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Evaluation of Outcomes and Treatment Safety of Patients with Metastatic Colorectal Cancer to the Liver with Estimation of Prognostic Factors

100%
Zeman M., Maciejewski A., Półtorak S., Kryj M.
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vol. 85
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issue 6
333-339
EN
Liver resection is essential part of colorectal cancer liver metastases (CLM) treatment. Mean 5-year overall survival after resection achieves 30-45%. There are many factors influencing long-term outcomes, and among them the inflammatory response to tumor plays an important role. The aim of the study was evaluation of outcomes and treatment safety of patients with metastatic colorectal cancer to the liver with estimation of prognostic factors. Material and methods. 130 consecutive patients (70 men and 60 women) operated in MSC Institute and Cancer Center in Gliwice from 2001 to 2009 due to colorectal liver metastases were analysed. Age of the patients ranged from 33 to 82 years (median 60 years). 96 (74%) patients underwent potentially radical resection, and in remaining 34 (26%) was performed radiofrequency ablation (RFA) alone or combined with the resection. In the resection group 37 right hepatectomies, 11 left hepatectomies, 28 segmentectomies and 20 metastasectomies were performed. Disease-free survival (DFS) and overall survival (OS) were statistically analysed using the Kaplan-Meier method. Factors determining DFS and OS were analysed using Cox regression model. Results. In the resection group the 3- and 5-years OS was 64,5% and 46,6% respectively, and the 3- and 5-years DFS was 32% and 30,5% respectively. In the RFA group the 3- and 5-years OS was 33% and 9,5%. Statistically significant prognostic factors in the resection group in uni- and multivariate analysis were: grade and nodal involvement of the primary tumor, diameter of metastatic focus, positive and narrow (<1 mm) resection margins, preoperative fibrinogen level, preoperative neutrophil to lymphocyte ratio and leukocyte amount of the peripheral blood. The perioperative mortality rate was 3%. Conclusions. Liver resection due to colorectal liver metastases is a safe and effective method resulting in high survival rates. We confirmed some generally accepted prognostic factors influencing longterm outcomes and shown the impact of inflammatory response. We also confirmed the hypothesis that preoperative plasma fibrinogen level influences outcomes after liver resection due to CLM.
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An Evaluation of the Efficacy of Microvascular Breast Reconstruction Techniques

100%
Dobrut M., Maciejewski A., Półtorak S.
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vol. 85
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issue 1
6-11
EN
The aim of the studywas to evaluate the efficacy of different microvascular techniques in breast reconstruction with the analysis of postoperative complications. The additional goal of the study is to analyze the quality of life of patients after microvascular breast reconstruction in comparison to the control group of patients who underwent only mastectomy without any reconstructive procedures. Also the algorithm of breast reconstruction is presented as the result of own experiences. Material and methods.Clinical material contain 2 groups of patients - women after surgical treatment in Department of Oncological and Reconstructive Surgery, Cancer Center in Gliwice in the year 2004-2009 where in 53 cases immediate and in 26 delayed breast microvascular reconstruction were performed. In all cases the diagnosis of cancer was proved by histopathological biopsy before the treatment. The type of radical resection (mastectomy) depended on histopathological type of cancer and its localization. The reconstruction - immediate vs delayed was carefully planned together with oncological treatment of the cases. Everywhere this plan was established based on carefully examinations of inferior epigastric vessels and theirs perforators. The choice between immediate and delayed microvascular reconstruction was based on prognosis and predictive factors. The QOL was analyzed due to own questionnaire when functional, aesthetics and social effects were evaluated. ResultsFree flap survival rate for all types of free flap was 95%. In cases where classic TRAM was used the rate was 85%, in cases where muscle sparring TRAM was chosen the survival rate was 100% and in remaining cases of DIEP reconstructions the rate was 89%. Generally the complications after microvascular reconstruction occurred in 13 cases (16%). In 9 cases the problems with flaps perfusion were notified. Total flap necrosis was observed in 2 TRAM and in 2 DIEP cases. In all those cases salvage surgery was administered in which the microanastomoses were explored and repaired. In 5 cases the cause of the complications was venous thrombosis, in 2 cases the vascular pedicle was kinked, and in remaining 1 the arterial thrombosis was found. The second type of complication was fat necrosis (<25% of flap volume) which was observed in 5 cases between 1 and 4 months after surgery, and it request minor plastic surgery. Donor site complications were noted in 4 cases. In two of those hernia in cicatrices was diagnosed (both were classic TRAM’s), in remaining 2 in which also fully muscle TRAM was classic the weakness of abdominal wall was observed. In group were msTRAM and DIEP were used no donor site complications occurred.
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Value of Combined Treatment of Retroperitoneal Sarcomas

88%
Kamiński A., Kołosza Z., Strojek J., Pilecki B., Półtorak S.
Polish Journal of Surgery
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2007
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vol. 79
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issue 4
297-304
EN
The aim of the study was to determine treatment results in patients with retroperitoneal sarcomas, especially as respects the value of combined therapy.Material and methods. The study group included 37 patients with retroperitoneal sarcomas who underwent treatment at the Department of Oncological Surgery, Oncology Center in Gliwice during the period between 1992 and 2005. The study group included 25 women and 12 men, aged between 21 and 68 years (mean age - 56.2 years). Adjuvant therapy after the operation was performed in the case of 15 patients. Nine received adjuvant teleradiotherapy (RT) at an average dose of 47.5 Gy (one patient after a non-resective procedure). Four received intraoperative brachytherapy (BT) at a dose of 15.8 Gy in combination with postoperative teleradiotherapy at a dose of 39 Gy. One patient was subjected to intraoperative brachytherapy. One female patient received adjuvant chemotherapy (Iphosphamid + Adriamycin).Results. The cumulative five-year total survival period of the analysed group was 40.7% according to Kaplan-Meier's method. Twenty patients died and four were diagnosed with recurrence, while 13 continue to live without recurrence. The type of resection had a significant effect on total survival (p=0.013): the five-year survival after radical procedures was 52.1%. We observed no five-year survivals after nonradical procedures. In order to determine the efficacy of combined treatment, patients who underwent to radical therapy were divided into three groups: patients without adjuvant therapy (group 1: 22 patients, 62.9%), patients subjected to adjuvant RT and BT therapy after the primary operation (group II: 5 patients, 14.25%), and patients who underwent the above-mentioned treatments after surgery, due to recurrence (group III: 8 patients, 22.85%).The total five-year survival in group I was 34.8%, in group II, 80%, and in group III, 72.9%. These differences were statistically insignificant (p=0.440). These results were probably influenced by the small number of patients, considering particular groups.Conclusions. 1. The most important prognostic factor in the treatment of retroperitoneal sarcomas is surgical margine type surgical margin. 2. Adjuvant radiotherapy, especially in combination with intraoperative brachytherapy, seems to be a promising method for the management of retroperitoneal sarcomas, and improves treatment results. 3. Treatment of retroperitoneal sarcomas should be undertaken in specialized centers adequately prepared for combined therapy.
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The Use of a Pedunculated, Extended Latissimus Dorsi Flap in Primary and Secondary Breast Reconstruction Procedures - Case Report

88%
Maciejewski A., Ulczok R., Dobrut M., Szumniak R., Półtorak S.
Polish Journal of Surgery
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2012
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vol. 84
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issue 7
367-370
EN
The extended latissimus dorsi flap (LD) is used in breast reconstruction since the 70's. LD flap is often used in corrective surgery in cases of unsatisfactory cosmetic results after breast-conserving therapy. In our department LD flap has several uses. In addition to free microvascular flaps - which applies in breast reconstructive surgery is routine, there are clinical situations where the use of pedicled LD flap is justified. The main indications for its use are: the inability to apply microvascular flap, the general condition (diabetes, advanced atherosclerosis), smoking, previous surgery of abdominal wall, abdominal obesity, patient preferences. Approximately 30% of patients after breast reconstruction require corrective procedures. Group which uses extended LD flap account for 24 patients. In 16 cases it was used for elective breast reconstruction. In the remaining eight cases it was used in the corrective procedures symmetry and shape of the previously reconstructed breast. Based on our own experience it can be concluded that the LD flap with an alternative to microvascular techniques. Complication rate when using the LD flap is relatively low and includes: seroma and slight motor disability of the shoulder girdle.
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Czerniaki złośliwe regionu głowy i szyi w materiale Kliniki Chirurgii Onkologicznej i Rekonstrukcyjnej Centrum Onkologii IMSC w Gliwicach

76%
Krakowczyk Ł., Maciejewski A., Grajek M., Szymczyk C., Wierzgoń J., Jędrzejewski P., Półtorak S.
Polish Journal of Otolaryngology
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2010
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vol. 64
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issue 7
55-59
EN
Introduction: About 25% of melanomas are localized in head and neck skin, and this particular localization is most difficult to treat, and the prognosis is less favorable. The depth of melanoma infiltration (Clark and Breslau grade) into the skin is the main factor of local advancement of the disease. Surgical treatment is an essential therapeutic modality in patients with melanoma. Aim: The aim of this study was to evaluate results of our surgical treatment of melanomas in head and neck localisation, treated from 1997 to 2007 in Department of Oncological and Reconstructive Surgery in Center of Oncology IMSC in Gliwice. Material: We analysed group of 47 patients (aged 26 to 75 years, mean 49), treated by surgical excision of malignant melanoma in the head and neck region. Most of the patiens required to use free fl aps or skin graft technique to close posexcisional defect, on basis of clinical considerations. Results: The 5-year total survival for all patients was 62% and were dependent on depht of melanoma infiltration and regional lymph node metastasis. The significant prognostic factors were: localization of primary focus, local progression of disease, free microscopical excision margins sex and age. Conclusions: Prognosis in the patients with melanoma of the head and neck is unreliable and dependent on local advancement of disease and localization of primary focus. Surgical treatment is an essential therapeutic modality in patients with melanoma. Adiuvant radiotherapy after surgical treatment of melanoma of the head and neck is intended for the patiens with high risk of local or regional recurence of disease.
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Transverse (Tram) rectus abdominis myocutaneous flaps for Rectovaginal and Rectovesical Fistulas Treatment after low Anterior rectal Resection due to Adenocarcinoma

76%
Krakowczyk Ł., Maciejewski A., Wierzgoń J., Szumniak R., Grajek M., Dobrut M., Półtorak S.
Polish Journal of Surgery
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2010
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vol. 82
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issue 5
279-282
EN
The rectovaginal or rectovesical fistula is a rare complication after low anterior resection for rectal cancer. Treatment is difficult and the result is often unsatisfactory.The aim of this paper was to present results of treatment with transverse rectus abdominis myocutaneous flaps of rectovaginal and rectovesical fistulas as complication of low anterior rectal resection due to adenocarcinoma.Material and methods. We report six patients with rectovaginal or rectovesical fistulas as a postoperative complication after low anterior resection of rectal cancer in Department of Oncological and Reconstructive Surgery in 2006-2008. Transverse rectus abdominis myocutaneous flaps are used for rectovaginal and rectovesical fistulas treatment.Results. In the follow-up period from 4 to 30 months no rectovaginal or rectovesical fistula recurrences and any postoperative complications were noted in all cases.Conclusions. Transverse (TRAM) rectus abdominis myocutaneous flaps are an effective, surgical method for rectovaginal or rectovesical fistulas treatement, especially in patients who recived pre or postoperative radiotherapy.
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VDR gene single nucleotide polymorphisms and their association with risk of oral cavity carcinoma

52%
Małodobra-Mazur M., Paduch A., Lebioda A., Konopacka M., Rogoliński J., Szymczyk C., Wierzgoń J., Maciejewski A., Chmielik E., Jonkisz A., Półtorak S., Dobosz T.
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2012
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vol. 59
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issue 4
627-630
EN
Vitamin D3 (1,25(OH)2D3 (1,25-dihydroxyvitamin D3)) is a hormone playing a crucial role in numerous biological processes in the human body, including induction and control of cell proliferation and differentiation. Numerous data relate the vitamin D3 level with various types of cancer. It has been suggested that SNPs in the vitamin D3 receptor (VDR) gene might influence both the risk of cancer occurrence and cancer progression. The aim of this study was to search for genetic correlations between individual SNPs in the VDR gene and the risk of oral cavity carcinoma. Two SNPs were selected based on the literature and our previous results. Seventy-three patients with squamous cell carcinoma of the head and neck and one hundred control subjects were investigated. Two SNPs in the VDR gene were genotyped in minisequencing reactions followed by capillary electrophoresis. Hardy-Weinberg equilibrium (HWE), the χ2 test and logistic regression were used for statistical analysis. The SNP rs2238135 in the VDR gene displayed statistical differences in frequency between the tested groups (p=0,0007). Furthermore, the G/C genotype of the rs2238135 in the VDR gene was characterized by a 3.16 fold increased risk of oral cavity carcinoma. The obtained results provide evidence for a genetic association between rs2238135 in the VDR gene and the occurrence and risk of oral cavity cancer.
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The Use of Double Independent Free Flaps for Tissue Reconstruction After Extensive Head and Neck Tumors Resection

52%
Maciejewski A., Jędrzejewski P., Szymczyk C., Wierzgoń J., Dobrut M., Szumniak R., Grajek M., Krakowczyk Ł., Półtorak S., Ulczok R., Oleś K.
Polish Journal of Surgery
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2010
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vol. 82
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issue 12
666-676
EN
Malignant tumors of head and neck regions usually need wide radical resections and may cause significant functional and aesthetic deficits. When a surgeon has to deal with extensive 3-D defect in lower or middle face region, double or multiple free flaps can be used.The aim of the study was to present own methods modifications and results of double free flaps techniques in patients with extensive defects of head and neck region. The authors present quality of life evaluation related to different flaps reconstructions.Material and methods. Clinical material consists of 33 patients with locally advanced cancer of lower or middle face region, who underwent surgical treatment in Departmant of Surgical and Reconstructive Surgery, Cancer Center Maria Skłodowska-Curie Instytute, Gliwice, Poland. In all patients double free flaps were chosen.Results. Whole group good functional and aesthetic results have been achieved. The QOL analysis show that the use of double flap in middle of lower face reconstruction gives generally very good results.Conclusions. The use of double free flaps after extensive resections of head and neck tumors is an efficient solution. The above-mentioned technique enables to reconstruct several different anatomical structures, restore optimal functioning, and assure a satisfactory psychosocial effect.
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