Upotreba staplera u onkološkoj kirurgiji rektuma povećava incidenciju niskih anteriornih resekcija: 11 godina iskustva (1996.-2006.)

Pozadina Niski karcinomi rektuma predstavljaju teškoću u izvođenju niske/ultraniske anastomoze. Staplerske tehnike anastomoze sve se više koriste, kako zbog brzine izvođenja, tako i zbog tehnički jednostavnijeg izvođenja niske anastomoze. Cilj istraživanja je utvrditi je li upotreba staplera povećala udio kontinuitetnih resekcija rektuma zbog karcinoma u KBC-u Zagreb. Metode U razdoblju od 11 godina (1996.−2006.) svi pacijenti s rektalnim karcinomom na Zavodu za abdominalnu kirurgiju bili su uključeni u istraživanje. Stapleri su u rektalnoj kirurgiji bili korišteni tijekom cijelog istraživačkog razdoblja, a kontinuirano i trajno nakon 2000. godine. Rezultati Operirano je 413 pacijenata i izvedeno 149 niskih anteriornih resekcija, 156 Milesovih operacija i preostalih operacija (Hartmann i palijativne). Tijekom godina broj operacija se stalno povećavao s povećanjem učestalosti niskih anteriornih resekcija rektuma. Učestalost Milesove operacije ostala je nepromijenjena s vrijednošću od oko 40%. Zaključci Uspostava kontinuiteta nakon resekcija rektuma značajno poboljšava kvalitetu života uz jednaku onkološku sigurnost ako je tehnički izvediva u usporedbi s abdominoperinealnom resekcijom rektuma. Konstantnom upotrebom staplera u onkološkoj rektalnoj kirurgiji postoji povećana učestalost niskih anteriornih resekcija rektuma. Nažalost, učestalost Milesove operacije ostaje nepromijenjena

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

Large-Gauge Needle Biopsy in Diagnosing Malignant Breast Neoplasia

This paper is concerned with large-gauge needle biopsies of suspicious breast neoplasia performed within a three-year period (22nd June 1999 through 21st December 2001). Within that time 262 large-gauge needle biopsies as well as cytological punctions were performed with the aim of diagnosing benign and malignant neoplasia. In the same three-year period 29 malignant breast tumors were diagnosed. In one of the patients a clinically and PHD verified alteration was found which pointed to Mb. Padget, while in another patient an atypical ductal hyperplasia was confirmed by a pathohistological test

FIRST SYNCHRONOUS LIVER RESECTION AS A PART OF CYTOREDUCTIVE SURGERY, PERITONECTOMY AND HIPEC IN CROATIA – CASE REPORT

Prikazujemo slučaj tridesetsedmogodišnje bolesnice s velikim adenokarcinomom poprečnoga debelog crijeva te metastazama u slezeni, jetri, peritoneumu, velikom omentumu, žučnome mjehuru, desnom jajniku i jajovodu. Nakon premještaja bolesnice u našu Bolnicu iz vanjske ustanove provedena je opsežna citoreduktivna kirurgija s multiorganskim resekcijama i hipertermijskom intraabdominalnom kemoterapijom (HIPEC). Nekoliko mjeseci kasnije ponovo je podvrgnuta kirurškom liječenju zbog novootkrivene metastaze u 7. jetrenom segmentu i ona je ukonjena. Kemoterapijske cikluse primala je tijekom cijeloga postoperativnog perioda. Danas, dvije godine nakon prve operacije, bolesnica je subjektivno bez tegoba i bez znakova recidiva bolesti. Agresivna citoreduktivna kirurgija koja uključuje multiorganske resekcije, peritonektomiju, HIPEC dokazano je primjenjiv način liječenja u određenih skupina bolesnika s uznapredovalim abdominalnim tumorima, u sklopu čega je i sinkrona resekcija jetre. Ovo je prva sinkrona resekcija jetre u sklopu redovito provođene citoreduktivne kirurgije i HIPEC-a u Hrvatskoj.We present a case of a 37-year-old female, with large adenocarcinoma of transverse colon, and metastases in spleen, liver, peritoneum, greater omentum, gall bladder and right adnexa. She was transferred to our Hospital, and extensive elective cytoreductive surgery with intraabdominal hyperthermal chemotherapy (HIPEC) was performed. Couple of months later, she was operated on for a newly evidenced secondary nodus in liver segment VII, and metastasectomy was performed. Throughout entire postoperative period she was receiving cyclic chemotherapy. At this point, 2 years from the first operation, she was without evidenced recurrence of the disease. Aggressive cytoreductive surgery with multiorgan resection, peritonectomy, HIPEC and adjuvant chemotherapy which was proved to be a feasible option in some patients, with synchronous liver resection (LR) proved to be feasible and beneficial for patients with three or fewer liver metastases. This is the first liver resection included in usually performed cytoreductive surgery and HIPEC in Croatia

Prva sinkrona resekcija jetre u sklopu citoreduktivne kirurgije, peritonektomije i HIPEC-a u Hrvatskoj – prikaz bolesnice [First synchronous liver resection as a part of cytoreductive surgery, peritonectomy and HIPEC in Croatia - case report]

We present a case of a 37-year-old female, with large adenocarcinoma of transverse colon, and metastases in spleen, liver, peritoneum, greater omentum, gall bladder and right adnexa. She was transferred to our Hospital, and extensive elective cytoreductive surgery with intraabdominal hyperthermal chemotherapy (HIPEC) was performed. Couple of months later, she was operated on for a newly evidenced secondary nodus in liver segment VII, and metastasectomy was performed. Throughout entire postoperative period she was receiving cyclic chemotherapy. At this point, 2 years from the first operation, she was without evidenced recurrence of the disease. Aggressive cytoreductive surgery with multiorgan resection, peritonectomy, HIPEC and adjuvant chemotherapy which was proved to be a feasible option in some patients, with synchronous liver resection (LR) proved to be feasible and beneficial for patients with three or fewer liver metastases. This is the first liver resection included in usually performed cytoreductive surgery and HIPEC in Croatia

Gardner's syndrome: genetic testing and colonoscopy are indicated in adolescents and young adults with cranial osteomas: a case report

We present a case of a 25-year-old female with diagnosed familial adenomatous polyposis and elevated carcinoembryonic antigen with negative family history. The suspicion of Gardner's syndrome was raised because extirpation of an osteoma of the left temporo-occipital region was made 10 years ago. Restorative procto-colectomy and ileal pouch anal anastomosis was made but histology delineated adenocarcinoma of the rectum (Dukes C stage). We conclude that cranial osteomas often precede gastrointestinal manifestations of familial adenomatous polyposis or Gardner's syndrome and such patients should be evaluated with genetic testing followed by colonoscopy if results are positive to prevent the development of colorectal carcinoma. If the diagnosis is positive all family members should be evaluated for familial adenomatous polyposis

Endomedullary radiofrequency ablation of metastatic lesion of the right femur 5 years after primary breast carcinoma: a case report

Metastatic tumors of the long bones usually present with severe pain refractory to analgesic therapy. Pathologic fractures of the bone may lead to the significant decrease of patient's quality of life and necessitate further surgical therapy. We present 66 year old female with metastatic left breast carcinoma (T2N0M0) diagnosed 5 years before presentation of the metastatic lesion of the right femur causing severe pain in the middle of the right upper leg. Pain persisted after palliative irradiation therapy. We performed radiofrequency ablation of the metastatic lesion of the right femur using R.I.TA. Medical System Generator. This resulted in total necrosis of the tumor mass that caused osteolysis of the internal part of the femoral cortex. First three months after RFA procedure, the pain and tenderness were absent and normal daily activities were performed without restrictions