[Show abstract][Hide abstract] ABSTRACT: Cholangiocarcinomas have been often met in daily practice. Biliar tract neoplasmas are the most important group in adenomas and papillomas. There is the medical and social problem with cancer patients because they call doctor too late when cancer changes reach a high level and only paliative procedures are recommended. In the most cases the prothesis implanted by ERCP and surgical digestive bypasses are applied.
was to evaluate some therapeutic methods in paliative treatment applied in patients with biliary tract cancer.
From 01.2003 to 12.2007 (5 years experience) in 4 departments of general surgery and departments of digestive tract diseases the medical treatment of 430 patients with biliary tract cancer was analyzed. All patients were divided into 3 groups: G1--prosthesis by ERCP; G2--percutaneously, transhepatic drainage of biliary tract; G3--surgical digestive bypass.
G1 techniques were applied in 75 patients, G2 in 14 cases and G3 in 74 cases. In the last group of patients the following procedures have been performed: triple bypass (TB) in 45 cases (62%), choledochoduodenostomy (ChD) in 7 cases (9%), gastroenterostomy (GE) in 10 patients (13%) and laparotomy with Kehr drainage in 12 patients (16%). The number of complications in G1 group was observed in 31%, in G2--42%, and in G3--63%. 30 days death rate was 14% in G1, 28% in G2 and 18% in G3. Over 12 months survival rate was in G1, 3 months in G2 and 15 months in G3. Differences are statistically sagnificant (p < 0.05).
From all applied methods of paliative treatment the best results were noticed in surgical digestive bypass and implantation of prosthesis by ERCP. After surgical treatment survival rate was higher, but the number of complications was higher in relation to another methods.
No preview · Article · May 2009 · Polski merkuriusz lekarski: organ Polskiego Towarzystwa Lekarskiego
[Show abstract][Hide abstract] ABSTRACT: Cholecystolithiasis is a serious problem of contemporary medicine. The most common operations in gastroenterologic surgery are gallbladder operations because of calculosis. The most common complications after gallbladder operations are bleeding from site of the gallbladder and bile leakage, but the most serious complication is a bile ducts injury.
The assessment of complications quantity after cholecystectomy due to cholecystolithiasis. Observation of operation's profile changes during last 10 years.
From January 1997 to December 2006 in Department of Surgery in MSWiA Hospital in Lodz and in Departments of Surgery in Leczyca and Piotrkow Trybunalski 6845 cholecystectomy were made including 4215 laparoscopic operations.
Complications were observed in 12.6% patients. Suppuration of the wound and postoperative hernias occurred more often after classic operations, in the other hand blood and bile leakage from site of the gallbladder were more often observed after laparoscopic operations. The ratio of complications after classic operations to laparoscopic operations was about 15.4% to 6.1%. Conversion was made in 11.5%. During first 5 years conversion was made in 17.6%, in the next 5 years average number of complications drop to 5.4%.
Nowadays laparoscopic cholecystectomy is a standard procedure in symptomatic and asymptomatic cholecystolithiasis. It's a safe operation, burden with a little amount of complications made during acute as well as chronic course of disease. Laparoscopic technique requires a lot of care and in the event of operator's doubts should be replace with classic operation.
No preview · Article · Jun 2007 · Polski merkuriusz lekarski: organ Polskiego Towarzystwa Lekarskiego
[Show abstract][Hide abstract] ABSTRACT: The suggested classifications of locally recurrent rectal cancer are based on the presence of symptoms and the degree of tumor fixation to the pelvic wall, or, otherwise, account for factor T in the TMN system. Although the results of rectal cancer treatment have improved, which may be attributed to total mesorectal excision and application of perioperative radiotherapy and radiochemotherapy, the ratio of cases of locally recurrent rectal cancer still amount from several to over a dozen percent. Among the available diagnostic methods for detecting locally recurrent rectal cancer after anterior rectal resection, endorectal sonography is of special importance. In the estimation of prognostic factors the lack of vascular invasion in recurrent cancer and the long period between the treatment of primary rectal cancer and the development of recurrence are a sign of good prognosis, while pain prior to recurrence treatment and male sex diminish the chances for cure. Locally recurrent rectal cancer impairs the patients' quality of life in all measurable aspects, but even after complete recovery we observe severe disturbances of sexual activity in most patients, and a number of patients require hygienic pads or suffer from chronic pain. Local recurrence of rectal cancer is more commonly qualified for excision after surgical treatment only, than after preoperative radiotherapy. The probability of total recurrent rectal cancer excision increases when the patient is younger, the primary tumour was less advanced and the first operation was sphincter-sparing surgery. Progress in the surgical treatment of recurrent rectal cancer was brought on by the introduction of the pedicled composite musculocutaneous flap to compensate the loss of perineal tissue. The application of intraoperative radiotherapy improves treatment results of recurrent rectal cancer, however at the cost of more frequent, serious postoperative complications and intense pain. In inoperable cases high dose regional chemotherapy accounts for some 30% of responses which last for several months. After R0 resections of locally recurrent rectal cancer combined with intraoperative radiotherapy and chemotherapy 5-year survival periods are obtained in approx. 35% of cases. If complete response (pT0) is observed within the excised tissues after preoperative radio- or chemoradiotherapy the likelihood of curability is significantly higher. Recurrence after local excision or electrocoagulation of rectal cancer can be efficiently treated with abdomino-perineal resection. According to various sources, perioperative mortality in patients with locally recurrent rectal cancer ranges from null to 30%. Local recurrence of rectal cancer should be treated in well equipped institutions with a high reference status.