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1
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Exenterative Pelvic Surgery in the Treatment of Female Genital Organ Malignancies

100%
Wojtasik P., Kładny J.
Polish Journal of Surgery
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2008
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vol. 80
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issue 12
688-693
2
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Elective Resection of Rectal Cancer Primary Tumor in Patients with Stage IV Disease - Own Experiences

81%
Halczak M., Wojtasik P., Al-Amawi T., Kładny J.
Polish Journal of Surgery
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2011
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vol. 83
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issue 7
372-376
EN
Optimal management of asymptomatic generalized rectal cancer is still the matter of debate.The aim of the study was to review stage IV rectal cancer patients who were treated in our clinic since 2000 till 2008 in order to evaluate the effectiveness of surgery.Material and methods. Fifty-two generalized rectal cancer patients treated with elective resection of primary tumor were identified. Patients' age, sex, duration of hospital stay, modality of surgery, complications, postoperative mortality rate and survival rate were assessed.Results. Median survival was 16.3 months. Postoperative complications occurred in 29% patients. Postoperative mortality rate was 1.9%.Conclusions. In properly selected group of patients elective resection of primary tumor may cause low mortality rate and acceptable morbidity rate. This surgical modality allows to avoid potential complications of tumor local growth.
3
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Advisability of Palliative Resections in Incurable Advanced Gastric Cancer

71%
Al-Amawi T., Świder-Al-Amawi M., Halczak M., Wojtasik P., Kładny J.
Polish Journal of Surgery
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2011
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vol. 83
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issue 8
449-456
EN
Effective treatment is the primary objective of surgeon in the treatment of advanced gastric cancer. Poor prognosis and significant advancement of gastric cancer at the time of diagnosis are decisive factors for the only possible surgical management method being palliative procedures.The aim of the study was the evaluation of the value of palliative resection procedures in patients with advanced gastric cancer.Material and methods. The subject in the study was a group of 105 patients with gastric adenocarcinoma at stage 4 of advancement, in whom curative treatment was not possible. The group constituted 44.5% of patients operated on due to gastric cancer at the Department of General and Oncological Surgery, PUM, in the years 1998-2009. The patients were divided into two groups: the first one comprised 44 patients post palliative resections, the second - 61 patients post non-resection procedures. The subject of analysis were early and late treatment results post palliative resections, and they were compared with the treatment results post non-resection procedures.Results. Palliative resections were performed in 44 patients (19 females and 25 males), while in 61 patients (38 males and 23 females) non-resection procedures were performed. Postoperative complications were observed in 25% of patients in the group post palliative resections and in 11.5% in the group of patients without the resection of primary focus. In-hospital mortality stood at 4.5% in the group post palliative resections and 4.8% in the group post non-resection procedures. The percentage of 1-year and 4-year survival post palliative resections stood at 43% and 8.8%, respectively. In the group without the resection of primary focus, 16% survived 1 year and nobody survived 2 years. Conclusions. Palliative resections improve the survival of patients with incurable gastric cancer and should be considered if only the loco-regional conditions are favourable.
4
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Is the Surgeon's Experience an Independent Prognostic Factor in Rectal Cancer?

71%
Kładny J., Al-Amawi T., Kozłowski M., Wojtasik P., Świder-Al-Amawi M.
Polish Journal of Surgery
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2007
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vol. 79
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issue 6
403-409
EN
The aim of the study was to evaluate the influence of the surgeons' caseload on the results of therapy in rectal cancer.Material and methods. 286 consecutive patients (155 males and 131 females) were enrolled and operated on for rectal cancer stage T2 (112 patients) and T3 (174 patients) in 8 surgical centers of Szczecin between January 1993 and December 1997. Studied group included about 79% of radically operated patients due were to rectal cancer in analyzed period.Results. The patients were assigned to one of two groups with regard to the surgeon's caseload. The first group was comprised of 116 patients (including 72 stage T3 and 54 stage T2 patients) operated on by surgeons more experienced in rectal surgery and the second group was comprised of 160 patients operated on by 36 surgeons with fewer caseloads. The surgeon's experience in rectal surgery was measured by the surgeon's caseload throughout the entire study period. We considered surgeons with greater than 25 cases over the study period experienced.Analysis of survival with regard to the managing center revealed significant differences for stage T3, with 5-year-survival rates ranging from 14% to 60%. Distinct differences were also noted for survival rates in stage T2 (5-year-survival rates ranged from 38% to 86%); however, these differences were not statistically significant. Analysis of the influence of surgeon's caseload on outcomes in rectal cancer revealed a significant influence in stage T3 and a lack of influence in stage T2.Conclusion. The surgeon's experience is an independent prognostic factor for stage T3 rectal cancer patients.
5
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Factors determining the quality of life in patients undergoing radical surgery due to malignant tumors of the rectum

52%
Błaszkowski T., Kładny J., Al-Amawi T., Kaczmarek K., Kwietniak M., Wojtasik P., Halczak M., Michalak T., Jezierski K., Chmialak M.
Polish Journal of Surgery
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2021
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vol. 93
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issue 3
1-9
EN
Introduction: Rectal cancer is one of the most common malignancies in developed countries. However, despite the increasingly better preoperative diagnostics, adaptation of surgical techniques to the location and advancement of the tumor, the combination of surgical treatment with neoadjuvant therapy and adjuvant treatment, standardized control tests, Poland still has not obtained satisfactory results regarding long-term survival. In addition, the effects of the therapy often differ significantly from those expected by patients and the doctors treating them. Aim of the study: To evaluate the effects of rectal cancer treatment among patients of the General and Oncological Surgery Clinic of the Pomeranian Medical University in Szczecin. The impact of numerous factors on postoperative quality of life was analyzed. Material and methods: Between 2007 - 2015, 263 radical resection procedures were performed in patients with diagnosed rectal cancer. Retrospectively, based on medical records, a database was created covering a range of clinical data. Information about death dates of some patients was obtained at the Registry Office in Szczecin. A survey supplementing clinical data and standardized quality of life assessment forms (EORTC QLQ - C30 and CR29) were sent to 120 living patients. A telephone conversation was carried out with some patients who did not respond to the surveys. Finally, data from 90 people was collected, which represents 75% of the patients enrolled in the study. Patients quality of life was assessed using EORTC questionnaire evaluation guides. Results: The patients quality of life worsened the most as a result of anorectal dysfunction. Incontinence of gases and stool, urgency and difficulty in defecation were demonstrated primarily in patients undergoing low rectal resection and irradiation. Patients undergoing radiotherapy, as a result of persistent low anterior resection syndrome, were forced to partially or completely withdraw from professional activity and to limit the pursuit of their interests. Their contacts with family, friends and acquaintances have also deteriorated. The presence of the intestinal stoma significantly affected the deterioration of the reception of the body's own image. However, no relation was found between the existence of the fistula and other aspects of the patients everyday life, including functioning in life and social roles. Conclusions: Due to the acceptable postoperative quality of life of patients with fistula and numerous imperfections of sphincter preserving techniques, operations resulting in terminal ostomy should not be considered as an extremity, and in the case of tumors of the lower rectum with unaffected sphincters, they should be considered as alternative methods for low anterior resection.
6
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Czynniki determinujące jakość życia u pacjentów poddanych radykalnym zabiegom operacyjnym z powodu nowotworów złośliwych odbytnicy

52%
Błaszkowski T., Kładny J., Al-Amawi T., Kaczmarek K., Kwietniak M., Wojtasik P., Halczak M., Michalak T., Jezierski K., Chmialak M.
Polish Journal of Surgery
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2021
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vol. 93
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issue 3
1-9
PL
Wprowadzenie: Rak odbytnicy jest jednym z najczęściej występujących nowotworów złośliwych w krajach wysoko rozwiniętych. Jednak, pomimo coraz lepszej diagnostyki przedoperacyjnej, dostosowywania technik chirurgicznych do położenia i zaawansowania nowotworu, skojarzenia leczenia operacyjnego z terapią neoadjuwantową oraz leczeniem uzupełniającym, wystandaryzowanych badań kontrolnych, nadal nie uzyskano w Polsce satysfakcjonujących wyników dotyczących odległych przeżyć. Ponadto, efekty zastosowanej terapii niejednokrotnie znacznie odbiegają od tych oczekiwanych przez pacjentów oraz prowadzących ich lekarzy. Cel: Celem niniejszej pracy jest ocena efektów leczenia nowotworów odbytnicy wśród pacjentów Kliniki Chirurgii Ogólnej i Onkologicznej Pomorskiego Uniwersytetu Medycznego w Szczecinie. Analizie poddany został wpływ licznych czynników na pooperacyjną jakość życia. Materiał i metody: W latach 2007–2015 w ramach Kliniki Chirurgii Ogólnej i Onkologicznej Pomorskiego Uniwersytetu Medycznego w Szczecinie wykonano 263 radykalne zabiegi resekcyjne u pacjentów z rozpoznanym nowotworem złośliwym odbytnicy. Retrospektywnie, na podstawie historii chorób, utworzono bazę danych obejmującą szereg danych klinicznych. W Urzędzie Stanu Cywilnego uzyskano informację o datach zgonów części chorych. Do 120 żyjących osób wysłano ankietę uzupełniającą dane kliniczne oraz standaryzowane formularze oceny jakości życia (EORTC QLQ – C30 oraz CR29). Z częścią pacjentów, którzy nie odpowiedzieli na ankiety, przeprowadzono rozmowę telefoniczną. Ostatecznie zebrano dane od 90 osób, co stanowi 75% pacjentów włączonych do badania. Jakość życia pacjentów oszacowano, wykorzystując przewodniki oceny kwestionariuszy EORTC. Wyniki: Jakość życia chorych w największym stopniu uległa pogorszeniu w wyniku dysfunkcji anorektalnej. Nietrzymanie gazów i stolca, parcia naglące oraz trudności z wypróżnieniami wykazano przede wszystkim u pacjentów poddanych niskiej resekcji odbytnicy oraz naświetlaniu. Osoby poddane radioterapii, na skutek przetrwałego zespołu niskiej resekcji odbytnicy, zmuszone były do częściowego lub całkowitego wycofania się z aktywności zawodowej oraz ograniczenia realizacji swoich zainteresowań. Pogorszeniu uległy również ich kontakty z rodziną, przyjaciółmi i znajomymi. Obecność stomii jelitowej w istotny sposób wpłynęła na pogorszenie odbioru obrazu własnego ciała. Nie stwierdzono jednak związku pomiędzy istnieniem przetoki a innymi aspektami codziennego życia pacjentów, łącznie z funkcjonowaniem w rolach życiowych i społecznych. Wnioski: Z uwagi na akceptowalną pooperacyjną jakość życia pacjentów z przetoką oraz liczne niedoskonałości technik prowadzących do zaoszczędzenia aparatu zwieraczowego, operacje skutkujące wyłonieniem stomii nie powinny być traktowane jako ostateczność, a w przypadku guzów dolnej części odbytnicy z niezajętymi zwieraczami, należałoby rozważać je jako metody alternatywne do przedniej niskiej resekcji.
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