Assessment of Operative Risk in Colorectal Oncologic Surgery

The objective of the present study is to elaborate a prognostic index for qualitative assessment of the operative risk in the surgical treatment of colorectal cancer (CRC).The documentation of 150 CRC patients, 91 males and 59 females, operated on in the Clinic of Surgery, Marko A. Markov Specialized Hospital of Oncological Diseases of Varna during the period from June 2008 till April 2009 was analyzed. Mean patients` age was 64,2 years (range, 34-84 years).Seventy patients presented with colon cancer, 76 - with rectum cancer while 4 patients presented with multiple tumour localizations. The risk factors included the following: patient`s age and gender; ASA stage; CRC localization according to ICD of WHO; surgical procedure according to OPCS4 system; emergency; CRC stage according to TNM classification; resection type, and hematocrit level. There were 55 patients with TNM stage I, 80 patients with TNM stages II-III, and 15 patients with TNM stage IV. The most common interventions were anterior resection (in 48 patients), right hemicolectomy (in 41 patients), and sigmoidectomy (in 23 patients). Thirty-day operative lethality rate was zero.The created data-base can successfully be used for the purposes of CRC prognostication with the patients forwarded to operative treatment

Prognostic significance of Epidermal Growth factor receptor in colon cancer patients on surgical treatment

Recently, pathological expression of epidermal growth factor receptor (EGFR) is increasingly used in the diagnosis of various epidermal tumours. The aim of this study is to analyze the role of EGFR in comparison to p53 as a prognostic marker in patients with colon cancer who undergo surgical treatment.Two types of immunohistochemical examinations (for EGFR and p53) have been performed in 120 patients with colon cancer histologically verified by using of hematoxylin-eosin staining.Our results clearly demonstrate that EGFR expression is present in 18 patients (in 15% of the cases). It occurs much more often in the patient with TNM stage II and especially in those with TNM stage III and relatively more frequently in the patients aged between 51 and 70 years and presenting with a moderately differentiated tumour. Besides, this expression immediately relates to a recurrence of the disease and worsened clinical course. There exists a correlation between the enhanced expression of EGFR and that of p53. Because of the small sample, our results are not statistically significant.EGFR can serve as an independent prognostic factor and indicator of more common recurrences of the disease, worse quality of life and poorer prognosis in colon cancer patients. Further intensive collaboration between coloproctologists and pathologists is needed to improve the individualized surgical behaviour in such patients

PANCREATOGASTROSTOMY WITH ONE CONTINUOUS SEROMUSCULAR CIRCULAR SUTURE

Objective One of the most feared complications after pancreaticoduodenectomy (PD) remains postoperative pancreatic fistula (POPF). In the current study, we demonstrate a new technique for pancreaticogastrostomy (PG), using one continuous seromuscular circular suture without trans pancreas sutures for PG. Material and Methods During the period December 2012 to December 2014, 32 consecutive patients underwent PD (either pylorus-preserving or classical Whipple’s) carried out using the above suture-less PG. Indication for PD was pancreatic duct carcinoma. Procedures were carried out by the same surgeon, same approach and anastomotic method in order to avoid technical changes. Results Postoperative mortality was zero and morbidity was 21.8% (n=7). Pancreatic leakage (Grade A/B) occurred in 2 (6.2%) patients. These pancreatic leaks were managed nonoperative by maintaining the closed drains. The most common postoperative complication delayed gastric emptying (Grade B/C) in 3 (9.3%) patients. Conclusion We conclude that the suture-less PG possesses several advantages over conventional PG and pancreaticojejunostomy (PJ). This technic seems to lessen the risk of a pancreatic leak, probably by diminishing the possibility of suture damage to the pancreas and by embedding the transected stump into the posterior gastric wall. This novel PG is a valid and valuable procedure, especially for soft, nonfibrotic pancreas

50 години Катедра „Социална медицина и организация на здравеопазването`

22 Май 201