Oskar Kornasiewicz, Piotr Hevelke and Marek Krawczyk
Mariusz Frączek, Piotr Hevelke, Krzysztof Komorzycki, Marcin Kotulski, Piotr Kalinowski, Barbara Górnicka and Marek Krawczyk
Esophagogastric Junction Versus Gastric Carcinoma - Implications for Surgical Tactics on the Basis of Own Experience
The exact prevalence and results of treatment of the carcinoma of esophagogastric junction (gastric cardia) are difficult to assess, and the data concerning thereof, presented in different series of patients, are frequently inconsistent. This phenomenon may result from terminological mess, resulting in different comprehension of the sole term "esophagogastric junction". That can be why the results of treatment of patients with this type of cancer are dispersed in the literature and may be as well found under "esophageal", as well as "gastric cancer" headings.
The aim of the study was to present the current view of the pathogenesis, pathology and terminological issues concerning this tumor, interesting at least for its localization at the border of two viscera and two body cavities. On the basis of our own material, we also tried to delineate the implications of such a localization to surgical tactics.
Material and methods. The patients with esophagogastric junction and more peripherally located gastric cancer were analysed in two groups, according to the date of resectional surgery performed: From 1989 to 1998 (group I), and from 1999 to 2005 (group II). In each group the patients with esophagogastric junction and peripheral gastric cancer were investigated separately. The influence of more aggressive approach to cardial cancer (additional thoracotomy approach) in group II patients on the cancer free tissue margin, number of metastatic lymph nodes excised, as well as on survival rate during a 5-years follow-up was assessed.
Results. The results show, that the additional thoracotomy, despite the increase in postoperative complications rate (mainly affecting the respiratory system- 19 vs 4.3% at laparotomy alone), did not influence the perioperative motality in our patients (approximately 5% in all subgroups). Despite the additional thoracotomy approach, facilitating the safe lower esophageal resection, the cancer free margins of the excised specimens remained unsatisfactory (the target safe margin value of 7 cm), although some improvement can be noted as compared with group I patients. The interesting finding was, that the survival rates following gastrectomy for ‘peripheral’ gastric carcinoma has been remaining practically unchanged during the 20 years of this study. Survival rates following gastric cardia resection improved in group II patients, but the differences did not reach the statistically significant level. The difference in survival rate was increasing with time in favor of group II patients, its value being triple at 5 years from surgery (18 vs 6%) as compared with group I.
Conclusions. We see the need for the development of a method allowing to select the patients with good prognosis, in whom further radicalization of resectional procedures (and subsequent treatment) would be justified by long-term disease-free survival.
Marek Krawczyk, Michał Grąt, Krzysztof Barski, Joanna Ligocka, Arkadiusz Antczak, Oskar Kornasiewicz, Michał Skalski, Waldemar Patkowski, Paweł Nyckowski, Krzysztof Zieniewicz, Ireneusz Grzelak, Jacek Pawlak, Abdulsalam Alsharabi, Tadeusz Wróblewski, Rafał Paluszkiewicz, Bogusław Najnigier, Krzysztof Dudek, Piotr Remiszewski, Piotr Smoter, Mariusz Grodzicki, Michał Korba, Marcin Kotulski, Bartosz Cieślak, Piotr Kalinowski, Piotr Gierej, Mariusz Frączek, Łukasz Rdzanek, Rafał Stankiewicz, Konrad Kobryń, Łukasz Nazarewski, Dorota Leonowicz, Magdalena Urban-Lechowicz, Anna Skwarek, Dorota Giercuszkiewicz, Agata Paczkowska, Jolanta Piwowarska, Remigiusz Gelo, Paweł Andruszkiewicz, Anna Brudkowska, Renata Andrzejewska, Grzegorz Niewiński, Beata Kilińska, Aleksandra Zarzycka, Robert Nowak, Cezary Kosiński, Teresa Korta, Urszula Ołdakowska-Jedynak, Joanna Sańko-Resmer, Bartosz Foroncewicz, Jacek Ziółkowski, Krzysztof Mucha, Grzegorz Senatorski, Leszek Pączek, Andrzej Habior, Robert Lechowicz, Sławomir Polański, Elżbieta Leowska, Ryszard Pacho, Małgorzata Andrzejewska, Olgierd Rowiński, Sławomir Kozieł, Jerzy Żurakowski, Bogna Ziarkiewicz-Wróblewska, Barbara Górnicka, Piotr Hevelke, Bogdan Michałowicz, Andrzej Karwowski and Jerzy Szczerbań
1000 Liver Transplantations at the Department of General, Transplant and Liver Surgery, Medical University of Warsaw - Analysis of Indications and Results
The aim of the study was to analyze indications and results of the first one thousand liver transplantations at Chair and Clinic of General, Transplantation and Liver Surgery, Medical University of Warsaw.
Material and methods. Data from 1000 transplantations (944 patients) performed at Chair and Clinic of General, Transplantation and Liver Surgery between 1994 and 2011 were analyzed retrospectively. These included 943 first transplantations and 55 retransplantations and 2 re-retransplantations. Frequency of particular indications for first transplantation and retransplantations was established. Perioperative mortality was defined as death within 30 days after the transplantation. Kaplan-Meier survival analysis was used to estimate 5-year patient and graft survival.
Results. The most common indications for first transplantation included: liver failure caused by hepatitis C infection (27.8%) and hepatitis B infection (18%) and alcoholic liver disease (17.7%). Early (< 6 months) and late (> 6 months) retransplantations were dominated by hepatic artery thrombosis (54.3%) and recurrence of the underlying disease (45%). Perioperative mortality rate was 8.9% for first transplantations and 34.5% for retransplantations. Five-year patient and graft survival rate was 74.3% and 71%, respectively, after first transplantations and 54.7% and 52.9%, respectively, after retransplantations.
Conclusions. Development of liver transplantation program provided more than 1000 transplantations and excellent long-term results. Liver failure caused by hepatitis C and B infections remains the most common cause of liver transplantation and structure of other indications is consistent with European data.