[Novelties in the Treatment of Colorectal Diseases - An Echo from the 10-th ESCP Congress].

Treatment of colorectal pathology stands continuous development. One of the promotional leaders of the new therapeutic approaches is the European Society of Coloproctology (ESCP). The annual congress of the organization held in Dublin, Ireland and it unites the elite of European Community countries. The most advanced scientific knowledge of the diseases of the colon and rectum, anal canal and perineum was presented.

[Mini-invasive approach in the treatment of acute necrotizing pancreatitis].

OBJECTIVES: The study aims to evaluate the efficacy of percutaneous necrosectomy performed under ultrasound control and endoscopic necrosectomy trough secondary sinus track (ENTSST) using nephroscope and cystoscope. MATERIAL AND METHOD: Puncture of fluid collections in the pancreas was performed under ultrasonographic control to 23 patients with acute necrotizing pancreatitis (ANP). ENTSST using nephroscope and cystoscope was performed to 47 patients after open or percutaneous necrosectomy and persistent sepsis (without satellite collection of CT). RESULTS: Seventeen (74%) patients treated with percutaneous necrosectomy recovered without open surgery. Two of this group died. The average hospital stay was 42 days. Twenty-three patients required an average of two (from 1 to 4) ENTSST. CONCLUSIONS: Based on our initial results we believe that the percutaneous necrosectomy and ENTSST in well selected patients might be the better choice than the open necrosectomy and postoperative lavage. Common solution of these methods has not been reached yet.

Investigation of circumferential resection margin in rectal cancer surgery.

PURPOSE: Literature data suggest that investigation of the circumferential resection margin (CRM) in rectal cancer surgery gives significant information for prognosis of the disease and the quality of the performed operation. The aim of this study was to analyze the clinical and morphological aspects of CRM in pT3 tumors in relation to their significance for rectal cancer treatment and staging. PATIENTS AND METHODS: Thirty patients with radically operated pT3 stage rectal cancer were investigated. The resected specimens were studied both macroscopically and microscopically to assess CRM and the quality of the performed operation. RESULTS: Six (20%) patients had positive CRM (CRM +; tumor cells in the margin or < 1 mm from it). These cases were characterized with deep infiltration (> 4 mm) in the rectal adventitia (perirectal tissue). Statistically significant correlation was found between CRM status and quality of the resected specimen (including the presence of rectal fascia in CRM). There was no correlation between pathological characteristics of the tumor and the status of CRM. CONCLUSION: The status of CRM is a factor independent from TNM classification. The presence of rectal fascia in CRM confirms the good quality of the operation. CRM+ could be a result of inadequate surgery or advanced disease. The status of CRM could be used in the decision-making for postoperative adjuvant treatment.

[Pathologic handling and investigation of surgical resected specimen in rectal cancer].

A methodic for pathologic handling and investigation of surgical resection specimen in rectal cancer is presented. It is conformed with recent trends of multidisciplinary approach to rectal cancer. Surgeon is involved in macroscopic investigation of the fresh specimen, whether pathologist is responsible for macroscopic and histological examination of the fixed specimen. A model of clinicomorphologic reporting chart for rectal cancer is developed. Special attention is given to inspection for completeness of the "mesorectum" and rectal fascia, as well as investigation of circumferential resection margin. Precise and exact handling and investigation of resected specimen from rectal cancer patients improve the accuracy of the staging, serve valuable information for radicality and quality of the performed operation, and determine the appropriate adjuvant therapy.