[Laparoscopic surgery of benign liver tumours]. / Benignus májdaganatok laparoszkópos resectiója.

273 patients underwent elective surgical treatment for benign liver lesions at the 1st Surgical Department of Semmelweis University, Budapest, Hungary between 2004 and 2014. Laparoscopic (LAP) interventions were performed in 83 cases. Cyst fenestration in 52, and hepatic resection in 31 cases. LAP liver resections were set against to open surgery of paired group of patients with comparable demographic and clinical parameters. Data revealed that the operative time in LAP group (113.7 min) was significantly longer than that in the open surgery group (89.5 min). The average postoperative length of hospital stay was shorter after LAP surgery (5.8 vs 9.1 days). There was no postoperative complication in the LAP group, two wound infections and one biliary collection were treated by ultrasonic drainage in the open group. Three patients were given blood transfusion in the LAP, four in the open group. Operative mortality was zero, and no reoperation required. The surgical technique which is described in detail in the text enables safe resection of segments 7-8 which are difficult to approach. Our data support the safety and feasibility of laparoscopic liver resection after adequate preoperative investigations.

[Verner-Morrison syndrome: a case study]. / Verner-Morrison-szindróma egy esete.

Verner and Morrison described a syndrome of watery diarrhea, hypokalemia, and achlorhydria (WDHA) in 1958. VIPomas producing high amounts of vasoactive intestinal peptide (VIP) commonly originate from the pancreas. Typical symptoms play a momentous role in the diagnosis of VIPoma. Diarrhea may persist for years before the diagnosis. Morbidity from untreated WDHA syndrome is associated with long-standing dehydration and with electrolyte and acid-base metabolism disorders, which may cause chronic renal failure. Assessment of specific marker (VIP) offers high sensitivity in establishing the diagnosis. Imaging modalities include endoscopic ultrasonography, computed tomography and magnetic resonance imaging, and particularly, scintigraphy with somatostatin analogues. Treatment options include resection of the tumor, chemotherapy or the reduction of symptoms with somatostatin analogues. Early diagnosis and management may affect survival of patients favorably. VIPoma cases may be associated with multiple endocrine neoplasia type 1.

[Ultrasound-guided central venous catheterization]. / Centrális véna kanülálása ultrahangvezérléssel.

Central venous cannulation is frequently used in patients with serious diseases, although it may be unsuccessful and known to have complications in many cases. It is especially true in more complicated cases e.g. after unsuccessful punctures or cervical operations. With the use of ultrasound control success rate increases, while the chance of the complications decreases. In this prospective study, authors used ultrasound control during jugular vein punction in complicated cases. 56 successful central venous cannulation controlled by ultrasound has been performed since year 2000. This report overviews these cases and the related literature.

[Minimally invasive interventions in the treatment of pancreatic diseases]. / Minimálisan invazív intervenciók a pancreasbetegségek kezelésében.

We have used minimal invasive therapy in the treatment of pancreatic diseases for a long time. CT and/or ultrasound guided techniques have been used for the treatment of pancreatic pseudocysts for more than 20 years. The development of technology has also made an opportunity for the extensive use of laparoscopic surgery at patients suffering from pancreatic diseases. Currently, almost every type of open operation has a laparoscopic version, too. By now we can take part in the combined use of the CT/US and laparoscopic techniques. Recently the new NOTES procedures have appeared. Based on the literary items, the author summarizes the possibilities of minimal invasive treatments in pancreatic diseases.

Evaluation and comparison of the clinical, surgical and pathological TNM staging of colorectal cancer.

BACKGROUND/AIMS: The aim of our study was to compare the results of clinical, surgical and pathological staging of colorectal cancer. METHODOLOGY: 660 patients with colorectal carcinoma were included in the study. The results of the clinical, surgical and pathological staging were compared. RESULTS: Clinical T values were identical with the surgical in 75.15%, and with the pathological in 74.54% respectively. Surgical T values were identical with the clinical in 78.48%. In 67.27% of the cases the clinical evaluation of N value was identical with the surgical one. Clinical evaluation was identical with the pathological result in 60.60% of the cases. Surgical diagnosis of the lymph node metastasis matched the pathological finding in 76.66%. Regarding the M value, the coincidence of the diagnoses was as follows: clinical versus pathological 72.72%, surgical versus pathological 90.90%. Clinical and surgical TNM stages were by 79.09% in accordance. By decision of total TNM stage the clinical-pathological staging showed worse (76.06%), while surgical-pathological showed significantly better (88.48%) matching. CONCLUSIONS: Based on our results we can state that in a quarter of all colorectal cancer cases the extent of the primary tumor could not have been established correctly. The lymph node involvement was well defined in just over half of the cases only. The M values were accurately stated in about three quarters of the cases. High grade of conformity of clinical, surgical and pathological staging can result in better treatment-planning, short- and long-term survival, and higher quality of life.

[Role of minimally invasive interventions in the treatment of complications caused by recidive Klatskin tumors]. / Minimálisan invazív beavatkozások szerepe a recidív Klatskin-tumorok szövódményeinek ellátásában.

BACKGROUND: The hilar cholangiocarcinoma grows slowly and gives metastases very rarely. The first prominent sign of this cancer is the jaundice. In spite of the small size of the tumour, oncologically radical resection is only feasible--owing to the anatomical position--in approximately 35-50% of the cases. This makes recidivity frequent. The recidive cancer involves the hilus of the liver, compresses the surrounding organs and develops different complications. METHODS: 37 patients underwent surgical resection in the 1st Surgical Department of Semmelweis University in the last ten years. Complete tumour-free surgical margins were found in only 48.6% of the cases. The mean follow-up was 23.2 (8-47) months. RESULTS: 9 patients were treated for complication caused by local recurrence. These were mechanical jaundice (9 cases), bleeding oesophageal varices (2 cases), gastric outlet obstruction (2 cases), liver abscess (3 cases) and pain caused by the infiltration of the coeliac ganglion (3 cases). Most part of the complication could be solved by minimal invasive therapy (percutane transhepatic endoprosthesis or drainage, endoscopic sclerotherapy, ultrasound-guided drainage, percutane blockade of the celiac ganglion). CONCLUSIONS: The fact that resected patients may survive several years as long as patients treated with endoprosthesis and irradiation only survive half a year, has brought a change in the way Klatskin cancer surgery is considered: resection of the tumour should be striven for--even by way of R1 resection. Therefore the risk of recurrence will increase. This is the first article in the literature, which has ever dealt with the complication caused by recidive cancer after resection of Klatskin tumour.