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Esophagogastric Junction Versus Gastric Carcinoma - Implications for Surgical Tactics on the Basis of Own Experience

100%

Frączek M., Hevelke P., Komorzycki K., Kotulski M., Kalinowski P., Górnicka B., Krawczyk M.

Polish Journal of Surgery

2007

vol. 79

issue 9

600-609

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.

Evolution Of The Results Of 1500 Liver Transplantations Performed In The Department Of General, Transplant And Liver Surgery Medical University Of Warsaw

36%

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

2015

vol. 87

issue 5

221-230

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.

1000 Liver Transplantations at the Department of General, Transplant and Liver Surgery, Medical University of Warsaw - Analysis of Indications and Results

32%

Krawczyk M., Grąt M., Barski K., Ligocka J., Antczak A., Kornasiewicz O., Skalski M., Patkowski W., Nyckowski P., Zieniewicz K., Grzelak I., Pawlak J., Alsharabi A., Wróblewski T., Paluszkiewicz R., Najnigier B., Dudek K., Remiszewski P., Smoter P., Grodzicki M., Korba M., Kotulski M., Cieślak B., Kalinowski P., Gierej P., Frączek M., Rdzanek Ł., Stankiewicz R., Kobryń K., Nazarewski Ł., Leonowicz D., Urban-Lechowicz M., Skwarek A., Giercuszkiewicz D., Paczkowska A., Piwowarska J., Gelo R., Andruszkiewicz P., Brudkowska A., Andrzejewska R., Niewiński G., Kilińska B., Zarzycka A., Nowak R., Kosiński C., Korta T., Ołdakowska-Jedynak U., Sańko-Resmer J., Foroncewicz B., Ziółkowski J., Mucha K., Senatorski G., Pączek L., Habior A., Lechowicz R., Polański S., Leowska E., Pacho R., Andrzejewska M., Rowiński O., Kozieł S., Żurakowski J., Ziarkiewicz-Wróblewska B., Górnicka B., Hevelke P., Michałowicz B., Karwowski A., Szczerbań J.

Polish Journal of Surgery

2012

vol. 84

issue 6

304-312

The aim of the study was to analyze indications and results of the first one thousand liver transplantations at Chair and Clinic of General, Transplantation and Liver Surgery, Medical University of Warsaw.Material and methods. Data from 1000 transplantations (944 patients) performed at Chair and Clinic of General, Transplantation and Liver Surgery between 1994 and 2011 were analyzed retrospectively. These included 943 first transplantations and 55 retransplantations and 2 re-retransplantations. Frequency of particular indications for first transplantation and retransplantations was established. Perioperative mortality was defined as death within 30 days after the transplantation. Kaplan-Meier survival analysis was used to estimate 5-year patient and graft survival.Results. The most common indications for first transplantation included: liver failure caused by hepatitis C infection (27.8%) and hepatitis B infection (18%) and alcoholic liver disease (17.7%). Early (< 6 months) and late (> 6 months) retransplantations were dominated by hepatic artery thrombosis (54.3%) and recurrence of the underlying disease (45%). Perioperative mortality rate was 8.9% for first transplantations and 34.5% for retransplantations. Five-year patient and graft survival rate was 74.3% and 71%, respectively, after first transplantations and 54.7% and 52.9%, respectively, after retransplantations.Conclusions. Development of liver transplantation program provided more than 1000 transplantations and excellent long-term results. Liver failure caused by hepatitis C and B infections remains the most common cause of liver transplantation and structure of other indications is consistent with European data.

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Esophagogastric Junction Versus Gastric Carcinoma - Implications for Surgical Tactics on the Basis of Own Experience

Evolution Of The Results Of 1500 Liver Transplantations Performed In The Department Of General, Transplant And Liver Surgery Medical University Of Warsaw

1000 Liver Transplantations at the Department of General, Transplant and Liver Surgery, Medical University of Warsaw - Analysis of Indications and Results