. The patients are divided into two groups: the first group of 50 patients treated with VATS and the second group of 50 patients treated with thoracotomy. The results obtained show a significantly shorter surgery duration in the group of the patients treated with VATS in relation to the group of patients treated by thoracotomy (p < 0.01). Video-assisted thoracoscopic surgery is characterized by a significantly low intensity of postsurgical pain in relation to thoracotomy (p < 0.001). The number and kind of postsurgical complications are similar in both target groups (p > 0.05). Only one relapse occurred in the VATS group. Video-assisted thoracoscopic surgery improves patients' life quality in relation to the thoracotomy patients. The patients return to work, or to sport activities after a very short time because of minimal sequels. That is why this method represents an obvious socio-economic interest. Today, in the era of a great video-development, VATS method is a treatment of choice for PSP.

Effect of probiotics on liver function after surgery resection for malignancy in the liver cirrhotic.

INTRODUCTION: Hepatic resection is the accepted treatment for various liver tumors. Increasing evidence suggests that two factors significantly influence outcome and successfulness of the hepatic resection in patients with HCC in cirrhosis. There are liver function recovery and the degree of inflammation during early postoperative period. OBJECTIVE: Aim of this study was to determine whether probiotic use influences on liver function recovery, degree of inflammation during early postoperative period, intraoperative risk, type and frequency of intraoperative and postoperative complications, morbidity, intraoperative and early postoperative mortality and a one-year survival rate in patients who have been used probiotic, and underwent the hepatic resection due to HCC in cirrhosis. PATIENTS AND METHODS: Study was conducted on 120 patients underwent the hepatic resection due to HCC in cirrhosis. This study has been done in University Clinical Centers Tuzla, Maribor and Strasbourg from October 2006 till February 2008. Patients were divided into 2 groups: 1) patients with liver cirrhosis and histologically verified HCC whom underwent liver resection surgery (segmentectomy/ bisegmenctetomy, right and left hemihepatectomy/extended hemihepatectomy) that used preoperatively and postoperatively probiotics (n = 60), 2) a control group of patients with liver cirrhosis and HCC, which did not use preoperative and postoperative probiotics (N = 60). Treatment with probiotics was conducted 3 days preoperatively and postoperatively with 7 day's oral supplementation. RESULTS: This study have shown next: patients underwent to the hepatic resection due to HCC in cirrhosis who have been used preoperatively and postoperatively probiotic had liver function recovery better and faster, acute immune response better, serum level of tumor markers lower, intraoperative and postoperative complications were less frequent, and morbidity and mortality rates were lower than in those who have not been using probiotic. CONCLUSION: Probiotic use may make liver function recovery better and increases immune response in early postoperative period and positively influences outcome and successfulness of the hepatic resection in patients with HCC in cirrhosis.

Mediastinal lymph node metastasis pattern in clinically N0 non-small-cell lung cancer patients who underwent surgical resection.

The aim of this study was to evaluate the incidence, clinical data and patterns of mediastinal lymph node metastasis (pN2) in non-small-cell lung cancer patients who underwent systematic mediastinal lymph node dissection (SMLND). We retrospectively studied 140 consecutive patients [125 male and 15 female, mean ages 54.61 +/- 9.23 years (range, 21-75)], underwent SMLND and major lung resections due to non-small lung cancer (NSCLC), from January 2005 till December 2009. Preoperative clinical staging for mediastinal lymph node metastasis was negative (cN0) in all patients. SMLND was defined as a complete removal of mediastinal lymph nodes. Clinicalpathological data were compared according to the pN stage. Lymph node metastasis to the mediastinum was confirmed in 13 (9.28%) patients. In squamous cell cancer pN2 were in 8 (5.71%) cases out of 82 cases with cN0. On the other side in the adenocarcinomas pN2 were in 5 (3.57%) cases out of 48 with cN0. Unvaried analysis revealed central tumor site as predictive factor for mediastinal lymph node involvement. The upper mediastinal compartment was infiltrated in 12 (8.57%) cases, middle in 8 (5.71%) and lower in 3 (2.14%) cases. Pneumonectomy was the most performed surgical procedure in pN2 patients. We concluded that SMLND improves pTNM staging in lung cancer patients who underwent major lung resections with central location of the tumour.

[Intraoperational and postoperational complications of colo-rectal anastomosis prepared by classical and stapler techniques]. / Intraoperativne i postoperativne komplikacije kolorektalnih anastomoza ucinjenih klasicnom i stapler tehnikom.

Resectional surgery on rectum, finishing with continued colo-rectal anastomosis by the classical manual technique, were burdened by a great number of post surgery complications of dehiscentio over 60%. If we take into reconsideration a high number of mortality 5-20% then we have valid reasons for developing modern and safer methods of surgical intervention of these patients. Two groups of 60 patients each, have been analyzed. They have been operated at the Surgical clinic University Clinical Center Tuzla because of rectum malignancy. The first group of patients where the colo-rectal anastomosis was manually operated was done between 1995-1998. In the second group of the patients being operated, colorectal continuity was done by stapler. The patients were operated in time period 2001-2002. The medium evaluation time was 20 months, for each group. All the patients were operated in elective programme, after endoscopic treatment and ph diagnosis done. The patients from the both analyzed groups were operated by the same surgeons. Preoperational procedure and postoperational observation was fullfilled according to the unified protocol. The patients with their colo-rectal continuity having been by stapler had a shorter surgery time, and less transfusion of blood. They had less ureter lesion. Also they have got a shorter hospitalization time with less number of anastomotic complications. Dehiscenc as well as bleeding. The patients with colorectal anastomosis made manually had more repeated surgeries. The patients from the manual group of the surgeries had more anastomotic relapses. The difference in the number of post operational strictures in both analyzed groups was not noticed. The patients with stapler colorectal anastomosis had no mortality. The manual group had one lethal case. The important thing that is noticed is a larger number of stapler colorectal anastomosis, not because of the illnes incidence increase but decrease of abdominoperineal rectum amputation. The patients have been safely operated from the oncologic point of wiev. They have continuing anastomosis which was not burdened with a larger number of morbidity and mortality. This was possible to do by improving surgical strategy and technique and introduction of stapler in every day surgical practice.

[Incidence and surgical treatment of cancer in gallbladder]. / Incidenca i hirurski tretman karcinoma zucne kese.

UNLABELLED: The gallbladder cancer is the most common primary cancer of the hepatobiliary system, and ranks fifth of the cancers of the gastrointestinal system. It is accidentaly found in 1-3 % of patients with gallstone disease, and in 0,5-2,4% on postmortem exam. GOAL: Show the incidence, clinical state, and suplement the diagnostic procedure of the patients with the risk factors for gallbladder cancer. Find proper surgical treatment in every stage of the disease according to Nevin-Moran system and the hystological type of the cancer. METHODS: Retrospectively we evaluated all cholecystectomies in our hospital in a three year period. We established the incidence of gallbladder cancer and we tried to discover the common characteristics of this group of patients. We analized the histological type of the cancer, and the stage of the disease in correlation with clinical presentation, results of the surgical treatment , and the survival and the quality of life. RESULTS: In three years we performed 2553 cholecystectomies, and in 1,7 % of patients -43 patient we discovered the cancer of gallbladder. It is 5 times more common in females. The mean age of the patients with gallbladder cancer is 65 years (55 - 82 years). The etiology of this disease is unknown. In 5 (11,6 %) patients cancer is discovered preoperatively. In 38 (88,4 %) patients it was adenocarcinoma of the gallbladder. Other morphologic types are analplastic cancer, carcinosarcoma, and "squamous cell carcinoma". In 30 patients (69,8 %) we performed cholecystectomy, and in 8 (18,6%) patients extended cholecystectomy with its components. Radical resective procedures on liver were performed in 5 (11,6%) patients. According to the localisation in 60% of cases the cancer was located in fundus, in 30% of cases in corpus,and 10% of cases in the neck of the gallbladder. No patient with stage V survived 1 year after the procedure. CONCLUSION: The incidence of the gallbladder cancer in our series is in the slight increase. The quality of life and the survival are inversely correlated with the depth of the invasion and the extent of the spread of the cancer. The extensive surgical procedures in advanced stage of the disease, because of the grim prognosis, does not justify the risk of the operative treatment.

[Total gastrectomy and systematic lymphadenectomy complications]. / Komplikacije nakon totalne gastrektomije i limfadenektomije.

Surgical treatment of stomach carcinoma by its specificity and takes the important place in oncological surgery. Incidence is in rise and every year about 250.000 new patients are registered. Identifying the sympotoms of disease, early diagnostics and surgical treatment improve the prognosis and results of treatment. Radical total gastrectomy (R0) and systematic lymphadenectomy (D2) represent a standard in surgical treatment of resectible stomach tumor. As for the lymphadenectomy, number of complications of surgical treatment is considerably getting higher. The objective of the paper is to show the frequency and variety of complications, the way of their treatment and results. 58 patients underwent radical total gastrectomy with lymphadenectomy in period of four years in our clinic. Sex ration is 2 : 1 in favour of men. Average age is 41.8 +/- 10.2 years. The most present abdominal complication is dehiscence of esophagojejunal anastomse 19.0% and of extraabdominal complication it is the deep vein thrombose 6.8%. Reconstruction of gastrointestinal continuity by method of Roux is the most present 55.2%. In early postoperative course 4.6% reoperations were made. Average duration of operation is 185 +/- 8.6 min. There has not been intraoperative morality. Postoperative moratily for 30 days is 10.3%, for 90 days 6.8%. Postoperative mortality and morbidity, number and different postoperative complications are statistically much higher in patients with systematic D2 and D3 lymphadenectomy (p < 0.05).

[Complications of laparoscopic cholecystectomy first and last procedures]. / Ukupne komplikacije laparoskopske holecistektomije prvih i poslijednjih 200 procedura.

BACKGROUND: The aim of this study were evaluated intraoperative and postoperative complication, and reasons for conversions among first 200 and last 200 procedures inside about 2 000 where we performed laparoscopic cholecystectomy in our clinic. MATERIAL AND METHODS: Retrospective-prospective we analised overall complication rate, operative time and reasons for conversions in first and last 200 procedures where we performed laparoscopic cholecystectomy. We use the USA technique for operation with three troacars. Demografic dates about patients, intraoperative finding and hospital statistic was the same in both groups. RESULTS: In the first group we have 8 (4%) intraoperative complications and 12 (4.8%) postoperative complications, the average operative time was 77.8 (+/- 12.01) minutes, and the number of conversions was 10 (5%). In first group we had two cases with intraopertive bleeding (1%), two cases with common bile duct injury (1%), three cases with adhesions (1.5%) and one cases of negative effects of resorption of CO2. In the second group we have 5 (2.5%) intraoperative complications, and 8 (4%) postoperative complications, the average operative time was 56.8 (+/- 12.03) minutes, and we done 5 (2.5%) conversions. The most important postoperative complications were: postoperative pancreatitis, deep veins thrombosis and postoperative abscess collection in both groups. We had statistically significant difference between first and last 200 procedures LC. Hospital stay were 3.10 (+/- 1.06) days for first, and 2.90 (+/- 67.09) days for second group. CONCLUSIONS: Analyses of our results after first and last 200 patients showed lower rate of complications, conversions and reoperations in the second group. Our results we explain with better surgery technique, more experience of surgeons and better surgery equipment.

[Analysis the efficacy of preoperative biliary stent placement in patients with malignant obstructions of distal choledochus]. / Analiza efikasnosti preoperativnog plasiranja bilijarnog stenta u pacijenata sa malignim opstrukcijama distalnog holedohusa.

BACKGROUND: In a very short time, malignant obstructions of distal choledochus cause a lot of damage to the liver function that may result in serious intra operative and postoperative complications and consequent high hospital mortality. Contradictory results with respect to the recovery of the liver function and origin of intra operative and postoperative complications lead us believe in the necessity of the evaluation of the preoperative placement of billiar stent in these patients, knowing that these patients see the doctor in the advanced stage of the disease with the relatively high level of the liver function damage. The goal of this research was a quantitative and qualitative analysis of intra operative and postoperative complications as well as high hospital mortality in both groups of subjects so that through this kind and scope of complications and mortality rate we could indirectly reach the conclusion relating to efficiency of the billiar stent placement. Another goal of the research was the analysis of liver tests before the operation and ten days after the operation with both groups of subjects so that, based upon the speed of their normalization, the conclusion could be reached in relation to the speed and level of the liver function recovery after the performed pancreatoduodenectomy. RESULTS: The subjects from the first group had more expressed symptoms of jaundice and high temperature and fever whereas in respect to the other presented symptoms there was no statistically significant difference. Preoperative values of ALT and AST values and the total values of bilirubin and C-reactive protein were statistically significantly higher in the first group of subjects (p<0.05). Contrary to that, ALP and GGT enzymes value were higher but there was no statistically significant difference between the compared groups. After the operation the normalization of all mentioned parameters of the liver function occurs in both groups of subjects but ALT, AST, ALP and GGT enzymes values and total bilirubin values in the first group of subjects were closer to the reference values. Based upon these data we can conclude that the liver function recovery also was better and faster. By analyzing intra operative complications no statistically significant difference was found between the compared groups. The total ratio of postoperative complications was 32 %, compared to 40 %, which is not a statistically significant difference. With respect to fistula and infections there were no statistically significant differences. Other postoperative complications in both groups were almost equally present and are not statistically significant. CONCLUSION: Better liver function recovery in the first group of subjects and the equal ratio of complications in both group of subjects, justifies the application of preoperative placement of billiar stent under our conditions.

[Segmental and bisegmental resections of liver in a treatment of malignant neoplasms]. / Segmentalne i bisegmentalne resekcije jetre u tretmanu malignih neoplazmi.

UNLABELLED: The news in understanding intrahepatal anatomy, such as radiology contemporary technology making easier segmental and bisegmental access to hepatal resection. This access comprises resection of isolated anatomical segments or a sector of liver which is depends of magnitude of intrahepatal pathological process. After segmental or bisegmental resection of liver, patients were analysed in the period from 15 and 30 days after the operation. Analysis of patients from this period comprise: localisation of tumour in relation on segments, liver test and follow up, technique of resection, intraoperative stream, the period of operation, blood follow up through v. portae, blood loss and quantitative and qualitative analysis of postoperative complications. RESULTS: between January 2000 and March 2005, sixty two subject were analysed that have been operated on our clinic (segmental or bisegmental resection), because of the metastatic process of liver and hepatocellular carcinoma of liver (HCC). Hospital mortality was 2.1%, with most often mortality in patients with HCC and cirrhosis of liver. High of morbidity from this period were 19,8%. Need for transfusion of blood (fresh erythrocytes) were 1,2 +/- 0,5 U. Patients with HCC had more needs from blood transfusions contrary patients without HCC; 2,9 +/- 1,4 contrary 0,7 +/- 0,28 U (p<0,05). Recidivism of malignant process in hepatal margin were 2,7%. CONCLUSION: Segmental hepatal resection is very accurate technique which makes possible complete resection of tumour and in the same time preservation of healthy liver parenchyma. Segmental hepatal resection is especially useful for patients with HCC and patients with recidivism or progress of primary process.

[Performing liver resections with or without Pringle manuever]. / Izvodenje resekcijskih zahvata na jetri sa ili bez upotrebe Pringle-ovog manevra.

Liver resections, because of its complexity, present a big challenge for every surgeon. A malignant diseases, which are the most frequent indications for this type of operations, additionally complicate job of the surgeons. Because the flag immunological system, in this type of patients, with reduced reserves of the liver, can have unforeseen postoperative consequence. The bleeding during and after operations presents one of the most difficult problems with liver resections. Introduction of the Pringle maneuver, reduce the risks for this operations to the minimum. The aim of this work at first is to analyze and compare functional parameters of the liver with or without intermittent hepatic pedicle clamping (HPC), for the purpose of the establishing invasivity and justification of its application. A statistical pattern was 30 patients with performed liver resections using intermittent HPC and 30 patients without using intermittent HPC, during liver resections. Results showed that performing liver resections with Pringle manuever do not have negative repercussions on the liver functions with less postoperative complications and postoperative hospital duration.

[Operative treatment of acute pancreatitis]. / Operativno lijecenje akutnog pankreatitisa.

Most attacks of acute pancreatitis are self limiting, and the patients recover completely within days or weeks. In a few cases, however, the course is severe, with development of organ failure (single or multiple) and local complications such as necrosis, abscesses, and pseudocist. Between 01.01.2001-01.06.2004, 286 cases of acute pancreatitis were treated in our clinic. The purpose of this study is to represent indication for operative treatment of acute pancreatitis and its complications, according to the Atlanta classification. According to our date, the most frequent cause are changes on biliary tract. Of these 286 patients, 247 suffered from a mild or moderate type of acute pancreatitis and responded fully to medical treatment (215 patients) or to biliary tract surgery (32 patients). The hospital mortality of this group of patients was 2.4%. Surgery was indicated when the patients developed signs of an acute abdomen (9 patients), pancreatic pseudocyst (7 patients), progressiv icterus (2 patients), infection of pancreatic necrosis (10 patients), and pancreatic abscess (7 patients). Four patients with pancreatic necrosis were stable, and they had conservative treatment. The most difficult decision in the management of these patients is whether surgery is required and which of the complementary approaches to necrosectomy and drainage is appropriate. The hospital mortality of patients with severe acute pancreatitis was 28.2%. Multiple organ failure was the predominant cause of death.

[Correlation of preoperative and postoperative functional status of the liver in hepatic resection]. / Korelacija preoperativnog i postoperativnog funkcionalnog stanja jetre kod resekcijskih zahvata.

Preoperative liver function have singificant influence on the morbidity and mortality, by performing liver resections. In addition to, intraoperative factors may contribute appearance, undesirable postoperative complications. Functional parameters, which we analized in this study (ALT, AST, albumins, bilirubin and prothrombin time), was measured preoperative and in the postoperative course. Study include 60 patients which are divided in two groups, at the basis Child-Pugh score, for the estimate operative risks. Results showes that, after liver resections frequently complications were in the group of patients with impaired liver functions, specially if the extensivity resections of the liver parenchyma, was the greatest.

[Anatomy of the colon, rectum and anus]. / Anatomija kolona, rektuma i anusa.

Deduction of operation, holds in colorectal surgery, include good knowledge of anatomy and her connection in that area. Large bowel has special anatomy and functional mark. Intensive study of colorectal cancer bring about a new knowledge about anatomy of the large bowel, especially about vascular variations. We described the very importance characteristic of colon, rectum and anus in this article.

[Multivisceral resection in locally advanced carcinoma of the colon and rectum]. / Multivisceralna resekcija kod lokalno uznapredovalog karcinoma kolona i rektuma.

Locally advanced colorectal canter may require an intraoperative decision for the block resection of surrounding organs or structures to achieve complete tumour removal. This decision must weigh the risk of complications and death of multivisceral resection against a potential survival benefit. Little is known about the prognostic factors and their influence on the outcome of multivisceral resection for colorectal cancer. We demonstrate our experience with multivisceral resections for the primary colorectal cancer. Patients undergoing multivisceral resection for primary colon or rectal cancer between I-I.2000-I-VII.2003 were identified from retrospective database. Multivisceral resection was performed in 41 of 378 patients with a median age of 61 years. Postoperative rates of complications and death in 41 patients were 30.9% and 12.1%. Histologic tumour infiltration was shown in 58.3% of patients with curative resection. Multivisceral resection is safe, and long-term survival after curative resection is similar to that after standard resection. As the palliative resections cannot be predicted accurately at the time of surgery, every effort should be made to achieve complete tumour resection.