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Józef Kładny, Tariq Al-Amawi, Michał Kozłowski, Piotr Wojtasik and Małgorzata Świder-Al-Amawi

Is the Surgeon's Experience an Independent Prognostic Factor in Rectal Cancer?

The aim of the study was to evaluate the influence of the surgeons' caseload on the results of therapy in rectal cancer.

Material and methods. 286 consecutive patients (155 males and 131 females) were enrolled and operated on for rectal cancer stage T2 (112 patients) and T3 (174 patients) in 8 surgical centers of Szczecin between January 1993 and December 1997. Studied group included about 79% of radically operated patients due were to rectal cancer in analyzed period.

Results. The patients were assigned to one of two groups with regard to the surgeon's caseload. The first group was comprised of 116 patients (including 72 stage T3 and 54 stage T2 patients) operated on by surgeons more experienced in rectal surgery and the second group was comprised of 160 patients operated on by 36 surgeons with fewer caseloads. The surgeon's experience in rectal surgery was measured by the surgeon's caseload throughout the entire study period. We considered surgeons with greater than 25 cases over the study period experienced.

Analysis of survival with regard to the managing center revealed significant differences for stage T3, with 5-year-survival rates ranging from 14% to 60%. Distinct differences were also noted for survival rates in stage T2 (5-year-survival rates ranged from 38% to 86%); however, these differences were not statistically significant. Analysis of the influence of surgeon's caseload on outcomes in rectal cancer revealed a significant influence in stage T3 and a lack of influence in stage T2.

Conclusion. The surgeon's experience is an independent prognostic factor for stage T3 rectal cancer patients.

Open access

Tariq Al-Amawi, Małgorzata Świder-Al-Amawi, Mirosław Halczak, Piotr Wojtasik and Józef Kładny

Advisability of Palliative Resections in Incurable Advanced Gastric Cancer

Effective treatment is the primary objective of surgeon in the treatment of advanced gastric cancer. Poor prognosis and significant advancement of gastric cancer at the time of diagnosis are decisive factors for the only possible surgical management method being palliative procedures.

The aim of the study was the evaluation of the value of palliative resection procedures in patients with advanced gastric cancer.

Material and methods. The subject in the study was a group of 105 patients with gastric adenocarcinoma at stage 4 of advancement, in whom curative treatment was not possible. The group constituted 44.5% of patients operated on due to gastric cancer at the Department of General and Oncological Surgery, PUM, in the years 1998-2009. The patients were divided into two groups: the first one comprised 44 patients post palliative resections, the second - 61 patients post non-resection procedures. The subject of analysis were early and late treatment results post palliative resections, and they were compared with the treatment results post non-resection procedures.

Results. Palliative resections were performed in 44 patients (19 females and 25 males), while in 61 patients (38 males and 23 females) non-resection procedures were performed. Postoperative complications were observed in 25% of patients in the group post palliative resections and in 11.5% in the group of patients without the resection of primary focus. In-hospital mortality stood at 4.5% in the group post palliative resections and 4.8% in the group post non-resection procedures. The percentage of 1-year and 4-year survival post palliative resections stood at 43% and 8.8%, respectively. In the group without the resection of primary focus, 16% survived 1 year and nobody survived 2 years. Conclusions. Palliative resections improve the survival of patients with incurable gastric cancer and should be considered if only the loco-regional conditions are favourable.

Open access

Mirosław Halczak, Piotr Wojtasik, Tariq Al-Amawi and Józef Kładny

Elective Resection of Rectal Cancer Primary Tumor in Patients with Stage IV Disease - Own Experiences

Optimal management of asymptomatic generalized rectal cancer is still the matter of debate.

The aim of the study was to review stage IV rectal cancer patients who were treated in our clinic since 2000 till 2008 in order to evaluate the effectiveness of surgery.

Material and methods. Fifty-two generalized rectal cancer patients treated with elective resection of primary tumor were identified. Patients' age, sex, duration of hospital stay, modality of surgery, complications, postoperative mortality rate and survival rate were assessed.

Results. Median survival was 16.3 months. Postoperative complications occurred in 29% patients. Postoperative mortality rate was 1.9%.

Conclusions. In properly selected group of patients elective resection of primary tumor may cause low mortality rate and acceptable morbidity rate. This surgical modality allows to avoid potential complications of tumor local growth.