The place of palliative multivisceral resections for locally advanced colorectal cancer

ABSTRACTBackground. Performance of multivisceral resections in cases of locally and systematically advanced colorectal cancer have their own place in the treatment of this disease. This approach is used usually in young patients as a part of two-stage surgical strategy or combined with adjuvant chemotherapy to achieve re-staging  of systemic metastases. Avoiding colostomy and better quality of life is a strong suggestion in this direction.Aim. To determine the indications and early postoperative results in group of patients with locally and systemically advanced colorectal cancer with multivisceral resection of local disease.Material and method. For a period of 8 years 2007 - 2014, 27 patients underwent local multivisceral resection with distant metastases left. For the same period total 191 patients were operated for locally advanced CRC. All methods for early postoperative results assessment were used.Results. The average age in the group was 64 years. Perioperative mortality rate is 3.7% and morbidity is 14,8%. In only 3 cases we preformed colostomy.Conclusion. In selected patients aggressive surgical attempt is justified and connected with low mortality and morbidity rate. Quality of life is a strong suggestion for such therapeutic strategy

Challenges in surgical treatment of locally recurent colorectal carcinoma

ABSTRACT Background. Locally  recurrent  CRC  is a disease  issuing an exceptional challenges to the surgeon. At the time of 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 a surgical radicality performing multivisceral resections in the surgical field of post-operative adhesions, adjuvant RT with neoangiogenesis and dissecting changed plans is often challenging.Aim. To assess the early perioperative results of patients with locally recurrent CRC.Material and method. A study based on 62 patients underwent surgery for locally recurrent CRC for a period of seven years  - January 2007 - December 2013. An early perioperative results are assessed.Results. All patients in the group underwent surgery. We performed 26 palliative and 36 potentially curative surgical interventions. The  average  hospital stay is 9.2 days (7 -  22 days) . In one case  patient  died of multiple organ failure postoperatively.  Perioperative mortality rate was estimated at 1.6% and  perioperative morbidity was 25.8%(16 patients). Conclusion. Perianastomotic  recurrences without distant dissemination  are most favorable for radical surgical treatment. It is imperative that the implementation of en block resection without breaking the adherent to the tumor structures is important for achievement radicality

Learning Curve in Laparoscopic Colorectal Surgery. Results of a Retrospective Personal Study

INTRODUCTION: Nowadays the term learning curve is widely accepted in the colorectal minimally invasive surgery and defines the level of education in the performance of a specific minimally invasive operation. The term has its own graphical image. The learning curve is completed when variations in one operative procedure have a stable level and the results are comparable with the published in the literature. The results can be identified by perioperative data—operative time, perioperative blood loss, level of conversions, perioperative morbidity, mortality rate, wound infection, rehospitalizations. On the other hand, in oncological cases, the number of harvested lymph nodes, tumor and circumferential resection margins, disease free survival are indicators which can be measured. There are a lot of approaches applied in surgical practice to complete the learning curve faster.  The number of operations to achieve a plateau in the learning curve is under debate in the literature.AIM: The aim of this article is to analyze perioperative data and define the number of laparoscopic colorectal operations until reaching a plateau in the learning curve.MATHERIALS AND METHODS: А single surgeon-based retrospective study on 183 minimally invasive colorectal resections analyzed the perioperative results in the time to achieve a plateau in the learning curve. The analyzed criteria were median operative time, blood loss, perioperative morbidity, level of conversions, median hospital stay, number of harvested lymph nodes. All the clinical methods were included.RESULTS: The level of perioperative complications decreased from 30% in 2014 to under 15% in 2018, with small variations up to date. The median hospital stay dropped from 7.5 days at the beginning to 6.5 days in 2018, blood loss became stable in median range of 73 mL in 2018. The number of extracted lymph nodes rose from 9.6 to 13.22 and more. After 2018, the conversion rate became stable in range of 16%.CONCLUSION:  To complete the learning curve, we identified 38 personally performed laparoscopic colorectal resections. The surgeon had previous personal experience of more than 100 open colorectal resections before the first laparoscopic one

Laparoscopic Versus Robotic Rectal Resections. Comparative Analysis of Perioperative Results

INTRODUCTION: Globally, the minimally invasive approach in colorectal surgery is accepted as more effective compared to open surgery in terms of better perioperative results with comparable oncological long-term ones. Laparoscopy in low rectal resection is challenging, even for experienced surgeons and is related to a high conversion rate. Robotic surgery has advantages in rotations of the instruments, 3D image, ergonomic position of the surgeon, precise movements, and intelligent systems for electrosurgery. The advantages are more visible in dissections in narrow spaces, such as the pelvis. On the other hand, the operating theater price of robotic surgery is higher compared to conventional laparoscopy. There are still limitations of both techniques in cases of advanced rectal cancer, obesity patients, and previous major surgery. Collected data in the literature show lower conversion rates in robotic rectal resections.AIM: The aim of this article is to conduct a comparative analysis of the perioperative results of a personal series of patients with laparoscopic and robotic rectal resections. We aim to assess the levels of perioperative complications and conversion rate.MATERIALS AND METHODS: This study is based on an individual series of 76 minimally invasive rectal resections divided into two subgroups—46 laparoscopic resections and 30 robotic ones. An assessment is performed on perioperative results using all clinical methodsRESULTS: There were no differences between the patients according to gender and age distribution. The male to female ratio was approximately 2:3. In the group of laparoscopic operations, 21 were high anterior rectal resections. In the group of robotics, the number of high resections was only 4. The conversion rate for the laparoscopic group was 23.9% compared with 12.9% for the robotic one. The mortality rate was 0% for both techniques. The perioperative morbidity rate was 11.4% for the laparoscopic group and 19.2% for the robotic one. The median operative time the laparoscopic group vs. the robotic group was 144.7 min vs. 194.7 min; the median hospital stay—6.0 vs. 6.2 days; the median blood loss—34.7 vs. 43.9 mL; the extracted lymph nodes—12.2 vs. 8.8, respectively.CONCLUSION: Robotic rectal resections have a lower conversion rate. It seems to have higher morbidity rate with the other perioperative results being comparable to conventional laparoscopy. The prevalence of low rectal resections in the group of robotic operations might explain this fact

Potentially curative multivisceral resections for locally advanced colorectal cancer

Background. Performing multivisceral resections in locally advanced colorectal cancer is the only way to achieve the surgical radicality in the treatment of this disease. The frequency of such cases remains high as a result of the global increase in morbidity and poor health culture of the population. Locally advanced colorectal cancer has exclusive specificity in terms of its location - upper abdominal floor,  pelvic area and requires multidisciplinary surgical skills and experience. In this publication are reported early perioperative results in 128 cases of potentially curative multivisceral resections. Aim. To assess the early perioperative results in patients with multivisceral resections for advanced colorectal cancer.Material and method. For period of 8 years 2007 - 2014, 191 patients with advanced colorectal cancer were operated. In 128 cases multivisceral resections were performed in attempt for achieve surgical radicalism.Results. Average age in the group was 66.7years. Perioperative mortality amounted to 3.1%(4 patients). Perioperative complications were observed in 25 (19.5%) patients.Conclusion. Surgery is the only method for achieve long term survival in patients with advanced colorectal cancer. Performance of multivisceral resections is challenging for the surgeon and often multidisciplinary approach is needed. Key words. Multivisceral, locally advanced, colorecta

ERP Protocols in Minimally Invasive Colorectal Surgery

INTRODUCTION: Despite constantly evolving surgical techniques focused on reducing tissue trauma during surgery, innovations in anesthesia, major colorectal resections continue to be associated with significant perioperative morbidity, which is associated by prolonged hospital stay and high cost of treatment. In order to explain the complications after operation, the mechanisms of pathophysiological changes due to surgical stress must be understood. At the end of the 1990s, components of the so-called fast-track rehabilitation program aimed to achieve early recovery after major surgery. These protocols eliminate old understandings of postoperative recovery and put into practice evidence-based principles and innovations aimed at reducing physiological stress and postoperative organ dysfunction through optimization of perioperative care and recovery.AIM: The aim of this article is to analyze the current recommendations for good clinical practice and the postulates of accelerated recovery protocols in minimally invasive colorectal surgery.MATERIALS AND METHODS: The evidence in the modern literature on the methods of enhanced recovery after minimally invasive colorectal surgery was reviewed. Our experience with 152 minimally invasive colorectal resections was discussed.RESULTS: Results published in the literature regarding postoperative recovery and morbidity using ERP were analyzed. The results of a personal study of 152 minimally invasive colorectal resections are reported. The perioperative complication rate was 13.8%, with a median hospital stay of 5.9 days, and perioperative mortality rate of 1.3%.CONCLUSION: Implementation of evidence-based methods of preparation, perioperative monitoring, and postoperative care and rehabilitation are associated with significantly better outcomes in terms of perioperative complications and postoperative recovery

A quartz crystal microbalance-assisted method for the assessment of iodine content in organoiodines

Introduction: A new experimental quantitative approach for evaluating iodine content in organoiodine compounds has been proposed, based on the quartz crystal microbalance (QCM) method. This approach relies on following the time behavior of the resonance frequency of the quartz plate under temperature activation of iodine-containing analyte deposited on its surface.Materials and Methods: We have applied the QCM method and the pharmacopoeial titrimetric method.Results and Conclusion: From the mass variations observed, the quantity of emitted iodine is precisely obtained, which readily delivers its initial content in the studied sample. The obtained value corresponds exactly to the theoretical prediction, in contrast to the value obtained by applying the conventional pharmacopoeial metrics

Percolation in the Harmonic Crystal and Voter Model in three dimensions

We investigate the site percolation transition in two strongly correlated systems in three dimensions: the massless harmonic crystal and the voter model. In the first case we start with a Gibbs measure for the potential, $U=\frac{J}{2} \sum_{} (\phi(x) - \phi(y))^2$, $x,y \in \mathbb{Z}^3$, $J > 0$ and $\phi(x) \in \mathbb{R}$, a scalar height variable, and define occupation variables $\rho_h(x) =1,(0)$ for $\phi(x) > h (<h)$. The probability $p$ of a site being occupied, is then a function of $h$. In the voter model we consider the stationary measure, in which each site is either occupied or empty, with probability $p$. In both cases the truncated pair correlation of the occupation variables, $G(x-y)$, decays asymptotically like $|x-y|^{-1}$. Using some novel Monte Carlo simulation methods and finite size scaling we find accurate values of $p_c$ as well as the critical exponents for these systems. The latter are different from that of independent percolation in $d=3$, as expected from the work of Weinrib and Halperin [WH] for the percolation transition of systems with $G(r) \sim r^{-a}$ [A. Weinrib and B. Halperin, Phys. Rev. B 27, 413 (1983)]. In particular the correlation length exponent $\nu$ is very close to the predicted value of 2 supporting the conjecture by WH that $\nu= \frac{2}{a}$ is exact.Comment: 8 figures. new version significantly different from the old one, includes new results, figures et

Comparative analysis of comorbidity, surgical complications, pharmacotherapeutic needs, and rehabilitation requirements in transabdominal preperitoneal hernia repair versus conventional operative treatment—current results and benefits

Background: Laparoscopic transabdominal preperitoneal (TAPP) inguinal hernia repair is a relatively new method of inguinal hernia surgical repair that, at theory, provides a good view of the inguinal anatomy and sac contents and, as a laparoscopic procedure, is considered less invasive and with fewer complications compared to total extraperitoneal (TEP) inguinal hernia repair. Purpose: This study aims to assess the short-term outcome of laparoscopic transabdominal preperitoneal inguinal hernia (TAPP) repair. Material and methods: The retrospective clinical data for 138 patients with unilateral and bilateral hernia, operated in the Department of General, Visceral, and Emergency Surgery of the University Emergency Medicine Hospital ‘N. Pirogov’ from 01 January 2022, to 01 January 2023, were included. The risk profile of the patients, the intraoperative and postoperative complications, the duration of hospital stay, the frequency, and the type of analgesics used were analyzed. Results: Forty-one women (29.7%) were included; men comprised 97 (70.29%) of the cohort. Of the selected group, 63 (45.7%) patients had indirect inguinal hernias, 34 (24.6%), and 25 (18.1%) were diagnosed with direct inguinal hernia and accreta inguinal hernia, respectively. A history of repeatedly occurring hernias was found in 16 patients (11.6%). The average hospital stay was 32 hours (or 1.3 days) and ranged from 24 hours (1 day) to 48 hours (2 days). Complications occurred in 11 (7.97%) patients. The need for analgesics and anti-inflammatory agents was reliably reduced compared to the patients undergoing conventional surgical treatment of inguinal hernia. The patients were followed for three months post-discharge for the occurrence of surgical morbidity associated with the TAPP hernia repair. None of the patients used an antimicrobial agent, as indicated by a possible complicating bacterial infection. Rehabilitation was started within the first 12 hours after the operation, thus contributing to a significantly shorter hospital stay compared to patients undergoing conventional surgical repair of an inguinal hernia. Conclusion: Our results demonstrate that TAPP inguinal hernia repair is a safe procedure with reduced postoperative pain. It has fewer complications, with no significantly longer operative time and a shorter overall hospital stay