Tumor, oncosurgery

Newer developments in the field of chemotherapeutic drug regimes, radiotherapy, and surgical techniques have improved the prognosis of cancer patients tremendously. Today increasing numbers of patients with aggressive disease are posted for surgical resection. The advances in reconstructive flap surgery offer the patient a near normal dignified postresection life. Hence, the expectations from the patients are also on the rise. Anesthetic challenges known in oncosurgery are that of difficult airway, maintenance of hemodynamics and temperature during long surgical hours, pain management, and postoperative intensive care management...

Even in modern conditions of achievements in the head and neck oncosurgery the restoration of the volume defects of the bone tissue in a jaw-facial region is impossible to do without the orthopedic methods application because of present severe psychoemotional and general state of the patients. The problem of prophylaxis of mandibular pathological fractures in its malignant affection constitute a peculiar place, taking into account a complexity and numerousness of the unsolved issues. There was elaborated and constructed apparatus for the pathological fracture prophylaxis or for fixing of fragments in the angle of a toothless mandibula...

An international panel of multidisciplinary experts convened to develop recommendations for the management of patients with liver metastases from colorectal cancer (CRC). The aim was to address the main issues facing the CRC hepatobiliary multidisciplinary team (MDT) when managing such patients and to standardize the treatment patients receive in different centers. Based on current evidence, the group agreed on a number of issues including the following: (a) the primary aim of treatment is achieving a long disease-free survival (DFS) interval following resection; (b) assessment of resectability should be performed with high-quality cross-sectional imaging, staging the liver with magnetic resonance imaging and/or abdominal computed tomography (CT), depending on local expertise, staging extrahepatic disease with thoracic and pelvic CT, and, in selected cases, fluorodeoxyglucose positron emission tomography with ultrasound (preferably contrast-enhanced ultrasound) for intraoperative staging; (c) optimal first-line chemotherapy-doublet or triplet chemotherapy regimens combined with targeted therapy-is advisable in potentially resectable patients; (d) in this situation, at least four courses of first-line chemotherapy should be given, with assessment of tumor response every 2 months; (e) response assessed by the Response Evaluation Criteria in Solid Tumors (conventional chemotherapy) or nonsize-based morphological changes (antiangiogenic agents) is clearly correlated with outcome; no imaging technique is currently able to accurately diagnose complete pathological response but high-quality imaging is crucial for patient management; (f) the duration of chemotherapy should be as short as possible and resection achieved as soon as technically possible in the absence of tumor progression; (g) the number of metastases or patient age should not be an absolute contraindication to surgery combined with chemotherapy; (h) for synchronous metastases, it is not advisable to undertake major hepatic surgery during surgery for removal of the primary CRC; the reverse surgical approach (liver first) produces as good an outcome as the conventional approach in selected cases; (i) for patients with resectable liver metastases from CRC, perioperative chemotherapy may be associated with a modestly better DFS outcome; and (j) whether initially resectable or unresectable, cure or at least a long survival duration is possible after complete resection of the metastases, and MDT treatment is essential for improving clinical and survival outcomes...

The estimation of modern methods of sevoflurane anesthesia under APV, in 40 child patients undergoing laparoscopic surgery. Most of the interventions were radical and carried out under the retroperitoneal tumors, tumors of the kidneys, adrenal glands and liver. The role of analgesia during balanced anesthesia performed epidural block with amido class local anesthetics (ropivacaine, lidocaine). We have investigated the role of risk factors associated with laparoscopic interventions (the influence of intra-abdominal pressure increase on cardiorespiratory system as well as insufflated CO2 on acid-base blood balance and the concentration of etCO2...

The purpose of the study was to construct and validate a risk model to predict morbidity in head and neck oncosurgeries. Potential risk factors of 300 surgically treated head and neck cancer patients like age, sex, tumor site, TNM stage, duration of surgery, adjunctive treatment, comorbidities and alcohol and tobacco usage were analyzed. Postoperative complications were noted. We developed a logistic model to predict the probability of patients developing morbidity based on the statistically significant variables-duration of surgery, preoperative radiation and hypertension...

AIM: Evaluate our more than seven year experience with transanal endoscopic microsurgical technique (TEM). MATERIALS AND METHODS: The authors prospectively evaluated a set of 393 patients who were operated using the TEM method. RESULTS: Out of 393 patients, 371 (94%) were indicated for the procedure for rectal tumor; 82 of these tumors were malignant. Nine patients underwent a rectoplasty for rectal stenosis, and in five patients drainage of a perirectal fluid collection was performed...

AIM: The aim of this work was to create a proposal design of the educational programme in surgical oncology (oncosurgery) in the Czech Republic, which would provide a recognized official specialty training for surgeons. MATERIAL AND METHODOLOGY: The programme was designed based on experience with this specialty in Europe and USA, as well as on the authors' own long-term practical experience in oncosurgery. The material was discussed by the Committee of the Czech Surgical Association and ammended based on the comments...

AIM: The aim of this work was to point out the role and the significance of surgery in the management of oncology patients in the Czech Republic (CR). MATERIAL AND METHODOLOGY: Involvement of surgery in the management of patients with solid tumors is documented based on statistical data collected from the National Oncologic Registry. RESULTS: In the Czech Republic, the number of patients operated for newly diagnosed malignant tumors is constantly increasing, e...

Standardization of therapeutic schedules becomes now more requested not only in oncology and oncosurgery. In fact, simple parametrisation and regular evaluation of oncological algorithms is more needed than files of instructions on diagnosis and therapy, which should be already contained in medical education. An original simple system of basic parameters is presented under acronyme NoT ReStInG SurGEONs,which includes five indicators of quality of diagnosis and three characteristics documenting quality of care and experience of therapeutic teams...

Disease-specific survival (DSS) rates were evaluated in 20 patients with primary malignant fibrous histiocytoma (MFH) of the bladder. The most common pathologic finding was the pleomorphic subtype of MFH (55%) with a mean tumor size of 6.8 cm. 10 patients underwent surgery without and 6 patients with adjuvant therapy. Local and systemic rates of progression were 30 and 60% after surgery only compared with 16.7 and 50% after surgery with adjuvant therapy. Although none of the patients showed metastatic dissemination at the time of diagnosis, overall 1- and 2-year DSS rates of only 47...

The minimally invasive technique, by means of the undoubted advantages of the method, has become fully accepted in the surgical treatments of the most benign and functional diseases. Today it has been proven that the laparoscopic technique is safely usable also in the surgical treatment of colorectal tumors. The authors, analyzing their own and the international experiences, present the laparoscopic surgical treatment of colorectal tumors. Seventy-four patients were treated with laparoscopic-assisted colorectal intestinal resection in the Department of Surgery of the University of Szeged between January 1, 2005 and December 31, 2008...

Extended oropharyngeal carcinoma are frequently resected using an "open" approach via temporary mandibulotomy. One disadvantage of this technique is a visible scar formation at the lower lip and the chin. This can be avoided by remaining continuity/integrity of the lower lip and the chin by a "downfacial degloving" approach. This technique allows an adequate exposition and resection of the tumor with an optimal functional as well as aesthetic result in the lower midface. Downfacial degloving during temporary mandibulotomy in oncosurgery is a simple technique with an optimal functional and aesthetic result...

Despite new efficient methods of pharmaco- and radiotherapy, surgery is still applied to most patients with malignant tumors as the main treatment. Rational definition of indications to a surgical intervention based upon precise morphological verification of the diagnosis and correct staging is half a battle of surgical success. When planning the time and volume of surgery, its aim (whether it is radical, palliative, or reconstructive intervention) should be understood very clearly. The ideology of oncosurgery has changed to a great extent...

The results are presented of 5-year experience with therapy of concurrent neoplasia and atherosclerotic lesions of the aorta and peripheral arteries gained at the Center for Oncosurgery, Regional Oncological Dispensary, Chelyabinsk. The analysis was concerned with the treatment received by 118 patients, irrespective of tumor stage or localization: surgical correction of blood flow was carried out in 60. Clinically significant atherosclerotic lesions of the aorta and peripheral arteries in a cancer patient should not be regarded as absolute or relative contraindication for combined treatment...

At present time, we can see increasing interest in prognosis and prognostic factors. This review refers to the problems of prognostics in oncology and oncosurgery. Authors emphasize importance of prognosis and its integrating role in issues of treatment tactics and strategy selection. This article presents main classification of prognostic factors, e.g. the subject-based one, which consists of three groups-tumor-related, host-related and environment related factors. Factors that belong to the first group are anatomic extent of disease that is classified according to the TNM classification, tumor histopathologic factors and a great number of molecular and genetic factors...

Of 14,448 operated patients with malignant tumor of different localization in 368 (25% +/- 0.1%)--simultant operations (SO) were performed. Terminology of SO was determined in oncosurgery, classification of indications to performance of SO was proposed in patients with coexistent oncosurgical diseases. Early postoperative complications had occurred in 63 (17.1% +/- 1.9%) patients, 20 (5.4% +/- 1.2%) patients died. Social-economical expediency of SO performance in oncosurgery was substantiated.

The main modality of treatment of solid tumors, surgery is a basic component of treatment of most solid tumors. Despite the wide introduction of new drugs into oncological care and improvement of highly effective drug treatments, surgery still remains the "golden standard" in treating the vast majority of solid tumors. Oncosurgery as an area of surgical science greatly differs from general surgery as it defines a procedure not as local resection of a primary tumor, but as ablastic mobilization of the tumor with the regional lymphatics en block...

Intraoperative autotransfusion is an effective method of the autologous haemotherapy. Gamma irradiation of the salvaged erythrocyte concentrates leads to inactivation of malignant cells and allows retransfusion in oncologic surgery. The risk of microbiological contamination of the autologous blood product has not been systematically studied in this field of surgery. During the evaluation of intraoperative autotransfusion in oncologic surgery at the University Hospital of Leipzig, the salvaged blood of 46 patients who underwent tumour surgery (urology, gynaecology and neurosurgery) was processed to a washed erythrocyte concentrate with a Cell Saver 5 or a Haemolite 2 (Haemonetics)...