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Andrzej Szawłowski, Marek Pertkiewicz, Michał Drews, Adam Dziki, Ireneusz Krasnodębski, Jan Kulig, Paweł Lampe, Zoran Stojcev, Grzegorz Wallner and Wojciech Zegarski

Recommendations of Association of Polish Surgeons and Polish Society of Oncological Surgery Gastrointestinal Fistulae in Patients Treated for Malignancy - Diagnostics and Treatment

Postoperative gastrointestinal fistulae occur more often in patients undergoing surgical treatment for oncological reasons than non-oncological reasons. Fistula is associated with a number of serious sequelae and complications: fluid and electrolyte abnormalities, acid-base abnormalities, local and systemic infection and progressive cachexia that increase morbidity, treatment duration and mortality. Development of fistula additionally delays or prevents specific treatment in oncology. For a patient, a fistula is associated with both physical and mental suffering resulting from concern over further therapy.

Although the introduction of advanced surgical techniques, intensive postoperative care, total parenteral nutrition and modern enteral nutrition, resulted in decreased postoperative mortality, however the number of patients with gastrointestinal fistulae hospitalized in the departments of surgery is not decreasing. This may result from the fact that many patients still present for treatment in the advanced phase of their malignancy (clinical stage III/IV according to International Union Against Cancer - UICC) and consequently in worse general status, which poses a high risk of postoperative complications and requires more extensive procedures in progressively older patients. Thus gastrointestinal fistulae still remain a serious clinical problem. Main components of treatment of fistulae include: adequate draining, fighting of infections, artificial nutrition and drugs that decrease gastrointestinal secretion (e.g. somatostatin) that are intended to create conditions for spontaneous fistula healing. Some cases may require an early or late surgical intervention.

Open access

Grzegorz Wallner, Michał Solecki, Andrzej Dąbrowski, Grzegorz Ćwik, Andrzej Dąbrowski, Andrzej Matyja, Paweł Lampe and Adam Dziki

Open access

Anna Pietrzak, Witold Bartnik, Marek Szczepkowski, Piotr Krokowicz, Adam Dziki, Jarosław Reguła and Grzegorz Wallner

Open access

Marek Krawczyk, Jerzy Wordliczek, Antoni Czupryna, Jan Dobrogowski, Marek Dobosz, Wojciech Gaszyński, Piotr Andziak, Hanna Misiołek and Adam Dziki

Open access

Przemysław Ciesielski, Maciej Berut, Krzysztof Górnicki, Jacek Skoczylas, Maja Gorajska, Marcin Żuk, Andrzej Rutkowski, Justyna Dłubek and Adam Dziki

Abstract

In Poland there there are about 15-16 thousand cases of colon cancer per year. The health care system allows the treatment of patients with colorectal cancer in highly specialized hospitals, oncology centers and district hospitals. The results of treatment within different reference level differ.

The aim of the study was to evaluate the results of surgical treatment of patients with colorectal cancer at a district hospitals compared with the results of highly specialized center.

Material and methods. A retrospective study. The material consisted of 171 consecutively operated patients diagnosed with colorectal cancer treated in the Department of Surgery, District Hospital in Wołomin. The control group consisted of 200 patients treated surgically at the Department of General and Colorectal Surgery, University Hospital in Łódź. In both centers, the patients were operated on by surgeons with experience in operations on the large bowel. The demographic data, information on the type of indication (elective vs emergent), and the severity of the disease by AJCC / TNM scale were collected. In the district hospital there were patients with more advanced disease (p <0.001), older (p = 0.0001), and often operated under emergent indication (p = 0.0001). The telephone survey collected data on survival or the date of death of the patient and set the percentage of five-year survival.

Results. The proportion of five-year survival in the study group and control group was respectively 46% and 71% (p <0.0001). The percentage of five-year survival among patients undergoing elective procedure in both centers were respectively for Wołomin and Łódź 58% and 73% (p = 0.008). The proportion of 5-year survival among “younger” patients (<70) was respectively in Wołomin and Łódź 64% and 81% (p = 0.004) for “older” patients with (> 70) 50% and 60% (p = 0.6747)

Conclusions. Overall results of surgical treatment of patients with colorectal cancer in the district hospital are inferior to treatment results in a highly specialized center. The population treated in the district hospital is statistically significantly different in comparison to patients treated in highly specialized center. The following differences were captured: severity of the disease, age and type of indication (elective vs emergent). The diffrences has an influence on the outcomes. The five years survival for patients > 70 years undergoing elective procedure is not statistically different between the district hospital and highly specialized center.

Open access

Maciej Śmietański, Kamil Bury, Andrzej Matyja, Adam Dziki, Grzegorz Wallner, Michał Studniarek, Jerzy Fridiger, Marek Szczepkowski, Maciej Świerblewski, Tadeusz Wróblewski, Wiesław Tarnowski, Rafał Solecki and Kryspin Mitura

Open access

Piotr Paluszkiewicz, Ewa Mayzner-Zawadzka, Włodzimierz Baranowski, Grzegorz Bręborowicz, Maciej Brzeziński, Grażyna Durek, Adam Dziki, Maria Czupryńska, Małgorzata Lipińska-Gediga, Magdalena Łętowska, Andrzej Mital, Elżbieta Nowacka, Magdalena Pychyńska-Pokorska, Jerzy Ratajczak, Jan Rogowski, Zbigniew Rybicki, Sławomir Sobieszczyk, Radzisław Trzciński, Marta Wawrzynowicz-Syczewska, Jerzy Windyga and Maria Wujtewicz

Recommendations for the Management of Trauma or Surgery-Related Massive Blood Loss

Exsanguination is an underestimated cause of treatment failures in patients with severe trauma or undergoing surgery. In some patients the primary dysfunction of blood clot formation is a direct cause of a massive blood loss. Patients without previous coagulation disorders are at risk of coagulopathy following intraoperative or post-traumatic bleeding, where the local haemostasis does not warrant bleeding cessation.

The aim of the study was to assess the therapeutic value of various components of a complex interdisciplinary approach, based on the opinion of the experts treating patients with massive bleeding.

Material and methods. The study was conducted by anonymous questionnaire, using the analogue representation of the argument strength. The results were analyzed based on the techniques of descriptive statistics. The argument was considered a key parameter, when the median value of strength was located in the highest quartile.

Results. It was found that the arguments of the highest strength for the risk of developing the posthaemorrhagic coagulation disorders are: loss of more than one third of blood volume, fluid therapy in an amount greater than 35 ml / kg, administration of more than 5 units of packed red blood cells, insufficient supply of fresh frozen plasma and platelets in proportion to packed red blood cells, severe acidosis and hypothermia. The most important tests for post-haemorrhage coagulopathy are: anatomically non-localized bleed, abnormal values of the standard coagulation parameters and fibrinogen level below 1 g / L. In the treatment of post-haemorrhagic coagulopathy the team of experts pointed out the benefits of antifibrinolytic drugs, concentrates of prothrombin complex and recombinant activated coagulation factor VII.

Conclusions. Multidisciplinary therapeutic management of bleeding patients is associated with employment of appropriate treatment methods to achieve the best possible outcome. Factors influencing the development of coagulopathy, the methods of diagnosis and proposed techniques of treatment may facilitate therapeutic decisions in bleeding patients requiring massive transfusion of blood components.

Open access

Marek Szczepkowski, Tomasz Banasiewicz, Piotr Krokowicz, Adam Dziki, Grzegorz Wallner, Michał Drews, Roman Herman, Zbigniew Lorenc, Piotr Richter, Krzysztof Bielecki, Wiesław Tarnowski, Jan Kruszewski, Józef Kładny, Stanisław Głuszek, Wojciech Zegarski, Wojciech Kielan, Krzysztof Paśnik, Marek Jackowski, Mariusz Wyleżoł, Zoran Stojcev and Alicja Przywózka