Expression of insulin-like growth factor receptor type 1 correlate with lymphatic metastases in human gastric cancer.

Most patients with gastric cancer are diagnosed at advanced clinical stages with a high frequency of lymph node metastasis. It is very important to find novel factors for the early diagnostic and prognostic evaluation of gastric cancer. It has been shown that IGF-1R activates mitotic division and inhibits apoptosis of cancer cells through the activation of signaling MAP/ERK and PI3K/Akt-1 pathways. IGF-1R plays a role in cell transformation and maintenance of the phenotype in modified cells. Moreover, an IGF-1 receptor effect influences the processes of adhesion, migration, invasion and metastasis of tumor cells. The aim of the study was to assess the expression of IGF-1R in gastric carcinoma in correlation with selected anatomo-clinical parameters. The study enrolled a group of 49 patients treated surgically for gastric cancer. 28 patients had no lymph node metastases. The expression of the studied proteins was assessed using the immunohistochemical method. We found that the expression of IGF-1R in gastric cancer is associated with lymph node metastasis (p < 0.001), is correlated with worse prognosis and high histological malignancy grade, and is an independent predictor of survival in patients with gastric cancer (p < 0.001). IGF-1R may play an important role in tumor growth and metastasis via the lymphatic pathway.

Effects of perioperative immunostimulating nutritional therapy on the phagocytic activity of blood platelets in patients with various clinical stages of gastric cancer.

PURPOSE: The aim of this study was to evaluate the total blood platelets count, fraction of phagocytizing thrombocytes (PhT%), and phagocytic index of thrombocytes (PhIT) in gastric cancer considering the stage of the disease, and perioperative immunonutrition support. METHODS: Our study included 44 patients operated for gastric cancer divided into 2 groups depending on the clinical stage, and 40 healthy volunteers -a control group. Group I included 18 patients with stage I-III locoregional malignancies and Group II included 26 patients with stage IV peritoneal dissemination. All patients received immunonutrition during the perioperative period. The phagocytic activity of blood platelets was assessed by measuring PhT% and PhIT prior to and after nutritional therapy. RESULTS: In Group I, the pre-treatment PhT% and PhIT amounted to 1.08 and 0.99, respectively, and 1.26, and 1.1 after the therapy (p<0.01). In Group II, pre-treatment PhT% and PhIT were 1.12 and 0.97, after 1.18 and 1.06, respectively (p<0.05). In the controls, PhT% and PhIT were 2.26 and 1.83, respectively, significantly higher comparing to gastric cancer patients (p<0.01). CONCLUSION: Severe impairment of the thrombocyte phagocytic activity in gastric cancer patients has been found. Phagocytic activity of blood platelets was partially improved as a result of perioperative immunonutrition both in locoregional disease and in peritoneal dissemination.

Parenteral nutrition and preOp preparation in prevention of post-operative insulin resistance in gastrointestinal carcinoma.

PURPOSE: The aim was to compare preventive effect of total parenteral nutrition (TPN) and oral nutrition (preOp) on the perioperative insulin resistance prevention in surgical gastrointestinal cancer patients. MATERIAL/METHODS: The study was conducted in a group of 75 elective gastric and large intestine cancer patients. Patients were randomly divided into 3 study groups, 25 patients each: group I (NIL) - no preparations influencing tissue sensitivity to insulin, group II (TPN) - total parenteral nutrition in its preoperative stage and group III (TPN + preOp) parenteral nutrition and preOp in the preoperative phase. RESULTS: Immediately after the surgery, no statistically significant differences in insulin resistance level between groups were observed. During the first 6 postoperative hours, a statistically significant decrease of insulin resistance level in the TPN+ preOp group in comparison to others, was observed. During the first 24 postoperative hours, the NIL group was the only one to keep the insulin resistance level the same as in the preoperative phase. CONCLUSIONS: Application of TPN in the preoperative phase leads to shortening of perioperative insulin resistance time. Combining TPN with oral application of carbohydrate before surgical procedure is an effective and the best method in postoperative insulin resistance syndrome prevention.

Matrix metalloproteinase 2 (MMP-2) and their tissue inhibitor 2 (TIMP-2) in gastric cancer patients.

BACKGROUND: Matrix metalloproteinase 2 (MMP-2) is able to degrade type IV collagen and its activity is mostly regulated by tissue inhibitor of matrix metalloproteinase 2 (TIMP-2). These proteins might play a role in tumor progression, including gastric cancer (GC). METHODS: The study included 108 individuals, GC patients and healthy subjects. Serum levels of all analyzed markers were evaluated by the immunological methods, while immunohistochemistry was used to assess the expression of these proteins in GC, interstitial inflammatory cells and normal tissues. RESULTS: The percentage of positive reactions of MMP-2 and TIMP-2 was higher in GC and inflammatory cells compared to normal tissue, while serum levels of these proteins were statistically lower in GC patients in comparison to healthy subjects. There was a significant positive correlation between TIMP-2 immunoreactivity in inflammatory cells and the presence of lymph node metastasis. Area under ROC curve (AUC) for TIMP-2 was higher than MMP-2, while serum MMP-2 was an independent prognostic factor of GC patients' survival. CONCLUSION: Our findings suggest that TIMP-2 seems to be a predictor of tumor progression, especially for nodal involvement, whereas serum MMP-2 might be useful as an independent prognostic factor of patients' survival.

Immunohistochemical assessment of apoptosis-associated proteins: p53, Bcl-xL, Bax and Bak in gastric cancer cells in correlation with clinical and pathomorphological factors.

PURPOSE: The p53 protein as well as Bcl-2 family proteins such as Bax, Bak and Bcl-xL regulate apoptosis. The study objective was to analyze the expression of p53, Bak, Bcl-xL and Bax in gastric cancer and in healthy gastric mucosa. MATERIAL AND METHODS: The study group consisted of 66 patients with gastric cancer, treated surgically in II Department of General and Gastroenterological Surgery, Medical University of Bialystok. The expression of the studied proteins was assessed using the immunohistochemical method. RESULTS: Significant differences were found in the expressions of the studied proteins as compared to healthy gastric mucosa. The expressions of p53 and Bax were significantly higher (70% vs 13% and 50% vs 13%), whereas those of Bak and Bcl-xL significantly lower (18% vs 83% and 74% vs 97%) in cancer cells than in normal mucosa (p<0.001). Significant differences were also noted in the expressions of Bax and Bcl-xL in relation to histological type. In the intestinal type (Lauren I), the expressions of Bax and Bcl-xL were higher as compared to the diffuse type (Lauren II) (93% vs 43% and 91% vs 43%). Simultaneously, correlations were noted between changes in the expression of Bax vs Bcl-xL and Bak. High expression of Bax showed a positive correlation with reduced Bak and Bcl-xL (p<0.05). Moreover, positive expression of p53 caused poorer distant survival of patients (p<0.05). CONCLUSION: Our study concluded that disturbances in the expression of p53, Bax, Bcl-xL and Bak proteins are associated with their involvement in the process of carcinogenesis in the stomach. It is suggesting that they might appeared in the early phase of carcinogenesis.

Platelet activation in patients with advanced gastric cancer.

The aim of this study was to evaluate platelet activation in gastric cancer patients with regard to histopathological classification and the presence of distant metastases, by using platelet morphological parameters: MPV, L-PLT, MPC, as well as quantitative evaluation of surface receptor expression: CD41a, CD61, CD42b, CD62P, by flow cytometry at the resting state and after TRAP activation. In gastric cancer patients higher values of MPV and LP, as well as decreased MPC values were determined. Quantitative evaluation of surface antigen expression also revealed higher number of CD41a, CD61 and CD62P molecules, as compared with the platelets in the control group. Significant decrease of CD42b molecules' number after TRAP incubation, and the increased CD41a, CD61 and CD62P expression also point to the retained reactivation capacity of platelets. Good correlation between morphological parameters and the number of CD62P molecules indicates the usefulness of routine tests in evaluation of platelet activation.

Correlation of peripheral blood monocyte and neutrophil direct counts with plasma inflammatory cytokines and TNF-alpha soluble receptors in the initial phase of acute pancreatitis.

MATERIAL: The relationship between direct count of peripheral blood leucocyte populations and plasma concentrations of IL-6, IL-8, sTNFR-55 and sTNFR-75 during five initial days of acute pancreatitis was studied. RESULTS: Most significant relationship was found for monocytes, which correlated with sTNFR-55 (R = 0.38, p < 0.05) and sTNFR-75 (R = 0.41, p < 0.05 and R = 0.55, p < 0.01 during 1st and 2nd day, respectively). Later, in days 2, 3 and 4 an interrelation between monocytes and IL-6 (R = 0.49 to R = 0.41, p < 0.01) was observed. Monocytes also correlated with IL-8 in days 2 and 3 (R = 0.41, p < 0.05 and R = 0.43, p < 0.01, respectively). Neutrophil count correlated with IL-6 in days 3 and 4 (R = 0.34, p < 0.05 and R = 0.56, p < 0.01, respectively) and with IL-8 in the 4th day only (R = 0.39, p < 0.05). No significant correlations of lymphocyte, eosinophil and basophil direct counts with cytokines and receptors during the initial 5 days of AP were found. CONCLUSIONS: Observed relationships between monocyte direct counts and plasma cytokine levels reflect monocytes involvement in the development of acute pancreatitis.

Serum erythropoietin and angiogenetic factors in human colorectal cancer.

AIMS AND BACKGROUND: Erythropoietin, VEGF, VE-cadherin are involved in angiogenesis. Besides that erythropoietin stimulates erythropoiesis and increases haemoglobin and hematocrit levels as well. Moreover, erythropoietin could directly stimulate colorectal cancer cell growth due to the presence of both erythropoietin receptor and erythropoietin production in malignant cells of this neoplasm. Therefore we aimed at measurement and comparison of serum erythropoietin with VEGF, VE-cadherin levels, blood haemoglobin and hematocrit in colorectal cancer patients of different clinicopathological profiles. METHODS: We applied ELISA kits to evaluate preoperative serum levels of endogenous erythropoietin, VEGF and VE-cadherin in samples from 92 colorectal cancer patients and control group of 16 healthy volunteers. RESULTS: Endogenous erythropoietin was significantly elevated in preoperative sera in colorectal cancer patients (p = 0.013) compared with healthy volunteers, however, erythropoietin levels were not significantly higher with the advancement of colorectal cancer. There were significantly higher levels of erythropoietin in the group of anaemic men in comparison to men with normal haemoglobin levels (p < 0.0001). VEGF and VE-cadherin did not correlate with erythropoietin. Erythropoietin levels negatively correlated with haemoglobin and hematocrit levels in all cancer patients; particularly in node positive cancers (N+), moderately differentiated tumours (G2) and deeply invading neoplasms (pT3+pT4). CONCLUSIONS: Erythropoietin levels increase in colorectal cancer but circulating erythropoietin does not associate with progression of the disease. Thus, the use of recombinant erythropoietin seems to be safe. Our results suggest that negative feedback regulation persists between haemoglobin and erythropoietin in colorectal cancer. Production of erythropoietin remains therefore anaemia-associated, hypoxia-dependent and doesn't seem to be autonomic despite abundant expression of erythropoietin by colorectal cancers.

P53 correlates positively with VEGF in preoperative sera of colorectal cancer patients.

Diversity of P53 impact on tumor angiogenesis is due to the fact that wild-type P53 decreases expression of vascular endothelial growth factor (VEGF), but mutant P53 upregulates it. Therefore, we aimed at uncovering relations between preoperative serum levels of VEGF and P53 in colorectal cancer (CRC) patients. Preoperative blood samples of 125 CRC patients and 16 control healthy volunteers were examined with an ELISA-kit for serum P53 levels and VEGF. P53 did not correlate with VEGF in the whole group of CRC patients. However, P53 associated with VEGF in case of colorectal cancer patients, whose serum values of VEGF were higher than in controls (VEGF{H} >5.9333 pg/ml) (r=0.274, p<0.009). We revealed a positive correlation between P53 and VEGF{H} in subsets of poorly differentiated (G3) cancers (p<0.02), lymph node positive (p<0.007), pT3 or pT4 patients (p<0.004) without analogous relation in moderately differentiated (G2) tumors, node negative patients or pT1 or pT2 patients. P53 and IGF-I negatively correlated in all CRC patients (p<0.04) and VEGF{H} individuals of pT3 or pT4 (p<0.05) without any significant linkage in tumors of pT1 or pT2. The positive correlation between serum P53 and VEGF points at mutation of P53 and is a highly probable sign of poor prognosis in colorectal cancer. For now it can not be excluded that the binary analysis of serum P53 and VEGF could help select CRC patients endangered by rapid growth and lymph node metastases.

Occurrence rate of oral Candida albicans in denture wearer patients.

PURPOSE: The aim was to determine the fungi occurrence rate in the oral cavity of denture wearer patients in comparison to those without dentures. MATERIAL AND METHODS: The examinations were conducted in patients treated in two clinical departments of the University Hospital. Demographic data and those connected with basic diseases were collected and the evaluation concerning dentition and oral hygiene was performed. Samples for mycological examinations from the tongue dorsa, palatal mucosa, and mucosal surfaces of dentures were collected from patients with dentures while tongue and palate swabs were taken from those without dentures. For culture and identify of fungi standard methods were used. RESULTS: Dental and mycological examinations were performed in 95 patients, out of which 57 (60.0%) used complete or partial dentures and 38 (40.0%) had their own dentition (without dentures). Oral cavity revealed only growth of Candida albicans species, more frequently in patients with dentures (38/57; 66.7%) than in those without dentures (11/ 38; 28.9%) (p = 0.0003). C. albicans statistically significantly more frequently was isolated in denture wearer patients with diabetes mellitus (p = 0.0207) and without diabetes (p = 0.0376) comparing to such groups of patients but without dentures. Among 32 patients with diabetes mellitus, 14 (43.8%) revealed C. albicans; this rate was comparable with 9/23 (39.1%) patients without diabetes (p > 0.05). A similar analysis, conducted in 25 surgical patients with abdominal cancer and 15--without--cancers, did not show statistically significant differences in the incidence rate of C. albicans; it also concerned denture wearers (14/16; 87.5%) and non-wearing dentures (5/9; 55.6%) (p > 0.05) with cancer. In 37 (64.9%) wearer patients denture stomatitis was observed, associated mainly with C. albicans infections (29/37; 78.4%). CONCLUSIONS: 1) Mycological findings from the present study do not indicate that diabetes mellitus or advanced cancer has a significant effect on oral colonisation by Candida albicans or other species of Candida genus. 2) The occurrence rate of oral Candida albicans in patients with dentures (diabetic and non-diabetic, cancer and non-cancer patients) was higher than in patients without dentures (p < 0.05).

Aerobic bacteria in the oral cavity of patients with removable dentures.

PURPOSE: Determination of bacterial composition in the oral cavity of patients with removable dentures and with own dentition (without dentures). MATERIAL AND METHODS: Bacteriological investigations were performed in 55 patients from the department of internal medicine (32 diabetic patients) and 40 patients treated in surgical department (25 patients with malignancy). Palate mucosa and tongue dorsa swabs were collected from two groups of patients, and additionally swabs from mucosal part of denture surfaces in prosthetic patients. Cultures in oxygenic and microaerophilic (5% CO2) conditions were conducted on solid non-selective and selective media as well as media enriched with 5% sheep blood. Standard procedures of bacterial culture and identification were applied. RESULTS: Among 95 of examined patients, 57 (60.0%) with removable dentures and 38 (40.0%) had their own dentition. As far as prosthetic patients were concerned, the rate of bacterial isolations from palate, tongue dorsa and denture plaque swabs were generally comparable (p > 0.05); in number and species compositions. Statistically significant differences were observed in the bacterial composition of denture plaques, palate and tongue dorsa in patients with and without abdominal cancers. Patients without cancer did not reveal staphylococci and enteric bacteria in the samples from a various sites of their oral cavities. These bacteria were most common in cancer patients. Similar (in number and species) composition of bacteria occurred in palate and tongue swabs in patients without dentures (p > 0.05). The incidence rate of aerobic bacteria in denture plaques and palatal mucosa of patients with (37/57; 64.9%) and without (20/57; 35.1%) denture associated stomatitis were comparable (except for Neisseria spp.). CONCLUSIONS: 1) Generally, there were no statistically significant differences in species composition of bacteria isolated from the hard palate and tongue dorsa in patients with and without removable dentures. 2) Staphylococcus spp. and Gram-negative enteric bacilli were isolated more often from denture plaque, palate and tongue dorsa of cancer patients than from patients without cancer (p < 0.05). 3) Staphylococcus spp. was isolated more frequently from denture plaques of diabetic patients compared with non-diabetic patients (p < 0.05). 4) No significant differences observed in isolation frequencies (%) of aerobic bacteria in denture plaques and palatal mucosa of patients with and without denture associated stomatitis.

The clinical and radiological assessment of periodontal bone loss treatment using Emdogain.

UNLABELLED: ADMISSION: Emdogain is the only one biomaterial using biomicra effect which is practiced in periodontal surgery. PURPOSE: The purpose of the study was a clinical and radiological assessment of bone loss treatment using Emdogain. MATERIAL AND METHODS: There were 19 persons examined (11 women and 8 men) which have bone loss treated. Initial and monitoring examination after 10 months embraced clinical parameters such as PPD, CAL and radiological--based on intraoral x-ray pictures. Emdogain treatment was made according to surgical procedures. RESULTS: The research has shown reduction of the depth of periodontal pockets average about 3.4 mm and attachment connective tissue growth about 2.2 mm. Bone loss filling was on 67.1% level. DISCUSSION: Bone loss filling and growth of connective tissue attachment are in our research lower than in most of the others publications. Our observation concerned 10 months period so we should expect better effects after longer time. MOTIONS: Emdogain is safe and effective regeneration material.

The clinical assessment of mobile teeth stabilization with Fibre-Kor.

PURPOSE: A glass fiber tapes are used in periodontal diseases to stabilize mobile teeth. The purpose of this project was to make a clinical appraisal of teeth stabilization which were using Fibre-Kor splinting. MATERIAL AND METHOD: 56 patients 35-67 year old were examined. There were made 162 teeth blocks using Fibre-Kor as reinforcement and Flow-It material as matrix. After 10 months clinical parameters such as: PI, SBI, GI and periodontal pocket were checked. RESULTS: Periodontal pockets depth decreased average by 0.58 mm after teeth stabilization. Bleeding index and inflammation of gums fall average by 2.55 and 1.95. The average oral cavity hygiene improved and achieved 1.46. CONCLUSION: The Fibre-Kor splint is an esthetic and functional solution of mobile teeth stabilization, and is a part of the specialist periodontal treatment.

Poly-C specific ribonuclease activity correlates with increased concentrations of IL-6, IL-8 and sTNFR55/sTNFR75 in plasma of patients with acute pancreatitis.

Plasma pancreatic-type Poly-C specific ribonuclease (P-RNase)-enzyme activity increases in patients with acute pancreatitis (AP) who develop pancreatic necrosis and severe disease course. It is considered as a marker of pancreatic tissue destruction. The aim of this study was to estimate interrelations between major inflammatory cytokines such as: interleukin 6 (IL-6), interleukin 8 (IL-8) and tumor necrosis factor soluble receptors: sTNFR55 and sTNFR75 output, and plasma P-RNase activity. The study was carried out in a group of 56 patients with AP, where 20 developed pancreatic necrosis. It was found that serum P-RNase concentration and levels of all studied inflammatory cytokines significantly increase already in the first day from diagnose of the disease (2.5 folds for P-RNase, 20 for IL-8, about 200 for IL-6 and 1.5 for receptors, respectively). In the first day from admission to hospital, P-RNase activity significantly correlated with plasma concentration of studied inflammatory cytokines. The most pronounced correlation was found for P-RNase and IL-6 in days 1-4 from diagnose, manifested by Pearson correlation r coefficients amounting to 0.86, 0.79, 0.60 and 0.57 respectively (p<0.001). Dividing the studied AP patients into two groups, varying in severity of disease a significant differences in P-RNase and IL-6, IL-8 and sTNFR55/sTNFR75 were found. In patients with acute necrotizing pancreatitis P-RNase significantly correlate with levels of major inflammatory cytokines. Carried out studies suggest that activity of P-RNase reflects severity of inflammatory reaction, which is dependent on development of pancreatic injury and tissue necrosis in AP.

[Patients with non-advanced pancreatic cancer benefit from extended lymphadenectomy]. / Patienten mit nicht-fortgeschrittenen Pankreaskarzinomen profitieren von der ausgedehnten Lymphadenektomie.

BACKGROUND: Despite improvements in surgical technique and adjuvant therapy models, the overall outcome for patients with pancreatic cancer has not significantly improved over the recent decades. The aim of the study was to assess the value of extended lymphadenectomy for pancreatic cancer. STUDY DESIGN: We performed a retrospective analysis of 136 patients with pancreatic cancer who underwent pancreatectomy and standard or extended lymph node dissection, to compare the rate of perioperative complications and 5-year survival. RESULTS: Of 136 patients treated, 43 (32 %) underwent standard (group I) and 93 (68 %) extended (group II) lymphadenectomy. Both groups were comparable with regard to various clinicopathological factors including patients' age, gender, tumour location, advancement and radicality of performed resection. The mean operative time in the extended group was longer (385 +/- 78 min) than in the standard group (359 +/- 62 min) but observed difference was insignificant. Similarly, there were no significant differences with respect to transfused blood and plasma units. The mean number of resected lymph nodes was significantly (p < 0.001) higher in group II (29.0 +/- 17.7) compared to I (13.0 +/- 7.4). The overall morbidity and mortality rates were 43 % and 6 %, respectively, without significant differences between both groups. The overall 5-year survival was 16.7 % and was similar regardless the type of performed lymphadenectomy. However, patients with node-negative pancreatic cancer following extended lymphadenectomy had significantly higher (p < 0.01) 5-year survival (48 %) compared to the standard resection (22 %). CONCLUSION: Extended pancreatoduodenectomy can be performed with similar morbidity and mortality rates as the standard procedure. However, only patients with non-advanced pancreatic cancer are likely to benefit of 5-year survival.

[Surgical palliation for pancreatic cancer. The 25-year experience of a single reference centre]. / Chirurgisch palliative Therapie beim Pankreaskarzinom - 25 Jahre Erfahrungen eines einzelnen Referenzzentrums.

BACKGROUND: In spite of dynamic development of modern diagnostic and therapeutic methods, the long-term results of surgical therapy in pancreatic cancer are still unsatisfying. The aim of this study was to analyse long-term results of surgical palliation for pancreatic cancer in a pancreatic surgery centre. METHODS: We performed a retrospective analysis of 418 patients who underwent non-resective, palliative procedures for pancreatic cancer between 1975 and 1999. In order to compare two consecutive periods of time, the patients were divided in 2 groups; group I treated from 1975 to 1990 (n = 204), and group II from 1991 to 1999 (n = 214). RESULTS: Of all patients qualified for surgery, 281 (67.2 %) underwent surgical bypass, 107 (25.6 %) laparotomy, and in 30 cases surgical intervention was limited to implantation of endoprosthesis. A significant tendency towards double (i. e. biliary and gastric) anastomosis was observed (32.3 % vs. 74.8 %; p < 0.01) in patients who underwent bypass procedures. The postoperative morbidity was 16.3 %. The postoperative mortality rate was 5.7 % and significantly (p < 0.01) decreased from 10.3 % (group I) to 1.4 % (group II). No differences neither in mortality nor morbidity related to the type of performed surgery were found. The mean time of hospital stay was 15.5 +/- 6.9 days and showed no differences related to the type of intervention. Jaundice or symptoms of gastric outlet obstruction were observed in 16 % of patients in the follow-up period and concomitantly performed biliary and gastric bypasses were associated with the lowest rate of the late gastrointestinal obstruction (4 %). The median survival time was 169 days and only 4 % of patients survived 12 months. The univariate analysis of prognostic factors showed that location and stage of the tumour, the type of surgical intervention and bypass procedure influenced 1-year survival. The multivariate analysis using Cox proportional hazard model proved that only stage and location of the tumour had independent prognostic value. CONCLUSION: Surgical palliation for pancreatic cancer can be performed with acceptable morbidity and mortality rates. For tumours located in the head and body of the pancreas combined biliary and gastric bypass should be preferred. For cancers located in the tail of the pancreas gastric bypass should be performed routinely. Because surgical palliation can prevent gastric outlet obstruction by gastroenterostomy, endoscopic biliary stenting should be only performed in patients with pancreatic head cancers and simultaneous evidence of distal metastases as well as in older patients with high comorbidity.

Does extended lymphadenectomy improve survival of pancreatic cancer patients?

PURPOSE: Aim of the study was to assess the value of extended lymphadenectomy for pancreatic cancer. MATERIALS AND METHODS: A retrospective analysis of 201 patients with pancreatic and ampullary cancer who underwent pancreatectomy with standard or extended lymph node dissection were analysed in order to compare the rate of perioperative complications and 5-year survival. RESULTS: Of 201 patients treated, 65 (32%) underwent standard (group I) and 136 (68%) extended (group II) lymphadenectomy. These two groups were similar with regard to age, gender, tumour location, advancement and radicality of performed resection. The mean operating time in the extended lymphadenectomy group was longer (383 +/- 81 min) compared to the standard group (357 +/- 64 min) but observed difference was insignificant. Similarly, there were no significant differences with respect to transfused blood and plasma units. The mean number of resected lymph nodes was significantly (p < 0.001) higher in group II (29.0 +/- 17.7) compared to group I (13.0 +/- 7.4). The overall morbidity and mortality rates were 43% and 6.9%, respectively without significant differences between both groups. The overall 5-year survival for pancreatic and ampullary cancer was 16.7% and 67.6% respectively, and was similar regardless the type of performed lymphadenectomy. Patients with node-negative pancreatic cancer following extended lymphadenectomy had significantly higher (p < 0.01) 5-year survival (48%) compared to the standard resection (22%). CONCLUSIONS: Extended lymphadenectomy can be performed with similar morbidity and mortality rates compared to the standard resection. Benefits of 5-year survival can be achieved only in a limited group of patients with non-advanced pancreatic cancer.

[Abrikosov's tumor of the esophagus]. / Guz abrikosowa przelyku.

The authors are reporting a case of Abrikosov's tumor of the oesophagus (myoblastoma granulocellulare, granular cell tumor, GCT). Due to the rare incidence of these lesions, they are also presenting general state of knowledge on these particular tumors based on the literature, diagnostic methods and treatment.

Prognostic factors of long-term survival after resective procedures for pancreatic cancer.

BACKGROUND/AIMS: Five-year survival rates following surgical resection of pancreatic cancer reported by the leading medical centers do not exceed 25%. It necessitates further extensive research in this area. The aim of the study was to determine prognostic factors of long-term survival after surgical treatment for pancreatic cancer. METHODOLOGY: From 1980 to 1999, 212 patients underwent surgical resection for pancreatic carcinoma. Statistical analysis of prognostic factors of long-term survival after pancreatic cancer surgery estimated by Kaplan-Meier method was carried out using multiple regression model. RESULTS: A group of 212 patients underwent surgery, where 98 had Whipple's resection, 50 Traverso, 35 total pancreatic resections, 25 left subtotal resections, and the remaining 4 segmental pancreatic body resections. Perioperative mortality was below 8%, 5-year survival approximately 15%, increasing to 65% in patients with early cancer. It was observed, that the following prognostic factors influenced the long-term survival rate: tumor size, localization, histopathologic type, and metastases to lymph nodes. The type and extent of surgery was of significance in the case of small neoplasms. CONCLUSIONS: Based on the analysis carried out, the authors conclude that the main prognostic factors for long-term survival after pancreatic cancer surgery are related to the tumor itself and show associations with the natural development biology.