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.

Venous access in cancer patients.

The most commonly used permanent venous access devices in cancer patients are the port, PICC port and PICC catheter (peripherally inserted central catheter). It is always necessary to consider the type of venous access needed for each individual cancer patient. Implantation should be performed using modern instruments to minimize the risk of early and late complications and thereby a delay in oncological treatment. The use of ultrasound is recommended at all stages of introduction. Precise tip placement of the central catheter in the sinoatrial junction region further reduces the number of thromboses arising in the catheter. A trend towards the treatment of catheter infections is certainly to maintain the venous access without compromising the patients health. Permanent venous access devices allow the application of chemotherapy and repeated blood sample collections with minimal impact on the quality of life in cancer patients.

[Renal cancer metastasis into common bile duct]. / Metastáza svetlobunecného renálního karcinomu do ductus choledochus.

We present rare case of clear cell renal carcinoma metastasis into common bile duct. It is a 9th case listed on the MEDLINE data base from 1966 to 2010.71-year-old woman underwent right nefrectomy for renal cancer G1 in 1986. She was reoperated in 2006 for relaps in renal bed on the right side. Histological examination confirmed clear cell renal carcinoma again. At present, a new liver metastasis in S 4/5 was detected. During the operation we found first described liver metastasis and second another one in common bile duct with intraluminal growth. Before surgery the patient showed neither clinical nor laboratory marks of biliary obstruction. Even abdominal ultrasound, SONO VUE, CT and body PET were negative. We carried out choledochectomy with hepaticojejunoanastomosis sec Roux and liver metastasis was destructed using radiofrequency ablation.

Use of radiofrequency ablation in the treatment of malignant liver lesions.

BACKGROUND/AIMS: The authors present their experience with the option of using radiofrequency ablation (RFA) in the treatment of malignant focal liver lesions. METHODOLOGY: In a prospective study conducted in the period from 2002-2005, 60 patients were treated using RFA during a total of 72 sessions and treating 108 lesions of various size, number and localisation. The method of RFA was applied either percutaneously under computed tomography (CT) or ultrasonographic (USG) navigation (22 patients) or surgically--during opened laparotomy or laparoscopy (42 patients). RESULTS: Median observation time was 12.7 months (with the range 3-36 months). Authors did not observe any serious complications after RFA treatment in the study population. Median time of local recurrence in the ablated lesion position was 13.5 months in the observed population, median time of metastatic progression in the residual liver parenchyma was 12 months, and overall median survival was 22 months. Percutaneous RFA application demonstrated significantly worse results when compared with surgical application in previously the mentioned parameters. Lesions larger than 3cm in diameter also showed statistically more frequent local recurrence. CONCLUSIONS: RFA is appreciated as minimally invasive method of treatment for liver malignancies with promising perspectives of therapeutic effects.