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.
- Klíčová slova
- laparoscopy, mini-invasive surgery, minimally-invasive surgery, pancreatic surgery, robotic surgery,
- MeSH
- laparoskopie * metody MeSH
- lidé MeSH
- miniinvazivní chirurgické výkony metody MeSH
- nádory slinivky břišní * chirurgie MeSH
- pankreas MeSH
- pankreatektomie metody MeSH
- roboticky asistované výkony * metody MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
- Geografické názvy
- Česká republika MeSH
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.
- Klíčová slova
- colorectal cancer, cytoreductive surgery, intraperitoneal chemotherapy, peritoneal metastases,
- MeSH
- cytoredukční chirurgie statistika a číselné údaje MeSH
- hypertermická intraperitoneální peroperační chemoterapie statistika a číselné údaje MeSH
- kolorektální nádory epidemiologie patologie MeSH
- lidé MeSH
- peritoneální nádory epidemiologie sekundární terapie MeSH
- prevalence MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
- Geografické názvy
- Česká republika epidemiologie MeSH
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.
- Klíčová slova
- biomarkers, circulating tumor DNA, colorectal cancer, follow-up, metastases,
- MeSH
- cirkulující nádorová DNA genetika MeSH
- kolorektální nádory * MeSH
- lidé středního věku MeSH
- lidé MeSH
- lokální recidiva nádoru MeSH
- nádorové biomarkery genetika MeSH
- tekutá biopsie MeSH
- Check Tag
- lidé středního věku MeSH
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
- kazuistiky MeSH
- Názvy látek
- cirkulující nádorová DNA MeSH
- nádorové biomarkery MeSH
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.
- MeSH
- cholecystektomie laparoskopická MeSH
- gastrointestinální nádory * diagnóza chirurgie MeSH
- lidé MeSH
- lymfom * diagnóza chirurgie MeSH
- nádory žlučníku * diagnóza chirurgie MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
- kazuistiky MeSH
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.
- MeSH
- exenterace pánve * metody MeSH
- kohortové studie MeSH
- lidé MeSH
- lymfadenektomie MeSH
- nádory ženských pohlavních orgánů * chirurgie MeSH
- retrospektivní studie MeSH
- Check Tag
- lidé MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
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.
- MeSH
- analýza přežití MeSH
- dospělí MeSH
- exenterace pánve škodlivé účinky psychologie MeSH
- kohortové studie MeSH
- kvalita života psychologie MeSH
- lidé středního věku MeSH
- lidé MeSH
- lokální recidiva nádoru mortalita psychologie chirurgie MeSH
- nádory pánve mortalita psychologie chirurgie MeSH
- nádory rekta mortalita psychologie chirurgie MeSH
- následné studie MeSH
- pooperační komplikace etiologie mortalita psychologie MeSH
- průzkumy a dotazníky MeSH
- retrospektivní studie MeSH
- senioři MeSH
- Check Tag
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
[Total pelvic exenteration - strategy of the surgery]
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.
- MeSH
- exenterace pánve metody MeSH
- lidé MeSH
- lymfadenektomie metody MeSH
- nádory pánve patologie chirurgie MeSH
- pooperační komplikace etiologie MeSH
- staging nádorů MeSH
- Check Tag
- lidé MeSH
- mužské pohlaví MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
