Search results

1

Total Thyroidectomy in Multinodular Non-Neoplastic Goiter

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Cichoń S., Anielski R., Konturek A., Barczyński M., Cichoń W., Orlicki P.

Polish Journal of Surgery

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2007

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vol. 79

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issue 7

482-489

EN

The aim of the study was to describe the experience of the authors in performing total thyroidectomies in patients referred to surgical treatment with the diagnosis of non-neoplastic multinodular goiter.Material and methods. Over a period of 6 years (2000-2005), 4999 surgical procedures were performed in patients diagnosed as having non-neoplastic goiter at our department. Thus, the analysis does not include patients operated on due to carcinoma of the thyroid, diagnosed either pre- or intraoperatively, or individuals with recurrent goiter. Total thyroidectomies were performed in 408 (8.16%) patients. Subtotal thyroidectomies, i.e. a total lobectomy involving one, dominant thyroid lobe and combined with a subtotal resection of the contralateral lobe, were done in 1251 (25.02%) individuals. In patients with lesions involving one thyroid lobe only, the operators performed a total resection of the affected lobe, while leaving the normal, contralateral lobe without any surgical intervention. Such a procedure was performed in 89 (1.78%) individuals. In very few cases, the operation consisted of a subtotal unilateral lobectomy; such a treatment modality was employed in 39 (0.78%) patients. The predominantly performed procedure employed in 3212 (64.1%) patients was subtotal bilateral lobectomy of the thyroid gland. The patients were divided into groups according to the type of surgery performed. The groups were then compared for clinical diagnosis and the prevalence of early and late postoperative complications. The Student-t test was employed to calculate the probability and confidence interval values.Results. Among surgical patients not suspected of thyroid carcinomas, neoplastic lesions were, nevertheless, confirmed by postoperative histopathology in 310 (6.2%) individuals. As shown in the presented data, increased extent of the procedure was associated with thyroid carcinoma, diagnosed only by postoperative histopathology an increased number of complications, among which the most common was hypocalcemia.Conclusions. 1. Total thyroidectomy may be a preferred method for treating bilateral multinodular goiter; when performed by an experienced endocrine surgeon, it is associated with a low percentage of postoperative complications. 2. Total thyroidectomy in bilateral multinodular goiters lead to a decreased number of secondary operations in patients.

2

Pediatric cataract surgery – indications for surgery, treatment techniques and postoperative procedures

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Prost M. E.

OphthaTherapy

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2020

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vol. 7

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issue 4

326-332

EN

Currently, surgery methods of pediatric cataracts allow obtaining good visual acuity in operated children. The operation should be performed in infants over 2 months of age because of more frequent occurrence of glaucoma in earlier operated patients. In children under 10 years of age posterior capsulotomy and anterior vitrectomy are required during surgery to prevent opacification of the posterior lens capsule after surgery. Due to the frequent occurrence of opacities in the visual axis, it is recommended no to implant intraocular lenses in infants under 7th month of life (2nd year of life according to some recommendations).

PL

Obecnie chirurgiczne metody leczenia zaćmy u dzieci pozwalają na uzyskanie dobrej ostrości wzroku u operowanych dzieci. Operacja powinna być przeprowadzona u dzieci w wieku powyżej 2. miesiąca życia ze względu na częstsze występowanie jaskry u pacjentów operowanych wcześniej. U dzieci poniżej 10. r.ż. jest konieczne wykonanie w trakcie operacji tylnej kapsulotomii i przedniej witrektomii, aby zapobiec mętnieniu tylnej torebki soczewki po zabiegu. Ze względu na częste występowanie zmętnień w osi widzenia nie zaleca się wszczepiania soczewek wewnątrzgałkowych dzieciom poniżej 7. miesiąca życia (2. r.ż. zgodnie z niektórymi wytycznymi).

3

The influence of bowel preparation on postoperative complications in surgical treatment of colorectal cancer

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Małek Z., Małek P., Dziki Ł.

Polish Journal of Surgery

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2019

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vol. 91(3)

10-14

EN

Introduction Colorectal cancer is the most common gastrointestinal cancer treated by departments and surgical clinics in Poland. Currently, the biggest challenge of surgery is to reduce the number of leaks in the bowel anastomoses and postoperative wound infections to a minimum. Objective Whether bowel preparation before surgery affects the early results of treatment? Methods The study was retrospective and included patients operated electively on one surgical center due to colorectal and rectal cancer in years 2013-2018. Patients who underwent surgery were divided into two groups in the study. The first was 109 patients with mechanical bowel irrigation. The second group of 118 patients, in addition to mechanical bowel preparation, received an oral antibiotic. Results The studied groups did not differ significantly in terms of traits that could affect the results of treatment within 30 days of surgery. Postoperative mortality was 0,9% and 0,85%. Complications: leakage of the bowel anastomosis 1,8% and 1,7%, postoperative obstruction 3,7% and 5,0%, wound dehiscence 2,75% and 0,85%, infection of the surgical site 13,8% and 3,4% respectively in the first and second group of patients. Conclusion 1. Mechanical bowel preparation in combination with the oral supply of antibiotic significantly reduces the frequency of surgical site infection compared to the mechanical rinsing itself. 2. Type of preparation of the intestine before the surgery does not significantly affect postoperative mortality and other complications, including anastomotic leak, but may be important for the frequency of postoperative wound dehiscence.

4

Non Small Cell Lung Cancer: Is There a Relationship Between Bacterial Colonization of the Tumour Parenchyma and Postoperative Infectious Complications?

100%

Dancewicz M., Szymankiewicz M., Kowalewski J., Bella M.

Polish Journal of Surgery

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2008

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vol. 80

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issue 1

21-25

EN

The aim of the study was to investigate the influence of bacterial colonisation of a neoplastic lung tumour on the frequency of infectious complications after radical surgical treatment of the malignancy.Material and methods. 49 patients operated on for non-small cell lung cancer (NSCLC) from 23rd January to 2nd November 2006 were included into the study. The analyzed group consisted of 39 men and 10 women, they were from 45 to 79 years old. Material for microbiological tests was collected in an operating theatre under sterile conditions directly after the resection of a tumour. A sample (5x5x5 mm) of the tumour was cultured for facultative anaerobes, obligate anaerobes and fungi. After the homogenisation of tumour tissues quantitative culture was also performed.Results. Potentially pathogenic microbes were cultured from tumours in 14 patients (28.6%). The most frequent bacterium was Propionibacterium acnes. It was found in six out of 49 tumours (12.2%). In 13 cases (26.6%) postoperative infectious complications were observed. They were as follows: infection of the lower airways - 8 cases (16.3%), surgical wound infection - 3 cases (6.1%), pleurisy - 1 case (2%) and pleural empyema - 1 case (2%). In 12 patients (24.5%) pathogenic microbes were isolated from biological material obtained from other sources than a tumour. In remaining 36 patients (73.5%) no infectious postoperative complications were observed. In 13 patients in whom bacteria were cultured from a tumour there were no postoperative infectious complications. Only in one patient the same bacterium (Staphylococcus aureus) was identified in a tumour and 35 days later in pleural effusion where four other pathogenic bacteria were isolated, too. In 12 patients whose postoperative course was complicated by infections had no pathogenic microbes cultured from a resected tumour. Statistical analysis showed no significant relations between the presence of pathogenic microbes within a lung malignant tumour and postoperative infectious complications in patients.Conclusions. The most frequent microbe cultured from non-small cell lung carcinoma is Propionibacterium acnes. There is no relation between the colonisation of a malignant tumour by bacteria and postoperative complications in patients treated surgically for NSCLC.

5

Evaluation of risk factors for postoperative complications in rectal cancer patients

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Zeman M., Czarnecki M., Grajek M., Idasiak A., Tukiendorf A., Czarniecka A.

Polish Journal of Surgery

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2020

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vol. 92(5)

24-30

EN

Introduction: The complications of surgical treatment for rectal cancer, particularly anastomotic leaks after anterior resection, are a significant clinical problem. We retrospectively analysed preoperative factors that may affect the occurrence of complications. Meterial and Methods: A total of 392 rectal cancer patients were included in a retrospective analysis. A total of 257 anterior resections (AR) and 135 abdominoperineal resections (APR) were performed. The risk factors for early postoperative complications were analysed by logistic regression and receiver operating characteristic curves. Results: The significant risk factors for severe complications (grade 3B and higher on the Clavien-Dindo scale) in the multivariate analysis were neutrophil to lymphocyte ratio > 5 (P = 0.047) in the AR group, age of the patients (P = 0.031) in the APR group, and coronary artery disease in both groups (P = 0.03, P = 0.011, respectively). There were no risk factors for anastomotic leaks in the AR group before the analysis was divided into early and late leaks. In the univariate analysis, the statistically significant risk factors for early leaks were preoperative neutrophil to lymphocyte ratio > 5 and peripheral blood platelet count, while late leaks were associated with coronary artery disease; however, in the multivariate analysis, these factors were not statistically significant. Conclusions: The risk factors for severe postoperative complications were neutrophil to lymphocyte ratio > 5, advanced age of the patients and coronary artery disease. The different risk factors for early and late anastomotic leaks after anterior resection may indicate their different aetiologies.

6

Comparison of criteria for elective tracheostomy in head and neck cancer surgery

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Kissin F., Rysz M., Budziszewska M., Krajewski R.

Polish Journal of Otolaryngology

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2021

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vol. 75

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issue 4

20-26

EN

Elective tracheostomy before resection of a malignancy in head and neck region assures unobstructed ventilation during postoperative period but is associated with an increased risk of complications. We aimed to evaluate retrospectively, how the application of elective tracheostomy scales would influence the frequency of tracheostomy in comparison with preoperative clinical judgement. In 205 patients operated on from 2013 till 2017, theresection of a malignancy involved suprahyoid or pharyngeal muscles, neck dissection and flap reconstruction. The decision on elective tracheostomy was made on the clinical basis. Score for each patient in 3 published scales was calculated. In the study group 76 patients had elective tracheostomy at the outset of a resection procedure. Among 129 patients without elective tracheostomy, 9 had tracheostomy in the postoperative period. Indications for elective tracheostomy were calculated for scale I, II and III. Only in 120 patients the decision whether to perform elective tracheostomy would be identical in each scale. Our results suggest that decisions to perform elective tracheostomy based on 3 scales show low specificity. The factors used in the published scales should be evaluated in a prospective multicenter study

7

Laparoscopically Assisted Ileo-Colonic Resection in Patients with Crohn’s Disease – Preliminary Report

100%

Borycka-Kiciak K., Dib N., Janaszek Ł., Sołtysiak Ł., Bukowicka B., Tarnowski W.

Polish Journal of Surgery

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2013

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vol. 85

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issue 9

505-510

EN

Despite increasing number of reports indicating good treatment outcomes, laparoscopic treatment of Crohn’s disease remains controversial. The aim of the study was to compare outcomes of laparoscopically assisted and open ileo-colonic resection in patients with active Crohn’s disease. Material and methods. 82 patients who underwent surgical treatment (44 laparoscopic and 38 open procedures) at the Department of General, Oncological and Gastrointestinal Surgery in Warsaw were enrolled to the study. The following perioperative parameters were compared in both these groups: duration of hospitalization and presence of postoperative complications in at least 12 months of follow‑up. Results. The conversion rate in the laparoscopy group was 29.5%. There were no statistically significant differences between the study groups with regard to duration of the surgical procedure, requirement for perioperative transfusions and total number of postoperative complications (19.3% in the laparoscopy group versus 28.9% in the open surgery group). However, amount of analgesic drugs required in the postoperative period was significantly lower (25±6 vs 43±9, p<0.01) and duration of hospitalization was significantly shorter (9.0 vs 11.3 days, p=0.021) after laparoscopic versus open procedures procedures. Most of the patients with complicated Crohn’s disease who were qualified to laparoscopic treatment, underwent successful treatment using this method. Patients in whom conversion was done, were more likely to be on long term preoperative immunosuppressive therapy versus other patients. Conclusions. Laparoscopy is a demanding procedure from the technical point of view, but provides valuable benefits to patients with Crohn’s disease, including those with a complicated disease. However, this method requires ongoing improvement of technical aspects and thorough analysis of failures to identify factors that could accurately select patients with indications and contraindications to this procedure.

8

Digestive System Fistula - A Problem Still Relevant Today

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Głuszek S., Korczak M., Kot M., Matykiewicz J., Kozieł D.

Polish Journal of Surgery

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2011

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vol. 83

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issue 1

32-41

EN

Digestive system fistula originates most frequently as a complication after surgical procedures, less often occurs in the course of inflammatory diseases, but it can also result from neoplasm and injuries.The aim of the study was to analyze the causes and retrospectively assess the perioperative procedures as well as the results of digestive system fistula treatment.Material and methods. Own experience in digestive system fistula treatment was presented. The subject group consisted of 32 patients treated at the General Surgery, Oncology and Endocrinology Clinical Department between 01.05.2005 and 30.04.2010 due to different digestive tract diseases. The causes of the occurrence of digestive system fistula, methods and results of treatment were analyzed.Results. The analysis covered 32 patients with digestive system fistula, among them 15 men and 17 women. Average age for men was 57 years (20-78), and for women 61 years (24-88). In 11 patients idiopathic fistula causally connected with primary inflammatory disease (7 cases) and with neoplasm (4 cases) was diagnosed, in 19 patients fistula was the result of complications after surgery, in 2 - after abdominal cavity injury. Recovery from fistula was achieved in 23 patients (72%) with the use of individually planned conservative therapy (TPN, EN, antibiotics, drainage, and others) and surgery, depending on the needs of individual patient. 5 patients (16%) died, whereas in 4 left (12%) recovery wasn't achieved (fistula in palliative patients, with advanced stages of neoplasm - bronchoesophageal fistula, the recurrence of uterine carcinoma).Conclusions. Recently the results of digestive system fistula treatment showed an improvement which manifests itself in mortality decrease and shortening of fistula healing time. Yet, digestive system fistula as a serious complication still poses a very difficult surgical problem.

9

Influence of Carbohydrate Metabolism Disturbances on Early Postoperative Complications in Patients after Planned Coronary Artery By-pass Graft Surgery

88%

Greberski K., Bugajski P., Kalawski R., Guzik P., Wysocki H.

Polish Journal of Surgery

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2007

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vol. 79

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issue 7

496-502

EN

Improper glucose metabolism unfavorably influences the peri- and postoperative course, considering patients subjected to coronary artery bypass graft surgery. In case of such patients, one can observe an increased amount of perioperative complications.The aim the study was to determine the correlation between carbohydrate metabolism disturbances and mortality, as well as other postoperative complications in patients subjected to coronary artery bypass graft surgery.Material and methods. The study group comprised 117 patients under 80 years of age qualified for coronary artery bypass graft surgery using extracorporeal circulation and Off-Pump Coronary Artery Bypass (OPCAB). Patient observations were undertaken during hospitalization and six weeks after CABG. The examination was of prospective and observational character. The following end-points were considered:1. Cardiological complications:- death connected with cardiac diseases,- cardiogenic shock (low-output syndrome requiring the use of IABP),- pulmonary edema,- myocardial infarction.2. Other complications:- cerebral stroke,- renal insufficiency,- impaired postoperative wound healing following sternotomy or after saphenous veinConsidering statistical analysis, the following patient groups were distinguished: normal glucose metabolism (NGM), impaired glucose metabolism (IGM) or impaired fasting glucose (IFG), previously diagnosed or new diagnosis of diabetes mellitus (DM). The IGT and IFG groups were described as AGM-noDM (abnormal glucose metabolism- no diabetes mellitus).Results. The total number of postoperative complications, considering particular patient groups was as follows: in the NGM group, postoperative complications were noted in 3 (8.8%) patients (p<0.001) vs 9 (23.7%) in the AGM-noDM group (p<0.001) vs 21 (46.7%) in the DM group (p<0.001).The occurrence of particular complications was as follows: cardiogenic shock requiring intra-aortic balloon contrapulsation in 1 (2.9%) patient with NGM vs 1 (2.6%) with AGM-noDM vs 2 (4.4%) with DM. Acute renal insufficiency was observed in 1 (2.9%) patient with NGM vs 3 (7.9%) with AGM-noDM vs 6 (13.3%) with DM. Coronary by-pass graft impatency was noted in 0 patients with NGM vs 0 with AGM-noDM vs 3 (6.7%) patients with DM (p=0.085). Reoperation due to postoperative bleeding was required in 2 (5.9%) patients with NGM vs 4 (10.5%) with AGM-noDM vs 4 (8.9%) with DM. Postoperative cerebral stroke was observed in 0 patients with NGM vs 1 (2.6%) with AGM-noDM vs 2 (4.4%) with DM. Impaired sternotomy wound healing concerned 0 patients with NGM vs 2 (5.9%) with AGM-noDM vs 1 (2.2%) with DM. Impaired saphenous vein wound healing was observed in 0 patients with NGM vs 2 (5.3%) with AGM-noDM vs 23 (51.1%) with DM (p<0.001).Pulmonary edema was observed in 0 patients with NGM vs 1 (2.6%) with AGM-noDM vs 0 with DM. Death did not ocuured in cases of patients with NGM vs 1 (2.6%) with AGM-noDM vs 3 (6.7%) with DM.Conclusions. Postoperative complications occurred more frequently in patients with carbohydrate metabolism disturbances, especially diabetes mellitus, subjected to planned coronary artery bypass graft surgery.

10

Comparison of Outcome Between Older and Younger Patients Following Surgery for Primary Hyperparathyroidism

88%

Jannasch O., Voigt C., Reschke K., Lippert H., Mroczkowski P.

Polish Journal of Surgery

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2013

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vol. 85

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issue 10

598-604

EN

The aim of the study was to compare preoperative findings, serum levels of calcium and parathormone (PTH) and outcome of patients undergoing surgery for primary hyperparathyroidism (pHPT) aged over 70 years with younger patients. Material and methods. Between January 1, 1996 and September 30, 2011 186 patients underwent surgery for pHPT. Patient data were collected from chart reviews and an electronically stored database. Groups were defined as patients aged 70 years or older and patients younger than 70 years. Outcome comparison included operation time, tumor size, pre- and postoperative serum levels of calcium and PTH and length of stay in hospital. Complications were defined as clinical and laboratory signs of hypocalcemia, persistent elevated serum calcium, temporary or persistent recurrent laryngeal nerve paralysis, bleeding with need for reoperation, surgical site infection or need of tracheotomy. Results. Parathyroidectomy alone was performed in 39.2% of patients. In 60.8% partial or total thyroidectomy was conducted simultaneously. More older patients had history of stroke and/or suffered from diabetes. Preoperative serum calcium and PTH did not differ between groups, but older patients displayed higher postoperative serum calcium (p=0.01). No significant differences between the two groups were observed regarding duration of surgery, surgical success rates, postoperative complications and hospitalization time. Conclusions. Even though older patients had more risk factors, our data suggest that there was no difference in surgical management and outcome. Decision for surgical management of pHPT should be done regardless of age.

11

Analiza powikłań pooperacyjnych wymagających ponownego zabiegu w materiale Kliniki Ginekologii Onkologicznej Centrum Onkologii w Warszawie z lat 2009–2014

75%

Wyględowski J., Osuch B., Maździarz A., Śpiewankiewicz B.

Current Gynecologic Oncology

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2015

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vol. 13

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issue 3

147-153

EN

The paper presents the frequency of conducting relaparotomies and discusses indications for reoperations after primary gynecologic surgeries due to oncological diseases. Operations and reoperations were conducted in the Department of Gynecologic Oncology of Maria Skłodowska-Curie Institute of Oncology in Warsaw, Poland from 2009 to 2014. In total, 3,917 procedures due to reproductive organ neoplasms were conducted in the investigated period. The main indications were ovarian carcinoma, endometrial cancer and cervical cancer. Repeated urgent surgical interventions were needed in 116 patients, which constitutes 2.96% of all operated women. The frequency of repeated surgeries within the peritoneal cavity in gynecology, as reported in the literature, ranges from 1% to 4.7% and concerns primary indications resulting from non-malignant pathologies of the reproductive organs. The analysis involved early and urgent reoperations conducted within 48 hours after the primary procedure. Patients reoperated because of sudden progression of the diseases and those who underwent exploratory laparotomy within 60 days or who had a palliative surgery were excluded from the study. The main indication for a necessary urgent intervention was peritoneal bleeding. Other indications included: obstruction, peritonitis, bowel perforation, abdominal wall hematoma, intestinal anastomosis dehiscence and urinary complications. The mortality in the group of patients who required relaparotomy was 4.31%. An early diagnosis of complications requiring a repeated surgical intervention and implementation of appropriate management affect the outcome considerably and significantly decrease treatment-associated mortality.

PL

W pracy przedstawiono częstość relaparotomii i wskazania do jej przeprowadzenia po pierwotnych operacjach ginekologicznych ze wskazań onkologicznych. Operacje i reoperacje wykonano w latach 2009–2014 w Klinice Ginekologii Onkologicznej Centrum Onkologii – Instytutu im Marii Skłodowskiej-Curie. W analizowanym okresie przeprowadzono 3917 operacji z powodu nowotworów narządu rodnego. Głównymi wskazaniami do leczenia chirurgicznego były nowotwory jajnika, trzonu macicy i szyjki macicy. Ponownych nagłych interwencji chirurgicznych wymagało 116 chorych leczonych operacyjnie, co stanowi 2,96% ogólnej liczby operowanych pacjentek. Przedstawiana w literaturze częstość ponownych interwencji w jamie otrzewnowej w ginekologii waha się od 1% do 4,7% i dotyczy pierwotnych wskazań do leczenia wynikających z niezłośliwych patologii narządu rodnego. Analizie poddano wczesne, nagłe reoperacje – przeprowadzone w ciągu 48 godzin od pierwotnego zabiegu. Z badania wyłączono pacjentki, które wymagały reoperacji związanej z gwałtowną progresją choroby, mające w czasie 60 dni laparotomię zwiadowczą czy operację paliatywną. Głównym wskazaniem wymagającym pilnej interwencji było krwawienie do jamy otrzewnowej. Inne wskazania to niedrożność, zapalenie otrzewnej, perforacja jelita, krwiak powłok, rozejście się zespolenia jelitowego i powikłania urologiczne. Śmiertelność w grupie pacjentek wymagających relaparotomii wyniosła w naszym materiale 4,31%. Wczesne rozpoznanie powikłań wymagających ponownego leczenia operacyjnego i wdrożenie właściwego postępowania mają istotny wpływ na ostateczne wyniki oraz znacznie zmniejszają śmiertelność związaną z zabiegiem chirurgicznym.

12

Limfadenektomia miednicza i okołoaortalna w przypadku raka endometrium

63%

Opławski M., Kojs Z., Smoczyńska M.

Current Gynecologic Oncology

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2013

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vol. 11

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issue 2

151-158

EN

Treatment of endometrial cancer includes surgery, radiotherapy, chemotherapy, and hormonal therapy. Since early 1990s, a matter of much controversy remains the scope of surgery, particularly in the context of excision of lymph nodes. Currently valid surgical classification of clinical stages entails the need to assess the presence of metastases to pelvic and periaortic nodes (FIGO 2009). Technique of mapping sentinel nodes in endometrial cancer is currently being developed and is inherently complicated due to several routes of lymphatic drainage from the uterus. Excision of lymph nodes should be a part of routine surgical staging, as apart from diagnostic-prognostic value, it is of paramount significance for clinical decision-making process. Planning of adjuvant therapy without such an assessment is imprecise. Intraoperative evaluation of extent of the neoplastic process is much more precise than assessment based on imaging studies or clinical criteria of staging, promoted by some centers. An increasing number of centers consider lymphadenectomy as an indispensable component of endometrial cancer management – according to present-day standards, reliable staging of endometrial cancer requires excision and study of lymph nodes. More extensive procedure is not associated with significant increase of complication rate, while reduces number of patients requiring radiotherapy, affecting favorably the patients’ quality of life. Patients undergoing pelvic and periaortic lymphadenectomy benefit from a longer recurrence-free survival and overall survival. Most frequent complication of these procedures is intraoperative bleeding, thromboembolic events and lymphocele. Favorable effects of a more extensive procedure are seen mainly in centers specialized in gynecologic oncology, where median number of excised pelvic and periaortic lymph nodes is significantly higher.

PL

W leczeniu raka błony śluzowej macicy stosuje się leczenie chirurgiczne, radioterapię, chemioterapię, hormonoterapię. Od początku lat dziewięćdziesiątych XX wieku kontrowersje wzbudza rozległość operacji, szczególnie w zakresie usuwania węzłów chłonnych. Obecnie obowiązująca chirurgiczna klasyfikacja stopnia zaawansowania tego nowotworu wskazuje na konieczność oceny występowania przerzutów do węzłów chłonnych miednicy oraz węzłów okołoaortalnych (FIGO 2009). Technika oznaczenia węzła wartownika w raku endometrium jest na etapie opracowywania i jest utrudniona z powodu kilku dróg spływu chłonki z macicy. Usuwanie węzłów chłonnych powinno być elementem chirurgicznej oceny zaawansowania tego nowotworu, gdyż poza wartością diagnostyczno-rokowniczą ma także znaczenie decyzyjne. Zaplanowanie terapii uzupełniającej bez takiej oceny jest nieprecyzyjne. Operacyjna ocena rozległości procesu nowotworowego cechuje się znacznie większą dokładnością niż ocena za pomocą badań obrazowych oraz kryteriów klinicznych zaawansowania tego nowotworu, promowanych przez część ośrodków. Zwiększa się liczba placówek uznających usuwanie węzłów chłonnych za niezbędny element leczenia operacyjnego raka endometrium – przy obecnym poziomie wiedzy prawidłowa ocena stopnia zaawansowania raka endometrium wymaga usuwania węzłów chłonnych. Poszerzenie zabiegu nie zwiększa znacznie liczby powikłań, za to zmniejsza częstość stosowania radioterapii, co korzystnie wpływa na jakość życia chorych. W przypadkach, w których usunięto węzły chłonne miednicy mniejszej wraz z węzłami okołoaortalnymi, stwierdzono dłuższy czas wolny od wznowy oraz dłuższe przeżycie. Najczęstsze powikłania takich zabiegów to krwawienie śródoperacyjne, incydenty zakrzepowo-zatorowe, występowanie lymphocele. Korzystne wyniki poszerzenia zabiegu są obserwowane głównie w wyspecjalizowanych ośrodkach ginekologii onkologicznej, w których mediana liczby usuniętych węzłów chłonnych miednicy oraz okołoaortalnych jest zdecydowanie większa.

13

The influence of patient-related constutional and environmental factors on early results of a combined modality therapy of esophageal cancer

63%

Pudło K., Błotniak A., Skoczylas T., Dąbrowski A., Szawłowski A., Kozłowski M., Lampe P., Wallner G.

Polish Journal of Surgery

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2016

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vol. 88(5)

448-463

EN

Among many various factors affecting the outcome of cancer treatment one can distinguish patient, tumor- and treatment-related factors. The association of patient-related factors and results of a combined modality therapy of esophageal cancer has not been extensively explored. The aim of the study was to analyze the impact of patient-related constitutional and environmental factors on early results of combined modality therapy of esophageal squamous cell carcinoma. Material and methods. We retrospectively analyzed prospectively collected data of 84 patients with esophageal cancer randomly assigned to a combined modality treatment. We evaluated the relationship between early outcome of neoadjuvant therapy (overall toxic events, serious toxic events, treatmentrelated mortality, clinical and pathological response to the treatment) or surgical treatment (postoperative morbidity, mortality and curative resections – R0) and constitutional (age, gender, height, body mass index, Karnofski Performance Status – KPS, blood type) or environmental (inhabitation, smoking duration and intensity, frequency and amount of alcohol consumption and occupational exposure) patient-related factors. Results. Significantly more neoadjuvant therapy related deaths were found in patients with KPS 70‑80 (p=0.0016). Interestingly, significantly more toxic events (p=0.0034) after neoadjuvant therapy and a higher postoperative morbidity rate (p=0.0293) were observed in nonsmokers. Similarly, significantly more toxic events (p=0.0029) after neoadjuvant therapy and a higher postoperative mortality rate (p=0.0405) were found in light drinkers. Conclusions. Smoking and consumption of excessive amount of alcohol may attenuate toxic effect of neoadiuvant and surgical therapy in patients treated due to esophageal cancer. The information regarding the mentioned above addictions should not result in giving up an attempt to provide a curative treatmen

14

Ocena ultrasonograficzna wybranych patologii nerwów obwodowych. Część III: Urazy i ocena pooperacyjna

51%

Kowalska B., Sudoł-Szopińska I.

Journal of Ultrasonography

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2013

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vol. 13

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issue 52

82-92

EN

The previous articles of the series devoted to ultrasound diagnostics of peripheral nerves concerned the most common nerve pathologies, i.e. entrapment neuropathies. The aim of the last part of the series is to present ultrasound possibilities in the postoperative control of the peripheral nerves as well as in the diagnostics of the second most common neuropathies of peripheral nerves, i.e. posttraumatic lesions. Early diagnostics of posttraumatic changes is of fundamental importance for the course of treatment and its long-term effects. It aids surgeons in making treatment decisions (whether surgical or conservative). When surgical treatment is necessary, the surgeon, based on US findings, is able to plan a given type of operative method. In certain cases, may even abandon the corrective or reconstructive surgery of the nerve trunk (when there are extensive defects of the nerve trunks) and instead, proceed with muscle transfers. Medical literature proposes a range of divisions of the kinds of peripheral nerve injuries depending on, among others, the mechanism or degree of damage. However, the most important issue in the surgeon-diagnostician communication is a detailed description of stumps of the nerve trunks, their distance and location. In the postoperative period, ultrasound is used for monitoring the operative or conservative treatment effects including the determination of the causes of a persistent or recurrent neuropathy. It facilitates decision-making concerning a repeated surgical procedure or assuming a wait-and-see attitude. It is a difficult task for a diagnostician and it requires experience, close cooperation with a clinician and knowledge concerning surgical techniques. Apart from a static assessment, a dynamic assessment of possible adhesions constitutes a crucial element of postoperative examination. This feature distinguishes ultrasound scanning from other methods used in the diagnostics of peripheral neuropathies.

PL

W poprzednich dwóch artykułach z serii poświęconej diagnostyce ultrasonograficznej nerwów obwodowych zostały przedstawione najczęstsze patologie, jakimi są neuropatie uciskowe. Celem kończącej cykl III części jest przedstawienie możliwości ultrasonografii w ocenie drugich co do częstości neuropatii obwodowych, tj. zmian pourazowych, oraz w kontroli pooperacyjnej nerwów obwodowych. Wczesna diagnostyka zmian pourazowych ma fundamentalne znaczenie dla przebiegu leczenia oraz jego odległych wyników. Ułatwia chirurgowi podjęcie decyzji o rodzaju postępowania (operacyjnym bądź zachowawczym). W przypadku konieczności leczenia operacyjnego chirurg w oparciu o wynik badania ultrasonograficznego może zaplanować rodzaj metody operacyjnej. W niektórych sytuacjach może nawet odstąpić od zabiegu naprawczego czy rekonstrukcyjnego (przy rozległych ubytkach pni nerwowych) na rzecz transferów mięśniowych. Literatura medyczna proponuje szereg podziałów uszkodzeń nerwów obwodowych, między innymi w zależności od mechanizmu czy stopnia uszkodzenia. Najważniejszy w komunikacji pomiędzy chirurgiem a diagnostą jest jednak szczegółowy opis obrazu kikutów pni nerwowych, ich odległości oraz miejsca położenia. W okresie pooperacyjnym diagnostyka ultrasonograficzna jest wykorzystywana w celu monitorowania efektów leczenia operacyjnego bądź zachowawczego, w tym do określenia przyczyn utrzymującej się bądź nawrotowej neuropatii. Pozwala na podjęcie decyzji o ponownym zabiegu operacyjnym lub przyjęciu postawy wyczekującej. Jest to dla diagnosty trudne zadanie, wymagające doświadczenia, ścisłej współpracy z klinicystą oraz znajomości technik operacyjnych. W ocenie pooperacyjnej bardzo ważny element badania, poza oceną statyczną, stanowi ocena dynamiczna pod kątem ewentualnych zrostów; jest to cecha wyróżniająca badanie ultrasonograficzne spośród innych metod diagnostyki neuropatii obwodowych.

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