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  • Author: Jarosław Szefel x
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Wiesław Janusz Kruszewski, Jakub Walczak, Mariusz Szajewski, Tomasz Buczek, Maciej Ciesielski and Jarosław Szefel

The quality of liver assessment in an oncological patient plays an important role in the selection of a proper type of medical intervention. Diagnostic techniques commonly used in liver imaging are still far from perfect. Intraoperative liver evaluation using an intraabdominal ultrasound probe remains an important tool for proper assessment of this organ.

The aim of the study was to evaluate suitability of this intraoperative diagnostic method for detection of primary and secondary neoplastic pathologies of the liver.

Material and methods. Between March 2010 and the end of December 2011, we performed intraoperative ultrasound examinations of the liver during 220 of 461 laparotomies carried out for oncological reasons.

Results. In 72 patients (33%), intraoperative ultrasonography using an intraabdominal probe revealed neoplastic pathologies in the liver. In 16 patients (7%), the pathologies had not been observed in the preoperative imaging examinations. In 7 cases (3%), the detected tumors were impalpable and invisible in macroscopic examination routinely performed during laparotomy. The time of performing preoperative liver examinations did not affect the detection of previously unrecognized liver tumors (p > 0.05). We found progression in the number of liver tumors in 28 patients (39%). In 20 patients (9%), the primary surgical plans were changed intraoperatively.

Conclusions. Liver examination using an intraabdominal ultrasound probe is a useful tool for assessment of neoplastic disease progression. The procedure allows proper choice of an optimal treatment regime and decreases the risk of performing an unnecessary oncological invasive procedure.

Open access

Jacek Wydra, Wiesław Kruszewski, Wojciech Jasiński, Mariusz Szajewski, Maciej Ciesielski, Jarosław Szefel and Jakub Walczak

Abstract

Colorectal cancer is the most common malignant neoplasm in elderly with peak of incidence in 7. and 8. decade of life. Elderly patients with colorectal cancer more often require surgery. Advanced age of patients seems to increase the risk of postoperative complications.

The aim of the study was to compare the frequency of early complications in two groups of patients: under 75 and over 75, undergoing elective colorectal cancer surgery.

Material and methods. 440 consecutive adult patients subjected to colorectal cancer surgery between 08.2006 to 10.2011 in Oncological Surgery Department, Gdynia Centre of Oncology. Group A (over 75 year-of-life): 109 patients, median 79 and group B (up to 75 year-of-life): 331 patients, median 65. Patients requiring emergency surgery were excluded from the study. Postoperative 30-day mortality, anastomotic leakage, wound infection, bowel obstruction, postoperative respiratory and circulatory insufficiency were among analyzed complications.

Results. Symptomatic disease was observed in 81.6% of group A and in 83% of group B. Groups A and B were comparable concerning: BMI, gender, tumor staging, rate of curative and palliative resections, and duration of hospital stay. Accompanying diseases were more common in group A (83% vs 65%; p<0.0002). Early complications occurred in 21.1% of patients from group A and in 19.9% from group B. The rate of reoperation in early perioperative period didn’t differ (6.4% vs 5.7%). Features like: age, gender, additional illnesses, tumor location and staging did not influence the occurrence of perioperative complications.

Conclusions. Age itself is not a risk factor for postoperative complications in spite of higher rate of accompanying diseases in elderly.

Open access

Wiesław Kruszewski, Wojciech Jasiński, Mariusz Szajewski, Jarosław Szefel, Krzysztof Kawecki, Maciej Ciesielski, Paweł Pikiel, Paweł Dilling and Cezary Warężak

Protective Stomy as a Complement to Anterior Rectal Resection. Analysis of Authors' Material and Literature Review

Anastomotic leak after anterior rectal resection for cancer is one of the most dangerous complications of the procedure. Protective stomy is a way to avoid life-threatening consequences of this complication. The procedure is still under evaluation.

The aim of the study was to evaluate the usefulness of forming a protective stomy as part of anterior rectal cancer resection on the basis of an analysis of the authors' material.

Material and methods. In 2008 - 2009, we treated 111 patients with rectal cancer. Thirty-two of those patients received preoperative radio(chemo)therapy. Eighty-four patients (76%) underwent resection of the primary tumour. In 20 patients (24%), we performed abdominoperineal or abdominosacral resection; in 6 (7%) cases the Hartmann procedure was used and in 58 (69%) cases anterior rectal resection was performed. In 53 of 58 cases, the resections were assessed as curative and in 5 as palliative. In 18 of 58 (31%) patients, anterior resections were defined as low anterior resections. Twelve (67%) of these patients were subjected to preoperative radio(chemo)therapy. Two of 58 patients, who underwent anterior resection, had been treated by stomy creation before the radical procedure. One of them required neoadjuvant radiotherapy. In the second patient with the stomy, we restored the intestinal continuity during the primary tumour resection. Among the remaining 40 patients, only one underwent protective stomy creation during the resective procedure. This patient did not require preoperative radiotherapy.

Results. We have not found any clinical indications of anastomotic leak in the analysed group of 58 patients subjected to anterior rectal resection for cancer.

Conclusions. Our modest experience reaffirms our conviction that anterior rectal cancer resection does not require routine protective stomy creation, also when low anterior resection follows preoperative radiotherapy.