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1
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Surgical Management of Injuries of the Hepatic Veins and Retrohepatic Inferior Vena Cava

100%
Arkuszewski P., Krawczyk M.
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issue 11
564-568
2
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Surgical Management of Liver Trauma

100%
Krawczyk M., Arkuszewski P.
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issue 11
554-563
3
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Split Liver Transplantation (SLT) - Practical Introduction to Technical Aspects of Liver Splitting

81%
Kornasiewicz O., Hevelke P., Krawczyk M.
Polish Journal of Surgery
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2008
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vol. 80
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issue 11
639-644
4
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Liver Resection for Non-Colorectal, Non-Endocrine Liver Metastasis

81%
Kornasiewicz O., Ligocka J., Krawczyk M.
Polish Journal of Surgery
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2015
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vol. 86
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issue 11
544-551
5
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Is the Age of Patients with Iatrogenic Bile Duct Injuries Increasing?

81%
Stankiewicz R., Najnigier B., Krawczyk M.
Polish Journal of Surgery
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2015
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vol. 87
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issue 3
129-133
EN
Resection of the gall-bladder is still the most common surgical procedure performed at general surgery departments. The laparoscopic method used in the majority of cases offers considerable benefits but at the same time is associated with an increased rate of bile duct complications. So far, a slim female aged 25-50 years was a typical patient with a iatrogenic bile duct injury. The aim of the study was to identify the age of patients with iatrogenic bile duct injuries as well as the clinical course observed in recent years. Material and methods. Gender and age structure of patients admitted to the Department of General, Transplant and Liver Surgery between the beginning of 2011 and June 2014 and treated for iatrogenic bile duct injuries, complications of laparoscopic cholecystectomy, were analysed. The patients were referred to the department as a reference centre. Results. In the group of 186 patients, females predominated (69.4%) and the mean age was 52 years. A considerable increase in the mean age of patients treated in 2014 as compared with previous years was seen. This was related to an increased rate of bile duct injuries in patients aged over 70 years, who accounted for about 25% of the group. In previous years, bile duct injuries in patients of such an advanced age happened considerably less frequently. Conclusions. A iatrogenic bile duct injury in an elderly person may prove a fatal complication. A repair surgery, i.e. the biliary-enteric anastomosis, is a major and burdensome procedure, particularly in the case of patients aged over 70 years. Special caution during laparoscopic cholecystectomy is advised in this population, and the slightest doubts should lead to conversion.
6
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Management of Giant Hepatic Hemangioma in Atypical Localization; Report of a Case and Literature Review

81%
Stankiewicz R., Kobryń K., Patkowski W., Krawczyk M.
Polish Journal of Surgery
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2015
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vol. 87
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issue 3
139-142
EN
Hemangiomas are the most common benign primary hepatic neoplasms, often being incidentally discovered. In most of the cases they are small and asymptomatic. It is widely accepted that clinical intervention is indicated only for symptomatic hemangiomas. We present a case of an asymptomatic giant hemangioma managed by enucleation due to its atypical localization. The hemangioma, originally located in segment 5, was now described in Computer Tomography (CT) Imaging as separating the gallbladder from the liver parenchyma. A careful evaluation of images revealed proximity to the portal vein (PV), right hepatic artery (RHA), right hepatic duct (RHD) and right branch of the portal vein (RBPV). Thus, in the case of an emergent operation, surgical maneuvers in the area of the altered hepatic anatomy and proximity to the hemangioma itself, would in fact increase the risk endangering the patient’s life. After patient’s consent, a surgical enucleation en block with the gall-bladder was performed. It is of great importance that specifically selected, asymptomatic patients diagnosed with a giant hemangioma, with the above mentioned or similar localization should be considered for surgical treatment.
7
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Experimental and numerical investigation of electrostatic spray liquid-liquid extraction with ionic liquids

81%
Krawczyk M., Kamiński K., Petera J.
Chemical and Process Engineering
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2012
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vol. 33
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issue 1
167-183
EN
A new concept of an electrostatic spray column for liquid-liquid extraction was investigated. An important problem for separation processes is the presence of azeotropic or close-boiling mixtures in their production, for example heptane with ethanol, since the separation is impossible by ordinary distillation. The use of ionic liquids (IL) as a dispersed solvent specially engineered for any specific organic mixture in terms of selectivity is a key factor to successful separation. As IL present particularly attractive combination of favorable characteristics for the separation of heptane and ethanol, in this work we use 1-butyl-3-methylimidazolium methyl sulfate [BMIM][MeSO4]. Because of high viscosity and relatively high cost of IL a new technique was introduced, consisting in the electrostatically spray generation to enhance the mass transport between the phases. In order to optimally design the geometry of the contactor a series of numerical simulation was performed. Especially multi-nozzle variants for better exploitation of contactor volume were investigated. Experiments showed excellent possibility of control of the dispersion characteristics by applied voltage and thus control of the rate of extraction. The preliminary simulations based on our mathematical model for a three nozzle variant exhibited visual agreement with the theory of electrostatics.
8
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Comparison of experimental data and numerical simulation of two-phase flow pattern in vertical minichannel

81%
Sowiński J., Krawczyk M., Dziubiński M.
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EN
The aim of the study was the implementation of a numerical simulation of the air-water two-phase flow in the minichannel and comparing results obtained with the values obtained experimentally. To perform the numerical simulations commercial software ANSYS FLUENT 12 was used. The first step of the study was to reproduce the actual research installation as a three-dimensional model with appropriate and possible simplifications - future computational domain. The next step was discretisation of the computational domain and determination of the types of boundary conditions. ANSYS FLUENT 12 has three built-in basic models with which a two-phase flow can be described. However, in this work Volume-of-Fluid (VOF) model was selected as it meets the established requirements of research. Preliminary calculations were performed for a simplified geometry. The calculations were later verified whether or not the simplifications of geometry were chosen correctly and if they affected the calculation. The next stage was validation of the chosen model. After positive verification, a series of calculations was performed, in which the boundary conditions were the same as the starting conditions in laboratory experiments. A satisfactory description of the experimental data accuracy was attained.
9
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Bile Duct Cysts

81%
Krawczyk M., Arkuszewski P., Zieniewicz K., Grąt M.
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EN
Aim of the study was analysis of methods of surgical treatment of patients with bile duct cysts.Material and methods. Retrospective analysis of data from 30 patients who underwent surgical treatment for bile duct cysts in Clinic of General, Transplantation and Liver Surgery, Warsaw Medical University, between 1 October 2001 and 31 December 2009.Results. Bile duct cysts are more common in females; female to male ration is 4:1. Most of the treated patients had bile duct cysts belonging to type I according to Todani classification - 13 patients (43.3%). Six patients (20%) had type IV cysts, 8 patients (26.7%) had type V cysts according to Todani classification. Three patients (10%) with isolated intrahepatic bile duct cysts were not classified to any group according to Todani classification. The most common type of surgical treatment was complete resection of intrahepatic bile duct with choledocho-intestinal Roux-en-Y anastomosis that was performed in 17 patients (56.7%). The other patients generally underwent various types of resections of the liver and bile ducts or only of the liver. Five patients (16.7%) required liver transplantation. Nine patients (30%) developed complications. One patient (3.3%) who underwent liver transplantation and retransplantation, died from progressive multiorgan failure and renal failure.Conclusions. First line treatment of patients with bile duct cysts involves their resection, sometimes with requirement of resection of liver parenchyma. Most of these patients underwent reconstruction of bile duct through choledocho-intestinal Roux-en-Y anastomosis. Some patients undergo liver transplantation. Surgical treatment of patients with bile duct cysts is demanding from the technical point of view and should be undertaken in centers that specialize in hepatobiliary surgery.
10
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Prediction of Survival in Patients with Unresectable Colorectal Liver Metastases

71%
Hołówko W., Grąt M., Hinderer B., Orlińska I., Krawczyk M.
Polish Journal of Surgery
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2015
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vol. 86
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issue 7
319-324
EN
Liver metastases are diagnosed synchronously with the primary tumour in 25% of patients with colorectal cancer. A half of the remaining patients develop liver metastases within 3 years following colectomy. At present, the only radical treatment of metastases is liver resection. Only 2.6% of patients survive 3 years if such treatment is not implemented. The aim of the study was to assess predictive factors of long-term survival in the group of patients with unresectable colorectal liver metastases carcinoma. Material and methods. Of 1029 patients with colorectal liver metastases, who were treated in the Department of General, Transplant and Liver Surgery of the Medical University of Warsaw in the years 2006-2012, cases of liver metastases assessed intraoperatively as unresectable were selected. The retrospective analysis included 85 patients. Based on the medical documentation, information concerning age, sex, characteristics of primary and secondary tumours, reasons for unresectability, neoadjuvant chemotherapy as well as local treatment of liver tumours was collected. Preoperative serum concentrations of CEA and CA 19-9 markers were considered. The Cox regression model, Kaplan- Meier estimator and log-rank test were applied in the statistical analyses. Results. The most common reason for unresectability were: number of metastases in 31 patients (36.5%) and extrahepatic metastases in 19 cases (22.4%). Overall survival in the entire group was 56.1% and 15.5% after 1 and 3 years respectively. A single-factor analysis showed that CEA serum levels (p=0.032; HR=1.002 per increase by 1 ng/ml) and the presence of extrahepatic metastases (p=0.037; HR=2.06) were predictors of worse survival. In a multivariate analysis, CEA concentration (p=0.017; HR=1.002 per increase by 1 ng/ml) was an independent predictor of death whereas the presence of extrahepatic metastases were not statistically significant (p=0.059; HR=2.09). Conclusions. Serum concentration of CEA marker is an independent predictor of worse survival, but the presence of extrahepatic metastases shows a similar tendency
11
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Surgical treatment of gall-bladder cancer

71%
Masior Ł., Krasnodębski M., Kobryń K., Grąt M., Krawczyk M.
Polish Journal of Surgery
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2015
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vol. 87
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issue 6
324-330
12
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Gall-Bladder and Hepatoduodenal Ligament Lymphangioma – Case Report and Literature Review

71%
Nazarewski Ł., Patkowski W., Pacho R., Marczewska M., Krawczyk M.
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vol. 85
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issue 1
39-43
EN
Lymphangiomas are rare benign lesions of the lymphatic vessels that are most commonly diagnosed in childhood. Intraperitoneal localization is unusual as, typically, they are located in the head and neck areas. In general, abdominal lymphangiomas seem to be asymptomatic, however, patients may occasionally suffer from acute abdominal symptoms, due to intestinal obstruction or peritonitis. The study presented a case of a 41-year-old female patient, clinically asymptomatic, who was accidentally diagnosed with a multiseptated cystic lesion of the right liver lobe surrounding the gall-bladder fossa in a routine ultrasound examination. Further examinations including computed tomography and magnetic resonance (MR) aroused suspicion of a polycystic lesion of the gall-bladder and hepatoduodenal ligament. The cystic lesion of the gall-bladder and hepatoduodenal ligament filled with lymphatic fluid was diagnosed intraoperatively. Simultaneous cholecystectomy and radical resection of the cystic lesion was undertaken. The histopathological examination revealed the presence of a lymphangioma. Additionally, the authors of the study reviewed literature data concerning gall-bladder lymphangiomas.
13
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Long-Term Results of Liver Resection in the Treatment of Patients with Hepatocellular Carcinoma

71%
Grąt M., Hołówko W., Grzegorczyk K., Skalski M., Krawczyk M.
Polish Journal of Surgery
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2011
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vol. 83
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issue 6
319-324
EN
The aim of the study was the analysis of the results of liver resection in the treatment of patients with hepatocellular carcinoma, taking into consideration the selected factors based on the department's material.Material and methods. Data of 122 patients subject to liver resection due to hepatocellular carcinoma at the Department of General, Transplantation and Liver Surgery, Medical University of Warsaw, were subject to retrospective analysis.The influence of selected factors on the long-term treatment results was determined, and the patient survival depending on the tumor stage as per the TNM scale was compared. The statistical significance threshold was set at p = 0.05.Results. 1- and 3-year overall survival and recurrence-free survival in the whole patient group was 82.1% and 56.3%, and 57.7% and 20.1%, respectively. The perioperative mortality rate was 1.6%. The neoplasm advancement exceeding the first stage on the TNM scale was associated with lower values of overall survival (p = 0.001, HR = 3.7) and recurrence-free survival (p = 0.00008, HR = 3.8). Elevation of AFP was the only independent prognostic factor for overall survival (p = 0.04, HR = 1.04 at alpha-fetoprotein levels > 1000 ng/ml), while the presence of neoplastic emboli in small blood vessels was an independent risk factor for HCC recurrence (p = 0.02, HR = 2.24).Conclusions. The alpha-fetoprotein levels and presence in the histopathological examination of neoplastic emboli in small blood vessels are independent prognostic factors for outcome of patients operated for hepatocellular carcinoma. The diagnosis of neoplasm at stage 1 as per TNM significantly improves long-term results of resective treatment.
14
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Comparison of Total Tumor Volume, Size and Number of Colorectal Liver Metastases in Prediction of Survival in Patients after Liver Resection

62%
Hołówko W., Grąt M., Wronka K. M., Stypułkowski J., Roszkowski R., Studnicki P., Krawczyk M.
Polish Journal of Surgery
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2015
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vol. 87
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issue 2
53-58
EN
Liver is the most common location of the colorectal cancer metastases occurrence. Liver resection is the only curative method of treatment. Unfortunately it is feasible only in 25% of patients with colorectal liver metastases, often because of the extensiveness of the disease. The aim of the study was to evaluate the predictive value of total tumor volume, size and number of colorectal liver metastases in patients treated with right hemihepatectomy. Material and methods. A retrospective analysis was performed in a group of 135 patients with colorectal liver metastases, who were treated with right hemihepatectomy. Total tumor volume was estimated based on the formula (4/3)πr3. Moreover, the study included an analysis of data on the number and size of tumors, radicality of the resection, time between primary tumor resection and liver resection, pre-operative blood serum concentration of carcinoembryonal antigen (CEA) and carcinoma antigen Ca19-9. The predictive value of the factors was evaluated by applying a Cox proportional hazards model and the area under the ROC curve. Results. The univariate analysis has shown the predictive value of size of the largest tumor (p=0.033; HR=1.065 per each cm) on the overall survival, however no predictive value of number of tumors (p=0.997; HR=1.000) and total tumor volume (p=0.212; HR=1.002) was observed. The multivariate analysis did not confirm the predictive value of the size of the largest tumor (p=0.141; HR=1.056). In the analysis of ROC curves, AUROC for the total tumor volume, the size of the largest tumor and the number of tumors were 0.629, 0.608, 0.520, respectively. Conclusions. Total tumor volume, size and number of liver metastases are not independent risk factors for the worse overall survival of patients with colorectal liver metastases treated with liver resection, therefore increased values of these factors should not be a contraindication for surgical treatment
15
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Esophagogastric Junction Versus Gastric Carcinoma - Implications for Surgical Tactics on the Basis of Own Experience

62%
Frączek M., Hevelke P., Komorzycki K., Kotulski M., Kalinowski P., Górnicka B., Krawczyk M.
Polish Journal of Surgery
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2007
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vol. 79
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issue 9
600-609
EN
The exact prevalence and results of treatment of the carcinoma of esophagogastric junction (gastric cardia) are difficult to assess, and the data concerning thereof, presented in different series of patients, are frequently inconsistent. This phenomenon may result from terminological mess, resulting in different comprehension of the sole term "esophagogastric junction". That can be why the results of treatment of patients with this type of cancer are dispersed in the literature and may be as well found under "esophageal", as well as "gastric cancer" headings.The aim of the study was to present the current view of the pathogenesis, pathology and terminological issues concerning this tumor, interesting at least for its localization at the border of two viscera and two body cavities. On the basis of our own material, we also tried to delineate the implications of such a localization to surgical tactics.Material and methods. The patients with esophagogastric junction and more peripherally located gastric cancer were analysed in two groups, according to the date of resectional surgery performed: From 1989 to 1998 (group I), and from 1999 to 2005 (group II). In each group the patients with esophagogastric junction and peripheral gastric cancer were investigated separately. The influence of more aggressive approach to cardial cancer (additional thoracotomy approach) in group II patients on the cancer free tissue margin, number of metastatic lymph nodes excised, as well as on survival rate during a 5-years follow-up was assessed.Results. The results show, that the additional thoracotomy, despite the increase in postoperative complications rate (mainly affecting the respiratory system- 19 vs 4.3% at laparotomy alone), did not influence the perioperative motality in our patients (approximately 5% in all subgroups). Despite the additional thoracotomy approach, facilitating the safe lower esophageal resection, the cancer free margins of the excised specimens remained unsatisfactory (the target safe margin value of 7 cm), although some improvement can be noted as compared with group I patients. The interesting finding was, that the survival rates following gastrectomy for ‘peripheral’ gastric carcinoma has been remaining practically unchanged during the 20 years of this study. Survival rates following gastric cardia resection improved in group II patients, but the differences did not reach the statistically significant level. The difference in survival rate was increasing with time in favor of group II patients, its value being triple at 5 years from surgery (18 vs 6%) as compared with group I.Conclusions. We see the need for the development of a method allowing to select the patients with good prognosis, in whom further radicalization of resectional procedures (and subsequent treatment) would be justified by long-term disease-free survival.
16
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Liver transplantation in the treatment of patients with hepatocelular carcinoma

52%
Krawczyk M., Grąt M., Kornasiewicz O., Zieniewicz K., Nyckowski P., Patkowski W., Grzelak I., Dudek K., Wróblewski T., Paluszkiewicz R.
Polish Journal of Surgery
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2010
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vol. 82
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issue 11
596-602
EN
The aim of the study was to analyse liver transplantation results in patients with hepatocellular carcinoma, considering selected factors.Material and methods. The study group comprised 82 patients subject to liver transplantation at the Department of General, Transplant and Liver Surgery, Warsaw Medical University, due to hepatocellular carcinoma. Retrospective analysis concerned the period between 2001 and 2010. Distant survival results were evaluated, depending on whether Milan criteria were fulfilled, and the preoperative level of alpha-fetoprotein estimated. The obtained results were subject to statistical analysis. p<0.05 was considered as statistically significant.Results. Mean survival time considering patients subject to liver transplantation, due to hepatocellular carcinoma amounted to 66.7 months (95% PU 58.9-74.4), while survival without tumor recurrence - 62.3 months (95% PU 54-70.6). The one, three and five - year survival rate was 88.7%, 74.8% and 72.0%, respectively. Survival without tumor recurrence was 87.5%, 67.1% and 67.1%, respectively. The overall survival of patients fulfilling the Milan criteria (44 of 82 patients - 53.7%) was significantly longer, in comparison to patients not fulfilling the above-mentioned (74.4 and 48.3 months, respectively, p=0.025). A significant difference was also observed, considering the overall survival in the absence of cancer recurrence (72.5 and 42.4 months, respectively, p=0.007). Considering patients not fulfilling the Milan criteria who presented with preoperative alpha-fetoprotein levels > 100 ng/ml, overall survival was shorter, as compared to the mean survival rate: 32.5 and 64.4 months, respectively, p = 0.009. Similar values were obtained in case of patients without tumor recurrence (27 and 57.1 months, p=0.011).Conclusions. The obtained results confirmed the significant value of Milan criteria, when qualifying patients with hepatocellular carcinoma for liver transplantation. The above-mentioned also showed the potential value of preoperative alpha-fetoprotein level measurements, not only in the diagnostics and early hepatocellular carcinoma diagnosis (patients with cirrhosis), but also in the prediction of survival and tumor recurrence after liver transplantation.
17
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The recommendations for perioperative pain relief in general surgery

52%
Krawczyk M., Wordliczek J., Czupryna A., Dobrogowski J., Dobosz M., Gaszyński W., Andziak P., Misiołek H., Dziki A.
Polish Journal of Surgery
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2012
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vol. 84
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issue 9
476-484
18
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Polish Consensus on Treatment of Gastric Cancer; Update 2013

43%
Kulig J., Wallner G., Drews M., Frączek M., Jeziorski A., Kielan W., Kołodziejczyk P., Nasierowska-Guttmejer A., Starzyńska T., Zinkiewicz K., Krawczyk M.
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vol. 85
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issue 9
544-562
19
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Short and Long-Term Outcomes After Primary Liver Transplantation in Elderly Patients

43%
Grąt M., Kornasiewicz O., Grąt K., Antczak A., Ligocka J., Hołówko W., Wronka K. M., Kobryń K., Skalski M., Pączek L., Krawczyk M.
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vol. 85
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issue 10
581-588
EN
The number of elderly patients undergoing liver transplantation (LT) is increasing worldwide. The aim of the study was to evaluate the impact of recipient age exceeding 60 years on early and long-term outcomes after LT. Material and methods. This study comprised data of 786 patients after primary LT performed at a single center between January 2005 and October 2012. Patients over and under 60 years of age were compared with respect to baseline characteristics and outcomes: postoperative mortality (90-day) and 5-year patient (PS) and graft (GS) survival. Associations between recipient age exceeding 60 years and LT results were assessed in multiple Cox regression models. Results. Recipients older than 60 years (n=107; 13.6%) were characterized by more frequent hepatitis C virus infections (p<0.001), malignancies (p<0.001), and cardiovascular comorbidities (p<0.001); less frequent primary sclerosing cholangitis (p=0.002) and Roux-en-Y hepaticojejunostomy (p<0.001); lower Model for End-stage Liver Disease (MELD; p=0.043); and increased donor age (p=0.012). Fiveyear PS of older and younger recipients was 72.7% and 80.6% (p=0.538), while the corresponding rates of GS were 70.3% and 77.5% (p=0.548), respectively. Recipient age exceeding 60 years was not significantly associated with postoperative mortality (p=0.215), PS (p=0.525) and GS (p=0.572) in multivariate analyses. The list of independent predictors comprised MELD (p<0.001) for postoperative mortality; malignancies (p=0.003) and MELD (p<0.001) for PS; and malignancies (p=0.003), MELD (p<0.001) and donor age (p=0.017) for GS. Conclusions. Despite major differences between elderly and young patients, chronological age exceeding 60 years alone should not be considered as a contraindication for LT.
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Evolution Of The Results Of 1500 Liver Transplantations Performed In The Department Of General, Transplant And Liver Surgery Medical University Of Warsaw

23%
Krawczyk M., Grąt M., Grąt K., Wronka K., Krasnodębski M., Stypułkowski J., Masior Ł., Hołówko W., Ligocka J., Nyckowski P., Wróblewski T., Paluszkiewicz R., Patkowski W., Zieniewicz K., Pączek L., Milkiewicz P., Ołdakowska-Jedynak U., Najnigier B., Dudek K., Remiszewski P., Grzelak I., Kornasiewicz O., Kotulski M., Smoter P., Grodzicki M., Korba M., Kalinowski P., Skalski M., Zając K., Stankiewicz R., Przybysz M., Cieślak B., Nazarewski Ł., Nowosad M., Kobryń K., Wasilewicz M., Raszeja-Wyszomirska J., Piwowarska J., Giercuszkiewicz D., Sańko-Resmer J., Rejowski S., Szydłowska-Jakimiuk M., Górnicka B., Wróblewska-Ziarkiewicz B., Mazurkiewicz M., Niewiński G., Pawlak J., Pacho R.
Polish Journal of Surgery
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2015
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vol. 87
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issue 5
221-230
EN
Liver transplantation is a well-established treatment of patients with end-stage liver disease and selected liver tumors. Remarkable progress has been made over the last years concerning nearly all of its aspects. The aim of this study was to evaluate the evolution of long-term outcomes after liver transplantations performed in the Department of General, Transplant and Liver Surgery (Medical University of Warsaw). Material and methods. Data of 1500 liver transplantations performed between 1989 and 2014 were retrospectively analyzed. Transplantations were divided into 3 groups: group 1 including first 500 operations, group 2 including subsequent 500, and group 3 comprising the most recent 500. Five year overall and graft survival were set as outcome measures. Results. Increased number of transplantations performed at the site was associated with increased age of the recipients (p<0.001) and donors (p<0.001), increased rate of male recipients (p<0.001), and increased rate of piggyback operations (p<0.001), and decreased MELD (p<0.001), as well as decreased blood (p=0.006) and plasma (p<0.001) transfusions. Overall survival was 71.6% at 5 years in group 1, 74.5% at 5 years in group 2, and 85% at 2.9 years in group 3 (p=0.008). Improvement of overall survival was particularly observed for primary transplantations (p=0.004). Increased graft survival rates did not reach the level of significance (p=0.136). Conclusions. Long-term outcomes after liver transplantations performed in the Department of General, Transplant and Liver Surgery are comparable to those achieved in the largest transplant centers worldwide and are continuously improving despite increasing recipient age and wider utilization of organs procured from older donors.
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