Colorectal carcinoma still a challenge for the surgeons in 2016

Locally recurrent CRC is a disease presenting an exceptional challenge to the surgeon. At the time of the diagnosis local recurrences are often accompanied by complications and engage adjacent organs and anatomical structures. Local recurrences are often associated with systemic ones. Attempts to achieve surgical radicalism performing multivisceral resections in the surgical field of post-operative adhesions, adjuvant RT with neoangiogenesis and dissecting changed plans is often challenging. The presence of residual tumor formation, or transmural lymphatic metastases after primary resection regarding colorectal cancer are the most common cause of local recurrence. As a rule, local recurrences of colorectal cancer are locally advanced - with macroscopic evidence of involvement of adjacent anatomical structures and organs. Usually therapy in these patients is multimodal, requires good communication with the surgeon, the medical oncologist and the radiotherapists, as well as interdisciplinary surgical skills

Surgical treatment of patients with chronic constipation - experience of Clinic of Coloproctology - Varna

BACKGROUND: Patients with chronic constipation can be difficult to manage either medically or surgically. We used Roma classification as criteria for including patients in our study. There are many diseases which could lead to chronic constipation. If they are treated by a surgeon, there can be obtained a permanent therapeutic effect. The group of patients with idiopathic chronic constipation couldn't obtain satisfying effect by surgical treatment, which was presided by inaccurate and embarrassed selection. Our aim is to present the results of experience of Clinic of General and Operative Surgery, Varna, Bulgaria.MATERIAL: For a period of 10 years, we have been operated 52 patients with diagnosis as morbus Pair (15 patients), megacolon (31 patients), and idiopathic chronic constipation (6 patients). The main indication for undergoing surgical treatment was the retention of more then 20% of the applied barium enema after the 5th day from irrigography. There were applied the followed operative methods: colectomy, subtotal colectomy, hemicolectomy, resection of the colon sygmoideum, anterior resection of the rectum and mobilization of the lineal flexure. We did analysis of the results. The evaluation of curativeness to applied methods was done. We followed the quality of life of our patients from 11 months to 6.2 years (median 3.2 years).CONCLUSION: The presence of organic disease is associated with very good therapeutic effect from the surgical treatment of chronic constipation. The problem with idiopathic chronic constipation remains unsolved when colectomy with ileo-recto anastomosis was undergone. The right selection of patients is a crucial factor for the success of the surgical treatment

Peritoneal metastases in colorectal cancer

Peritoneal carcinomatosis (PC) is a common evolution of cancer of the gastrointestinal tract, and has been traditionally regarded as a terminal disease with short median survival. During the last 20 years, due to its favourable oncologic results, a new loco-regional therapeutic approach, combining cytoreductive surgery with intra-operative intraperitoneal chemotherapy has achieved an important development. After liver metastatic disease, peritoneal carcinomatosis is the second most frequent cause of death in colorectal cancer patient is defined as a stage IV tumour which prognosis is the worst. The extent of peritoneal carcinomatosis is, however, difficult for assessment preoperatively, and precise evaluation is most often performed during surgical exploration. Cytoreductive surgery associated with chemotherapy for the treatment of peritoneal carcinomatosis should be performed in young patients with limited and resectable carcinomatosis, in specialized institutions involved in the management of peritoneal surface malignancies

Local excision for early rectal cancer - is it proper surgical decision?

Sphincter preservation, disease control, and long-term survival are the main goals in the treatment of rectal cancer. Although transanal local excision is attractive because it is a sphincter spar ing procedure, some contradictory data exist in the literature about its ability to locally control disease and provide over all survival comparable with radical procedures, even for patients with early stage tumor. In patients with early rectal cancer (T1), local excision may be an alternative approach in highly selected patients. For more advanced rectal cancer, radical surgical resection is the treatment of choice.METHODS: We reviewed the literature to identify the current recurrence and survival rates of both techniques as well as the salvage surgery success, only 1 study was prospective, 5 were comparative, and 5 were case reports. We present a case report of a woman with local excision of rectal tumor. Five years later a rectal recurrence has showed up. We describe the case and make some conclusions.Scripta Scientifica Medica 2009; 41(2): 169-171

Benchmarking of COBAYA3 pin-by-pin for VVER

This paper presents results of the benchmarking of COBAYA3 pin-by-pin for VVER-1000 obtained in the frame of the EU NURISP project. The 3D lattice solver in COBAYA3 uses transport corrected multi-group diffusion approximation with side-dependent interface discontinuity factors of GET or Selengut Black Box type. The objective of this study is to test the few-group calculation scheme when using structur ed and unstructured spatial meshes. Unstructured mesh is necessary to model the water gaps between the hexagonal assemblies. The benchmark problems include pin-by-pin calculations of 2D subsets of the core and comparison with APOLLO2 and TR IPOLI4 transport reference solutions. COBAYA3 solutions in 2, 4 and 8 energy groups have been tested. The results show excellent agreement with the reference on es when using side-dependent interface discontinuity factors

Postoperative follow-up of patients with liver resections on the occasion of colorectal metastases

Проучването обхваща 107 болни с чернодробни резекции по повод на чернодробни метастази от колоректален рак (КРР). Касае се за 54 мъже на средна възраст от 65,02 10,44 г. и за 53 жени на средна възраст от 65,13 8,48 г. Извършени са 50 би- и трисегментектомии, 45 - моносегментектомии, 20 хемихепатектомии и 5 клиновидни резекции. Установяват се различия по отношение на основните оперативни показатели, преживяемостта и смъртността на болните в зависимост от броя на резецираните чернодробни сегменти и поредността на резекцията. Препоръчва се извършването на моно- и бисегментектомии при случаите с онкохирургическа целесъобразност.The study covered 107 patients who had undergone liver resections on the occasion of colorectal cancer (CRC). There were 54 males at a mean age of 65,02 10,44 years and 53 females at a mean age of 65,13 8,48 years. Fifty bi- and trisegmentectomies, 45 monosegmentectomies, 20 hemihepatectomies and 5 wedge resections were done. Certain differences in respect of the main operative parameters, patients` survival and mortality rates in dependence on the number of resected segments and the consecutive number of the resection were established. The performance of mono- and bisegmentectomies in the cases with oncological surgical advisability was recommended

Prognostic value of C-reactive protein in patients with liver resections on the occasion of colorectal metastases

Серумните концентрации на С-реактивния протеин са изследвани при 107 оперирани болни с чернодробни метастази от колоректален рак (КРР). Касае се за 54 мъже на средна възраст от 65,02 10,44 г. (между 31 и 81 г.) и за 53 жени на средна възраст от 65,13 8,48 г. (между 40 и 81 г.). Извършени са общо 120 чернодробни резекции - 50 би- и трисегментектомии, 45 - моносегментектомии, 20 хемихепатектомии и 5 клиновидни резекции. Анализирана е следоперативната преживяемост в месеци в зависимост от праговата концентрация на С-реактивния протеин от 10 mg/L. Преживяемостта е по-добра при болните с ниски предоперативни стойности на този показател. Установява се умерена корелационна зависимост (r=0,38; p<0,05) между концентрациите на С-реактивния протеин ≤10 mg/L и броя на преживените месеци след операцията. Изследването на С-реактивния протеин подпомага прогнозирането на преживяемостта на оперираните болни с чернодробни метастази от КРР.Serum C-reactive protein concentrations of 107 patients operated for colorectal cancer liver metastases were examined. It dealt with 54 males at a mean age of 65,02 10,44 years (range, 31 and 81 years) and 53 females at a mean age of 65,13 8,48 years (range, 40 and 81 years). A total of 120 liver resections such as 50 bi- and trisegmentectomies, 45 monosegmentectomies, 20 hemihepatectomies and 5 wedge resections were performed. The postoperative survival rate (in months) was analyzed depending on the threshold C-reactive protein concentration of 10 mg/L. The survival rate was better among the patients with lower preoperative values of this parameter. There was moderate correlation dependence between C-reactive protein concentrations ≤10 mg/L and the number of months survived following surgery. The examination of the C-reactive protein helps the prognostication of the survival of the apteints operated for colorectal cancer liver metastases