Rozhledy v Chirurgii最新文献

{"title":"Our experience with robotic-assisted thymic surgery.","authors":"M Podhráský, J Tvrdoň, J Schützner","doi":"10.33699/PIS.2024.103.2.40-47","DOIUrl":"https://doi.org/10.33699/PIS.2024.103.2.40-47","url":null,"abstract":"<p><p>Thoracic surgery is increasingly influenced by the development of minimally invasive approaches which have also influenced surgery in the area of the anterior mediastinum. The previously standard approach to the thymus via partial sternotomy was gradually replaced by the videothoracoscopic approach in most cases. In recent years, robotically assisted surgery has been gaining ground worldwide in this area, as well. The aim of our paper is to provide a comprehensive overview of procedures in the field of the thymus, including their indications, and to share our first experience with robot-assisted thymus surgery. At the 3rd Department of Surgery, since the start of the robot-assisted thymus surgery program, 23 thymectomies have been performed using this approach, of which 17 were performed for thymoma, 3 for myasthenia gravis, and 3 for parathyroid adenoma localized in thymus tissue. From our experience and the available data, it follows that the length of hospitalization, the rate of complications and the resulting effect of robot-assisted procedures is comparable to VTS procedures; however, the robot-assisted surgery also allows for mini-invasive treatment even in significantly obese patients and in patients with advanced thymic tumors who would otherwise be indicated for open thymectomy.</p>","PeriodicalId":52413,"journal":{"name":"Rozhledy v Chirurgii","volume":"103 2","pages":"40-47"},"PeriodicalIF":0.0,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140865877","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":"Breast cancer in 80+ year olds.","authors":"P Kosáč, M Zábojníková, P Vážan, V Petrů, M Ratajský, K Lajmar, B Dudešek, P Kudlová, J Duben, L Podrazká, J Gatěk","doi":"10.48095/ccrvch2024258","DOIUrl":"https://doi.org/10.48095/ccrvch2024258","url":null,"abstract":"<p><strong>Introduction: </strong>The risk of breast cancer increases with increasing age. The aim of our retrospective study was to determine the extent of breast and axillary surgery, including subsequent adjuvant therapy, in 80-year and older patients.</p><p><strong>Methods: </strong>Between 2017 and 2021, 834 breast cancer patients were operated in the Surgical Department of the EUC Clinic. Ninety-eight women (2× with bilateral cancer) and 2 men were included in this retrospective study. A total of 102 breast cancer cases in patients older than 80 years were analyzed. The surgical procedure corresponded to the stage of the disease and the general condition of the patient. Adjuvant systemic therapy was indicated according to the same principles.</p><p><strong>Results: </strong>At the time of surgery, the patients were more than 80 years old (80-96 years). The predominant type of invasive ductal carcinoma was diagnosed 83×, lobular carcinoma 6×, mucinous 6×, papillary carcinoma 4×, other 3×, with luminal A, B predominating (89×). The breast-conserving procedures were performed 63×. Sentinel node biopsy was performed 65×, supplemented by axillary lymph node dissection 13×. Primary axillary lymph node dissection was performed 15×. No axillary procedure was performed 23×. Radiotherapy was given 49×, chemotherapy 9× and hormonal therapy 82×. Local and regional recurrences were each observed 2×. A total of 37 patients died, 10 of them from breast cancer.</p><p><strong>Conclusion: </strong>The most common cause of death in patients aged 80+ years is a cardiovascular disease, not breast cancer itself. This fact should be taken into account when determining the treatment plan.</p>","PeriodicalId":52413,"journal":{"name":"Rozhledy v Chirurgii","volume":"103 7","pages":"258-262"},"PeriodicalIF":0.0,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141983843","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 neoadjuvant treatment in localized pancreatic cancer.","authors":"R Němeček, M Eid","doi":"10.48095/ccrvch2024429","DOIUrl":"https://doi.org/10.48095/ccrvch2024429","url":null,"abstract":"<p><p>Pancreatic carcinoma is a prognostically unfavorable cancer disease with growing incidence and mortality, which is the 3rd most common cause of cancer-related death in developed countries. The 5-year survival rate does not exceed 11% and is the lowest across all cancer diagnoses. Only about 20-30% of patients have resectable (RPC) or borderline resectable (BRPC) disease at the time of diagnosis. Radical resection is an essential therapeutic modality in these cases and is considered the only potentially curative procedure. Neoadjuvant chemotherapy and/or chemoradiotherapy is established mainly in BRPC. The role of neoadjuvant therapy in RPC is currently under investigation. This review article describes the current options, advantages and disadvantages of neoadjuvant treatment in BRPC and RPC.</p>","PeriodicalId":52413,"journal":{"name":"Rozhledy v Chirurgii","volume":"103 11","pages":"429-436"},"PeriodicalIF":0.0,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142792774","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":"Breast cancer localization by iodine seed 125I vs. wire- -guided localization - retrospective case-control study.","authors":"J Žatecký, Z Heralt, D Sekret, E Sehnálková, M Peteja","doi":"10.48095/ccrvch2024263","DOIUrl":"https://doi.org/10.48095/ccrvch2024263","url":null,"abstract":"<p><strong>Introduction: </strong>For many years, the gold standard in the localization of non-palpable malignant breast tumors has been the use of wire-guided method. However, this has recently been replaced by more modern localization techniques in many institutions.</p><p><strong>Methods: </strong>This is a retrospective case-control study comparing two localization techniques (iodine seed 125I and wire-guided localization) for localizing non-palpable tumors in patients with histologically verified breast carcinoma.</p><p><strong>Results: </strong>The study included 62 patients - 31 with localization of malignant breast tumor by iodine seed (subgroup 125I) and 31 by wire-guided localization (subgroup FV). The average volume of the resected tissue in subgroup 125I (46.2 cm3) was statistically significantly smaller compared to subgroup FV (83.7 cm3; P = 0.0063). R0 resection was achieved in 29 cases (93.5%) in subgroup 125I and in 24 cases (77.4%) in subgroup FV (P = 0.0714). In subgroup 125I, re-resection was not indicated in any case, while in subgroup FV, re-resection due to tumor reaching the margin was indicated in 6 cases (19.4%; P = 0.01).</p><p><strong>Conclusion: </strong>Our initial experience show that the use of iodine seeds for localizing non-palpable breast tumors is associated with the removal of a smaller volume of resected tissue compared to wire-guided localization, with a trend towards more frequent achievement of R0 resection. In the subgroup of patients localized with iodine seeds, there was a smaller proportion of re-resections due to inadequate safety margins.</p>","PeriodicalId":52413,"journal":{"name":"Rozhledy v Chirurgii","volume":"103 7","pages":"263-268"},"PeriodicalIF":0.0,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141983844","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":"Prophylactic surgical mesh placement as a prevention of parastomal hernia in open radical cystectomy with ileal conduit diversion - pilot study.","authors":"M Louda, P Navrátil, Š Šachová, L Holub, A Fibír, M Balík, M Broďák","doi":"10.33699/PIS.2024.103.3.91-95","DOIUrl":"https://doi.org/10.33699/PIS.2024.103.3.91-95","url":null,"abstract":"<p><strong>Introduction: </strong>This study examines the efficacy of prophylactic mesh implantation during open radical cystectomy with ileal conduit diversion in preventing parastomal hernias (PH). Despite PH being a common complication, prophylactic methods have been underexplored.</p><p><strong>Methods: </strong>A pilot, single-center, prospective cohort study was conducted involving five patients undergoing surgery with mesh implantation. Demographic and clinical characteristics were monitored, including the incidence of PH, operation time, blood loss, and hospitalization duration.</p><p><strong>Results: </strong>During the mean follow-up period of 9.1±3.2 months post-operation, no occurrences of PH were observed in the patient group. Despite the risks associated with implanting foreign material in an area of surgery involving open small intestine, no infectious complications were noted.</p><p><strong>Conclusion: </strong>Prophylactic mesh implantation in radical cystectomy with ileal conduit diversion appears to be an effective preventive measure against PH. Further extensive studies are required to definitively confirm the efficacy and safety of mesh use in this context.</p>","PeriodicalId":52413,"journal":{"name":"Rozhledy v Chirurgii","volume":"103 3","pages":"91-95"},"PeriodicalIF":0.0,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141421860","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":"Radicality of mediastinal lymphadenectomy in minimally invasive pulmonary resection: a comparative analysis of uniportal and multiportal thoracoscopic approaches.","authors":"L Tulinský, M Kepičová, P Ihnát, M Mitták, D Adamica, L Čierna, L Martínek","doi":"10.33699/PIS.2024.103.2.48-56","DOIUrl":"https://doi.org/10.33699/PIS.2024.103.2.48-56","url":null,"abstract":"<p><strong>Introduction: </strong>Lung cancer is a serious health problem with a high mortality rate. In the context of surgical management, minimally invasive approaches, including uniportal thoracoscopic techniques, offer potential benefits such as faster recovery and increased patient cooperation. The aim of this study was to compare the accessibility of the mediastinal lymph nodes between uniportal and multiportal thoracoscopic approaches and to verify whether the use of the uniportal approach affects the radicality of the lymphadenectomy.</p><p><strong>Methods: </strong>A comparative study conducted from January 2015 to July 2022 at the University Hospital Ostrava focused on evaluating the radicality of mediastinal lymphadenectomy between subgroups of patients undergoing surgery using the uniportal thoracoscopic approach and the multiportal thoracoscopic approach.</p><p><strong>Results: </strong>A total of 278 patients were included in the study. There were no significant differences in the number of available lymphatic stations between the subgroups. The mean number of lymph node stations removed was 6.46 in the left hemithorax and 6.50 in the right hemithorax. Thirty-day postoperative morbidity for the entire patient population was 24.5%, with 18.3% having minor complications and 3.6% having major complications. The overall mortality rate in the study population was 2.5%, with a statistically significant difference in mortality between uniportal and multiportal approaches (1.0% vs 6.4%, p=0.020).</p><p><strong>Conclusions: </strong>The uniportal approach demonstrated comparable accessibility and lymph node yield to the multiportal approach. There was also no difference in postoperative morbidity between the two approaches. The study suggests the possibility of lower mortality after uniportal lung resection compared with multiportal lung resection, but this conclusion should be interpreted with caution.</p>","PeriodicalId":52413,"journal":{"name":"Rozhledy v Chirurgii","volume":"103 2","pages":"48-56"},"PeriodicalIF":0.0,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140871292","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":"From adjustable gastric banding to Roux-en-Y gastric bypass - case report.","authors":"E Koblihová, M Kasalický, J Pažin, K Havlová, R Pohnán","doi":"10.33699/PIS.2024.103.1.31-34","DOIUrl":"https://doi.org/10.33699/PIS.2024.103.1.31-34","url":null,"abstract":"<p><strong>Introduction: </strong>Adjustable gastric banding (AGB) used to be a popular bariatric procedure. However, it fails in more than half of those operated on in the long term, becomes ineffective and must be removed. Therefore, the use of AGB has been in decline globally. Sleeve gastrectomy (SG) and Roux-en-Y gastric bypass (RYGB) are the most used bariatric revision surgeries when AGB is removed.</p><p><strong>Case report: </strong>We present the case of a woman after AGB removal and conversion to SG who developed a stenosis of the sleeve. Therefore, a decision was made to convert to RYGB with a good effect.</p><p><strong>Conclusion: </strong>Revisional procedures are more technically challenging than primary procedures and have higher complication rates. The most performed revisional operations include SG and RYGB. Stenosis of the sleeve can occur after SG, with a negative impact on the patient's nutritional status and quality of life. This can be managed by endoscopic dilatation, and where this solution proves ineffective, RYGB can be indicated.</p>","PeriodicalId":52413,"journal":{"name":"Rozhledy v Chirurgii","volume":"103 1","pages":"31-34"},"PeriodicalIF":0.0,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140177709","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":"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}