Rozhledy v Chirurgii最新文献

{"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":"Fractures of the posterior malleolus as a part of complex ankle fractures: Trends in diagnosis and treatment at our institution.","authors":"V Kunc, L Kopp","doi":"10.33699/PIS.2024.103.5.175-180","DOIUrl":"https://doi.org/10.33699/PIS.2024.103.5.175-180","url":null,"abstract":"<p><strong>Introduction: </strong>The management of posterior malleolus fractures has experienced notable advancements in recent years, predominantly driven by the CT-based Bartoníček-Rammelt classification. This study aims to systematically document the evolving trends in the approach to these fractures within the context of our institution.</p><p><strong>Methods: </strong>A comprehensive retrospective analysis was undertaken involving 66 patients who underwent surgical intervention for posterior malleolus fractures at our institution during the years 2020 and 2021. Patient classification was conducted based on the Lauge-Hansen classification, with additional categorization according to the Bartoníček-Rammelt classification in instances where CT scans were performed.</p><p><strong>Results: </strong>CT examinations were performed in 30 patients (45.45%); according to the Bartoníček-Rammelt classification they revealed type I in 2 cases, type II in 7 cases, type III in 12 cases, and type IV in 9 cases. Patients lacking specific fixation for type III posterior malleolus fractures, as per the Bartoníček-Rammelt classification, exhibited the most unfavorable treatment outcomes.</p><p><strong>Conclusion: </strong>Our findings elucidate a progressive trend in the utilization of CT examinations between 2020 and 2021, although this escalation remained insufficient during this period. Consequently, we have intensified efforts to advocate for increased use of CT scans. The issues with not optimally treated type III fractures, as classified by Bartoníček-Rammelt, are quite clear from our study. We were surprised by how often these cases occurred, and they often led to more complications. These fractures diagnosed by CT scans were not treated optimally, as surgeons tend to be reluctant in adopting modern treatment procedures. This emphasizes the importance of ongoing and thorough education in all kinds of healthcare settings, including those that specialize in ankle and foot surgery.</p>","PeriodicalId":52413,"journal":{"name":"Rozhledy v Chirurgii","volume":"103 5","pages":"175-180"},"PeriodicalIF":0.0,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143400639","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":"Intraosseous ganglion cyst of the scaphoid with an extraosseous component -an uncommon cause of volar wrist pain: case report and literature review.","authors":"D Ira, B Čechová, M Krtička, J Kovařík","doi":"10.33699/PIS.2024.103.5.193-198","DOIUrl":"https://doi.org/10.33699/PIS.2024.103.5.193-198","url":null,"abstract":"<p><p>Intraosseous ganglion is a relatively rare cause of chronic wrist pain. The ganglion is most commonly found in the os lunatum and os scaphoideum and in many cases includes an extraosseous component, both of which can be a source of clinical difficulty. In our case report, we present a patient with atypical chronic volar wrist pain who was diagnosed to have an intraosseous ganglion of the os scaphoideum with a volar extraosseous component as the main source of her problems. The patient had both components of the ganglion removed and the defect in the os scaphoideum was filled with an autogenous cancellous bone graft resulting in resolution of the clinical complaints and elimination of the risk of os scaphoideum fracture. The diagnostic and therapeutic considerations in patients found to have an intraosseous ganglion of the wrist with an extraosseous component are described and discussed in relation to the relevant literature.</p>","PeriodicalId":52413,"journal":{"name":"Rozhledy v Chirurgii","volume":"103 5","pages":"193-198"},"PeriodicalIF":0.0,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143400644","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 utilization of 3D printing in surgery as an innovative approach to preoperative planning.","authors":"J Hrubovčák, L Tulinský, M Pieš, R Hájovský, J Velička, K Chrz, T Bosek, J Szeliga, L Martínek","doi":"10.48095/ccrvch2024305","DOIUrl":"10.48095/ccrvch2024305","url":null,"abstract":"<p><strong>Introduction: </strong>3D printing, a concept over 40 years old, is finding broader application in clinical practice thanks to technological advancements. At University Hospital Ostrava, 3D printing is utilized to create anatomically accurate models of specific patients before surgical procedures based on imaging data.</p><p><strong>Case series: </strong>3D printing is employed as a complement to conventional imaging methods to produce morphologically precise models of anatomical structures of individual patients. These models primarily serve for preoperative planning in elective abdominal, vascular, and thoracic surgery. They are also used in planning osteosynthesis of complex fractures and corrective osteotomies. Multicolor printing, although increasing the process's time demands, allows better clarity and differentiation of individual anatomical structures within a single model.</p><p><strong>Discussion: </strong>Compared to 2D images, 3D models provide better spatial orientation and awareness of the operated structures, contributing to improved surgical outcomes. The benefits of 3D printing in preoperative planning and patient education are confirmed by studies across the fields ranging from cardiac surgery to traumatology.</p><p><strong>Conclusion: </strong>After overcoming initial challenges, 3D printing has become a reliable component of the surgical arsenal at University Hospital Ostrava for elective surgery. While 3D printing does not represent a universal answer to all medical challenges, its role is highly beneficial and promising in many indicated cases.</p>","PeriodicalId":52413,"journal":{"name":"Rozhledy v Chirurgii","volume":"103 8","pages":"305-312"},"PeriodicalIF":0.0,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142309120","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":"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}