Laparoscopy-Assisted Transanal Total Mesorectal Excision.

BACKGROUND: Rectal cancer located in distal third still remains a technical challenge for surgeons. Transanal total mesorectal excision with laparoscopic assistance is quite new surgical approach for rectal cancer treatment that seems to solve some of the associated technical issues. The aim of the study was to present our experience in laparoscopy-assisted transanal total mesorectal excision. MATERIALS AND METHODS: After obtaining approval from the local Ethics Committee, a single centre prospective double-arm comparative non-randomized trial was initiated. With recruiting still in progress at present, between 27.02.2017 and 01.10.2017 four laparoscopy-assisted transanal total mesorectal excision procedures and two laparoscopic total mesorectal excisions were performed in the department of Endoscopic Endocrine Surgery and Coloproctolgy at the Military Medical Academy in Sofia. RESULTS: There is no conversion in both groups. No postoperative mortality 30 days after surgery. The quality of total mesorectal excision was satisfactory in all patients estimated by the Quirque classification. There was no distal or proximal tumor involvement of surgical margins. In one of the cases, we reported positive circumferential resection margin. We had two cases with postoperative morbidity. CONCLUSION: Transanal total mesorectal excision with laparoscopic assistance is quite new minimally invasive surgical approach for rectal cancer treatment. Avoiding the procedure-related complications during the learning curve is essential before applying the method to every patient. Multicenter randomized control trial is needed so that we could answer the questions raised in this study.

An Incidental Finding of Heart Echinococcosis in a Patient with Infective Endocarditis: a Case Report.

Echinococcosis is a cosmopolitan zoonotic parasitic disease caused by infection with the larval stage of tapeworms from the Echinococcus genus, most commonly Echinococcus granulosus. According to WHO, more than 1 million people are affected by hydatid disease at any time.1 About 10% of the annual cases are not officially diagnosed.2 In humans, the disease is characterized by development of three-layered cysts. The cysts develop primarily in the liver and the lungs, but can also affect any other organ due to the spreading of the oncospheres. Cardiac involvement is very uncommon - only about 0.01-2% of all cases.4,5 In most cases, the cysts develop asymptomatically, but heart cysts could manifest with chest pain, dyspnea, cough, hemophtisis and can complicate with rupture. Diagnosis is based on a number of imaging techniques and positive serological tests. Treatment for cardiac localization is almost exclusively surgical. We present a case of an incidental finding of an echinococcal cyst in the left atrium (rarest possible localization of heart echinococcosis) in a patient, admitted for infective endocarditis.

Distant Liver Metastases as a Major Factor Influencing Survival in Patients with Colorectal Cancer.

AIM: To assess the effect of the factor 'hepatic metastatic disease' on long-term outcomes in patients with colorectal cancer. MATERIALS AND METHODS: We analysed retrospectively 200 randomly selected patients. Forty-two of them were excluded from the study for different reasons so the study contingent was 158 patients over a period of 23 years. All were diagnosed and treated in the Lozenetz University Hospital, in the Department of General Surgery. 125 of the patients were diagnosed with colorectal cancer without distant metastases and 33 of the patients had liver metastases as a result of colorectal carcinoma. The statistical analysis was performed using SPSS 19 IMB, with a level of significance of P < 0.05 at which the null hypothesis is rejected. We also used descriptive analysis, Kaplan-Meier estimator, Log-Rank Test and Life-Table statistics models. RESULTS: The median survival for patients without metastases was 160 months, and the median was 102 months. The median survival for patients with liver metastases was 28 months and the median was 21 months. One-year survival for patients without metastases was 92% versus 69% in patients with liver metastases. CONCLUSION: Average, annual and median survivals are influenced statistically significantly by the presence of liver metastases compared to overall survival and that of patients without metastatic colorectal cancer. Liver metastatic disease is a proven factor affecting long-term prognosis and survival in patients with colorectal cancer.