Lymphadenectomy in Papilary Thyroid Cancer

Studie hodnotí vlastní soubor pacientů s papilárním karcinomem a postižení lymfatických uzlin. Celkem bylo odstraněno 351 uzlin a 113 bylo postiženo metastázou karcinomu.Study described metastases in lymph mode by thyroid papilocarcinoma. There were examined 351 nodes and 113 were positive

Does probiotic application improve clinical outcomes in colorectal surgery?

Aim: To evaluate the effects of pre-operative administration of type-specific probiotics in colorectal surgery on the rate of post-operative (especially infection-related) complications; on the period of antibiotic administration; and on the speed of restoration of gut motility and length of hospital stay. Methods: Patients undergoing elective colon or rectal resection with anastomosis from June 2011 to April 2013 were in turns randomly divided into the probiotics group (22 patients) and the control group (23 patients). Patients with probiotics received (twice daily, 10 days before surgery) enterosolvent capsules consisting of 6 × 109 of five different freeze-dried Lactobacilli and Bifidobacteria species (L. rhamnosus 55%, B. breve 20%, L. casei 15%, L. acidophilus 5%, B. longum 5%). Postoperatively, the inflammatory complications, duration of antibiotic treatment, speed of restoration of intestinal peristalsis in patients and length of hospital stay were evaluated. Results: The interval to first peristalsis was significantly shorter in the probiotics group compared with the control group (1.5 days vs 2.0 days; p = 0.01). The decrease in infection-related complications (surgical wound infection, pneumonia) in the probiotics group was not statistically significant. The shorter antibiotic administration period in the probiotics group was statistically significant at the significance level p = 0.089. The length of hospital stay in patients with probiotics was shorter than in the control group, but not significantly. An improvement of health in the probiotics patients occurred in 21 of 25 clinical and laboratory numerically assessed parameters (p = 0.01). Conclusion: Pre-operative probiotic administration (L. rhamnosus, B. breve, L. casei, L. acidophilus, B. longum) in patients undergoing colorectal resection with anastomosis resulted in faster restoration of intestinal peristalsis, and in an improved clinical state of the patients (especially reduced infection-related complications) described by 25 clinical and laboratory parameters

Micrometastases in the sentinel lymph node - Necessity of axillar lymph node dissection?

Either radical mastectomy with axillar lymphadenectomy or conservative surgery with axillar lymph node dissection are the standard treatments for patients with breast carcinoma. Sentinel lymph node biopsy is a new method that - if negative - allows axillar lymph node preservation and so minimizes major complications associated with this operation (especially lymphedema of the upper extremity). However, the development of the diagnostic means gave rise to new clinical entities - micrometastases and findings of clusters or solitary cells in the sentinel lymph node. Even though the probability of non-sentinel lymph node metastasis is only 10 %, all patients with the finding of micrometastases in the sentinel lymph node are currently indicated for axillar lymph node dissection. Based on the present retrospective study involving 398 females with breast carcinoma, the authors define a risk group for non-sentinel lymph node metastases. The other patients may be spared from successive axillar dissection

Sexual dysfunctions following sphincter-preserving rectal resection

Increase in number of sphincter-preserving rectal resections for carcinoma, as well as improved patient survival brings to the fore the question relating to quality of patient's life also in the sense of influencing their sexual functions. These functions may be reduced (temporary or permanently) as a consequence of surgery, radiotherapy or mental suffering of patients with malignant disease. Using standardized questionnaires, in this prospective study of 42 patients with rectal cancer, pre-operative and post-operative sexual functions of men (International Index of Erectile Function; IIEF) and women (modified Female Sexual Function Index; FSFI) were compared. Impact of the conventional (open) versus laparoscopic surgical approach on the deterioration of sexual functions, as well as risk factors in relation to the tumour, and risk demographic characteristics of patients were assessed. In total, 28 of 42 patients (67.7%) were sexually active preoperatively. In the group of 20 men, a worsening of sexual functions occurred in 15 patients (75.0%). This deterioration of sexual functions in men was statistically significant (P = 0.01). In the group of 8 women, a worsening occurred in 4 patients (50.0%), but it was not statistically significant. As risk factor the perioperative blood loss in women was identified (P = 0.1). The influences of the age, BMI, tumour size and distance, and duration of surgery were not found out. Impact of the open or laparoscopic approach on sexual dysfunctions was not proven

Locoregional Recurrence after Conservative Surgery by Early Breast Carcinoma

Konzervativní výkony u karcinomu prsu jsou alternativou mastektomie, avšak počet lokálních recidiv je větší. Cílem prospektivní studie bylo zjistit počet lokálních recidiv v prsu po konzervativních výkonech a určit rizikové faktory, které se na vzniku podílí, se zvláštním zaměřením na rozsah resekce. Do studie bylo zařazeno 330 pacientek. Lokální recidivy byly diagnostikovány 5x (1,51%). Dvě recidivy byly prvními známkami generalizace procesu. Tři byly velikosti 8 mm až 20 mm a nebyla prokázána generalizace. Doporučujeme dodržet vzdálenost 5 mm resekční linie od nádoru.Conservative surgery is considered as standard and alternative mastectomy in early stage breast cancer but number of local recurrence is higher. Aim of the study was to detect number of local recurrence after conservative surgery and to identify risk faktors of local recurrence especially importance of resection margins. Conservative surgery was performed in 330 patients. In breast local recurrence appeared in 5 (1,51%) patients and one had regional recurrence without in breast recurrence. We recommend keeping this resection distance

Significance of the resection margin and risk factors for close or positive resection margin in patients undergoing breast-conserving surgery

Purpose: While positive resection margin (RM) in women undergoing breast-conserving surgery (BCS) represents a clear indication for re-resection, there is no unequivocal recommendation regarding the extent of the clear RM. The aim of this study was to define the optimal extent of the RM and the risk factors for close or positive RM. Methods: Patients scheduled for BCS had diagnosis confirmed before BCS (lumpectomy and quadrantectomy) by core biopsy. Sentinel lymph node biopsy followed BCS, and in case of positive findings axillary lymph node dissection followed. According to RM patients were categorized into 4 groups: 1) Patients with positive RM; 2) Clear RM 5 mm. In the first 3 groups where re-resection was indicated, the presence of tumor cells in the re-resection specimen was determined. All patients were followed for local recurrence. Results: 330patients undergoing BCS were studied. Median follow up was 39.6 months (range 12-70). Lumpectomy was performed in 111 cases and quadrantectomy in 219. In 19 cases the final procedure was mastectomy due to the impossibility to achieve negative RM. In 78 cases re-resection followed the primary procedure due to close or positive RM. Clear RM was < 2 mm in 12 cases (15%), 2-5 mm in 56 (72%) and positive margin in 10 (13%). Positive re-resection specimen was detected in 31 cases (39.7%) (in 10 cases with positive RM after primary procedure, in 3 with negative margin < 2 mm and in 18 with 2-5 mm margin). The re-resection rate according to the location of the primary tumor was 77% (n=60) in the upper outer quadrant, 8% (n=6) in the lower outer quadrant, 6% (n=5) in the upper inner quadrant, 4% (n=3) in the lower inner quadrant, and 5% (n=4) in centrally located tumors. Multicentric/multifocal tumor was diagnosed in 16 cases from which re-resection was indicated in 12 cases (75%). The number of re-resection according to tumor size was as follows: Tis 8 cases (30.7%), T1a none, T1b 14 (20.2%), T1c 34 (22.5%), T2 22 (28%). Re-resection was performed in 8 cases (31%) of ductal carcinoma in situ (DCIS), in 53 (22%) of ductal carcinoma, in 10 (37%) of lobular carcinoma, and in 7 (15%) of other histology. Five cases with local relapse were detected during follow up. Conclusion: The generally recommended clear RM of 1-5 mm is not sufficient because of the high number of positive specimens in the case of clear RM of 2-5 mm. The risk factors for close or positive RM are multicentric tumors and upper outer location of the primary tumor. Longer follow up will be needed to analyze local relapse rate according to RM status

Local recurrences after conservative surgery in breast carcinoma

Východisko: Lokální recidivy v prsu po konzervativní chirurgické terapii musíme hodnotit jako selhání primární léčby. Ve studii jsme sledovali počet lokálních recidiv po konzervativních chirurgických výkonech i ve vztahu k relapsům a úmrtí na karcinom. Metoda a výsledky: V období od 1.12. 1998 do 30.06.2004 bylo na chirurgickém oddělení nemocnice Atlas ve Zlíně léčeno 143 pacientů s karcinomem prsu, které podstoupily konzervativní výkon. U všech následovala radioterapie prsu a boost. Minimální makroskopická vzdálenost byla l,0 cm. Reexcise následovala, když minimální mikroskopická vzdálenost byla pod 5mm. Minimální dávka na lůžko tumoru a na celý prs byla 50Gy během 5-6 týdnů, denně 2Gy. Vždy byla nasazena brachyterapie. Kombinace chemoterapie s hormonální terapií následovala u 56x, jen chemoterapie 31x, jen hormonální terapie 31x, bez adjuvantní terapie 25x. Výsledky: Medián sledování byl 32 měsíců. Velikost nádoru dle TNM klasifikace: TIS 10, pT1a 1x, pTb 28x, pTc 55x, pT2 44x, pT3 5x. Stadium: 0 1x, I 58x, IIA 56x, IIB 24x, IIIA 4x. Lokální recidiva v prsu se objevila 5x, (3, 49%). Vzdálené metastázy byly registrovány 6x, (4,1%) a z nich 3x(2,09%) došlo k úmrtí základní onemocnění. Lokální recidiva byla pouze jedenkrát následována vznikem vzdálených metastáz a úmrtím na karcinom a to v intervalu 12 měsíců. Velikost primárního tumoru, který recidivoval, se pohybovala od l0mm do 45mm a recidivy objevily se v intervalu od 12 do 42 měsíců. Lokální recidivy byly řešeny mastektomií 4x, jedenkrát reresekcí. Závěr: Počet lokálních recidiv v souboru je v souladu s mezinárodním doporučením a je výsledkem moderní multimodální léčby.Backgrounds: Local recurrences in breast after conservative surgery are failure of primary therapy. The aim of the study was monitoring of local recurrences after conservative surgery and also relationships of local recurrences with disease free interval and survival. Materials and Methods: Between 1.12. 1998 and 30.06.2004, 143 patients with breast carcinoma were treated at Department of Surgery Atlas Hospital Zlin by conservative surgery. All patients received radiotherapy and boost in breast. Macroscopic free margins were l0 mm and reexcision were done in all patients with free margins less than 5mm. Dose of the radiotherapy whole breast and cavity were 50Gy, interval 5-6 weeks, daily 2Gy. Brachytherapy received all patients, combination of chemotherapy and hormonal therapy were 56x, only chemotherapy 31x, only hormonal therapy 31x and without adjuvant therapy 25x. Results: Median follow-up was 32 month. Tumor size according to TNM classification: TIS 10, pT1a 1x, pTb 28x, pTc 55x, pT2 44x, pT3 5x. Stage: 0 1x, I 58x, IIA 56x, IIB 24x, IIIA 4x. Local recurrences in breast were 5x, (3, 49%), distant metastases 6x, (4, 1%) and 3x (2, 09%) appeared distant metastases and death at breast carcinoma without local recurrence. Only in one patient local recurrence were followed by distant metastases and death. Interval from local recurrence and death was 12 month. Size of the original tumor with local recurrences was from 10mm to 45 mm. Interval from the time of initial treatment to local recurrences was from12 to 42 month. Surgical treatment of local recurrences included mastectomy 4x and conservative surgery 1x. Conclusion: Number of local recurrences is in correspondence with international guideline and results of modern multimodal therapy

Sentinel lymph node biopsy in the breast carcinoma in clinical practice

Cíl: V chirurgickém léčení časného karcinomu prsu biopsie sentinelové uzliny postupně nahradila disekci axilárních uzlin I. a II. etáže. Cílem studie je ověřit proveditelnost a spolehlivost metody v našich podmínkách. Metoda: V období od června 1998 do června 2007 bylo provedeno 458 biopsií sentinelové uzliny (SLNB). Ke značení uzlin byla nejdříve použita Patentblue a od roku 2000 kombinace radiokoloidu s gama sondou a Patentblue. Po SLNB následovala vždy disekce axily, od které bylo upuštěno u negativních sentinelových uzlin v roce 2002. Výsledky: Z celkového počtu 458 SLNB bylo do souboru zařazeno 382 pacientek. Pouze SLNB bez současné disekce axily byla provedena 170x. V 70 případech byla sentinelová uzlina pozitivní a následovala disekce axily. Non-sentinelové uzliny byly pozitivní 17x. Celkem bylo v základním souboru 382 biopsií vyšetřeno 899 sentinelových uzlin. Průměr byl 2,35. Falešně negativní uzliny byly zaznamenány u pacientek se SLNB a následnou disekcí axily 3x (4,6 %.) Nebyla registrována lokální recidiva v axile u negativní sentinelové uzliny bez následné disekce axily. Závěr: Biopsie sentinelové uzliny je bezpečná alternativa axilární disekce v chirurgické léčbě časného karcinomu prsu.Aim: In the management of early breast carcinoma, biopsy of sentinel lymph nodes has gradually replaced dissection of Level I and II axillary nodes. The aim of the study is to assess feasibility and reliability of the method in our conditions. Method: From June 1998 to June 2007, a total of 458 sentinel no de biopsies (SLNB) were performed. Originally, patent blue sentinel node mapping was used. Since 2000, a combination of radiocolloid application and a gamma- probe (detector), as well as the patent blue, has been used. Originally, SLNBs were followed by axi1lary dissections, however, in 2002, the procedure was waived in cases of negative sentinel nodes findings. Results: Out of the total of 458 SLNB patients, 382 female patients were inc1uded in the study. SLNB, without concomitant axi1lary dissection, was performed in 170 subjects. In 70 subjects, the sentinel node was positive and they were indicated for axillary dissections. Positive non-sentinel nodes were detected 17 times. In total, 899 sentinel nodes were examined in the study group of 382 biopsies. The mean was 2.35. False negative nodes were recorded in three cases in female patients with SLNB and axi1lary dissection (4.6%). No local relapses in the axi1la were recorded in negative sentinel node findings without subsequent axi1lary dissections. Conclusion: Sentinel node biopsy is a safe alternative to axi1lary dissection in the surgical management of ear1y breast carcinoma