Alicja Klimczak, Michał Mik, Łukasz Dziki, Wojciech Seroka and Adam Dziki
Resections and Palliative Procedures in Patients Operated on for Colorectal Cancer in Poland in 2005-2008
The aim of the study was analysis of the number of resection and palliative procedures in patients operated on for colorectal cancer in Poland. We also analyzed the number of sphincter-sparing surgery in patients with rectal cancer.
Material and methods. Statistical data about surgical procedures performed in patients with colorectal cancer were obtained from the National Institute of Hygiene in Warsaw. The procedures were divided into palliations and resections. The analysis was performed for the period from 2005 to 2008. We analyzed the data including women and men.
Results. We observed an increase in the number of resections from 3381 to 3768 (85.6-88% of all treatments) (2005-2008) in patients with colon cancer. A similar regularity was observed in patients who underwent surgery for rectal cancer from 2335 to 2712, respectively (76.4 to 81.4% of all treatments). Similarly, the number of sphincter-sparing surgery over the course of the period has increased from 1502 to 1916 operations.
Conclusions. The increase in the percentage of resections and sphincter-sparing surgery may indicate the progress in the earlier detection of colorectal cancer. Another reason for this increase may be improving the level of education of surgeons due to the better availability of workshops and training. However, analysis is based on too short period of time and these conclusions cannot be regarded as final.
Jarosław Buczyński, Ewa Langner and Adam Dziki
A foreign body in the rectum is not a very common emergency case in surgical practice, of various etiology. In the years 2003-2011, 8 people were hospitalised in the Clinic of General and Colorectal Surgery due to a foreign body in the rectum. All the patients were male. All of them were qualified for foreign body removal in a surgical suite, under general anaesthesia due to a potential need for expanding the scope of the procedure. In all situations attempts were made at removing the object through the anus, which proved successful in 7 cases, without complications.In one case the scope of the procedure needed to be expanded with laparotomy and sigmoidotomy, through which the foreign body was removed. This procedure was also carried out with no complications.
Łukasz Dziki, Michał Mik, Radzisław Trzciński, Marcin Włodarczyk, Mariusz Skoneczny and Adam Dziki
A perianal fistula is a pathological canal covered by granulation tissue connecting the anal canal and perianal area epidermis. The above-mentioned problem is the reason for the patient to visit the surgeonproctologist. Unfortunately, the disease is characterized by a high recurrence rate, even despite proper management.
The aim of the study was to determine the current condition of perianal fistula treatment methods in everyday surgical practice, considering members of the Society of Polish Surgeons. Material and methods. 1523 members of the Society of Polish Surgeons received an anonymous questionnaire comprising 15 questions regarding perianal fistula treatment in everyday practice.
Results. Results were obtained from 807 (53%) members. After receiving answers, questionnaire results were collected, analysed, and presented in a descriptive form.
Conclusions. Study results showed that most Polish surgeons choose the fistulectomy/fistulotomy method. Considering treatment of perianal fistulas the most important issue is to find the correct, primary fistula canal. Further methods should be individually selected for each patient. One should also remember that every fistula is different. Surgical departments that operate a small number of perianal fistulas should direct such patients to reference centers.
Łukasz Dziki, Michł Mik, Radzisław Trzciński, Jarosław Buczyński, Justyna Darnikowska, Michał Spychalski, Anna Wierzbicka and Adam Dziki
Loop stoma allows reducing the percentage of anastomotic leak and re-operation caused bythis complication. Our department has performed the loop stoma on a skin bridge since 2011.
The aim of the study was to evaluate the early results of treatment after the skin bridge loop stoma creation in comparison with the stoma made on a plastic rod. Both groups had 20 patients.
Material and methods. The study involved 40 patients with ileostomy, operated 2010-2013. We evaluated 20 patients with a loop ileostomy on a plastic rod, compared to 20 other patients with a skinbridge ileostomy. The study included 24 men and 16 women. Median age was 68.3. All evaluated patients were previously operated due to rectal cancer.
Results. It has been shown that the surgical site infection is more common in the group with a plastic rod (5 vs 1 patient). Inflammation of the skin around the stoma occurred in 18 patients (90%) in the first group, while no such complication was found in patients in the second group. The average number of exchanged ostomy wafers was 2,9 per weekin the first group of patients, and 1,1 in the second group (p 0,05).
Conclusions. The creation of the skin bridge stoma allows for tight fit of the ostomy appliance immediately after surgery completion. The equipment has stable and long-lasting contact with the skin, no skin inflammatory changes occur. Also the surgical site infection rates are lower in this group of patients. As perioperative patient does not require an increased number of ostomy appliance, the cost of treatment can be considered as an important aspect.
Mariusz Pawlak, Zbigniew Morawiec, Łukasz Dziki, Jan Morawiec, Agnieszka Kolacińska and Adam Dziki
Abstract The aim of the study
was to assess the impact of hospital caseload on long-term outcomes of rectal cancer patients. We posed two questions: 1. Does the number of operations carried out in the surgical department influence five year survival and local recurrence rates? 2. Does surgery alone without adjuvant therapy performed in the particular department affect long-term results?
Material and methods. 215 consecutive rectal cancer patients treated in six hospitals of the Łódź district between 1994 and 1998 were enrolled into this prospective study. We analyzed patients in whom local excision, low anterior resection, abdominoperineal resection and Hartmann’s procedure were performed. 27 percent of patients received adjuvant therapy such as radio- or chemotherapy or both. Long-term results were compared between high and low volume institutions by means of local recurrence and five year survival rates.
Results. In high volume departments; 69.2% of five year survival rates were obtained versus 46.6% for low volume institutions (p=0.00433). Similar differences were noted comparing local recurrence rates between the aforementioned groups: 19.7% versus 36.5%, respectively (p=0.00430). In surgically treated patients who did not receive adjuvant therapy statistically significant differences were found: 76.5% of patients operated on in high volume hospitals survived five years as compared with 42.9% for low caseload institutions (p=0.00013). Local recurrence rates were 15.5% for high caseload institutions and 38.5% for low caseload hospitals (p=0.00042).
Conclusions. High volume hospitals achieved better results in rectal cancer patients with regard to five year survival and local recurrence rates. Better outcomes were also obtained in high caseload departments regarding surgically treated patients who did not receive adjuvant therapy.
Jacek Kabziński, Karolina Przybyłowska, Michał Mik, Andrzej Sygut, Łukasz Dziki, Adam Dziki and Ireneusz Majsterek
An Association of ARG399GLN Polymorphism of XRCC1 Gene with a Risk of Colorectal Cancer
Colorectal cancer is one of the most commonly diagnosed cancer and a leading cause of death from cancer. DNA repair defects have been associated with an individual susceptibility to cancer. Therefore, polymorphisms of DNA repair genes, including XRCC1 gene, are suspected to may increase the risk of colorectal cancer.
The aim of the study was to examine the association between Arg399Gln polymorphisms of XRCC1 gene and the occurrence of colorectal cancer. Research and understanding of the molecular basis of the formation of colorectal cancer will allow for typing of genetically loaded persons and qualifying them to a high-risk group.
Material and methods. In case-control study we genotyped 150 colorectal cancer patients and 170 healthy subjects from Polish population. Analysis was performed by PCR-restriction fragment length polymorphism (PCR-RFLP).
Results. We found that Gln/Gln genotype is associated with increased risk of colorectal cancer (OR 1.984; Cl 95% 1.070-3.677; p=0.029). We also found that Arg/Gln genotype is a risk factor for progression of tumor growth (OR 3.52; Cl 95% 1.157-10.707; p=0.023).
Conclusions. The current state of research suggests a link between Arg399Gln XRCC1 polymorphism and increased risk of colorectal cancer. Therefore, we conclude that the Arg399Gln polymorphism of XRCC1 gene may underlie at the molecular basis of the causes of colorectal cancer.
Michał Spychalski, Łukasz Dziki, Jarosław Buczyński, Andrzej Kulig, Stanisław Sporny and Adam Dziki
Celecoxib - A Selective Cyclooxygenase-2 Inhibitor Exhibits Dose - Dependent Chemopreventive Activity on an Animal Model of Colorectal Cancer*
Colorectal cancer (CRC) is still one of the unresolved issues in medicine. Despite constant improvements in diagnosis and treatment, the prognosis for CRC is unsatisfactory. In recent years, much attention has been paid to experiments concerning chemoprevention of CRC.
The aim of the study was evaluation of the effectiveness of celecoxib, a selective Cyclooxygenase-2 (COX-2) inhibitor of chemically-induced CRC carcinogenesis in Fisher F344 rats.
Material and methods. Forty-five four-week old male F344 rats were randomized into four groups. In Groups 1, 2, and 3, we induced the CRC carcinogenesis through two subcutaneous injections of Azoxymethane in doses of 20 mg/kg. Rats from groups 1 and 2 were treated with celecoxib in doses of 10 and 30 mg/kg from the start of the experiment. Group 4 was a negative control. The experiment ended in the 26th week. We assessed the following parameters: the number of Aberrant Crypt Foci (premalignant lesions in colons) and the immunoexpression indexes: COX-2, Vascular Endothelial Growth Factor (VEGF), and c-myc.
Results. Celecoxib reduced the ACF number. The ACF reduction was dose-dependent. The median ACF number per field of vision was as follows for each of the groups: 1.7, 0.75, 3.2, and 0.2. Celecoxib, irrespective of the dose, reduced the VEGF immunoexpression index. We did not observe a reduction of COX-2 or c-myc immunoexpression in the celecoxib groups.
Conclusions. In this experiment, we proved that celecoxib possessed chemopreventive activity. Carcinogenesis inhibition by selective COX-2 inhibitor was dose-dependent. We demonstrated that celecoxib hidners angiogenesis, expressed as VEGF immunoexpression. We indirectly confirmed the hypothesis of a celecoxib COX-2 independent pathway mechanism of action.
Łukasz Dziki, Anna Puła, Konrad Stawiski, Barbara Mudza, Marcin Włodarczyk and Adam Dziki
The aim of the study was to assess patients’ awareness of the prevention and treatment of colorectal cancer.
Material and methods. Patients diagnosed with colorectal cancer, hospitalised at the Department of General and Colorectal Surgery of the Medical University in Łódź during the period from January 2015 to April 2015, were asked to complete a questionnaire concerning their families’ medical case record, factors predisposing them to the development of colorectal cancer, the tests applied in diagnostics, and the treatment process. The questionnaire comprised 42 closed-ended questions with one correct answer. A statistical analysis of all answers was carried out.
Results. The study group consisted of 30 men and 20 women aged 27–94 years old. A strong, statistically significant negative correlation between a patient’s age and his/her awareness of the prevention and treatment of colorectal cancer was noted (p<0.001; r= −0.51). The study demonstrated a statistically significant relationship between the occurrence of neoplasms in a patient’s family (p=0.009) or, more specifically, the occurrence of colorectal cancer (p=0.008), and the awareness of the prevention programme. The women’s group was characterised by statistically significantly greater awareness of colonoscopy as a screening examination (p=0.004).
Conclusions. Patients need more information on colorectal cancer, its risk factors, prevention, the treatment process, and postoperative care. Lack of awareness of the colorectal cancer issue can be one of the major factors contributing to the high incidence of this disease.
Bartosz Mucha, Karolina Przybyłowska-Sygut, Łukasz Dziki, Adam Dziki, Andrzej Sygut and Ireneusz Majsterek
Lack of Association Between the 135G/C Rad51 Gene Polymorphism and the Risk of Colorectal Cancer Among Polish Population
One of the major causes of carcinogenesis is loss of genome stability. RAD51 in process of homologous recombination (HR) played crucial role in maintenance integrity of genome through initiate of DNA double strand breaks repair. Presence of single nucleotide polymorphism (SNP) in RAD51 gene could change the capacity of DNA repair and altered the response to damaging agents. Research on potential impact of genetic variability on development and progression CRC may contribute to setting new genetic markers or/and determined individual susceptibility to CRC.
The aim of the study. This study was designed to evaluate the effect of 135 G/C (rs1801320) RAD51 polymorphism located in the 5' untraslated region on the risk and progression of CRC.
Material and methods. The subjects consisted of histologically confirmed colorectal cancer (n = 200) and controls (n = 200) with lack of previous history of cancer. The distribution of genotypes was determined by restriction fragment length polymorphism PCR (RFLP - PCR). Statistical analysis was based on multivariate regression model.
Results and conclusion. Our study reveal no significance association of 135 G/C RAD51 polymorphism with occurrence and progression of colorectal cancer.