Surgical Treatment as a Prognostic Factor for Survival in Patients with Neuroendocrine Tumors

Background: Surgical treatment is the only method that offers radical treatment in patients with neuro-endocrine tumors (NET). These tumors are commonly found later in their progression with bulky primary tumors with metastases. The slow growth of these tumours allows for aggressive surgical treatment, although up to 90% of NET patients develop metastases, and in 40% of them metastases are present at the moment of diagnosis.Aim: The aim of our study is to assess the prognostic factors influencing survival and quality of life in patients with NET. We established that such factors are: the presence of metastases, their resectability, as well as the type of surgical intervention. Materials and Methods: We performed a retrospective analysis of the characteristics of patients with NET subjected to surgical treatment in our Department for the period 1991 - 2015, as well as prospective analysis of their survival.Results: 98 patients with NET were included in our series: the mean survival time was 7.2 years with a median of 5.3 years. After a statistical analysis of the results, we established that the presence and number of liver metastases (p=0.025), as well as their resectability (Ñ

Short-Term Results after Surgical Treatment of Pancreatic Cancer - Prognostic Factors and Prerequisites for Their Improvement

Introduction: Over the past few decades there have been a significant improvement in the results of radical surgery for pancreatic cancer as the early postoperative mortality is minimized in the major centers. However, the rate of postoperative morbidity remains relatively high. The most common surgical complications are: insufficiency of pancreatic or biliary anastomosis, the occurrence of bleeding or delayed gastric emptying. Aim: The aim of this paper is to analyze the short-term results after left and right pancreatic resections for pancreatic cancer and to determine the factors influencing their appearance, the prerequisites for reducing the complications and possibilities for preventing them. Materials and Methods: A retrospective study was performed. Between 1999 and 2015, 365 patients underwent different pancreatic resections for pancreatic cancer in the Department of General and Hepato-pancreatic Surgery of the University Hospital `Alexandrovska`. Clinicopathological material was analyzed by different statistical methods using SPSS-19. Results: 244 duodenohemipancreatectomies, 40 left subtotal pancreatectomies and 81 left hemipancreatectomies were performed. Observed mortality rate was 6.85%. Applying own modification of the prosthesis of the anastomoses with drainage type `perdue` leads to decreased rates of pancreatic anastomotic leaks - 3.28%. With regard to the early postoperative results, prognostic factors are blood loss, the values of T-Bil, D-Bil and ALP. Conclusion: Optimizing surgical technique according to the existing changes of the pancreas in the specific case is the basis of reducing of the postoperative morbidity rate. On the other hand, the implementation of adequate intensive care leads to reduction in early postoperative mortality and improvement of survival

Doppler-guided transanal hemorrhoidal dearterilization versus conventional hemorrhoidectomy for treatment of hemorrhoids – early and long-term postoperative results

Abstract Background A variety of effective methods for treatment of hemorrhoids has been proposed. In recent years, there has been an increasing number of studies comparing transanal hemorrhoidal dearterilization (THD) and conventional hemorrhoidectomy (CH), but the focus of most studies has been about the early postoperative results. The data about long-term outcomes is still limited. We aimed to compare Doppler-guided THD and CH with regard to early and long-term postoperative results. Methods The conducted prospective research included 287 patients who underwent CH (167 cases) or Doppler-guided THD with mycopexy (120 patients) between November 2010 and December 2015. Information on hemorrhoidal stage, demographic data, presenting symptoms, complications, duration of hospital stay, postoperative pain, patients’ satisfaction and follow-up were obtained. Statistical tests were performed by SPSS 19.0. Results There was no significant difference between the studied groups according to gender, mean age, preoperative prolapse, pain and pruritus, hemorrhoidal stage and postoperative complications. Preoperative bleeding was more frequent in THD group (p = 0,002). The mean visual analog scale (VAS) pain scores in CH and THD groups on days 1, 2 and 7 were 7.01 vs 5.03, 5.07 vs 2.98, 2.39 vs 0,57 (p = 0,000). Practically, there was no difference in VAS on day 30 and patients’ satisfaction at the 18th month. Mean hospital stay was 5,13 (CH) and 3,38 days (THD), p = 0,000. The postoperative follow-up was between 18 and 78 months (mean 46 ± 16 months). During this stage, 5 patients (2,99%) in CH group required surgery for recurrence. In THD group, 3 patients (2,5%), all with 4th-degree hemorrhoids underwent additional procedures (p 0,802). Conclusions Doppler-guided THD seems to be an efficient and safe option for treatment of hemorrhoids, related to lower postoperative pain and excellent, similar long-term outcomes compared to CH. For advanced grades of hemorrhoids, Doppler-guided THD could be a valuable alternative, but there is a need for patients’ selection. Trial registration (retrospectively registered) researchregistry3090