Michał Drews’s research while affiliated with Medical University of Lublin and other places

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Publications (176)


Nomogram-Based Prognostic Evaluation of Gastric Cancer Patients with Low Counts of Examined Lymph Nodes Outperforms the Predictive Ability of the 7th and 8th Editions of the American Joint Committee on Cancer Staging System
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September 2022

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37 Reads

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1 Citation

Journal of Gastrointestinal Surgery

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Lukasz Bobrzynski

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Piotr Kolodziejczyk

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Background: The American Joint Committee on Cancer (AJCC) staging system has limited accuracy in predicting survival of gastric cancer patients with inadequate counts of evaluated lymph nodes (LNs). We therefore aimed to develop a prognostic nomogram suitable for clinical applications in such cases. Methods: A total of 1511 noncardia gastric cancer patients treated between 1990 and 2010 in the academic surgical center were reviewed to compare the 7th and 8th editions of the AJCC staging system. A nomogram was developed for the prediction of 5-year survival in patients with less than 16 LNs evaluated (n = 546). External validation was performed using datasets derived from the Polish Gastric Cancer Study Group (n = 668) and the SEER database (n = 11,225). Results: The 8th edition of AJCC staging showed better overall discriminatory power compared to the previous version, but no improvement was found for patients with < 16 evaluated LNs. The developed nomogram had better concordance index (0.695) than the former (0.682) or latest (0.680) staging editions, including patients subject to neoadjuvant treatment, and calibration curves showed excellent agreement between the nomogram-predicted and actual survival. High discriminatory power was also demonstrated for both validation cohorts. Subsequently, the nomogram showed the best accuracy for the prediction of 5-year survival through the time-dependent ROC curve analysis in the training and validation cohorts. Conclusions: A clinically relevant nomogram was built for the prediction of 5-year survival in patients with inadequate numbers of LNs evaluated in surgical specimens. The predictive accuracy of the nomogram was validated in two Western populations.


Instillation-TIME (iTIME) as a rationale amendment for TIME conception. Is there enough evidence for the efficiency of negative pressure wound therapy with instillation (iNPWT) to announce a breakthrough idea for wound treatment?
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  • Full-text available

July 2019

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84 Reads

Negative Pressure Wound Therapy Journal

An increased number of patients developing difficult-to-heal wounds results in billions spending for chronic wound care management. Introduction of TIME conception has been a breakthrough idea for wound healing based on phase-adapted wound therapy that interacts and influence each other and included: T – tissue management, I - infection control, M - moisture balance, E - edge of the wound. Negative pressure wound therapy (NPWT) revolutionized the management of wound healing. Moreover, recently NPWT with instillation (iNPWT) has gained the popularity of optimizing wound healing. In the context of acceleration of wound healing, iNPWT meets the criteria of the TIME conception. All individual components of TIME strategy are found in iNPWT providing “all in one” conception. Such management is easy to apply, monitor and it is well- tolerated by patients. Based on the current studies, iNPWT is found to be an important alternative for other methods of wound healing. It is believed that iNPWT will evolve and gain popularity as an innovative treatment for TIME conception.

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Checklist in colorectal surgery - proposal of experts of the Polish Club of Coloproctology and National Consultant in general surgery

December 2017

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47 Reads

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2 Citations

Polish Journal of Surgery

A checklist is a collection of information that helps reduce the risk of failure due to limitations in human memory and attention. In surgery, the first Surgical Safety Checklist (SSC), created under the supervision of WHO (World Health Organization), was established in 2007 and covers three stages related to the patient&apos;s stay in the operating theater and operation: 1. Prior to initiation (induction) of anesthesia; 2. before cutting the skin; 3. before the patient leaves the operating room Colorectal surgery is particularly at high risk for complications and relatively high mortality. Elimination or, more likely, reducing the risk of complications by standardizing perioperative procedures may be particularly important in this group. The introduction of "dedicated" colorectal checklist surgery seems to be justified. The checklist proposed by the authors in colorectal surgery is divided into four stages, in which conscientious completion of checklists is intended to reduce the potential risk of complications due to hospitalization and surgical treatment. The presented checklist is obviously not closed, as a new publications or recommendations appear, some points may be modified, new issues may be added to the checklist. At present, however, it is a tool considering the well-known and confirmed elements of intraoperative procedures, the compliance of which may significantly reduce the rate of adverse events or surgical complications.


Polish Consensus on Treatment of Gastric Cancer; update 2017

October 2017

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25 Reads

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7 Citations

Polish Journal of Surgery

The "Polish Research on Gastric Cancer" project has been continued since 1986. The main aim of this project, which is a multicenter and interdisciplinary research, is enhancing the treatment results of gastric cancer patients by developing and promoting the use of optimal methods for diagnosis and treatment, both surgical as well as combined. One of the more important achievements of the project is the development and publication of a document named "Polish Consensus on Treatment of Patients with Gastric Cancer", whose first version was published in 1998. Following versions were updated adequately to changing trends in the proceedings in patients with gastric cancer. A scientific symposium on "Polish Consensus on Treatment of Gastric Cancer - update 2016" was held in 3-4 June 2016 in Cracow. During the symposium a panel session was held during which all authors publicly presented the Consensus assumptions to be discussed further. Moreover, the already mentioned session was preceded by a correspondence as well as a working meeting in order to consolidate the position. It has to be underlined that the directions and guidelines included in the Consensus are not the arbitrarily assumed rules of conduct in a legal aspect and as such every doctor/team of doctors is entitled to make different decisions as long as they are beneficial to a patient with gastric cancer. The Consensus discusses as follows: a) recommended qualifications (stage of advancement, pathological, lymph node topography and the extent of lymphadenectomy, division of cancer of the gastroesophageal junction), b) rules for diagnostics including recommendations regarding endoscopic examination and clinical evaluation of the advancement stage, c) recommendations regarding surgical treatment (extent of resection, extent of lymphadenectomy, tactics of proceedings in cancer of the gastroesophageal junction), d) recommendations regarding combined treatment with chemotherapy or radiotherapy, e) place of endoscopic and less invasive surgery in the treatment of gastric cancer. This publication is a summary of the arrangements made in the panel session during the abovementioned scientific symposium in Cracow in 2016.


Fig. 1. Pretreatment CT shows one target lesion measuring 87 mm in diameter and attenuation of 81 HU (arrow) 
Fig. 2. CT scan after the last cycle of TACE showing decrease in diameter of the target lesion (60 mm) and a decrease in attenuation-39 HU (arrow) 
Fig. 3. Pretreatment angiogram shows diffuse pattern of contrast enhancement throughout liver without distinct nodules 
Long-term survival in a patient with unresectable liver metastases from uveal melanoma treated with transarterial chemoembolization with irinotecan eluting beads – case report and review of literature

September 2017

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84 Reads

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2 Citations

Introduction Treatment of unresectable liver metastases (LM) from uveal melanoma (UM) remains a major clinical challenge. Systemic chemotherapy and chemoimmunotherapy regimens extrapolated from cutaneous melanoma are considered to be ineffective in therapy of metastases from uveal melanoma. Studies suggest that the progression of hepatic metastases rather than the primary tumor or metastases in other organs determines survival. Case report We report a case of transarterial chemoembolization of 57-year-old man diagnosed with unresectable liver metastases from uveal melanoma with irinotecan eluting beads. Therapy resulted in long progression free survival and overall survival, 41 months and 45 months after diagnosis of metastatic disease respectively. Patient did not experience any major side effects of the therapy. Follow-up CTs indicate stable disease in mRECIST criteria and partial response in CHOI criteria. Conclusions Transarterial chemoembolization with drug eluting beads loaded with irinotecan may be an effective treatment of unresectable liver metastases from uveal melanoma.



Figure 1. Relative expression of STS, HSD3B1, CYP19A1, HSD17B7, ESR1, ESR2, AR, PELP1, CREBBP, NCOA1, NCOR1 and NR2F1 mRNA in healthy and primary tumoral gastric tissue samples. (A) Expression of genes encoding steroidogenic enzymes. (B) Expression levels of genes encoding steroid hormone receptors. (C) Expression of genes encoding coregulators of steroid hormone receptors. White dots represent healthy tissue and black dots represent primary tumoral tissue from patients with gastric cancer, which were analyzed through reverse transcription‑quantitative polymerase chain reaction analysis and normalized to expression levels of β2‑microglobulin, β‑glucuronidase and porphobilinogen deaminase. The quantity of analyzed genes is presented as the decimal logarithm that represents the ratio between the amount of target gene in a sample and the target gene in the calibrator. STS, steroid sulfatase; HSD3B1, hydroxy‑delta‑5‑steroid dehydrogenase 3 beta‑ and steroid delta‑isomerase 1; CYP19A1, aromatase; HSD17B7, 17β‑hydroxysteroid dehydrogenase type 7; ESR1, estrogen receptor α; ESR2, estrogen receptor β; AR, androgen receptor; PELP1, proline, glutamate and leucine rich protein 1; CREBBP, CREB binding protein; NCOA1, nuclear receptor coactivator 1; NCOR1, nuclear receptor corepressor 1; NR2F1, nuclear receptor subfamily 2, group F, member 1. 
mRNA expression of steroidogenic enzymes, steroid hormone receptors and their coregulators in gastric cancer

March 2017

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103 Reads

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16 Citations

Oncology Letters

Epidemiological and experimental findings suggest that the development of gastric cancer (GC) is regulated by steroid hormones. In postmenopausal women and older men, the majority of steroid hormones are produced locally in peripheral tissue through the enzymatic conversion of steroid precursors. Therefore, using reverse transcription‑quantitative polymerase chain reaction analysis, the mRNA expression of genes encoding steroidogenic enzymes, including steroid sulfatase (STS), hydroxy‑delta‑5‑steroid dehydrogenase 3 beta‑ and steroid delta‑isomerase 1 (HSD3B1), 17β‑hydroxysteroid dehydrogenase type 7 and aromatase (CYP19A1), was investigated in primary tumoral and adjacent healthy gastric mucosa from 60 patients with GC. Furthermore, the mRNA levels for estrogen receptor α, estrogen receptor β (ESR2) and androgen receptor (AR), along with their coregulators, including proline, glutamate and leucine rich protein 1, CREB binding protein, nuclear receptor coactivator 1 (NCOA1), nuclear receptor corepressor 1 (NCOR1) and nuclear receptor subfamily 2 group F member 1 (NR2F1), were investigated. Additionally, the association between the mRNA expression of these genes and the clinicopathological features of patients with GC was examined. Significantly decreased levels of STS, HSD3B1, ESR2, AR, NCOA1 and NCOR1 mRNA, in addition to significantly increased levels of CYP19A1 mRNA were demonstrated in tumoral tissue samples compared with adjacent healthy gastric tissue samples. Deregulated expres‑ sion of these genes in the analyzed tissue samples was associ‑ ated with certain clinicopathological features of GC, such as age and localization of the tumor. The results of the current study suggest that all of the genes analyzed are expressed in tumoral and adjacent healthy gastric mucosa. In addition, the results indicate that abnormal expression of STS, ESR2, AR, NCOA1 and NCOR1 may serve a role in the development and progression of GC, and may be associated with specific clinicopathological features in patients with GC.


Conservative Measures for Managing Constipation in Patients Living With a Colostomy

March 2017

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119 Reads

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7 Citations

Journal of Wound Ostomy and Continence Nursing

Purpose: The purpose of this study was to determine the effect of a conservative regimen for the treatment of constipation in persons living with a colostomy. Design: Prospective, noncontrolled, single-center study. Subjects and setting: The study sample comprised 35 patients with a colostomy who were diagnosed with constipation. Subjects with morphologic changes causing constipation such as stomal stenosis and neoplastic and inflammatory changes were excluded. The study was conducted in the Proctology and Stoma Outpatient Clinic at Poznan University of Medical Sciences. Methods: Patients at our Stoma Outpatient Clinic underwent baseline evaluation, and those with symptoms of constipation (prolonged periods between bowel movements, passage of pasty or hardened fecal effluent, and associated symptoms such as abdominal discomfort or bloating, flatulence, and pain with passage of effluent into the stoma) received individualized dietary recommendations that typically included an increase in dietary fiber and fluid intake, along with increased fluid intake. The outcomes of dietary changes were evaluated during a follow-up visit 3 months later. If dietary changes alone did not improve constipation symptoms, we prescribed a psyllium-based bulk-forming agent, an osmotic stool softener, and a probiotic, with or without a prokinetic agent such as metoclopramide taken 3 times daily. Results: Dietary interventions alone were deemed successful in 60% of study subjects (n = 21); the remaining 14 patients required additional treatment. Conclusions: Dietary modifications alone relieved constipation in more than half of a group of 35 patients with constipation. We therefore recommend a trial of dietary modifications prior to the initiation of pharmacotherapy in patients with a colostomy.



Gastrointestinal tract anastomoses with the biofragmentable anastomosis ring: is it still a valid technique for bowel anastomosis? Analysis of 203 cases and review of the literature

January 2017

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106 Reads

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15 Citations

International Journal of Colorectal Disease

PurposeBiofragmentable anastomosis ring (BAR) is an alternative to manual and stapled anastomoses performed within the upper and lower gastrointestinal (GI) tract. The aim of this study was to evaluate the effectiveness of BAR utility for bowel anastomoses based on our own material. MethodsA retrospective analysis was performed to a total of 203 patients who underwent bowel surgery with the use of BAR anastomosis within upper and lower gastrointestinal tract between 2004 and 2014. Data for the analysis was collected based on medical records, treatment protocols, and the results of histological examinations. ResultsThe study group consisted of 86 women and 117 men. The most common underlying pathology was a malignant disease (n = 165). Biofragmentable anastomosis ring (BAR) size 31 was the most commonly used (n = 87). A total of 169 colocolic or colorectal anastomoses and 28 ileocolic and 8 enteroenteric anastomoses were performed. The mortality rate was 0.5 % (n = 1) whereas re-surgery rate within 30 days was 8.4 % (n = 17). Twenty-eight patients developed perioperative complications with surgical site infection as the most common one (n = 11). Eight patients developed specific complications associated with BAR including an anastomotic leak (n = 6) and intestinal obstruction (n = 2). The mean time of hospital stay after surgery was 12.7 days. Conclusions The use of BAR for the GI tract anastomoses is simple and rapid method and it is characterized with an acceptable number of perioperative mortality and complication rates. Based on our experience, we recommend the use of BAR anastomosis in different types of intestinal anastomosis in varying clinical scenarios.


Citations (76)


... To improve the survival and quality of life of CRC patients, accurate prognosis prediction and personalized treatment plans are imperative (24). Prognostic predictions and postoperative management strategies for CRC largely depend on postsurgical pathological staging information (24,25), with different pathological stages dictating varied postoperative treatment modalities, i.e., either more aggressive adjuvant therapies or conservative observation. Our study compared the performance of our developed nomogram model with that of traditional TNM staging for prognostic prediction in CRC patients. ...

Reference:

Development and validation of nomograms for predicting the prognosis of colorectal cancer patients
Nomogram-Based Prognostic Evaluation of Gastric Cancer Patients with Low Counts of Examined Lymph Nodes Outperforms the Predictive Ability of the 7th and 8th Editions of the American Joint Committee on Cancer Staging System
  • Citing Article
  • September 2022

Journal of Gastrointestinal Surgery

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Lukasz Bobrzynski

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Piotr Kolodziejczyk

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[...]

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... [26][27][28] Nowadays, different types of checklists to reduce postoperative complications are frequently used in colorectal surgery, such as those described here. [29][30][31][32][33][34] They are increasingly imposed through a variety of professional and regulatory mandates, especially in North America and Europe, serving as evidence of due diligence and performance of care teams with respect to prevention of patient harm. [26][27][28] However, concerns have emerged since behavioural compliance to checklists has been shown to be highly variable, with inconsistent performance occurring notably when the checklist becomes a trivial exercise in 'checking the box'. ...

Checklist in colorectal surgery - proposal of experts of the Polish Club of Coloproctology and National Consultant in general surgery
  • Citing Article
  • December 2017

Polish Journal of Surgery

... The first edition of the Polish Consensus -Principles of Gastric Cancer Management -was published in the Polish Journal of Surgery at a conference memorializing the 20th anniversary of this project in 1997 [1]. Subsequent consensus updates followed in 2013 and 2017 [2,3]. ...

Polish Consensus on Treatment of Gastric Cancer; update 2017
  • Citing Article
  • October 2017

Polish Journal of Surgery

... [1] In addition, DEB-TACE also shows potential in treating HCC patients who were in early or advanced stages, and it is more encouraging that a few studies illuminate that DEB-TACE has the potential to be applied in patients with other solid tumors, such as unresectable soft tissue sarcoma and liver metastasis from other sites. [2][3][4][5][6][7][8] Based on the most recent global epidemiology report of cancer, several carcinomas remain to be the major causes of cancer death, which include lung cancer, colorectal carcinoma, gastric cancer, and so on. [9] For the purpose of enhancing treatment response and prolonging survival of patients with these cancers, increasing studies have been done to explore optional treatment modalities. ...

Long-term survival in a patient with unresectable liver metastases from uveal melanoma treated with transarterial chemoembolization with irinotecan eluting beads – case report and review of literature

... Additionally, to prevent CRC, processed meat consumption must be limited to <76 g per day [39]. Patients who consume red or processed meat ≥4 times per week have been reported to have a 20% higher risk of developing CRC than those who consume red or processed meat <2 times per week [40]. ...

A Prospective, Descriptive Study to Assess the Effect of Dietary and Pharmacological Strategies to Manage Constipation in Patients with a Stoma
  • Citing Article
  • November 2015

Ostomy/wound Management

... 8,9 More recently, the expression of genes involved in steroidogenesis was characterized as a signature for survival of patients with hormoneindependent cancers such as gastric cancer and gastrointestinal stromal tumors. 10,11 Since steroids are important modulators of the immune response, we investigated whether the enzymes involved in steroid metabolism were associated with clinical outcome and antitumor immune responses in ccRCC. Our results shed light on the inhibitory function of glucocorticoid regeneration through HSD11B1 in the immune response against renal cancer. ...

mRNA expression of steroidogenic enzymes, steroid hormone receptors and their coregulators in gastric cancer

Oncology Letters

... Both the patient and surgeon observe how the stoma is stenosing over time. The management begins with the modification of the diet to make the feces softer since there is difficulty in evacuating the feces, and their flatus even becomes louder; complete obstruction is rare because the stenosis is treated before this happens [6,7]. ...

Conservative Measures for Managing Constipation in Patients Living With a Colostomy
  • Citing Article
  • March 2017

Journal of Wound Ostomy and Continence Nursing

... Protected amoxicillin, 3rd-generation cephalosporins or fluoroquinolones are often first-line antibiotics. The duration of treatment varies from 2 to 5 weeks, depending on the patient's condition, the existence of comorbidities (such as diabetes), and the type of surgery performed [15]. ...

A diabetic patient with suppurative thyroiditis due to Salmonella enterica complicated by acute kidney injury

Polish Archives of Internal Medicine

... In recent years, scientific interest has been focused on the study of systemic and local anastomotic protection factors, aiming to enhance the healing process [68]. The most promising results have been observed with the use of the intraluminal latex implant, mechanical protection using a biofragmentable ring (BAR), the administration of growth factors (EGF, PDGF), and the application of bioadhesives (fibrin glue, fibrin sealant, Floseal) [69][70][71]. Various adhesive biological materials have been tested from time to time, aiming to enhance mechanical strength and to reduce the incidence of anastomotic dehiscence. These fibrous adhesives are biodegradable and biocompatible and have been used in numerous surgical procedures [72,73]. ...

Gastrointestinal tract anastomoses with the biofragmentable anastomosis ring: is it still a valid technique for bowel anastomosis? Analysis of 203 cases and review of the literature

International Journal of Colorectal Disease

... The postoperative incontinence rate is not related to the dosage regardless of the type of formulation of BTA used. Also, there is no diference in healing rates with regard to the site and number of injections per session [49]. BTA has been shown to give comparable results with internal vs. external anal sphincter injection. ...

Reference:

Fissure-In-ANO
Erratum to: Botulinum Toxin Injection for Treatment of Chronic Anal Fissure: Is There Any Dose-Dependent Efficiency? A Meta-Analysis
  • Citing Article
  • September 2016

World Journal of Surgery