Rozhledy v Chirurgii最新文献

{"title":"Perioperative systemic therapy as a part of comprehensive multimodal treatment in esophageal and gastric cancer - new treatment guidelines.","authors":"R Lordick Obermannová, V Jedlička, J Dvorský, T Sokop, P Grell, M Slavik, J Trna, L Kunovský-, I Kiss","doi":"10.48095/ccrvch2024443","DOIUrl":"https://doi.org/10.48095/ccrvch2024443","url":null,"abstract":"<p><p>Esophageal and gastric cancer are diseases with a serious prognosis. While the incidence of gastric cancer is decreasing, the incidence of the gastroesophageal junction and esophageal cancer is increasing. Men are affected more often than women. Despite some progress in the last 10 years, cancer-specific mortality is very high, reaching 70%. The prognosis is mainly determined by the stage, histology, general condition and comorbidities. The treatment approach is curative for early and localized stages, requir-ing comprehensive care already during neoadjuvant therapy. Nutritional support is an essential part of preoperative preparation, and centres specializing in esophagogastric surgery are increasingly adopting the concept of prehabilitation. The main treatment modalities are endoscopy, surgery, systemic therapy and radiotherapy. In locally ad-vanced squamous cell carcinoma, neoadjuvant chemoradiotherapy followed by post-operative immunotherapy is the standard of care, if pathological complete remission has not been achieved. Definitive chemoradiotherapy is an alternative in patients with comorbidities. For adenocarcinoma, perioperative FLOT chemotherapy is the first choice and has shown better results than chemoradiotherapy. Chemoradiotherapy has its place in patients who would not tolerate FLOT or when trying to achieve a higher response rate. According to phase II studies, patients with MSI-high tumours could be treated with neoadjuvant immunotherapy, alone or in combination with chemotherapy; this approach has led to a pathological complete remission rate of approximately 60% and is a promising organ-preserving approach. For HER2-positive tumours, preoperative systemic therapy with trastuzumab may be considered as it demonstrates a significantly higher number of pathological complete remissions and offers the possibility of achiev-ing a higher R0 resection rate. In oligometastatic disease, surgical management of the primary tumour and metastases may be considered in individual cases in patients who respond to systemic therapy. However, an impact on overall survival has only been documented in patients with retroperitoneal involvement and no peritoneal metastases.</p>","PeriodicalId":52413,"journal":{"name":"Rozhledy v Chirurgii","volume":"103 11","pages":"443-453"},"PeriodicalIF":0.0,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142792735","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Standardized ERAS protocol in liver and pancreatic surgery.","authors":"K Vinklerová, J Zajak, F Čečka, J Páral, J Sedláčková","doi":"10.48095/ccrvch2024351","DOIUrl":"10.48095/ccrvch2024351","url":null,"abstract":"<p><p>ERAS (enhanced recovery after surgery) represents a comprehensive strategy aimed at expediting patient recovery, reducing complications, and optimizing postoperative care. The ERAS protocol encompasses recommendations for the preoperative, perioperative, and postoperative phases of patient care. Implementation of the ERAS protocol yields a multitude of benefits for both patients and the healthcare system. It shortens hospital stays, diminishes the number and severity of postoperative complications, and enhances patient's quality of life. These factors contribute to healthcare cost sav-ings and improved bed turnover efficiency. Rigorous adherence to the ERAS protocol is paramount to achieving optimal outcomes. The comprehensive ERAS strategy thus marks a paradigm shift in perioperative care and emerges as an indispensable standard in liver and pancreatic surgery.</p>","PeriodicalId":52413,"journal":{"name":"Rozhledy v Chirurgii","volume":"103 9","pages":"351-357"},"PeriodicalIF":0.0,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142677455","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Complete pathological response after neoadjuvant chemotherapy and the benefit of subsequent surgery in oligometastatic pancreatic cancer patient.","authors":"A Langer, M Loveček, O Urban, D Kurfúrstová, R Kovář, B Mohelníková Duchoňová","doi":"10.48095/ccrvch2024454","DOIUrl":"https://doi.org/10.48095/ccrvch2024454","url":null,"abstract":"<p><strong>Introduction: </strong>Pancreatic cancer is one of the most aggressive tumors diagnosed in local-ly advanced or metastatic stage in more than half of the cases. The standard of care is a systemic chemotherapy but the prognosis of metastatic patients remains extremely poor with a median overall survival less than one year.  However, there is increasing evidence of surgery treatment benefit in a carefully selected oligometastatic cases.  -Because oligometastatic pancreatic cancer is rare, there is a lack of robust clinical trials defining strategy, efficacy and safety of this procedure.</p><p><strong>Patient concerns: </strong>A 77-year-old man presented with a mass in the tail of the pancreas and solitary liver metastasis. After four cycles of chemotherapy, distal pancreatectomy with liver metastasectomy was performed, and the tissues were histologically examined. The complete pathological response was found in the primary tumor and residual adenocarcinoma in liver metastasis.</p><p><strong>Outcomes: </strong>The patient is alive without recurrency more than two years from the diagnosis.</p>","PeriodicalId":52413,"journal":{"name":"Rozhledy v Chirurgii","volume":"103 11","pages":"454-457"},"PeriodicalIF":0.0,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142792711","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Minimal invasive surgery of pancreatic cancer at the Department of Surgery of Masaryk university hospital Brno, Czech Republic.","authors":"J Hlavsa, T Pavlík, D Marek, A Šikyňová, Viktor Procházka, P Moravčík, M Eid, L Ostřížková, J Vlažný, K Múčková, M Dastych, R Kroupa, J Pospíšil, D Ivanecká, A Kitzlerová, Z Kala","doi":"10.33699/PIS.2024.103.4.122-131","DOIUrl":"https://doi.org/10.33699/PIS.2024.103.4.122-131","url":null,"abstract":"<p><strong>Introduction: </strong>The aim of the study was to perform a retrospective analysis of patients who had undergone laparoscopic resection for pancreatic cancer (PC) at the Department of Surgery of the Faculty of Medicine, Masaryk University and University Hospital Brno, Czech Republic from 2010 to 2023.</p><p><strong>Methods: </strong>Forty-six patients with laparoscopic (n=19) or open (n=27) distal pancreatectomy (DP) for PC were included. Both groups were statistically evaluated and compared in the following parameters: clinical stage, tumor grade, nodes examined by the pathologist, blood loss, duration of surgery, three-month morbidity and mortality, length of ICU stay, overall length of hospital stay, readmission rate and overall survival.</p><p><strong>Results: </strong>There were more T3 tumors in the open DP group (81.5% vs 57.9%, p=0.035). The rate of dedifferentiated (G3) tumors was higher in the open DP group (18.5% vs 5.3%, p=0.354). The mean number of nodes examined by the pathologist was equal in both groups (open DP 15.1 (min- max, 3-39) vs lapDP 15.6 (min-max, 5-39). Laparotomy was associated with a higher mean blood loss (531 ml vs 198 ml, p=0.002). However, it was shorter on average (190 minutes vs 216 minutes, p=0.006). Clinically relevant complications (Dindo III and higher) and POPF (types B and C) were observed in 10/46 (21.7%) and 14/46 (30.5%) cases without any statistically significant difference between both groups (p=0.489 and p=0.241, respectively). The median ICU stay was similar for lapDP and open DP (median: 5.0 days vs 6.0 days, p=0.396). Overall length of hospital stay was identical in both groups (median: lapDP 12.0 days vs open DP 12 days, p=0.920). The three-month readmission rate was 5/46 (10.9%). One-, 2-, 3and 5-year overall survival probability after laparoscopic and open DP was 76.9% (95% CI 59.4-99.7%), 61.5% (95% CI 41,1-92.2%), 41.0% (95% CI 20,5-82.2%) and 20.5% (95% CI 6.2-68.2%), and 73.4% (95% CI 58.3-92.4%), 33.1% (95% CI 18,9-57.9%), 20.7% (95% CI 9.5-44.9%) and 20.7% (95% CI 9.5-44.9%), respectively. No statistically significant difference was observed between both groups (p=0.484).</p><p><strong>Conclusion: </strong>When comparing lapDP and open DP performed for pancreatic cancer, our experience confirmed that lapDP was particularly suitable for patients with smaller tumors located further from the porto-mesenteric axis. The laparoscopic approach was associated with lower blood loss, reduced length of ICU stay, comparable morbidity and overall survival. The relatively long length of hospital stays, surprisingly identical in both groups, prompted us to implement the ERAS (Enhanced Recovery After Surgery) protocol in this surgical field.</p>","PeriodicalId":52413,"journal":{"name":"Rozhledy v Chirurgii","volume":"103 4","pages":"122-131"},"PeriodicalIF":0.0,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143383941","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The role of perioperative chemoimmunotherapy in the treatment of potentially resectable MSI-H gastric adenocarcinoma - a case report.","authors":"T Sokop, M Kysela, F Sládek, R Lordick Obermannová","doi":"10.48095/ccrvch2024458","DOIUrl":"https://doi.org/10.48095/ccrvch2024458","url":null,"abstract":"<p><strong>Introduction: </strong>Gastric and gastroesophageal junction adenocarcinoma is a disease with high mortality. Approximately 10% of these tumors are characterized by microsatellite instability with a presumed good response to immunotherapy. So far, treatment with checkpoint inhibitors is part of palliative regimens, in the Czech Republic this treat-ment is reimbursed in patients with MSI-H gastroesophageal adenocarcinoma exhibiting a combined positive score ≥ 5. Promising results of immunotherapy used in the early stages of MSI-H gastroesophageal adenocarcinoma were published recently.</p><p><strong>Case report: </strong>A 59-year-old woman with locally advanced poorly cohesive MSI-H adenocarcinoma of the small curvature of the stomach. Based on the indication of the multidisciplinary team, she started neoadjuvant treatment with chemoimmunotherapy. The outcome was significant partial regression of the primary tumor and infiltrated gastric lymph nodes. Subsequently, the patient underwent uncomplicated radical total gas-trectomy with D2 lymphadenectomy. After a short postoperative recovery, she continues adjuvant treatment with immunotherapy, so far with good tolerance.</p><p><strong>Conclusion: </strong>This case report supports the potential importance of immunotherapy in the treatment of resectable locally advanced MSI-H gastric cancer, which is currently being evaluated in clinical trials.</p>","PeriodicalId":52413,"journal":{"name":"Rozhledy v Chirurgii","volume":"103 11","pages":"458-461"},"PeriodicalIF":0.0,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142792776","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pain management in surgical disciplines.","authors":"A Mátlová, P Ševčík","doi":"10.48095/ccrvch2024478","DOIUrl":"https://doi.org/10.48095/ccrvch2024478","url":null,"abstract":"<p><p>Pain is a complicated subjective entity that is difficult to quantify and treat. Individuals learn the concept of pain through their life experience, and a person's concept of pain perception changes. Although pain usually fulfills an adaptive role, it can have ad-verse effects on quality of life - functional, social and psychological balance. Therefore, it is necessary to respect the communication of the individual experiencing and feeling pain, or to monitor the various symptoms of pain. Today, perioperative pain management is part of the comprehensive care of patients undergoing surgery, and is associated with numerous benefits for the patient and society. Currently, there are enough drugs, dosage forms, treatment modalities available, as well as enough literary data, incl. knowledge about the organization of postoperative pain treatment. Comprehensive care begins even before surgery in specialized outpatient clinics with the proper preparation of the patient for anesthesia and surgery. The treatment of postoperative pain itself is similar to the care of a patient after a surgical procedure, a multidisciplinary team task, in which the attending physician, surgeon, anesthetist and nurses of the postoperative department participate in particular. Part of this extensive collaboration are specialized teams for the treatment of acute postoperative pain, which primarily have a conciliatory, educational and organizational role, and help to provide specialized treatment procedures for pain relief. It is necessary for all specialists to combine basic knowledge and their application in practice.</p>","PeriodicalId":52413,"journal":{"name":"Rozhledy v Chirurgii","volume":"103 12","pages":"478-488"},"PeriodicalIF":0.0,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144040504","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Ischemie dolních končetin jako komplikace operace křečových žil - přehled literatury.","authors":"K Houdek, J Moláček, I Říha, V Opatrný, R Šulc, B Čertík","doi":"10.48095/ccrvch2024489","DOIUrl":"https://doi.org/10.48095/ccrvch2024489","url":null,"abstract":"<p><strong>Objectives: </strong>Each surgeon is concerned about the potential for periprocedural injury. While severe complications during varicose vein surgery are uncommon, they can have significant consequences, including prolonged disability or even mortality. This paper presents a review of the literature on ischaemic complications following varicose vein procedures.</p><p><strong>Method: </strong>Review of literature data available in online database (PubMed, Medline, 1970-2021).</p><p><strong>Results: </strong>A total of 33 cases of severe ischaemia were identified following the procedure of great saphenous vein ligation and stripping, with a minimum of 100 cases observed following the sclerotherapy. These were primarily attributable to peripheral embolization or thrombosis, and 16 cases of brain ischaemia were documented following sclero-therapy. No mortality was reported, and 22 amputations were documented in the open surgery cohort, compared to no mortality deaths and 56 amputations in the sclerotherapy group.</p><p><strong>Conclusion: </strong>In order to prevent ischaemic injury during a lower limb varicose vein procedure, it is essential that the surgeon has provided a comprehensive preoperative examination, has a detailed understanding of the anatomy, has gained significant experience in performing the procedure, and has developed the requisite surgical skills. In the event that an injury does occur, it is of the utmost importance that the repair procedure is carried out by an experienced vascular surgeon, as the time is crucial in such cases.</p>","PeriodicalId":52413,"journal":{"name":"Rozhledy v Chirurgii","volume":"103 12","pages":"489-493"},"PeriodicalIF":0.0,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143999004","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Borrelial pseudolymphoma of the eyebrow in an adult.","authors":"V Woznica,&nbsp;I Třešková","doi":"10.33699/PIS.2023.102.2.88-90","DOIUrl":"https://doi.org/10.33699/PIS.2023.102.2.88-90","url":null,"abstract":"<p><p>Borrelial pseudolymphoma, more commonly known as Borrelia lymphocytoma and previously also as lymphadenosis benigna cutis, is a rare manifestation of Lyme borreliosis, which occurs nearly always in children after an infection caused by Borrelia afzelii; this pathogen is transmitted exclusively by the Ixodes ricinus tick in our region. The most common body locations of this lymphocytoma include the earlobe, scrotum, nipples and the areomamillary complex. Therefore, the case of our patient was unexpected and quite rare. The aim of this article is to point out the high incidence of Lyme disease and its atypical manifestations which can be cured without surgical intervention in most cases. The authors describe the case of a 58-year-old healthy female patient with a very rare manifestation of Lyme disease.</p>","PeriodicalId":52413,"journal":{"name":"Rozhledy v Chirurgii","volume":"102 2","pages":"88-90"},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9828672","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Peroral endoscopic myotomy (POEM) in the treatment of severe postfundoplication dysphagia.","authors":"M Vašátko,&nbsp;K Hugová,&nbsp;J Jarošová,&nbsp;J Špičák,&nbsp;J Martínek","doi":"10.33699/PIS.2023.102.5.208-213","DOIUrl":"https://doi.org/10.33699/PIS.2023.102.5.208-213","url":null,"abstract":"<p><p>Although uncommon, chronic postfundoplication dysphagia (PFD) is a serious complication of antireflux surgery. Currently, reoperation is the only possible solution as endoscopic pneumatic or hydraulic dilation are not effective. At present, POEM represents a standard method for the treatment of esophageal achalasia; however, in patients with PFD it is an experimental approach whose clinical effectiveness is unknown. Our case report describes a female patient who suffered from severe PFD after two surgeries (fundoplication and subsequent reoperation). Dysphagia and progressive weight loss had developed over the years and all treatment attempts (several sessions of dilation) were unsuccessful. Subsequently, esophageal resection was considered as the last resort. After a discussion in a multidisciplinary team and additional examinations (EndoFLIP), POEM was performed without any complications, and the procedure had an excellent effect without any adverse events.</p>","PeriodicalId":52413,"journal":{"name":"Rozhledy v Chirurgii","volume":"102 5","pages":"208-213"},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9925739","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Robotic pulmonary segmentectomy, initial experience in the Czech Republic.","authors":"J Kolařík,&nbsp;J Tavandžis,&nbsp;R Novysedlák,&nbsp;J Vachtenheim,&nbsp;D Sibřina,&nbsp;M Švorcová,&nbsp;J Pozniak,&nbsp;J Šimonek,&nbsp;J Schützner,&nbsp;R Lischke","doi":"10.33699/PIS.2023.102.5.199-203","DOIUrl":"https://doi.org/10.33699/PIS.2023.102.5.199-203","url":null,"abstract":"<p><strong>Introduction: </strong>The initiation of lung cancer screening in Czechia and diagnosis in earlier stages has been reflected by an increasing demand for anatomical lung segmentectomy. The purpose of this study was to describe early results of the first robotic-assisted thoracoscopic segmentectomies performed in the country.</p><p><strong>Methods: </strong>Our institution has performed 151 robotic anatomical lung resections since the initiation of the screening program in August 2020, which enabled us to attain the status of a proctoring and case observation centre. The robotic segmentectomy program was initiated after completing 70 robotic lobectomies. We performed a retrospective analysis of the results of our first 20 patients indicated for robotic segmentectomy.</p><p><strong>Results: </strong>Median age of the patients was 60, with 11 females and 7 males. The most common indications included primary lung malignancy (n=13), pulmonary metastasis (n=2) and benign lesions (n=3). We performed 11 simple segmentectomies, 6 complex (S2, S3, S1a+2, S10 on the right) and one right S6 segmentectomy with bronchoplasty. The mean number of harvested lymph nodes for NSCLC was 20, the mean blood loss was 25 mL (from 10 mL to 100 mL), and the mean operative time was 200 minutes. All resection margins were tumour-free. There was no conversion to thoracotomy. Two patients were excluded as they required conversion to robotic lobectomy given that their lesions were localized close to the intersegmental plane. One complication (recurrent laryngeal nerve paralysis) occurred in 1 patient. Mean chest tube duration was 1.9 days and length of stay 3.9 days.</p><p><strong>Conclusion: </strong>Our experience suggests that implementation of the robotic segmentectomy program after completion of the robotic learning curve provides promising outcomes. Robotic technology and preoperative planning facilitate this technically demanding procedure especially when bronchoplasty is required.</p>","PeriodicalId":52413,"journal":{"name":"Rozhledy v Chirurgii","volume":"102 5","pages":"199-203"},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9980089","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}