Sentimag biopsija limfnog čvora stražara u konzervativnoj kirurgiji dojke – preliminarni rezultati

Segmentectomy and sentinel lymph node biopsy is a golden standard for early breast cancer (clinical and radiological cT1-2, c N0). Recently, superparamagnetic iron oxide (SPIO) nanoparticle tracer has been introduced enabling intraoperative tracer injection. We prospectively recorded data on tumor histology, marked lymph nodes and their final histology and patient characteristics for early breast cancer patients who underwent breast conservative surgery. At 128 female breast cancer patients underwent sentinel lymph node biopsy by SentiMag. Three patients were excluded from further analysis because the postoperative pathology report was ductal carcinoma in situ (DCIS). The identifi cation rate was 95.2 % (119 of 125). Of the 19.2 % (24 of 125) patients with lymph node involvement, 1.6% (2 of 125) had micrometastasis, and 1 % (1 of 125) had single tumor cells within the sentinel, l at least a micrometastasis. Of 30 positive lymph nodes removed, 24 (80 %) were true sentinel nodes. The average lymph node retrieval rate was 2.3 nodes per patient. SentiMag’s performance was comparable to published data and to standard sentinel with blue patent die and/or technetium. The benefi t of easier application and logistics is a great advantage.Segmentektomija i biopsija limfnog čvora stražara zlatni su standard za kirurško liječenje ranog raka dojke (klinički i radiološki cT1-2, c N0). Čestice superparamagnetskog željeznog oksida (superparamagnetic iron oxide, SPIO) od nedavno se koriste kao unutaroperacijski nanočestični obilježivač. Prospektivno smo bilježili demografske podatke o bolesnicama, histologiju tumora te označenih i neoznačenih limfnih čvorova. U 128 bolesnica učinjena je biopsija limfnog čvora stražara u aksili detektorom SentiMag. Tri bolesnice su isključene, jer je konačan patohistoloski nalaz bio carcinoma ductale in situ (DCIS). Limfni čvor je pronađen u 119 od 125 bolesnica (95.2%), pozitivne limfne čvorove su imale 24 (19.2%), makrometasaze 2 (1.6%) i mikrometastaze 1 bolesnica (0.08%). Od 30 pozitivnih odstranjenih limfnih čvorava, obilježenih je bilo 24 (80 %). Prosječno su po bolesnici izvađena 2.3 limfna čvora. Mogućnost otkrivanja limfnog čvora stražara SentiMagom usporediva je s dosad objavljenim podatcima i zlatnim standardom. Prednosti metode su lakše rukovanje i minimalna logistika

Usporedba dvije metode poslijeoperacijske analgezije kod bolesnika s rektalnim karcinomom

Adequate postoperative analgesia is a fundamental human right. The goal of this study was to determine benefits in the treatment of acute postoperative pain by additionally placing a wound catheter at the end of the operation. We have analyzed the effectiveness of postoperative pain therapy of patients who had surgery for rectal carcinoma at the University Hospital for Tumours from 1st April to 30th November 2018. Patients were divided into two groups according to pain therapy protocol. Each group had 30 patients. The first group of patients received intravenous multimodal analgesia. The second group received both the intravenous multimodal analgesia and additional local anesthesia through the wound catheter. We measured the pain intensity with the Numerical rating scale and the amount of opioid analgesic fentanyl given to the patients. We recorded these data: when the patient came out of the operation theatre (time zero), six hours, twenty-four hours, and forty-eight hours after the surgery. Furthermore, we took registered the timing of the first postoperative bowel movements. Results showed a slightly better pain control in the second group but without statistical significance.Učinkovito liječenje boli jedno je od temeljnih ljudskih prava. Cilj istraživanja bio je ustanoviti prednosti u liječenju akutne poslijeoperacijske boli postavljanjenm ranskog katetera na kraju operacije. Analizirali smo učinkovitost liječenja poslijeoperacijske boli kod bolesnika koji su operirani zbog rektalnog karcinoma u Klinici za tumore u periodu od 1. travnja do 30. studenog 2018. Bolesnici su podijeljeni u dvije grupe ovisno o protokolu za analgeziju. Svaka grupa je uključivala 30 bolesnika. Prva grupa je primala intravensku multimodalnu analgeziju. Drugagrupa bolesnika dobivala je jednaku intravensku multimodalnu analgeziju i dodatno je postavljen ranski kateter u ranu na kraju operacije. Za mjerenje jačine boli primjenili smo Numeričku skalu boli i ukupnu količinu opioidnog analgetika fentanyla koju su bolesnici primili, podatke smo bilježili po izlasku iz operacijske sale (nulto vrijeme), šest sati, dvadeset četiri sata te četrdeset osam sati nakon operacije. Nadalje, zapisivali smo vrijeme pojave prve peristaltike. Rezultati su pokazali da postoji izvjesna prednost u drugoj grupi, ali ona nije statistički značajna