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EN
The aim of the study was to analyze clinicopathological features in breast cancer patients with local recurrence (LR). Material and methods. A retrospective analysis of database of breast cancer patients operated on in the Department of Surgical Oncology in Łódź from 2 January 2009 to 30 June 2013, identified 1080 women with primary breast cancer and 11 patients with LR. Results. LR rate was 0.23% per year. True recurrence (TR) occurred more frequently in patients with luminal B molecular subtype, in HER-2 positive and in triple-negative subgroups. In one patient with luminal -A subtype new primary (triple negative) occurred. TR were noted predominantly in patients with axillary lymph nodes metastases and with luminal B subtype who did not receive adjuvant chemotherapy but were given only endocrine therapy. LR were observed more frequently in patients who did not receive adjuvant radiotherapy or this treatment was delayed. Minimal surgical margins in postoperative specimens measured by pathologist were 4-25 mm, mean 9.5 mm. Conclusions. The LR rate in patients operated on breast cancer in the Department of Surgical Oncology between 2009 and 2013 was low. TR was diagnosed in patients with non- luminal A breast cancer despite wide surgical margins, especially if the patients did not receive optimal adjuvant systemic treatment or radiotherapy was delayed or omitted. Complete cancer excision followed by an immediate implementation of optimal adjuvant treatment seems to be crucial especially in patients with poor tumor biology.
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Local Antibiotic Therapy in Rectal Cancer Surgery

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EN
Infectious complications and their consequences are still key issues in rectal cancer surgery. Currently, intravenous antibiotic administration is a recognized method for lowering the rate of these complications. The aim of the study was to assess the efficacy of complementary application of a gentamicin-impregnated sponge in the perineal wound or in the vicinity of intestinal anastomosis after abdominoperineal resection or low anterior resection. Material and methods. 112 patients with primary rectal cancer were enrolled in this study. 42 patients were treated with a gentamicin sponge and drainage (group A) and 70 individuals were treated with drainage alone (group B). In the aforementioned groups a routine short-term regimen of antibiotic prophylaxis was used. We applied gentamicin-impregnated sponges in 27 patients in whom anterior resection was performed and in 15 patients from the abdominoperineal resection group (64% and 36%, respectively). In the control group, 44 anterior resections and 26 abdominoperineal resections were carried out (63% and 37%, respectively). Results. We did not observe statistically significant differences in the incidence of suppurative complications (intraabdominal abscess, perineal wound infection): 4 cases (9.52%) in group A and 9 (12.58%) in group B and anastomotic leakage with clinical manifestation after low anterior resection: 1 case (3.7%) in group A and 2 (4.5%) in group B. Postoperative fever of unknown origin was noted more often in group B: 23 patients (32.8%) versus 10 patients (23.8%) in group A and this difference was statistically significant (p<0.05). Hospitalization after surgery was also significantly longer in group B (9-37 days, median 11 days) as compared with group A (8-26 days, median 13 days) (p<0.05). Conclusions. Local antibiotic therapy in rectal cancer surgery lowered the incidence of postoperative fever of unknown origin and permitted shorter hospitalization after surgery. Local gentamicin application in rectal cancer surgery did not change significantly the rate of infectious complications.
EN
was to assess the impact of hospital caseload on long-term outcomes of rectal cancer patients. We posed two questions: 1. Does the number of operations carried out in the surgical department influence five year survival and local recurrence rates? 2. Does surgery alone without adjuvant therapy performed in the particular department affect long-term results? Material and methods. 215 consecutive rectal cancer patients treated in six hospitals of the Łódź district between 1994 and 1998 were enrolled into this prospective study. We analyzed patients in whom local excision, low anterior resection, abdominoperineal resection and Hartmann’s procedure were performed. 27 percent of patients received adjuvant therapy such as radio- or chemotherapy or both. Long-term results were compared between high and low volume institutions by means of local recurrence and five year survival rates. Results. In high volume departments; 69.2% of five year survival rates were obtained versus 46.6% for low volume institutions (p=0.00433). Similar differences were noted comparing local recurrence rates between the aforementioned groups: 19.7% versus 36.5%, respectively (p=0.00430). In surgically treated patients who did not receive adjuvant therapy statistically significant differences were found: 76.5% of patients operated on in high volume hospitals survived five years as compared with 42.9% for low caseload institutions (p=0.00013). Local recurrence rates were 15.5% for high caseload institutions and 38.5% for low caseload hospitals (p=0.00042). Conclusions. High volume hospitals achieved better results in rectal cancer patients with regard to five year survival and local recurrence rates. Better outcomes were also obtained in high caseload departments regarding surgically treated patients who did not receive adjuvant therapy.
EN
Background: The aim of this study was to establish whether the gene expression of estrogen receptor alpha (encoded by ESR1) correlates with the expression of glutathione peroxidase 1 (encoded by GPX1) in the tumor and adjacent tumor-free breast tissue, and whether this correlation is affected by breast cancer. Such relationships may give further insights into breast cancer pathology with respect to the status of estrogen receptor. Methods: We used the quantitative real-time PCR technique to analyze differences in the expression levels of the ESR1 and GPX1 genes in paired malignant and non-malignant tissues from breast cancer patients. Results: ESR1 and GPX1 expression levels were found to be significantly down-regulated by 14.7% and 7.4% (respectively) in the tumorous breast tissue when compared to the non-malignant one. Down-regulation of these genes was independent of the tumor histopathology classification and clinicopathological factors, while the ESR1 mRNA level was reduced with increasing tumor grade (G1: 103% vs. G2: 85.8% vs. G3: 84.5%; p<0.05). In the non-malignant and malignant breast tissues, the expression levels of ESR1 and GPX1 were significantly correlated with each other (Rs=0.450 and Rs=0.360; respectively). Conclusion: Our data suggest that down-regulation of ESR1 and GPX1 was independent of clinicopathological factors. Down-regulation of ESR1 gene expression was enhanced by the development of the disease. Moreover, GPX1 and ESR1 gene expression was interdependent in the malignant breast tissue and further work is needed to determine the mechanism underlying this relationship.
EN
The breast cancer suppressor proteins BRCA1 and BRCA2 interact with RAD51, a protein essential for maintaining genomic stability by playing a central role in homology-dependent recombinational repair of the DNA double-strand breaks. Therefore, genetic variability in the RAD51 gene may contribute to the appearance and/or progression of breast cancer. A single nucleotide polymorphism in the 5'- untranslated region of RAD51 (a G to C substitution at position 135, the G/C polymorphism) is reported to modulate breast cancer risk. We investigated the distribution of genotypes and frequency of alleles of the G/C polymorphism in breast cancer. Tumor tissues were obtained from postmenopausal women with node-negative and node-positive breast carcinoma with uniform tumor size. Blood samples from age matched healthy women served as control. The G/C polymorphism was determined by PCR-based MvaI restriction fragment length polymorphism. The distribution of the genotypes of the G/C polymorphism did not differ significantly (P >0.05) from those predicted by the Hardy-Weinberg distribution. There were no differences in the genotype distribution and allele frequencies between node-positive and node-negative patients. There were no significant differences between distributions of the genotypes in subgroups assigned to histological grades according to Scarf-Bloom-Richardson criteria and the distribution predicted by Hardy-Weinberg equilibrium (P >0.05). Our study implies that the G/C polymorphism of the RAD51 gene may not be directly involved in the development and/or progression of breast cancer and so it may not be useful as an independent marker in this disease.
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