Minimally-invasive pancreatic surgery in high volume centers in the Czech Republic - current status and possible implementations.

INTRODUCTION: Minimally-invasive surgical methods have been becoming ever more common also in the segment of pancreatic surgery. The aim of this paper was to analyze the current state of minimally-invasive surgery in the Czech Republic and the justification and potential of implementing such procedures. METHODS: Analysis of high volume centers using healthcare providers´ and payers´ data. RESULTS: Thirteen pancreatic surgical centers meet the proposed criteria for being called a high volume center - a center of highly specialized care in pancreatic surgery based on the annual number of at least 17 major resections of the pancreas. According to data from healthcare payers, laparoscopy was used in 0.6%-65.7% of procedures in individual centers. However, these are not resection procedures. The centers themselves report a significantly smaller number of minimally-invasive pancreatic resection procedures. The actual numbers of minimally-invasive resection procedures in the current system are practically impossible to verify. The potential for implementing minimally-invasive pancreatic surgery in the Czech Republic can be estimated based on the identification of candidate patients. CONCLUSION: Due to the fragmentation of this operative segment, its costs and small numbers of patients suitable for minimally-invasive pancreatic surgery even among high volume centers, the implementation rate of these methods is very slow. The need to centralize this segment of care appears to be very urgent from all points of view.

Cytoreduction and hyperthermic intraperitoneal chemotherapy in the treatment of peritoneal metastases from colorectal cancer in the Czech Republic in 2018.

BACKGROUND: For highly selected patients with peritoneal metastases (PM) from colorectal cancer (CRC), an aggressive surgical approach with intraperitoneal chemotherapy may be beneficial. This management may prolong overall survival, which is well documented by the results of a number of clinical trials. In the Czech Republic, five specialized centers of surgical oncology are able to perform cytoreductive surgery (CRS) in combination with hyperthermic intraperitoneal chemotherapy (HIPEC). All of these centers provided accurate information on the number of CRS procedures in 2018 in the PM CRC indication. The estimation of the prevalence of peritoneal metastases from CRC is based on data from the Czech National Cancer Registry. PURPOSE: To determine the number of cytoreductive procedures performed in patients with peritoneal metastases from CRC in the Czech Republic in 2018, and to compare it with the number of patients who could hypothetically benefit from this procedure according to statistical data. RESULTS: Twenty-five CRS/HIPEC procedures were performed on patients with peritoneal metastases from CRC in 2018 in the Czech Republic. However, based on the prevalence of peritoneal metastases from CRC in the Czech Republic, cytoreduction with intraperitoneal chemotherapy (CRS/HIPEC) could probably bring benefit to a minimum of 150 patients a year in the Czech Republic. CONCLUSION: In the Czech Republic in 2018, the cytoreduction and HIPEC procedures for peritoneal metastases from CRC were performed in significantly fewer cases than would correspond to the estimated number of potentially curable patients.To increase the awareness of this issue and improve the number of potentially curative cytoreductive procedures, there will be necessary better awareness and closer cooperation among specialized centers, general surgeons, and clinical oncologists.

Circulating tumor DNA as a biomarker in metastatic colorectal carcinoma case report.

INTRODUCTION: Colorectal cancer (CRC) is the third most common malignant disease worldwide. The stage of the disease at the time of diagnosis and the capture of an early recurrence have a direct impact on long-term survival. Existing control screening methods often do not reflect real-time metastatic disease. In patients with detectable circulating tumor DNA (ctDNA), liquid biopsy can be an effective monitoring tool. CASE REPORT: In 2012, we performed sigmoid resection in a 57 years old patient for advanced CRC. The follow-up assessments included: blood samples for CA 19-9 and CEA, endoscopy and imaging methods. We also sampled peripheral blood to determine the level of ctDNA. Its value corresponded to the development of the disease throughout the period. Twice it outperformed imaging methods. CEA showed some degree of unreliability, especially after prolonged illness. CA 19-9 was in the normal range at all times. CONCLUSION: Circulating tumor DNA is an effective tool in the diagnosis of recurrent metastatic CRC. In patients with detectable ctDNA, its level correlates with the tumoral mass in real time. It has a predictive value in monitoring the treatment response. Its implementation in the follow-up of patients with CRC may have an impact on the choice of treatment strategy and consequently on patient survival.

[Total pelvic exenteration - strategy and extent of surgery]. / Totální pánevní exenterace - strategie a rozsah operacního výkonu.

INTRODUCTION: Pelvic exenteration is an essential part of complex treatment of advanced tumours of the small pelvis. The strategy of surgery is well known and consensual. However, the optimal extent of lymphadenectomy is still under discussion. The aim of this paper is to summarize the strategy of surgery and the extent of lymphadenectomy. METHODS: Review of the literature and retrospective analysis of 63 patients of our cohort, operated on at the Department of Surgery of the First Faculty of Medicine, Charles University and Thomayer Hospital between 1999-2015. CONCLUSION: The paper describes indications for pelvic exenteration, the strategy of surgery and the necessary extent of lymphadenectomy.

[Primary gastrointestinal lymphoma]. / Primární lymfomy zazívacího traktu z pohledu chirurga.

This article deals with a surgical approach to primary gastrointestinal lymphoma - a rare finding when compared to primary gastric carcinoma. The clinical findings, diagnosis and staging of the disease as well as various treatment methods and prognosis of the condition are discussed. As it is evident from the paper, the opinions of individual authors regarding this diagnosis may often differ considerably. Furthermore, this paper presents two separate case studies of surgical treatment for gastric lymphomas performed at our department in 2016. Case study 1 describes a surgical intervention for acute abdomen, where lymphoma was already diagnosed peroperatively. Case study 2 presents the case of a patient indicated for elective laparoscopic cholecystectomy with an unexpected finding of primary gallbladder lymphoma.Key words: primary gastrointestinal lymphoma - chemotherapy - surgical intervention - primary intestinal lymphoma - primary lymphoma of the gallbladder.

[Quality of life after extensive pelvic surgery]. / Kvalita zivota po extenzivních pánevních operacích.

INTRODUCTION: Multiorgan resections in the small pelvis are standard procedures in oncosurgery and some indications have no alternative. In advanced pelvic cancer, pelvic exenteration with en bloc resection of the involved organs and structures, including portions of the bony pelvis, is indicated. The 5-year survival rate is fairly good, around 50%, but little is known about the long-term quality of life. The aim was to describe the quality of life of long-term total pelvic exenteration survivors. METHOD: In total, 63 pelvic exenterations were performed between 2000 to 2015 at the Department of Surgery, Thomayer Hospital, First Faculty of Medicine, Charles University in Prague, mostly for primary or relapsed rectal cancer. In this retrospective cohort study, the quality of life was assessed using the EORTC QLQ-C30 (version 3.0) and the EORTC QLQ-CR29 questionnaires. The completed questionnaires were scored according to EORTC instructions. RESULTS: At the time of this survey, 24 patients after TPE were surviving longer than one year after the surgery. The five-year survival of all patients was 49%, median survival 4.6 years, and median follow-up 15 months. Most of our patients reported a good level of their physical, emotional, cognitive and social functions. Some patients reported a worse body image, and of course a worsening in their sexual life. Regarding symptom-oriented questions, some patients evaluated the necessity of more frequent care of the stomia as slightly problematic; most patients reported impotence (men) or painful sexual intercourse (women). CONCLUSION: Long-term quality of life in survivors of pelvic exenteration for rectal cancer is comparable with reported results following primary rectal cancer resection with the exception of the sexual function. The quality of life gradually improves in the course of weeks to months from the surgery. KEY WORDS: pelvic exenteration quality of life.

[Pelvic exenteration in the treatment of advanced tumours of the small pelvis]. / Pánevní exenterace v lécbe pokrocilých nádoru malé pánve.

INTRODUCTION: Pelvic exenteration is the essential part of complex treatment of advanced urologic, gynaecologic and colorectal tumours of the small pelvis. The aim of this work is to summarize the individual types of pelvic exenteration, their indications, contraindications and long-term results. METHODS: Overview of the current literature and retrospective analysis of our cohort of 37 patients operated on at the Department of Surgery of the First Faculty of Medicine, Charles University, and Thomayer Hospital during the period 1999-2012. CONCLUSION: This work summarizes the classification, indications and types of pelvic exenteration.

[Total pelvic exenteration - strategy of the surgery]. / Totální pelvická exenterace - strategie výkonu.

INTRODUCTION: Total pelvic exenteration (TPE) has a key role in the complex treatment of advanced T4 tumours of the small pelvis, which cannot be radically removed by a less invasive procedure. The aim of this work is to summarize the strategy of TPE, perioperative care of the patients, complications of the intervention and their management. METHODS: Overview of the current literature and the authors experience, based on our own group of 37 patients after TPE performed during the period 1999-2012. CONCLUSION: This article aims to summarize the strategy of TPE, complications and the authors own experience.

[The new blood test bio-marker SEPT9 and colorectal carcinoma screening]. / Nový krevní test bio-markeru SEPT9 a screening kolorektálního karcinomu.

Due to its high incidence and mortality rates, the colorectal carcinoma represents a crucial medical issue. However, when it is detected in early stage there is high rate of successful treatment. Thats why, early stage cancer screening programmes were introduced into the clinical practice. They focus on the finding of hidden bleeding, using various laboratory techniques, sigmoidoscopy, and, primarily, colonoscopy. However, screening programmes have not yet reached the effect required. New techniques are therefore being developed, such as the detection of blood bio-markers. This group includes also methylated SEPT9 (mSEPT9) detection in blood. We applied this test on 57 patients; we divided the group into two parts. There were 33 asymptomatic individuals in the first group. In this group, we were got only one positive mSEPT9 result. The consequent colonoscopies were negative. The other group had 24 proven carcinomas. Of them, two had negative mSEPT9 results. The remaining in all 22 patients was tested mSEPT9 positive. After its efficiency is tested by further studies, this test may be used especially for patients with low compliance, as it only requires routine blood drawing.

[Ileocaecal actinomycosis - a case report]. / Ileocékalna aktinomykóza - kazuistika.

Abdominal actinomycosis as an aetiological cause of acute abdomen in immunocompetent patients is considered to be very rare. The authors present a case of a young patient with acute appendicitis in the terrain of specific colitis imitating caecal tumour. Especially nowadays, in the era of globalization, it would be an unnecessary mistake not to think of this aetiological unit when the pain and tenderness in the right hypogastrium with signs of peritonism are expressed.

[Diverticular disease of the large bowel - surgical treatment]. / Divertikulární choroba tracníku - chirurgická lécba.

INTRODUCTION: Surgical treatment, despite the rapid development of the numerous modern miniinvasive intervention techniques, remains essential in the treatment of complicated diverticular disease. AIM: The aim of this work is to summarize indications for surgical treatment in both acute and elective patients suffering from diverticular disease of the large bowel. METHODS: Review of the literature and recent findings concerning indications for surgical intervention in patients with diverticulosis of the colon. CONCLUSION: The article describes indications, types of procedures, techniques and postoperative care in patients undergoing surgical intervention for diverticular disease.

[Laparoscopic resection of the sigmoid colon for the diverticular disease]. / Laparoskopická resekce sigmatu pro divertikulární chorobu.

INTRODUCTION: Laparoscopic resection of the sigmoid colon for diverticular disease is nowadays a fully accepted alternative to traditional open procedures. AIM: The aim of this work is to summarize the indications, advantages and risks of laparoscopic sigmoid resection for diverticular disease. METHODS: Review of the literature and recent findings concerning the significance of laparoscopic resection for diverticulosis of the sigmoid colon. CONCLUSION: The article presents the indications, risks, techniques and perioperative care in patients after laparoscopic resection of the sigmoid colon for diverticular disease.

Betamethasone in hernia surgery: a randomized controlled trial.

BACKGROUND: Post-operative pain and nausea may be a problem in day-case surgery. This study aims to investigate the effect of betamethasone on pain and nausea in inguinal hernia surgery. METHODS: Patients aged 18-70 years scheduled for open inguinal hernia surgery at two Swedish hospitals, March 2005-December 2009, were eligible for inclusion. Patients were randomized, to either treatment with 12 mg betamethasone intravenously or placebo. Post-operative pain was assessed using a visual analogue scale on the recovery ward, each day the first post-operative week and at 1 month after surgery. One year after surgery, residual pain was estimated by the Inguinal Pain Questionnaire. RESULTS: A total of 398 patients were included (21 women, 377 men). Pain at rest on the day of surgery was significantly lower in the treatment group (p = 0.012). The pain was also significantly lower in the treatment group the day after surgery (p < 0.001), but not during the remaining part of the first post-operative week. Bleeding complications were reported by 17 patients (8.5%) in the Betamethasone group and seven (3.5%) in the placebo group (p = 0.028). One month after surgery, 21 out of 173 (12%) in the betamethasone group still had pain, compared to 33 out of 159 (21%) in the placebo arm (p = 0.049). After 1 year, no significant difference in pain was seen. CONCLUSION: A 12 mg betamethasone reduced pain during the first 24 h and at 1 month after inguinal hernia surgery. If combined with diclofenac, however, this dose may increase the risk for bleeding complications.

[Surgical treatment of liver metastases of gastric cancer]. / Chirurgická lécba jaterních metastáz karcinomu zaludku.

INTRODUCTION: Gastric cancer, despite of its decreasing incidence, remains a serious medical problem. Many patients see a specialist as late as in the IVth stage of the disease with peritoneal seedings or liver metastases. Liver resection for gastric cancer metastases remains to be a controversial issue. MATERIAL AND METHODS: The aim of this study is to present, through our case report and literature review, the current opinions on liver resections for metastatic gastric cancer. RESULTS: Based on our experience and review of the Medline literature of the last five years, we would like to present the current trends in this field. CONCLUSIONS: Liver resection for gastric cancer metastases remains a controversial topic. However, in a very carefully selected group of patients, improved survival can be reached by combining liver resection and modern systemic treatment.

[Metastasis of breast cancer in gastointestinal tract - report of a case and review of the literature]. / Metastázy karcinomu prsu do gastrointestinálního traktu - kazuistika a prehled literatury.

Metastatic breast cancer affecting the gastrointestinal tract except from the liver is very rare, however, some case reports can be found in literature, autopsy series and several retrospective studies focusing on this issue. In our surgery department we have also documented a case report of metastatic breast cancer manifesting as an obstructive tumor of small intestine.