Maciej Ciesielski and Wiesław Kruszewski
Laparoscopic Surgery For Colon Cancer - A Favorite Method? A Review of Literature
Wojciech Czarzasty, Wiesław Kruszewski, Jacek Zieliński and Marcin Niżnik
A One-Year Follow-Up of the Quality of Life After Stapled Hemorrhoidopexy
Articles presenting treatment outcomes of stapled hemorrhoidopexy are rarely based on detailed analyses of the quality of life.
The aim of the study was the assessment of changes within one year of treatment in the quality of life of patients who underwent stapled hemorrhoidopexy using QLQ-C30 form (version 3).
Material and methods. 120 patients with grade III and IV internal hemorrhoidal disease treated with stapled hemorrhoidopexy were enrolled in the study. They answered questions from QLQ-C30 form and were subjected to examination a day before surgery and 1 day, 7 days, 4 weeks, 6 and 12 months after surgery. Assessment included operation site inspection, pain intensity measurement in VAS scale and parameters incorporated in QLQ-C30 form evaluation.
Results. The overall quality of life decreased immediately after surgery (a day after 50% vs. 60% before surgery), but rapidly improved in one week and in one month periods (60% and 80% consecutively) reaching a plateau one month after surgery. Early complications occurred in 6 patients (5%). Recurrence of the disease was not observed. Bleeding from anastomosis site and severe pain in anal area immediately post surgery as a result of improper purse-string suture placement were the main complications.
Conclusions. In patients with grade III or IV hemorrhoidal disease, stapled hemorrhoidopexy ensures a rapid improvement in the quality of life after surgery to the level experienced prior to the operation. 7-day convalescence period is sufficient. After one month, the overall quality of life improves significantly and reaches a plateau.
Paweł Dilling, Jakub Walczak, Paweł Pikiel and Wiesław J. Kruszewski
Ipilimumab, an anticancer drug, is an anti-CTLA4 monoclonal antibody. It is used in treatment of disseminated melanoma. Therapy is associated with high risk of complications. One of the most serious, although one of the rarest is perforation of gastrointestinal tract. In this case report we describe a 52-year old male, with disseminated melanoma with unknown starting point, treated with anti- CTLA4 monoclonal antibody. After 3rd dose of drug administration, bloody diarrhea and acute abdominal pain occurred as a symptom of gastrointestinal perforation. A single perforation was sutured during laparotomy. Symptoms of acute abdomen returned after 10 days. Pus-faecalperitonitis, symptoms of necro-hemorrhagic colitis and multilocal perforation of the colon were found during relaparotomy. Pancolectomy with end ileostomy was performed. Few hours since relaparotomy pacient died due to multiple organ failure. The purpose of this case report is to draw attention to a risk of multilocal colon perforation in patient treated with ipilumumab.
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.
Beata Szutowicz-Wydra, Jacek Wydra, Wiesław J. Kruszewski, Maciej Ciesielski, Mariusz Szajewski, Jakub Walczak and Rita Hansdorfer-Korzon
Breast cancer often requires combined oncologic treatments, the base of which is surgery. Quality of life (QoL) after each surgical procedure may influence the process of decision making among women, who qualify for multiple oncological strategies. Our knowledge about QoL in breast cancer patients is derived from comparative studies. Results may differ, depending on country, culture, and societal relations.
The aim of the study was to investigate the quality of life of Polish patients treated with breast-conserving therapy (BCT) or mastectomy with breast reconstruction.
Material and methods. The study involved women who underwent surgery for breast cancer in the Department of Surgical Oncology of the Gdynia Oncology Center from September 2010 to November 2013. Eighty-two breast reconstructions (in 79 patients) and 226 BCT procedures were performed. QoL was measured with the use of EORTC QLQ-C30 and QLQ-BR23 questionnaires.
Results. Global QoL was high in both groups and did not differ significantly. Body image was slightly better after BCT than after mastectomy with breast reconstruction, but sexual QoL was lower. Future perspective was quite low in both groups. Disease symptoms were not bothering.
Conclusions. The global QoL among Polish breast cancer patients treated with BCT or mastectomy with breast reconstruction is high and does not differ between groups. There is a need for anxiety and disease-related fear prophylaxis and for the improvement of sex life of breast cancer survivors.
Jacek Wydra, Wiesław Kruszewski, Wojciech Jasiński, Mariusz Szajewski, Maciej Ciesielski, Jarosław Szefel and Jakub Walczak
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.
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.