Diagnostics and treatment of small intestine tumors in our own experience

Introduction. Small intestine cancers are a difficult oncological problem. Lack of specific symptoms and difficulties with accessing the location even for advanced diagnostic techniques delay the diagnosis and implementation of appropriate treatment. Aim. Analysis of incidence, clinical symptoms, diagnostic methods and results of treatment of small intestine tumors in the material of the Maria Skłodowska-Curie Institute — Oncology Center (MSCI) in Warsaw. Material and method. A retrospective analysis of 54 patients undergoing surgery for small intestine tumor in the years 2006–2015. The evaluated group consisted of 26 (48%) males, 28 (52%) females, median age was 63.5 ± 13.5 years (23–86). Results. In the study group 18 (33%) cases of sarcomas were found, including 16 (30%) cases of GIST. The remaining cases were diagnosed as: adenocarcinoma — 13 patients (24%), neuroendocrine tumor (NET) — 8 (15%), malignant melanoma — 6 (11%), lymphoma — 3 (6%) and benign tumors — 6 (11%). Symptoms included gastrointestinal bleeding (55.5%), abdominal pain (48%), weight loss (31.5%), nausea (30%), vomiting (24%), flatulence (24%), inte­stinal passage disturbances (15%). In 70% of patients anemia was diagnosed, which in 33% required an average of 4.5 packed red blood cells (PRBC) units (range 1–100) to be transfused before treatment. The test that led to diagnosis was in 26 (48%) cases computed tomography, in 8 (15%) cases capsule endoscopy and in 5 (9%) cases double-balloon enteroscopy. Partial resection of the small intestine with regional lymph nodes was performed in 38 patients (70%), local excision in 5 (9%) patients and anastomosis gastric pass in 4 (7%) patients. So far, 17 (31%) deaths have been reported in this group of patients. 5-year survival was 93.8% for sarcomas, 53.9% for SIC, 66.7% for GEP-NET. Conclusions. Partial resection of the small intestine remains the basic method of radical surgical treatment. Both diagnostics and treatment should be carried out in reference centers

External audit of providers of the Cervical Cancer Prevention Programme in Poland in 2016/2017

Introduction. The Cervical Cancer (CC) Prevention Programme includes 3 phases: basic (Pap smear collection), diagnostic (Pap smear evaluation) and in-depth (colposcopy/biopsy in case of abnormal smear test findings). The Programme service providers are subject to an external audit and this publication’s objective is to analyse its results from 2016 and the first half of 2017. Materials and methods. The audit of the Programme performance in the period 01.01.2016–30.06.2017 was carried out by external auditors by way of personal visits to the offices of the service providers and by way of direct data retrieval. The audit covered 12% (198) of the basic phase, 100% (66) of the diagnostic phase and 100% (62) of the in-depth phase facilities. The Polish National Health Fund (NHF) did not make available the routinely collected data for the purpose of audit. Audit data collected in the developed protocols were analysed. Results. The number of Pap smears (2,028,988) and the number of colposcopies (13,636) outside the Programme was, respectively, more than two and three times higher than in the Programme (cytology — 801,640, colposcopy — 3929). The performance of the procedures (Programme vs outside the Programme) was highly variable depending on the provider. The percentage of Pap smears unsuitable for evaluation did not differ significantly between gynaecologists and midwives. All audited cytological laboratories carried out rescreening of samples. Biopsy was not performed in 11% (2016) and 15% (2017) of colposcopy laboratories. Inaccuracies were found in 19% (61) of the audit protocols. Discussion. Significantly higher number of procedures performed outside the Programme results from lower renu­meration of procedures within the Programme. Variable provider's preferences in the mode of procedures execution indicates that with the use of appropriate organisational solutions it would be possible to reduce opportunistic screening, which is of unknown quality. The quality of Pap smear sample collection in the case of gynaecologists and midwives is the same, but the number of primary care provider (PCP) facilities where midwives collect smears is very limited. The inaccuracies noted in the audit protocols indicate that the lack of access to data collected by the National Health Fund decreased the quality of the audit carried out and the reliability of the data obtained. Conclusions. Restoring full access to data collected by the NHF is crucial for the Programme audit quality. Measures should be implemented to reduce opportunistic screening and shift the stream of tests to the Programme (both at the basic and at the in-depth phase), and to increase the availability of tests in PCP facilities through training for midwives.

Endoscopist biopsy rate as a quality indicator for outpatient gastroscopy: a multicenter cohort study with validation.

BACKGROUND AND AIMS: The diagnosis of gastric premalignant conditions (GPCs) relies on endoscopy with mucosal sampling. We hypothesized that the endoscopist biopsy rate (EBR) might constitute a quality indicator for EGD, and we have analyzed its association with GPC detection and the rate of missed gastric cancers (GCs). METHODS: We analyzed EGD databases from 2 high-volume outpatient units. EBR values, defined as the proportion of EGDs with ≥1 biopsy to all examinations were calculated for each endoscopist in Unit A (derivation cohort) and divided by the quartile values into 4 groups. Detection of GPC was calculated for each group and compared using multivariate clustered logistic regression models. Unit B database was used for validation. All patients were followed in the Cancer Registry for missed GCs diagnosed between 1 month and 3 years after EGDs with negative results. RESULTS: Sixteen endoscopists in Unit A performed 17,490 EGDs of which 15,340 (87.7%) were analyzed. EBR quartile values were 22.4% to 36.7% (low EBR), 36.8% to 43.7% (moderate), 43.8% to 51.6% (high), and 51.7% and 65.8% (very-high); median value 43.8%. The odds ratios for the moderate, high, and very-high EBR groups of detecting GPC were 1.6 (95% confidence interval [CI], 1.3-1.9), 2.0 (95% CI, 1.7-2.4), and 2.5 (95% CI, 2.1-2.9), respectively, compared with the low EBR group (P < .001). This association was confirmed with the same thresholds in the validation cohort. Endoscopists with higher EBR (≥43.8%) had a lower risk of missed cancer compared with those in the lower EBR group (odds ratio, 0.44; 95% CI, 0.20-1.00; P = .049). CONCLUSIONS: The EBR parameter is highly variable among endoscopists and is associated with efficacy in GPC detection and the rate of missed GCs

Wpływ radiochemioterapii na odległą jakość życia chorych leczonych operacyjnie z powodu raka żołądka

WSTĘP: Poprawa wyników leczenia raka żołądka (RŻ) szczególnie w następstwie coraz szerzej stosowanego leczenia skojarzonego sprawia, że coraz ważniejszym aspektem oceny odległych wyników leczenia jest zależna od terapii jakość życia Celem pracy jest porównanie odległej HRQoL chorych poddanych leczeniu uzupełniającemu w formie chemioradioterapii (CRT) według schematu MacDonalda, poprzedzonej wykonaniem gastrektomii. MATERIAŁ I METODY: W latach 2009–2012 w NIO-PIB w Warszawie 154 chorych, w tym 55 (35,7%) kobiet i 99(64,3%) mężczyzn, po gastrektomii (TG) z powodu RŻ, leczono uzupełniająco według schematu MacDonalda. Do badania włączono wszystkich (39) chorych wolnych od nowotworu w okresie obserwacji, którzy wyrazili na to zgodę. Grupę kontrolną (36 chorych) stanowili chorzy poddani wyłącznie leczeniu operacyjnemu w analogicznym zakresie. Jakość życia oceniano na podstawie kwestionariuszy EORTC: formularza ogólnego QLQ C-30. v.3.0 oraz modułu QLQ STO 22. WYNIKI: Wśród parametrów ocenianych w grupie badanej znamiennie gorsze oceny jakości życia dotyczyły jakości codziennego funkcjonowania FS (p = 0,007), wydolności fizycznej PF2 (p = 0,032) oraz statusu materialnego FI (p = 0,04). Nie wykazano różnic statystycznych w ocenie jakości życia przy pomocy kwestionariusza QLQ STO 22. PODSUMOWANIE: U osób wolnych od choroby nowotworowej żołądka CRT znamiennie obniża jakość życia w zakresie codziennego funkcjonowania, wydolności fizycznej oraz statusu materialnego. Odległa, zależna od stanu zdrowia jakość życia została uznana za dobrą

Does epidural analgesia modify the risk of complications after gastrectomy?

Introduction. The surgical treatment of Gastric Cancer is associated with overall complication rates as high as 50%. The intent of this study was to assess the impact of epidural analgesia (EA) on postoperative complication rates among patients undergoing gastric resections. Materials and methods. Of the 617 gastric cancer patients who between 2002 and 2010 had undergone stomach resection, 246 (39.8%) were administered EA. Groups with and without EA were compared. Results. The general rate of complications was lower in the EA group in the univariable analysis – 38.5% vs. 54.2% (odds ratio [OR]: 0.47, 95% confidence interval [CI]: 0.34–0.66, p &lt; 0.001), intra-abdominal abscess (OR 0,28, 95% CI: 0.14–0.59, p = 0.001), pneumonia (OR 0,39, 95% CI: 0.24–0.63, p &lt; 0.001), temperature &gt; 38°C (OR 0.53, 95% CI: 0.37–0.74, p &lt; 0.001) and re-operation (OR 0.53, 95% CI: 0.28–1.00, p = 0.049). These relationships were confirmed in a multivariable analysis for the general number of complications (OR 0.53, 95% CI: 0.37–0.75, p &lt; 0.001), intra-abdominal abscess (OR 0.36, 95% CI: 0.16–0.77, p = 0.009), temperature &gt; 38°C (OR 0.56, 95% CI: 0.39–0.82, p = 0.009), pneumonia (OR 0.42, 95% CI: 0.25–0.71, p = 0.001). Conclusions. Our findings indicate that postoperative treatment with EA for patients undergoing stomach resection is safe and contributes to a reduction in the number of postoperative complications

Retrospective analysis of nilotinib and dasatinib efficacy in second line treatment of chronic myeloid leukemia in Polish hematological centers

Until now, there has been no randomized study directly comparing the activity of second-generation BCR-ABL tyrosine kinase inhibitors (TKI-2G) nilotinib and dasatinib in chronic myeloid leukemia (CML). The aim of our study was to retrospectively analyze efficacy of nilotinib and dasatinib in the real life setting of CML with resistance or intolerance of imatinib. Of 108 included patients treated in polish hematology centers, 75 received dasatinib and 33 patients received nilotinib. Rates of complete cytogenetic response (CCyR) did not differ between the two groups of patients. After six months of therapy, CCyR was achieved in 34.7% of patients treated with dasatinib and 38.7% treated with nilotinib (p=0.86), while after 12 months, the CCyR rates were 60.0% and 77.0% in dasatinib and nilotinib groups, respectively (p=0.11). Moreover, we have not observed any significant difference in the probability of progression-free survival (p=0.89) or overall survival (p=0.99) between patients treated with these two TKI-2G. In conclusion, the results of our analysis indicate that nilotinib and dasatinib have comparable and satisfactory efficacy in the treatment of CML patients refractory or intolerant to imatinib. Our findings support current strategy of choice of IKT-2G according to drug toxicity profile and risk of specific adverse events in an individual patient