BACKGROUND: Data registries lack a definitive classification system that distinguishes different locations of colon cancer from one another. OBJECTIVE: To establish an international consensus on the definition of primary colon cancer segment locations. DESIGN: Between December 2022 and June 2023, the Delphi survey study was conducted to seek opinions from relevant international experts and eventually develop a consensus definition of each colon cancer segment. SETTING: Three-round online-based Delphi survey study. INTERVENTIONS: The online survey included 17 questions. In the first 2 rounds, participating experts were asked to rank each statement on a scale of 1 (least relevant) to 9 (most relevant). Consensus statements and definitions were revised according to the results for statements obtaining a consensus score of 7 to 9. During the third round and online meeting, definitions and statements that reached a moderate or high consensus (above 4 for more than 70% of participants) were included. MAIN OUTCOME MEASURES: The primary goal of our project was focused on precisely localizing the specific segment affected by primary colon cancer rather than identifying surgical treatment or type of resection needed for a particular segment. RESULTS: The first round included 331 experts; 301 (91%) completed the second round and 295 (98%) completed the final round. Experts strongly supported the use of a "10-cm rule" to describe colon cancer sites at the flexures and anatomical landmarks for other segments. Regarding the definition of rectosigmoid cancer, experts from United States and Europe reached a high consensus that the term rectosigmoid as a colon cancer location must be abolished in contrast to experts from Asia. The description of overlapping segments of cancers achieved a consensus of 64%. LIMITATIONS: Subjective decisions are based on individual expert clinical experience. CONCLUSIONS: This Delphi survey, the first internationally conducted consensus study, achieved a remarkable level of consensus among a panel of global experts. Ambiguity still exists regarding overlapping lesions. See Video Abstract . ESTANDARIZACIN DE LA DEFINICIN DE CADA SEGMENTO DE CNCER DE COLON CONSENSO DELPHI SOBRE LA TOMA DE DECISIONES CLNICAS PARA RESULTADOS ONCOLGICOS: ANTECEDENTES:Las bases de datos carecen de un sistema de clasificación definitivo que distinga las diferentes localizaciones del cáncer de colon.OBJETIVO:Establecer un consenso internacional sobre la definición de las localizaciones de los segmentos del cáncer de colon priamrio.DISEÑO:Entre diciembre de 2022 y junio de 2023, se realizó un estudio Delphi para recabar la opinión de expertos internacionales relevantes y, finalmente, desarrollar una definición consensuada de cada segmento del cáncer de colon.ESCENARIO:Estudio Delphi en línea de 3 rondas.INTERVENCIONES:La encuesta en línea incluyó 17 preguntas. En las dos primeras rondas, se pidió a los expertos participantes que calificaran cada afirmación en una escala del 1 al 9 (9 es la más relevante). Las afirmaciones y definiciones de consenso se revisaron según los resultados, obteniendo una puntuación de consenso de 7 a 9. Durante la tercera ronda y la reunión en línea, se incluyeron las definiciones y afirmaciones que alcanzaron un consenso moderado o alto (superior a 4 en más del 70 % de los participantes).MEDIDA PRINCIPALES DE RESULTADOS:El objetivo principal de nuestro proyecto se centró en localizar con precisión el segmento específico afectado por el cáncer de colon primario, en lugar de identificar el tratamiento quirúrgico o el tipo de resección necesario para un segmento en particular.RESULTADOS:La primera ronda incluyó a 331 expertos, 301 (91%) completaron la segunda ronda y 295 (98%) completaron la ronda final. Los expertos apoyaron firmemente el uso de una "regla de 10 cm" para describir las localizaciones del cáncer de colon en las flexuras y puntos de referencia anatómicos para otros segmentos. En cuanto a la definición de cáncer rectosigmoideo, expertos de América y Europa alcanzaron un alto consenso en la necesidad de abolir el término "rectosigmoide" como localización del cáncer de colon, a diferencia de los expertos de Asia. La descripción de los cánceres en segmentos que se superponen a alcanzó un consenso del 64%.LIMITACIONES:Las decisiones subjetivas se basan en la experiencia clínica individual de cada experto.CONCLUSIONES:Esta encuesta Delphi, el primer estudio de consenso realizado a nivel internacional, alcanzó un notable nivel de consenso entre un panel de expertos globales. Todavía existe ambigüedad en cuanto a las lesiones superpuestas. (Traducción-Dr. Jorge Silva Velazco ).

• MeSH
• delfská metoda MeSH
• klinické rozhodování * metody   MeSH
• konsensus MeSH
• lidé MeSH
• nádory tračníku * patologie   klasifikace   diagnóza   chirurgie   MeSH
• průzkumy a dotazníky MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH

INTRODUCTION: Giant inguinoscrotal hernias (GIH), defined as hernias extending below the inner thigh midpoint in a standing position, are rare and often seen in resource-limited settings due to delayed medical care. These hernias pose surgical challenges, particularly in low- and middle-income countries (LMICs), where standardized management protocols are lacking, and risks such as cardiorespiratory compromise are significant. CASE PRESENTATION: A 55-year-old male presented with a large, irreducible right inguinoscrotal hernia of 1.5 years duration. Elective surgery involved sac separation and laparotomy, revealing herniation of bowel segments, including the terminal ileum and sigmoid colon, with concurrent intestinal malrotation. Ladd's procedure, appendectomy, and hernia repair were performed without complications. Postoperative recovery was uneventful, with the patient remaining asymptomatic during follow-up. DISCUSSION: GIH management depends on hernia classification. While Type I hernias require simpler repairs, Types II and III often necessitate advanced techniques, such as Preoperative Progressive Pneumoperitoneum or bowel resection, to prevent abdominal compartment syndrome (ACS). Anatomical anomalies, such as malrotation, complicate surgical planning. Successful outcomes rely on individualized, resource-appropriate strategies and meticulous care, especially in LMICs. CONCLUSION: GIH presents unique challenges, particularly in resource-constrained settings. Tailored approaches, informed by classification and patient-specific factors, are essential. This case underscores the importance of innovative strategies, careful planning, and standardized protocols to improve outcomes for GIH patients globally.

• Publikační typ
• časopisecké články MeSH
• kazuistiky MeSH

Accelerated partial breast irradiation (APBI) represents a valid option for adjuvant therapy of selected early breast cancer (BC). This single-institution prospective randomized study compares the health-related quality of life (HRQoL) between women treated with the highly conformal-external beam APBI technique and those with the more commonly used moderately hypofractionated whole breast irradiation (hypo-WBI). Eligible patients were women over 50 years with early BC (G1/2 DCIS ≤ 25 mm or G1/2 invasive non-lobular luminal-like HER2 negative carcinoma ≤ 20 mm) after breast-conserving surgery with negative margins. APBI arm consisted of 30 Gy in 5 consecutive daily fractions and WBI arm of 40 Gy in 15 fractions plus 10 Gy in 5 fractions boost to the tumor bed. Patients were requested to complete the official Czech translation of the EORTC QoL questionnaires, including QLQ-C30 and QLQ-BR45, before radiation (baseline), at the end of radiation (M0) and 1 (M1), 3 (M3), 6 (M6), 12 (M12), and 24 (M24) months after radiation. Linear regression models were used to analyze differences in HRQoL between the arms. The 85 enrolled patients exhibited no differences in HRQoL scores between the two arms at baseline. Patients in the APBI arm reported more favorable global health status at M6 (p = 0.055). Other functional scales showed a decrease in the WBI arm at M0 (p = 0.027 for physical functioning). During radiation, symptoms scores increased. Significant between-group differences were observed for the pain (p = 0.002), systemic therapy side effects (p = 0.004), and breast symptoms (p < 0.001) scales at M0, with higher scores in the WBI arm. During follow-up, scores on symptoms scales returned to at least the baseline values. Early BC patients treated with APBI showed non-inferior short-term and late HRQoL outcomes compared to hypo-WBI. In addition to previous findings regarding toxicity, promising pain and breast symptoms results, suggest that APBI should be strongly considered as a treatment option for selected low-risk patients.Trial registration NCT06007118, August 23, 2023 (retrospectively registered).

• MeSH
• adjuvantní radioterapie škodlivé účinky   metody   MeSH
• kvalita života * MeSH
• lidé středního věku MeSH
• lidé MeSH
• nádory prsu * radioterapie   chirurgie   psychologie   MeSH
• prospektivní studie MeSH
• průzkumy a dotazníky MeSH
• segmentální mastektomie MeSH
• senioři MeSH
• výsledek terapie MeSH
• Check Tag
• lidé středního věku MeSH
• lidé MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• práce podpořená grantem MeSH
• randomizované kontrolované studie MeSH

BACKGROUND: Large femoral defects after trauma, femoral non-unions, fractures complicated by osteomyelitis or defects after bone tumour resection present high burden and increased morbidity for patient and are challenging for reconstructive surgeons. Defects larger than 6 cm and smaller defects after failed spongioplasty are suitable for reconstruction using a free, eventually a pedicled vascularised bone flap. The free fibular flap is preferred but an iliac crest free flap or a pedicled medial femoral condyle flap can be also used. These vascularised flaps are ideal for bridging defects of long bones and can be also used as osteocutaneous or osteomuscular flaps for coverage of soft tissue defect if present. The patients and their families were informed that data will be submitted for publication and they gave their written informed consent prior to the submission. The study was approved by the institutional ethic committee. METHODS: We analysed a group of eight patients with large diaphyseal or distal metaphyseal femoral defects. A free fibular flap was used in six patients, a pedicled medial ipsilateral femoral condyle flap was used in two patients and a defect in one patient was reconstructed using an iliac crest free flap. RESULTS: All flaps healed completely in all patients and no fracture of the flap was detected during the study period. In one patient, a locking plate broke and was replaced by a compression plate. At the last check-up all patients were able to step on the reconstructed limb with full weight. DISCUSSION: Although our study comprises a heterogeneous group of cases, they all have been successfully treated by a similar technique, adapted in each case specifically to the needs of the patient. A major limitation parameter of reconstruction by a free vascularised flap is the size of bone defect needed to be reconstructed. In case of a bone defect longer than 6 cm and a concomitant soft tissue disruption, a vascularised double-barrel fibula is the preferred. CONCLUSION: Large femoral defects can be successfully reconstructed with good long-term results using suitable free or pedicled vascularised bone flaps, especially preferring the free fibular flap.

• MeSH
• chirurgické laloky * MeSH
• dospělí MeSH
• femur * chirurgie   transplantace   MeSH
• fibula transplantace   chirurgie   zranění   MeSH
• fraktury femuru chirurgie   MeSH
• lidé středního věku MeSH
• lidé MeSH
• mladý dospělý MeSH
• retrospektivní studie MeSH
• senioři MeSH
• transplantace kostí * metody   MeSH
• volné tkáňové laloky transplantace   MeSH
• výsledek terapie MeSH
• zákroky plastické chirurgie * metody   MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mladý dospělý MeSH
• mužské pohlaví MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH

• MeSH
• lidé MeSH
• lokální recidiva nádoru diagnóza   prevence a kontrola   MeSH
• neoadjuvantní terapie metody   MeSH
• radikální mastektomie metody   MeSH
• retrospektivní studie MeSH
• segmentální mastektomie * metody   MeSH
• triple-negativní karcinom prsu * chirurgie   diagnóza   terapie   MeSH
• Check Tag
• lidé MeSH
• ženské pohlaví MeSH
• Publikační typ
• souhrny MeSH

Úvod: S narůstajícím věkem se zvyšuje riziko maligních nádorů vč. rakoviny prsu. Cílem naší retrospektivní studie bylo zjistit rozsah chirurgického výkonu na prsu i v axile vč. následné adjuvantní terapie u pacientů 80 let a více. Metody: V letech 2017–2021 bylo na Chirurgickém oddělení EUC Kliniky operováno 834 pacientů s karcinomem prsu. Do retrospektivní studie bylo zařazeno 96 žen s jednostranným karcinomem, 2 ženy s oboustranným karcinomem a 2 muži s karcinomem prsu. Celkem bylo analyzováno 102 případů karcinomu prsu u pacientů starších 8o let. Chirurgický výkon odpovídal stadiu onemocnění a celkovému stavu pacienta. Adjuvantní systémová terapie byla indikována podle stejných zásad. Výsledky: Od 1. 1. 2017 do 31. 12. 2021 bylo operováno 98 pacientek (2× s bilaterálním karcinomem) a 2 muži. V době výkonu bylo pacientům více než 80 let (80–96 let). Dominoval invazivní duktální karcinom 83× následovaný lobulárním karcinomem 6×, dále mucinózní 6×, papilární karcinom 4×, ostatní typy 3×, s převahou luminal A, B (89×). Počet prs záchovných výkonů byl 63×. Biopsie sentinelové uzliny byla provedena 65×, doplněna byla disekcí axily 13×. Primární disekce axily byla provedena 15×. U 23 pacientů nebyl proveden žádný výkon v axile. Radioterapie byla 49×, chemoterapie 9× a hormonální terapie 82×. Lokální recidivy byly 2×, regionální recidivy 2×. Celkem zemřelo 37 pacientů, z toho 10 na karcinom prsu. Nejčastější příčinou úmrtí byly kardiovaskulární choroby (ve 27 případech). Závěr: Nejčastější příčinou úmrtí u pacientů ve věku 80 let a více jsou kardiovaskulární choroby, ne vlastní karcinom prsu. Tuto skutečnost bychom měli zohlednit při stanovování léčebného plánu.

Introduction: The risk of breast cancer increases with increasing age. The aim of our retrospective study was to determine the extent of breast and axillary surgery, including subsequent adjuvant therapy, in 80-year and older patients. Methods: Between 2017 and 2021, 834 breast cancer patients were operated in the Surgical Department of the EUC Clinic. Ninety-eight women (2× with bilateral cancer) and 2 men were included in this retrospective study. A total of 102 breast cancer cases in patients older than 80 years were analyzed. The surgical procedure corresponded to the stage of the disease and the general condition of the patient. Adjuvant systemic therapy was indicated according to the same principles. Results: At the time of surgery, the patients were more than 80 years old (80–96 years). The predominant type of invasive ductal carcinoma was diagnosed 83×, lobular carcinoma 6×, mucinous 6×, papillary carcinoma 4×, other 3×, with luminal A, B predominating (89×). The breast-conserving procedures were performed 63×. Sentinel node biopsy was performed 65×, supplemented by axillary lymph node dissection 13×. Primary axillary lymph node dissection was performed 15×. No axillary procedure was performed 23×. Radiotherapy was given 49×, chemotherapy 9× and hormonal therapy 82×. Local and regional recurrences were each observed 2×. A total of 37 patients died, 10 of them from breast cancer. Conclusion: The most common cause of death in patients aged 80+ years is a cardiovascular disease, not breast cancer itself. This fact should be taken into account when determining the treatment plan.

• MeSH
• adjuvantní radioterapie MeSH
• axila chirurgie   patologie   MeSH
• lidé MeSH
• nádory prsu * chirurgie   patologie   MeSH
• retrospektivní studie MeSH
• segmentální mastektomie MeSH
• senioři nad 80 let MeSH
• Check Tag
• lidé MeSH
• mužské pohlaví MeSH
• senioři nad 80 let MeSH
• ženské pohlaví MeSH
• Publikační typ
• přehledy MeSH

The role of postmastectomy radiotherapy and regional nodal irradiation after radical mastectomy is defined in high-risk patients with locally advanced tumors, positive margins, and unfavorable biology. The benefit of postmastectomy radiotherapy in intermediate-risk patients (T3N0 tumors) remains a matter of controversy. It has been demonstrated that radiotherapy after breast-conserving surgery lowers the locoregional recurrence rate compared with surgery alone and improves the overall survival rate. In patients with four or more positive lymph nodes or extracapsular extension, regional lymph node irradiation is indicated regardless of the surgery type (breast-conserving surgery or mastectomy). Despite the consensus that patients with more than three positive lymph nodes should be treated with radiotherapy, there is controversy regarding the recommendations for patients with one to three involved lymph nodes. In patients with N0 disease with negative findings on axillary surgery, there is a trend to administer regional lymph node irradiation in patients with a high risk of recurrence. In patients treated with neoadjuvant systemic therapy and mastectomy, adjuvant radiotherapy should be administered in cases of clinical stage III and/or ≥ypN1. In patients treated with neoadjuvant systemic therapy and breast-conserving surgery, postoperative radiotherapy is indicated irrespective of pathological response.

• MeSH
• adjuvantní radioterapie MeSH
• lidé MeSH
• lokální recidiva nádoru patologie   MeSH
• mastektomie MeSH
• nádory prsu * farmakoterapie   MeSH
• segmentální mastektomie MeSH
• Check Tag
• lidé MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• přehledy MeSH

BACKGROUND: Accelerated partial breast irradiation (APBI) is an alternative breast-conserving therapy approach where radiation is delivered in less time compared to whole breast irradiation (WBI), resulting in improved patient convenience, less toxicity, and cost savings. This prospective randomized study compares the external beam APBI with commonly used moderate hypofractionated WBI in terms of feasibility, safety, tolerance, and cosmetic effects. METHODS: Early breast cancer patients after partial mastectomy were equally randomized into two arms- external APBI and moderate hypofractionated WBI. External beam technique using available technical innovations commonly used in targeted hypofractionated radiotherapy to minimize irradiated volumes was used (cone beam computed tomography navigation to clips in the tumor bed, deep inspiration breath hold technique, volumetric modulated arc therapy dose application, using flattening filter free beams and the six degrees of freedom robotic treatment couch). Cosmetics results and toxicity were evaluated using questionnaires, CTCAE criteria, and photo documentation. RESULTS: The analysis of 84 patients with a median age of 64 years showed significantly fewer acute adverse events in the APBI arm regarding skin reactions, local and general symptoms during a median follow-up of 37 months (range 21-45 months). A significant difference in favor of the APBI arm in grade ≥ 2 late skin toxicity was observed (p = 0.026). Late toxicity in the breast area (deformation, edema, fibrosis, and pain), affecting the quality of life and cosmetic effect, occurred in 61% and 17% of patients in WBI and APBI arms, respectively. The cosmetic effect was more favorable in the APBI arm, especially 6 to 12 months after the radiotherapy. CONCLUSION: External APBI demonstrated better feasibility and less toxicity than the standard regimen in the adjuvant setting for treating early breast cancer patients. The presented study confirmed the level of evidence for establishing the external APBI in daily clinical practice. TRIAL REGISTRATION: NCT06007118.

• MeSH
• kojenec MeSH
• kombinovaná terapie MeSH
• kvalita života MeSH
• lidé MeSH
• mastektomie MeSH
• nádory prsu * radioterapie   chirurgie   patologie   MeSH
• předškolní dítě MeSH
• prospektivní studie MeSH
• segmentální mastektomie MeSH
• Check Tag
• kojenec MeSH
• lidé MeSH
• předškolní dítě MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• randomizované kontrolované studie MeSH

PURPOSE: Localizing breast lesions by marking tumors and their detection using probes during surgery is a common part of clinical practice. Various nonwire localization systems were intended to be compared from different perspectives. METHODS: Various measurement experiments were performed. Localization techniques, including radioactive seed (RSLS), magnetically guided (MGLS), or radar (SLS), were compared in signal propagation in water and tissue environments, signal interference by surgical instruments, and the practical experience of surgeons. Individual experiments were thoroughly prospectively planned. RESULTS: The RSLS signal was detectable at the largest evaluated distance, ie, 60 mm. The SLS and MGLS signal detection was shorter, up to 25 mm to 45 mm and 30 mm, respectively. The signal intensity and the maximum detection distance in water differed slightly depending on the localization marker orientation to the probe, especially for SLS and MGLS. Signal propagation in the tissue was noted to a depth of 60 mm for RSLS, 50 mm for SLS, and 20 mm for MGLS. Except for the expected signal interferences by approaching surgical instruments from any direction for MGLS, the signal interruption for RSLS and SLS was observed only by inserting instruments directly between the localization marker and probe. Moreover, the SLS signal interference by instrument touch was noted. Based on surgeons' results, individual systems did not differ significantly for most measurement condition settings. CONCLUSION: Apparent differences noted among localization systems can help experts choose an appropriate system for a specific situation or reveal small nuances that have not yet been observed in clinical practice.

• MeSH
• lidé MeSH
• mikrochirurgie MeSH
• nádory prsu * diagnostické zobrazování   chirurgie   patologie   MeSH
• prsy patologie   MeSH
• segmentální mastektomie metody   MeSH
• voda MeSH
• zaměřovací značky pro radioterapii MeSH
• Check Tag
• lidé MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• práce podpořená grantem MeSH

Introduction Oral cavity squamous cell carcinoma (OCSCC) is the most common malignancy in the oral cavity. Two types of mandibular resections have been described: the segmental mandibulectomy and the marginal mandibulectomy. Both may have a different impact over the quality of life, oncological prognosis, and functional or aesthetic result. Objectives The aim of this study was to systematically explore the literature to determine the survival outcomes and disease control rates in patients who underwent segmental or marginal mandibulectomy for OCSCC with histological evidence of cortical and medullary bone invasion. Data Synthesis This review involved a systematic search of the electronic databases MEDLINE/PUBMED, Google Scholar, Ovid Medline, Embase, and Scopus including articles from 1985 to 2019. Fifteen articles were included for qualitative analysis and 11 articles were considered for meta-analysis calculations. All of them correspond to retrospective cohort studies. Conclusion This systematic review reveals the low-level evidence regarding the impact over local control or survival according to the type of mandibulectomy. Our results need to be considered with precaution according to the limited evidence available. We just found difference regarding the 5-year disease-free survival, and a tendency in favor of segmental mandibulectomy was confirmed when medullary invasion was evident.

• Publikační typ
• časopisecké články MeSH
• přehledy MeSH