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.
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.
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.
Michał Mik, Łukasz Dziki, Radzisław Trzciński and Adam Dziki
The 30-day mortality is one of the factors reflecting the quality of treatment. All these efforts focused on decreasing 30-day mortality will directly improve quality of care.
The aim of the study was to identify risk factors of 30-day postoperative mortality in a cohort of patients operated on for colorectal cancer in one tertiary colorectal centre.
Material and methods. Patients operated on due to colorectal cancer (CRC) between 2008 and 2014 were included in the study. 30-day mortality was assessed as an endpoint of the retrospective study.
All records were collected from prospective database.
Results. 1744 patients were operated on due to CRC. The 30-day mortality was noted in 65 patients (3.5%). In multivariable analyses we revealed that spread disease and poor general condition at admission were risk factors of 30-day mortality: OR 2.35; 2.01-2.57 95%CI, p=0.03 and OR 2.18; 1.95-2.41 95% CI; p=0.01, respectively. Emergency surgery significantly increased the risk of 30-day mortality: OR 2.64; 2.45-2.87 95%CI; p=0.009. Low serum albumin concentration level and diabetes mellitus were additional risk factors for 30-day mortality, OR 1.65; 1.52-1.78 95%CI; p=0.01 and OR 1.67; 1.41-1.82 95%CI; p=0.03, respectively. Mortality was significantly higher after resection procedures than after only palliative operations: 4.21% vs 1.57%; p=0.002.
Conclusions. Emergent patients, patients with advanced disease and in poor general state have to be assessed by multidisciplinary team to prepare them to operation. Additionally to reduce the risk of 30-day mortality decision of extend of surgery should be made by experienced surgeons.
Katarzyna Malinowska, Michał Mik, Łukasz Dziki, Adam Dziki and Ireneusz Majsterek
Cancers are among the most feared diseases of modern civilization. In Poland, colorectal cancer is one of the tumors with the worst prognosis. The ability to cure is primarily dependent on the stage of the disease at the time of diagnosis.
The aim of the study was evaluate antioxidant response in patients with colorectal carcinoma.
Material and methods. Twenty patients (14 men and 6 women) aged 61.9± 11.1 years with colorectal cancer were included in the study. Twenty healthy subjects (4 men and 16 women) aged 64 ± 15.3 years formed the control group. The erythrocyte activities of antioxidant enzymes, superoxide dismutase (SOD), and glutathione peroxidase (GPx),
Results. A significant increase of GPx, and SOD (p < 0.05) were seen in patients compared to healthy controls.
Conclusion. The results indicate that the tested antioxidant enzyme activity of glutathione peroxidase and superoxide dismutase is increased in patients diagnosed with colorectal cancer compared to the control group.
Karolina Przybyłowska, Jerzy Mrowicki, Andrzej Sygut, Piotr Narbutt, Łukasz Dziki, Adam Dziki and Ireneusz Majsterek
Contribution of the -173 G/C Polymorphism of Macrophage Migration Inhibitory Factor Gene to the Risk of Inflammatory Bowel Diseases
Inflammatory bowel disease (IBD) represents a heterogeneous group of chronic disorders characterized by inflammation of gastrointestinal tract, typically with a relapsing and remitting clinical course of unknown etiology. Presumably, IBD develops with response exogenous environmental factors only in persons with genetic predisposition. This predisposition was suggested to be associated with polymorphism and mutations in genes encoding proinflammatory immune system proteins. Enhanced production of macrophage migration inhibitory factor (MIF) was found in patients with inflammatory bowel disease (IBD) and mice with experimental colitis. These results suggest that MIF plays a critical role in etiology of the colitis.
The aim of the study was determine whether the MIF -173 G/C gene polymorphism is associated with the susceptibility to inflammatory bowel disease (IBD).
Material and methods. A total of 99 IBD patients, including 58 patients with ulcerative colitis (UC) and 41 with Crohn's disease (CD) and 436 healthy controls recruited from the Polish population, were genotyped for MIF polymorphisms. Genotyping of MIF gene polymorphism was performed by a RFLP-PCR.
Results. We found an increased risk of UC for the C allele of the MIF-173 G/C polymorphism. The distribution of the genotypes was not significantly different in the CD group compared with the controls.
Conclusions. We demonstrated that the C allele is associated with an increased risk for development of UC. This suggests that the G/C polymorphism in the MIF gene promoter may be a potential risk factor for UC in Polish population.