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Multiple colon perforation as a fatal complication during treatment of metastatic melanoma with ipilimumab – case report

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Dilling P., Walczak J., Pikiel P., Kruszewski W. J.
Polish Journal of Surgery
|
2015
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vol. 86
|
issue 2
94-96
EN
Ipilimumab, an anticancer drug, is an anti-CTLA4 monoclonal antibody. It is used in treatment of disseminated melanoma. Therapy is associated with high risk of complications. One of the most serious, although one of the rarest is perforation of gastrointestinal tract. In this case report we describe a 52-year old male, with disseminated melanoma with unknown starting point, treated with anti- CTLA4 monoclonal antibody. After 3rd dose of drug administration, bloody diarrhea and acute abdominal pain occurred as a symptom of gastrointestinal perforation. A single perforation was sutured during laparotomy. Symptoms of acute abdomen returned after 10 days. Pus-faecalperitonitis, symptoms of necro-hemorrhagic colitis and multilocal perforation of the colon were found during relaparotomy. Pancolectomy with end ileostomy was performed. Few hours since relaparotomy pacient died due to multiple organ failure. The purpose of this case report is to draw attention to a risk of multilocal colon perforation in patient treated with ipilumumab.
2
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Is Age a Risk Factor of Postoperative Complications in Colorectal Cancer?

76%
Wydra J., Kruszewski W., Jasiński W., Szajewski M., Ciesielski M., Szefel J., Walczak J.
Polish Journal of Surgery
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2013
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vol. 85
|
issue 9
491-495
EN
Colorectal cancer is the most common malignant neoplasm in elderly with peak of incidence in 7. and 8. decade of life. Elderly patients with colorectal cancer more often require surgery. Advanced age of patients seems to increase the risk of postoperative complications. The aim of the study was to compare the frequency of early complications in two groups of patients: under 75 and over 75, undergoing elective colorectal cancer surgery. Material and methods. 440 consecutive adult patients subjected to colorectal cancer surgery between 08.2006 to 10.2011 in Oncological Surgery Department, Gdynia Centre of Oncology. Group A (over 75 year-of-life): 109 patients, median 79 and group B (up to 75 year-of-life): 331 patients, median 65. Patients requiring emergency surgery were excluded from the study. Postoperative 30-day mortality, anastomotic leakage, wound infection, bowel obstruction, postoperative respiratory and circulatory insufficiency were among analyzed complications. Results. Symptomatic disease was observed in 81.6% of group A and in 83% of group B. Groups A and B were comparable concerning: BMI, gender, tumor staging, rate of curative and palliative resections, and duration of hospital stay. Accompanying diseases were more common in group A (83% vs 65%; p<0.0002). Early complications occurred in 21.1% of patients from group A and in 19.9% from group B. The rate of reoperation in early perioperative period didn’t differ (6.4% vs 5.7%). Features like: age, gender, additional illnesses, tumor location and staging did not influence the occurrence of perioperative complications. Conclusions. Age itself is not a risk factor for postoperative complications in spite of higher rate of accompanying diseases in elderly.
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The Value of Intraoperative Liver Ultrasound Assessment Using an Intraabdominal Probe During Laparotomy Performed for Oncological Reasons

76%
Kruszewski W. J., Walczak J., Szajewski M., Buczek T., Ciesielski M., Szefel J.
Polish Journal of Surgery
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2013
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vol. 85
|
issue 2
78-82
EN
The quality of liver assessment in an oncological patient plays an important role in the selection of a proper type of medical intervention. Diagnostic techniques commonly used in liver imaging are still far from perfect. Intraoperative liver evaluation using an intraabdominal ultrasound probe remains an important tool for proper assessment of this organ. The aim of the study was to evaluate suitability of this intraoperative diagnostic method for detection of primary and secondary neoplastic pathologies of the liver. Material and methods. Between March 2010 and the end of December 2011, we performed intraoperative ultrasound examinations of the liver during 220 of 461 laparotomies carried out for oncological reasons. Results. In 72 patients (33%), intraoperative ultrasonography using an intraabdominal probe revealed neoplastic pathologies in the liver. In 16 patients (7%), the pathologies had not been observed in the preoperative imaging examinations. In 7 cases (3%), the detected tumors were impalpable and invisible in macroscopic examination routinely performed during laparotomy. The time of performing preoperative liver examinations did not affect the detection of previously unrecognized liver tumors (p > 0.05). We found progression in the number of liver tumors in 28 patients (39%). In 20 patients (9%), the primary surgical plans were changed intraoperatively. Conclusions. Liver examination using an intraabdominal ultrasound probe is a useful tool for assessment of neoplastic disease progression. The procedure allows proper choice of an optimal treatment regime and decreases the risk of performing an unnecessary oncological invasive procedure.
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