[Surgical complications of esophageal resections: our experience with 168 operations]. / Nyelocso-reszekciók sebészi szövodményei: tapasztalataink 168 mutét kapcsán.

We performed 346 operations for oesophageal cancer between 1 June 1991 and 31 May 2001. 168 of them were resections. The resection rate was 48.5 percent. The most frequently performed operation was subtotal resection of the oesophagus with the removal of paraesophageal lymph nodes. Reconstruction was usually performed with gastric tube pulled up retrosternally according to Akiyama with cervical oesophago-gastrostomy (135/168). In 24 patients intrathoracic oesophago-gastrostomy and in 9 patients other type of reconstruction was performed. Considerable co-morbidity was present in 88 percent of our patients (148/168). Alcohol dependency was noted in 88 patients however we suspect there were patients who did not admit alcohol abuse. Extended resection i.e. other organs' resection together with the oesophagus was performed in 59 patients. Postoperative recovery was uneventful in 49.4 percent (83/168) of our patients. Surgical complications occurred in 28.6 percent. Anastomotic leak was observed in 21 cases (12.5 percent). The most severe complication was necrosis of an organ used in reconstruction (7 patients, 4.2 percent). 23 patients (13.7 percent) died in the postoperative period, 7 of them (4.2 percent) because of surgical complication. Statistical analysis proved that the R status and the extension of resection had no influence on the frequency of complications and mortality rate except for when the removal of the entire stomach or gastric stump was performed in one sitting with the oesophageal resection. The frequency of anastomotic leakage is grossly affected by the anastomosis technique and whether it was in cervical or in thoracic position.

[Lung biopsy using mediastinoscope in the time of VATS]. / Tüdobiopszia mediastinoscoppal a VATS korában.

Patients with diffuse lung disease need lung biopsy for accurate diagnosis and treatment. Both traditional open lung biopsy through a thoracotomy and video assisted thoracoscopic lung biopsy are effective methods for obtaining parenchymal samples. The authors present their surgical method and experience. Thirty patients were operated on for lung biopsy using mediastinoscope between 1999-2003. Lung parenchymal samples were eligible for histological examination. No serious postoperative complications developed. The method is simple, safe and low-cost.

[Hungarian surgeons and surgical treatment of stomach cancer at the turn of the Millennium. I. Extent of stomach resection]. / A magyar sebészek válaszai az ezredfordulón a gyomorrák sebészetének alapvetó kérdéseire. I. A reszekció kiterjedésének megválasztása a szerven.

Authors interviewed the most prestigeous Hungarian surgical clinics and departments about the operative treatment of gastric cancer using question form. Forty-seven of the involved 51 clinics and departments filled out and sent the questionnaires back. 68.5 per cent of the gastric resections were performed by these clinics and departments in 1999. The main purpose of this paper was to show how the Hungarian surgeons decide the extension of the resection on the organ. Only 5 out of 47 clinics and departments are satisfied with 2-3 cm long resection distance proximally from the tumor, 25 of 47 answering institutes aimed to 4-6 cm and 15 of them think that more than 6 cm is necessary. In case of antral tumor 2 departments perform total gastrectomy. Seventeen clinics and departments perform subtotal resection in case of antral tumor. Seventeen institutes decide to perform subtotal or total gastrectomy depending on the preoperative histology. Thirty-two departments perform total gastrectomy in case of mid-third tumors, and 15 of them perform subtotal gastrectomy if the resection distance is adequate. The necessity of total gastrectomy is generally accepted in case of tumors in the proximal third. Only two departments perform proximal resections regularly and 8 departments perform that in selected cases. Describing the results of prospective randomised studies we analyse the answers of the questionnaires. Our opinion is not described here. In addition to demonstrating the Hungarian situation we would like our readers to compare their own practice with the principles of other authors.

[Hungarian surgeons and surgical treatment of stomach cancer at the turn of the Millennium. II. Regional extension of the resection]. / A magyar sebészek válaszai az ezredfordulón a gyomorrák sebészetének alapvetó kérdéseire. II. A reszekció regionális kiterjesztése.

Authors interviewed the most considerable Hungarian surgical clinics and departments about the operative treatment of gastric cancer using a question form. Forty-seven of 51 clinics and departments sent the questionnaires back. 68.5 per cent of the gastric resections were performed in these clinics and departments in 1999. The main purpose of this paper was to show how the Hungarian surgeons decide the extension of the resection outside of the stomach. Extended lymphadenectomy is performed in 43 clinics and departments. Twenty-three institutes described splenectomy to be necessary in case of cardiac or upper third tumors and 21 clinics and departments perform it in case of suspicious hilar lymph nodes. Combined, extended operation is performed if the tumorous infiltrates surrounding organs in 38 institutes if radical resection is feasible, and 8 clinics and departments perform it as palliation as well. Showing the results of prospective randomised studies we analyse the answers of the questionnaires. Our opinion is not described here. In addition to demonstrating the Hungarian situation we would like our readers to compare their own practice with the principles of other authors.

[Effect of extending the resection on postoperative complications of total gastrectomies: experience with 161 operations]. / A reszekció kiterjesztésének hatása a total gastrectomiák posztoperatív szövódményeire: tapasztalataink 161 mútét kapcsán.

Authors operated on 416 patients for gastric cancer between 1st of June 1991 and 31st of May 2001. Among them 305 lesions were resectable. So the resection rate was 73.3 per cent. Gastrectomy was performed in 161 patients (52.8 per cent of resections). Total gastrectomy with omentectomy was performed in 44 patients. In 96 patients splenectomy, in 19 patients splenectomy with the resection of the left side of the pancreas, in 33 patients distal esophageal resection and in 8 patients other organ resection was performed with total gastrectomy. Standard, two field lymphadenectomy has been performed only in the past few years. Uneventful recovery followed in 100 cases (62 per cent), 61 patients (38 per cent) suffered complications in the postoperative period. The most frequent surgical complication was anastomotic leak, which was observed in 8 patients (5 per cent). Septic complications, intraluminal bleeding, postoperative pancreatitis, intraabdominal bleeding, pancreatic fistula and small bowel obstruction were the most frequent surgical complications. Most general complications occurred in the cardiorespiratory system. In 9 patients reoperation was necessary. Eight patients (5 per cent) died in the postoperative period. In patients with extended gastrectomy significantly more complications occurred--compared with gastrectomy + omentectomy only. This could also be observed in patients with only splenectomy. If more organs were removed or resected with total gastrectomy and splenectomy, the complication rate increased only if pancreatic resection was performed. Mortality rate increased in these patients as well. The esophageal or other neighbouring organ (colon, small-bowel, liver, diaphragm etc.) resection had no influence on the postoperative morbidity or mortality. Extended operations should be performed, as the risk is acceptable, if there is hope for tumour clearance.