Subtotal Esophagectomy-Akiyama Procedure： In a Case with Esophageal Squamous Cell Carcinoma

Adenocarcinoma, typically in the distal third of the esophagus, and squamous cell carcinoma, typically in the proximal two thirds of the esophagus, each make up 49% of cases of esophageal cancer. The remaining cancers in this area include sarcoma (1%), lymphoma (0.5%), cylindroma (0.25%), and primary melanoma (0.25%). Case report We present patient S.G. 62 years old, male, with the following symptoms started 3 months from hospital admission: difficult swalloing mostly for the hard foods and eventually for the liquids too, chest burning, cough and vomiting, throat pain, weight loss. In the laboratory findings only a mild anemia was found, Hemoglobine 10.8 g/dl, and slightly high values of CRP. Patient was hospitalized in the First Clinic of General Surgery, University Hospital Center “Mother Teresa” Tirana, Albania and underwent an upper gastrointestinal tract endoscopy and 28 cm form the incisive teeth and esophageal narrowing was detected which could not allow the scope to go lower for further examination. Biopsy was taken through endoscopy. Patient was planned for a CT scan and tumor markers, CEA and CA 19-9, both later ones came in normal values. CT scan showed an irregular, asymmetric narrowing of the thoracic esophagus, thickening of the esophagus walls with 4 cm of extension without invasion of local periesophageal fat and regional lymphadenopathy. The biopsy resulted; esophageal squamous cell carcinoma G2. In these circumstances patient underwent a feeding jejunostomy and was sent to follow the protocol of neoadjuvant chemo and radiotherapy. Three months later the patient is returned in our clinic, where he underwent the surgical intervention. Postoperatively the patient was treated in the Intensive Care Unit. The next day after the operation, cervical drains were removed and in the fourth postoperative day the thoracic and abdominal drains were also removed. Patient comes in the surgery ward in the fifth postoperative day where is treated afterwards with an excellent postoperative course. In the tenth postoperative day the anastomosis integrity is verified by x-ray swallowing contrast gastrografin, and the next day he was discharged from the hospital. Keywords: Esophageal, squamous cell carcinoma, subtotal esophagectomy DOI: 10.7176/ALST/79-05 Publication date:March 31st 202

Cecal volvulus during pregnancy. Case report

Introduction. Acute intestinal obstruction in pregnancy is a rare, but life-threatening complication associated with high fetal and maternal mortality. Case report. A 20-year old gravida presented with a 24 hour history of several episodes of vomiting, complete constipation and severe crampy abdominal pain. The patient was admitted with the diagnosis of acute abdomen associated with septic shock. On examination echography showed distended intestinal loops and presence of free peritoneal fluid. Abdominal X-ray with shielding of the fetus revealed colonic air-fluid levels. The obstetrician consult diagnosed dead fetus in utero and was decided to operate immediately. On laparotomy was found complete cecal volvulus with gangrene of cecum, part of ascending colon and terminal ileum. A right hemicolectomy was performed with side to side ileotransverse anastomosis. Afterwards a lower segment cesarean section was made and a stillborn fetus was delivered. The patient made an uneventful recovery and was discharged on 9th postoperative day. Conclusion. Cecal volvulus during pregnancy is a rare, but serious surgical problem. Correct diagnosis may be difficult until exploratory laparotomy is performed. Undue delay in diagnosis and surgical treatment can increase the maternal and fetal mortality

Rectal cancer surgery. A ten years experience

Il cancro del retto è una delle più comuni malattie maligne nella popolazione occidentale. Il trattamento del cancro del retto è cambiato radicalmente negli ultimi anni seguendo i repentini progressi delle tecniche chirurgiche, della diagnostica per immagini e della terapia adiuvante. Lo studio prende in esame 152 pazienti operati per cancro del retto nella 1ª Clinica di Chirurgia Generale del Centro Ospedaliero Universitario “Madre Teresa” di Tirana, Albania in un periodo di dieci anni. Nella documentazione medica sono stati analizzati dati demografici, diagnostici, clinici, operatori, patologici e post operatori. La ratio M:F era di 1,5:1. L’età media dei pazienti era di 59,8 ± 12,2 (29 – 79) anni. 48% dei pazienti erano di età compresa tra 61 a 70 anni. L’intervallo di diagnosi era di 6± 4,6 mesi. La distanza media del tumore dal margine anale era di 8,3 ± 4,2 (3,7 – 16) cm. Il 30% dei pazienti risultava allo stadio D della malattia secondo la classificazione di Aster–Coller. L’indice globale di operabilità è stato del 97,5%. Il 30% dei pazienti è stato sottoposto a trattamenti chirurgici palliativi. Il 67,5% dei pazienti è stato trattato con intento curativo. L’intervento curativo più comune è stata la resezione anteriore del retto con escissione del mesoretto, effettuata su 76 pazienti (51%). La degenza media ospedaliera post operatoria è stata di 12 ± 9,7 (3 – 45) giorni. La morbilità e la mortalità globale sono state del 30% e del 2,6% rispettivamente. Il trattamento chirurgico del cancro del retto in Albania negli ultimi anni è cambiato radicalmente. La resezione anteriore bassa e l’utilizzo della chemioterapia adiuvante hanno portato a risultati positivi sulla qualità della vita e sulla sopravivenza dei pazienti

Primary Small Bowel Melanoma. Literature Review and a Case Report

Primary Small Bowel Melanoma. Literature Review and a Case Report Alma Llukacaj, Henri Kolani, Etmont Celiku, Eljona Xhelili Small bowel melanoma (SBM) is a rare entity, most of the time poorly diagnosed, and therefore it presents itself late in the course of the disease. Whether arise primarily or metastatically from a cutaneous melanoma, it is difficult to establish. In this report, we present a rare case of primary SBM and review of the current literature. A 50-year-old man is presented with melena and severe anemia in the emergency department. A series of investigations including abdominal ultrasonography (US), esophageal-gastro-duodenoscopy (EGDS) and colonoscopy were normal. Abdominal computed tomography showed a prominent mass which urged for immediate surgery. On laparotomy, the mass was resected, and histologically diagnosed as melanoma. Meticulous postoperative clinical examination revealed no cutaneous lesions. Review of the literature discusses gastrointestinal malignant melanoma and the possibilities of existence of true primary intestinal melanoma. Keywords: small bowel, gastrointestinal melanoma, surgery, primary tumor, melanocyt

Surgical treatment of the adenocarcinoma of the cardia

Adenocarcinomas of the esophagogastric junction should be classified into adenocarcinoma of the distal esophagus (Type I), true carcinoma of the cardia (Type II), and subcardial carcinoma (Type III) in a pathogenic and therapeutic point of view. During a 15-year period (1995 - 2009), 117 surgical laparotomies for adenocarcinoma of the cardia were performed in elective surgery in the First Clinic of General Surgery UHC “Mother Theresa” in Tirana. The classification was performed by summarizing the information obtained from oral contrast radiography, endoscopy, and intra-operative findings. There were 54 (46%) patients of Type I, 40 (34%) of Type II and 23 (20%) of Type III . Surgical procedures included “subtotal esophagectomy and proximal gastrectomy”, “distal esophagectomy and proximal gastrectomy”, “total gastrectomy and distal esophagectomy”. All anastomoses performed in the above mentioned procedures were hand sewn. Thirty-seven patients (32%) resulted inoperable at the time of laparotomy and 80 (68%) patients were treated with curative intent, those resulting in an operability index of 68%. The overall morbidity and mortality rates of 29% and 4,3% respectively

The surgical treatment of secondary hepatic metastases from colorectal carcinoma

The Surgical Treatment of Secondary Hepatic Metastases from Colorectal Carcinoma. Henri KOLANI1*; Frenki VILA2; Eriol BRAHOLLI2; Eljona XHELILI3; Bledi MASATI3; Asfloral HAXHIU3; Etmont CELIKU4Abstract Introduction:Colorectal cancer is the third most common cancer and the third leading cause of mortality among men and women in our country, and is represented by a vast number of cases diagnosed and treated in our clinic slightly second to gastric cancer. More than 50% of the patients with colorectal cancer (CRC) have or will develop metastasis, with a quarter having distant metastatic disease at the time of diagnosis, most frequently in the liver. Liver metastasis is the leading cause of cancer-related morbidity and mortality in colorectal cancer. The only potentially curative treatment for liver metastasis is liver resection, but only 15% to 20% of the patients are suitable for surgical resection. Regardless the early diagnosis and the treatment strategy the survival rarely exceeds the 3-year period. Treatment: Surgical resection remains one of the major curative treatment options available to patients with colorectal liver metastases. Surgery and chemotherapy form the backbone of the treatment in patients with colorectal liver metastases.This article provides an overview of the surgical management of colorectal liver metastases. Conclusions: According to the data from retrospective and comparative studies the surgical resection remains the best choice of treatment followed by higher rates of survivability. Our experiences with cases operated with synchronous and metachronous liver metastases secondary to colorectal cancer, shows an increase in survivability by 25 to 50%, and in the meantime, there is no positive data in the conservatory treated cases limited to chemiotherapy. Keywords: Hepatic metastases; Colorectal cancer; Surgical resection