Izloženost operacijskog osoblja udisanju ugljičnog monoksida tijekom peritonektomije [Operating theater staff exposure to carbon monoxide during peritonectomy procedure]

In the operating room surgical staff is exposed to inhalation of smoke from the combustion of tissues when using electrocautery. By introducing peritonectomy in the treatment of malignant neoplasms of the peritoneum exposure to smoke is significantly increased. The procedure consists of removing macroscopic tumor masses combined with hyperthermic intraperitoneal chemotherapy. To adequately perform this procedure, high power monopolar cautery is used. The aim of this study was to measure the amount of inhaled carbon monoxide, as the harmful substance found in the smoke liberated during peritonectomy procedures, compared to standard colorectal resections. A total of 360 blood samples from surgeons doing procedures were analysed, divided into two groups. Group A contained blood samples collected during peritonectomy procedures using electrocautery. Group B contained blood samples collected during standard colorectal resections. Samples from total of 30 procedures, 15 in each group, each participated by three surgeons, were collected. Samples were collected at the start of the intervention, in 20th and 40th minutes, and at the end of procedures. Carboxyhemoglobin values of all participants were higher in peritonectomy group. Increase in methemoglobin levels was not statistically significant between two groups. Increase in the value of carboxyhemoglobin with time was measured in control group, but those values did not lead to symptoms of acute poisoning by carbon-monoxide. Results suggest a need to prevent chronic surgical staff CO poisoning by use of personal protective equipment and devices for the evacuation of smoke in each procedure, especially in peritonectomy procedures due to increased production of smoke particles

Tumor retroperitoneuma: pričaj mi o živcima Retroperitonealni femoralni schwannom sa jatrogenom postoperacijskom femoralnom neuropatijom: prikaz slučaja

Retroperitoneal femoral schwannomas constitute a rather small percentage of primary retroperitoneal tumors. Proper preoperative diagnosis is often difficult since imaging studies are nonspecific and differential diagnosis quite extensive. We present the case of a 71-year-old patient with a radiologically described retroperitoneal mass - postoperatively confirmed by pathohistology as a benign schwannoma. The tumor was removed in toto; however, the postoperative course was complicated with symptoms of femoral nerve damage. Although benign in nature (and exceedingly rare to turn malignant) schwannomas are treated surgically as the rate of complete resection without nerve damage is high. Left untreated they gain in mass and can cause significant pain due to displacement of the involved nerve. The significance of this case report is in highlighting the importance of considering schwannomas as a differential diagnosis of retroperitoneal tumors which in turn will lead to a strong strategy for avoiding postoperative complications.Retroperitonealni schwannomi femoralnog živca predstavljaju mali udio primarnih tumora retroperitoneuma. Uzimajući u obzir kako je radiološka dijagnostika u ovom slučaju nespecifična, a diferencijalna dijagnoza primarnih retroperitonealnih tumora široka, ispravnu preoperacijsku dijagnozu ponekad je teško postići. U ovom radu prikazat ćemo slučaj 71-godišnjeg pacijenta sa radiološki opisanim tumorom retroperitoneuma koji je nakon kirurške ekstirpacije patohistološki definiran kao schwannom. Tumor je odstranjen u cijelosti, međutim postoperacijski tijek kompliciran je simptomima jatrogenog oštećenja femoralnog živca. Iako su schwannomi uglavnom dobroćudni tumori uz rijetke slučajeve maligne alteracije, njihovo liječenje prvenstveno je kirurško. Postotak cjelovite resekcije bez oštećenja živca je visok. Neliječeni schwanomi dobivaju na masi te uzrokuju bol pomicanjem i pritiskanjem okolnih struktura. Važnost ovog prikaza leži u naglašavanju femoralnog schwannoma kao diferencijalno-dijagnostičke mogućnosti u razmatranju retroperitonealnih tumora. Na taj način može se stvoriti uspješna strategija sprječavanja postoperacijskih komplikacija

Recurrent retroperitoneal dedifferentiated liposarcoma

Liposarcomas (LPS) are malignant tumors deriving from the adipocytic differentiation process. They are divided into four subtypes of LPS – well-dif ferentiated (WDLPS), dedifferentiated (DDLPS), myxoid (MLPS), and pleomorphic (PLPS). Regarding histological subtype and molecular pathology, tumors have different recurrence rates, radiosensitivity, and chemosensitivity, representing a challenge to every physician involved in their treatment decision. DDLPS commonly appears as a focal outgrowth of a WDLPS lesion

Immunohistochemical expression of 8-oxo-7,8-dihydro-2′-deoxyguanosine in cytoplasm of tumour and adjacent normal mucosa cells in patients with colorectal cancer

BACKGROUND: The aim of this research was to study the levels of 8-oxo-7,8-dihydro-2'-deoxyguanosine (8-oxodG) in tumour tissue samples of colorectal carcinoma based upon immunohistochemical detection and compare those results with patients' outcome. ----- METHODS: Tumour blocks of patients surgically treated for colorectal cancer were evaluated by 8-oxodG immunohistochemical staining. The expression was analysed in 500 tumour cells. The percentage of positive cells, as well as staining intensity, was recorded, and Allred score was calculated. For each patient, data of age, gender, tumour size and location, margin status, histologic grade, tumour stage, lymph node status, vascular invasion, overall survival, and therapy protocols were collected. Tumour grade was divided into two groups as low and high grade. ----- RESULTS: In this study, 146 consecutive patients with primary colorectal carcinoma were included. All data were available for 138 patients, and they were included in this research. There were 83 male and 55 female patients; the median age was 64 years (range 35-87 years). The results showed shorter 5- and 10-year survival in patients with 8-oxodG positive tumour cells (5-year survival, n=138, Mantel-Cox, chi-square 4.116, degree of freedom (df)=1, p<0.05; 10-year survival, n=134, Mantel-Cox, chi-square 4.374, df=1, p<0.05). The results showed a positive correlation between Allred score and high tumour grade (two-tailed Spearman's ρ 0.184; p<0.05), as well as with non-polypoid tumour growth (two-tailed Spearman's ρ 0.198; p<0.05). There was no significant difference of 8-oxodG expression related to age, sex, blood group, size and tumour site, distance from the edge of the resected tumour margin, lymph nodes involvement, and vascular invasion. ----- CONCLUSIONS: In this study, the positive correlation between 8-oxodG presence in the tumour cells, worse clinical outcome, higher tumour grade, and flat morphology was found

COVID-19 i kolorektalni karcinom – toksične poveznice i kako ih prekinuti: KBC Zagreb, iskustvo tercijarnog centra

Colorectal cancer (CRC) is one of the most prevalent oncological diseases globally, taking 3rd place in incidence in the general population. High in mortality, it is also a form of cancer whose outcome is highly dependable on its stage at diagnosis. Therefore, many countries have adopted a more or less successful screening process to ensure early diagnosis and, in turn, higher survival rates and better results overall. The COVID-19 pandemic has altered the established medical routines worldwide, with massively postponing diagnostic procedures and elective surgeries. This study aims to measure the effect the pandemic has had on colorectal cancer treatment in our Institution. Variables such as deferral time from diagnosis to commencement of treatment, lapse of time between different phases of the treatment process, time of presentation (elective versus emergent surgery), the physical status of the patient at the time of surgery (ASA classification) and metastatic index (positive lymph node ratio), were taken into account. We juxtaposed data from patients treated at the Surgical Department of Clinical Hospital Center in Zagreb in 2019 and 2020, the latter being heavily affected by the pandemic. In 2019 and 2020, 347 and 314 patients, respectively, with C18-C20 diagnoses (International Statistical Classification of Diseases and Related Health Problems ICD-10), have been treated at our Hospital. With exclusion criteria applied, the patient count falls to 173 for 2019 and 157 for 2020. These numbers include operated cases with or without an anastomosis formation and with or without neoadjuvant chemotherapy applied. From the analysis we excluded patients with recurrent colorectal tumors, synchronous and metachronous tumors, and patients treated palliatively. Furthermore, colorectal adenomas were also excluded from the study. Our data shows significant difference between observed variables in the two patient groups, attributed to the COVID-19 pandemic. Since there is still no reliable way to predict the duration of this global health crisis, it is imperative to implement strategies to lessen the damaging effect the pandemic has had on favourable oncosurgical treatment outcomes in colorectal cancer patients.Kolorektalni karcinom jedna je od najčešćih onkoloških bolesti u svijetu. Uz visoki mortalitet obilježena je i ovisnošću ishoda liječenja o stadiju bolesti u trenutku dijagnoze. Mnoge su države stoga usvojile više ili manje uspješne programe probira kako bi osigurale ranu dijagnozu, bolje stope preživljenja te generalno optimalnije ishode liječenja. Pandemija COVID-19 u kratkom je roku promijenila temelje medicinske svakodnevice uz nemale odgode dijagnostičkih procedura i elektivnih zahvata. Cilj ovog rada jest procijeniti utjecaj koji je pandemija imala na liječenje kolorektalnog karcinoma u našoj ustanovi. Uspoređivana su dva jednogodišnja razdoblja – 2019. i 2020. od kojih je potonja godina bila značajno pogođena COVID 19 pandemijom. Uspoređivali smo podatke pacijenta liječenih na Zavodu za kirurgiju Kliničkog bolničkog Centra Zagreb, vođenih pod MKB dijagnozama C18-C20. U 2019. godini na našem je Zavodu liječeno 347 pacijena s kolorektalnim karcinom, po primjeni kriterija isključenja ta brojka pada na 173. Bolesnika s operiranim karcinomom koloektuma u 2020. godini u našoj je ustanovi bilo 314, po primjeni kriterija isključenja 157. Praćeni parametri uključivali su vremensku odgodu od incijalne dijagnoze do početka liječenja, vrijeme proteklo između različitih etapa onko kirurškog liječenja, odnos elektivnih i hitnih zahvata, fizičku spremnost pacijenata u vrijeme operacije (ASA klasifikacija) te metastatski index (udio pozitivnih metastatskih limfnih čvorova u dobivenim preparatima). U studiju su uključeni bolesnici neovisno o primjeni neoadjuvantne kemoterapije te neovisno je li intraoepracijski uspostavljen kontinuitet probavne cijevi. Recidivni tumori, metakroni i sinkroni tumori, palijativno liječeni pacijenti, reoperirani te pacijenti operirani uslijed kolorektalnog adenoma nisu uključeni u ovu studiju. Naši podaci pokazuju značajne razlike među praćenim parametrima u dva razdoblja te se iste uvelike pripisuju utjecaju COVID-19 pandemije. Kako su budućnost i trajanje ove medicinske krize još uvijek neizvjesni, potrebno je što prije usvojiti strategije kojima bi se smanjio razorni utjecaj pandemije na ishode liječenja bolesnika sa kolorektalnim karcinomom

Hyperthermic Intraperitoneal Chemotherapy (HIPEC) and Cytoreductive Surgery (CS) as Treatment of Peritoneal Carcinomatosis: Preliminary Results in Croatia

The purpose of our study was to evaluate initial results following introduction of Hyperthermic Intraperitoneal Chemotherapy (HIPEC) and Cytoreductive Surgery (CS). Twenty two patients with intraperitoneal malignancy undergone cytoreductive surgery (CS) and hyperthermic intraoperative chemotherapy (HIPEC) between January of 2007 and January 2010. Nine patients had adenocarcinoma of colorectal origin, 8 patients had ovarian cancer, and 5 had pseudomyxoma peritonei. Inclusion criteria were diagnosis of peritoneal carcinomatosis based on intraoperative assessment during first operative procedure for intraabdominal malignancy or follow-up diagnostic imaging proof. Excluded were patients with known malignant proliferation outside abdomen, liver metastasis and ASA score 4 and higher. All patients with pseudomyxoma peritonei diagnosis are alive, with mean follow-up time 24.8 months (range 15–35). In group of patients with adenocarcinoma from colorectal origin, 3 died, resulting in mean survival time 7.6 months (range 1–16). In group of patients with ovarian cancer, 2 died, resulting in mean survival time 13.8 months (range 0–31). Two patients died in early postoperative period. Most of the patients had some sort of mental disorder. Although HIPEC with CS improves survival, during introduction period higher morbidity and mortality could be expected

Radiofrequency ablation as locoregional therapy for unresectable hepatic malignancies: initial results in 24 patients with 5-years follow-up

Radiofrequency ablation (RFA) is one treatment modality for unresectable liver metastases. Patients with hepatic malignancies (n = 24) underwent elective RFA. All tumors were ablated with a curative intent, with a margin of 1 cm, in a single session of RFA. The median diameter of tumor was 3.1 cm (range 1.7-6.9 cm). Studied patients were not candidates for resection due to multifocal hepatic disease, extrahepatic disease, proximity to major vascular structures or presence of cirrhosis with functional hepatic reserve inadequate to tolerate major hepatic resection. Complete tumor necrosis was achieved in 87.5% and tumor recurred in 3 patients (12.5%) with lesions larger than 5 cm. Distant intrahepatic recurrence was diagnosed in another 4 (16.7%). Distant metastases were found in 7 (29.2%) patients. Four of these 7 patients had also distant intrahepatic recurrence of disease. Two and 5-years survival rates were 41.7% (10 patients) and 8.3% (2 patients) respectively. RFA is safe and effective option for patients with unresectable hepatic malignancies smaller than 5 cm without distant metastatic disease. RF ablation resulted in complete tumor necrosis in 87.5% with 2 and 5-years survival rates much higher than with chemotherapy alone or only supportive therapy, when survival is measured in weeks or months. If RFA is unavailable, percutaneous ethanol injection therapy can be done but with inferior survival rates