Purpose: After endoscopic polypectomy, the risk factors for malignancy include positive margin, poor tumor differentiation, deep submucosal and lymphovascular invasion. Even in the presence of high-risk factors, residual disease is observed in less than 15% of samples, and even less in lymph nodes. Study aimed to evaluate results of patients after radicalization in a non-curative polypectomy in 10 year follow-up period, and to compare classical and transanal approach and their impact on quality of life and disease-free survival. Results: Cohort include 45 patients, three patients had adenocarcinoma in situ, one of them positive lymphatic nodes. Only seven (23 %) patients had 12 and more lymph nodes described. TEM cohort had significantly shorter hospital stay (median 7 vs. 11 days, p < 0.0001), significantly lower incidence of herniation (0% vs. 30%, p = 0.020), shorter distance of tumor from the anal verge (median 7 vs. 23.5, p < 0.0001), and lower number of lymph nodes (median 0 vs. 5, p < 0.0001). Overall survival was without statistical significance (p = 0.690). The group of classically operated had higher proportion of subsequent procedures and limitations (p=0.149, and p=0.540). Conclusion: Following malignant polypectomy, surgery should be considered in medically fit patients if the polypectomy margin is positive, unknown, or if the lymphovascular invasion is present. TEM surgery is an acceptable option for high-risk patients . Identifying patients requiring surgery for possible lymph node metastases is still the most important problem.
PURPOSE: The study aimed to determine a simple diagnostic test that could predict the risk of anastomotic leakage in early postoperative period. METHODS: A single-center, retrospective study was conducted. The electronic medical records of patients who underwent resection for rectal tumor between January 1, 2016, and December 31, 2021, in University Hospital Olomouc, were reviewed. The data included risk factors for leakage and laboratory parameters commonly obtained. RESULTS: The decrease in platelets was significant as for the possibility of being a marker of anastomotic leakage; OR = 0.980 (p = 0.036). A decrease of 34 or higher predicts leakage with a sensitivity of 45 % (95 % CI: 23.1–68.5 %) and specificity of 81.1 % (95 % CI: 75.2–86.1 %). Postoperative leukocyte blood level (OR = 1.134; p = 0.019) and leukocyte level on postoperative day 1 (OR = 1.184; p = 0.023) were significant predictors for leakage. WBC values ≥ 8.8 predict leakage with a sensitivity of 70.0 % (95 % CI: 45.7–88.1 %) and specificity of 55.3 % (95 % CI: 48.4–62.0 %). Hemoglobin blood level ≤ 79.5 predicts leakage with a sensitivity of 70.0 % (95 % CI: 45.7–88.1 %) and specificity of 62.2 % (95 % CI: 55.5–68.7 %). CONCLUSION: Despite the fact that the specificity and sensitivity of the followed parameters are low, they could serve as markers useful for early diagnosis or suspicion for leakage (Tab. 5, Fig. 3, Ref. 14).
• Severe complication of hiatal hernia with gastric and esophageal necrosis. • Acute total gastrectomy with esophagojejunoanastomosis via right-sided thoracotomy. • Simultaneous resection of multiple jejunal diverticula present.
- Publikační typ
- kazuistiky MeSH
The authors present the effect of preoperative oral nutritional supplements (ONS) in the form of sipping on the postoperative morbidity and mortality of patients suffering from carcinoma of esophagus and gastroesophageal junction who underwent esophagectomy and who do not in the high risk of malnutrition. The main goal was to assess whether preoperative ONS results in a decrease in 30-day postoperative morbidity and mortality who do not qualify to the high risk of malnutrition strategy. 29 patients who underwent surgery were included, 14 patients (48.3%) without sipping, 15 patients (51.7%) with sipping. In the sipping group, there were significantly more patients who had adenocarcinoma (p = 0.035) and the tumor localized in the distal part of the esophagus (p = 0.006), showed significantly higher values of albumin (p = 0.007) and prealbumin (p = 0.005) when compared to patients without sipping. No statistically significant difference in 30-day postoperative morbidity (p = 0.700) and in 30-day postoperative mortality (p = 1.000).
- MeSH
- dospělí MeSH
- ezofagektomie metody škodlivé účinky MeSH
- lidé středního věku MeSH
- lidé MeSH
- nádory jícnu * chirurgie komplikace mortalita terapie MeSH
- nutriční podpora metody MeSH
- pooperační komplikace mortalita prevence a kontrola MeSH
- předoperační péče * metody MeSH
- riziko MeSH
- senioři MeSH
- výsledek terapie MeSH
- Check Tag
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- práce podpořená grantem MeSH
- randomizované kontrolované studie MeSH
INTRODUCTION: This study primarily sought to evaluate the risk factors for toxic megacolon development and treatment outcomes in Clostridium difficile-positive COVID-19 patients, secondarily to determining predictors of survival. METHODS: During the second COVID-19 wave (May 2020 to May 2021), we identified 645 patients with confirmed COVID-19 infection, including 160 patients with a severe course in the intensive care unit. We selected patients with Clostridium difficile infection (CDI) (31 patients) and patients with toxic megacolon (9 patients) and analyzed possible risk factors. RESULTS: Patients who developed toxic megacolon had a higher incidence (without statistical significance, due to small sample size) of cancer and chronic obstructive pulmonary disease, a higher proportion of them required antibiotic treatment using cephalosporins or penicillins, and there was a higher rate of extracorporeal circulation usage. C-reactive protein (CRP) and interleukin-6 values showed significant differences between the groups (CRP [median 126 mg/L in the non-toxic megacolon cohort and 237 mg/L in the toxic megacolon cohort; p = 0.037] and interleukin-6 [median 252 ng/L in the group without toxic megacolon and 1127 ng/L in those with toxic megacolon; p = 0.016]). As possible predictors of survival, age, presence of chronic venous insufficiency, cardiac disease, mechanical ventilation, and infection with Candida species were significant for increasing the risk of death, while corticosteroid and cephalosporin treatment and current Klebsiella infection decreased this risk. CONCLUSIONS: More than ever, the COVID-19 pandemic required strong up-to-date treatment recommendations to decrease the rate of serious in-hospital complications. Further studies are required to evaluate the interplay between COVID-19 and CDI/toxic megacolon.
- Publikační typ
- časopisecké články MeSH
Achalázie jícnu je závažnou příčinou dysfagie. Možnosti terapie achalázie zahrnují endoskopické a chirurgické metody. Indikace jednotlivých metod se do jisté míry překrývají a vyžadují pečlivou diagnostiku. Přehledový článek popisuje jednotlivé metody a zejména se zabývá otázkami indikací pneumatické dilatace, perorální endoskopické myotomie (POEM) a laparoskopické či robotické Hellerovy myotomie. Zvláštní prostor je věnován revizním výkonům po Hellerově myotomii (HM). Přidanou hodnotou POEM je řešení spastických poruch jícnu a při „re-do“ myotomii. Achalázii typu II lze léčit dilatací, POEM i HM, achalázii typu I lze léčit stejnými modalitami. U typu III je v současné době metodou volby POEM. Navzdory aktuální akcentaci endoskopické myotomie zůstává chirurgická terapie, zejména laparoskopická či roboticky asistovaná Hellerova myotomie, nadále bezpečnou variantou terapie. Je indikována zejména u nemocných, kteří nejsou vhodní pro endoskopickou terapii nebo u nemocných s pokročilými nálezy achalázie. V budoucnu by identifikace rizika postinstrumentačních komplikací (perforace, operační reflux) měla vést k diferenciaci indikace laparoskopického (robotického) přístupu a POEM, případně může vést k synchronní či metachronní indikaci konstrukce manžety.
Oesophageal achalasia is a serious cause of dysphagia. Therapeutic options for achalasia include endoscopic and surgical methods. Indications for individual methods overlap to a certain extent and require careful diagnosis. The review article describes individual methods, focusing particularly on the issues of indications of pneumatic dilatation, peroral endoscopic myotomy (POEM) and laparoscopic or robotic Heller’s myotomy. Special attention is paid to revision procedures after Heller’s myotomy. The main added value of POEM is the treatment of spastic disorders of the oesophagus and re-do myotomy. Type 2 achalasia can be treated with dilatation, POEM and HM; type 1 achalasia can be treated using the same modalities. For type 3, POEM is the current method of choice. Despite the current emphasis on endoscopic myotomy, surgical therapy, especially laparoscopic or robotically assisted Heller’s myotomy, remains a safe therapeutic option. It is indicated especially in patients who are not suitable for endoscopic therapy or those with advanced achalasia findings. In the future, identification of the risk of postoperative complications (perforation, reflux) should lead to differentiation of the indication of the laparoscopic (robotic) approach and POEM, or it may lead to a synchronous or metachronous indication of the cuff construction.
- MeSH
- achalázie jícnu * chirurgie diagnóza komplikace MeSH
- ezofagektomie MeSH
- gastrointestinální endoskopie MeSH
- Hellerova myotomie metody MeSH
- lidé MeSH
- pyloromyotomie metody MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- práce podpořená grantem MeSH
INTRODUCTION AND IMPORTANCE: This case report describes postoperative complications in a patient after hybrid oesophagectomy for oesophageal carcinoma after COVID pneumonia. The global COVID-19 pandemic affected cancer patients indicated for surgery. Covid 19 may worsen the results of oesophageal cancer surgery. More similar studies are needed. CASE PRESENTATION: A 69-year-old male was diagnosed with squamous cell carcinoma of the middle oesophagus based on PET/CT without disease generalisation. His stenotic tumour required a nutritive jejunostomy, with subsequent neoadjuvant radiochemotherapy indicated according to the CROSS protocol. The patient developed COVID pneumonia during the cancer therapy. After managing the COVID pneumonia, oncological therapy was completed and a hybrid oesophagectomy was performed 8 weeks later. Serious complications (respiratory failure, septic shock, anastomosis dehiscence) developed during the postoperative period. All complications were managed therapeutically. The patient was type IVb according to the Clavien-Dindo classification. CLINICAL DISCUSSION: Postoperative complications may develop in any patient operated for oesophageal carcinoma, especially if high-risk predictive factors are present. The question arises as to how much the post-COVID condition affected the onset of these serious complications. CONCLUSION: Post-COVID patients are at a risk of developing post-COVID syndrome, which may lead to a wide range of symptoms in the affected organs. Further studies on the relationship between COVID-19 and oesophagectomy for oesophageal carcinoma will be necessary to clarify the relationship between the complications during the postoperative period in patients with oesophageal malignancy.
- Publikační typ
- časopisecké články MeSH
Introduction: The authors report long-term outcomes in patients who received neoadjuvant chemoradiotherapy and consequently underwent hybrid oesophagectomy for oesophageal cancer (OC). Aim: To evaluate long-term outcomes in patients suffering from OC, who underwent hybrid oesophagectomy. Material and methods: Our cohort consisted of patients suffering from OC, who received neoadjuvant chemoradiotherapy. Hybrid esophagectomy was performed 8-10 weeks after oncological treatment. Results: Ninety-four patients underwent surgery for OC from 2011 to 2015. Histology revealed adenocarcinoma in 60.6%, squamous cell carcinoma (SCC) in 36.2%, and other type of cancer in 3.2%. Seventy-three (77.7%) patients with advanced stage (T3-4, N0-2, M0) were indicated to receive neoadjuvant chemoradiotherapy (nCRT). Trans-hiatal hybrid oesophagectomy was performed in 83 (88.3%) patients. Transthoracic hybrid oesophagectomy was performed in 11 (11.7%) patients. Histology of the resected specimens of 18 (24.7%) patients did not reveal OC, i.e. pathological complete response (pCR). In our cohort, we proved an association between occurrence of pCR and age as well as disease-free survival (DFS). The patients who presented with pCR were significantly younger - below 60 years of age (p = 0.017). They also showed significantly higher mean DFS (p = 0.004). Conclusions: Combined oesophagectomy with neoadjuvant chemoradiotherapy results in a better long-term outcome in patients suffering from oesophageal cancer. In our set of patients who underwent hybrid esophagectomy, satisfactory short-term and especially long-term results of surgical treatment for oesophageal cancer were observed.
- Publikační typ
- časopisecké články MeSH
V pediatrické praxi přibývá případů polknutí magnetických cizích těles. Jde o magnetky ve tvaru kuliček, kostiček apod., které jsou součástí hraček. Tyto předměty jsou často drobné, a tím je usnadněno jejich náhodné polknutí. Přitom, pokud dojde k ingesci více než jednoho magnetického cizího tělesa, může dojít k závažným komplikacím, především ve smyslu perforace trávicího traktu.
The incidence of swalowing magnetic foreign bodies increases in children, often in the form of balls, cubes etc., which are part of toys. These magnets are often small, making it easy to accidentally swallow them. If more than one magnetic foreign body is ingested, serious complications can occur, especially perforation of the gastrointestinal tract.
- MeSH
- chirurgie trávicího traktu metody MeSH
- cizí tělesa * chirurgie MeSH
- dítě MeSH
- gastrointestinální endoskopie MeSH
- lidé MeSH
- magnety MeSH
- směrnice pro lékařskou praxi jako téma MeSH
- úrazy v domácnosti MeSH
- Check Tag
- dítě MeSH
- lidé MeSH
- ženské pohlaví MeSH
- Publikační typ
- kazuistiky MeSH
- práce podpořená grantem MeSH
BACKGROUND: Gastropericardial fistula is a pathological communication between the stomach and the pericardium. This case report describes a gastropericardial fistula in a patient with upside-down stomach. CASE PRESENTATION: The male patient (86) was examined for severe chest pain behind the sternum. CT revealed upside-down stomach with perforation on the lesser gastric curvature and fistulation into the pericardium with pneumopericardium. The patient was indicated for surgery. The procedure was performed from a transverse laparotomy and consisted of repositioning the stomach into the abdominal cavity, resection of the hernial sac, suture of the perforation of the lesser curvature, gastropexy and transhiatal drainage of the mediastinum and lesser sac. In the early postoperative period, the recovery was uneventful. Acute myocardial infarction with cardiorespiratory failure developed on the postoperative day (POD) 13. The patient died on POD 24 due to cardiorespiratory failure, confirmed by a sectional finding. CONCLUSIONS: Gastropericardial fistula is a rare acute complication of the diseases of the upper GIT. It is invariably a serious, life-threatening condition. Diagnosis is confirmed by thoracic CT and a contrast swallow study. The necessity of acute surgical treatment is widely accepted. The type of procedure must be selected based on the patient's individual criteria.
- MeSH
- lidé MeSH
- nemoci žaludku * MeSH
- perikard diagnostické zobrazování chirurgie MeSH
- píštěl žaludku * diagnostické zobrazování etiologie MeSH
- pneumoperikard * diagnostické zobrazování etiologie MeSH
- žaludeční vředy * MeSH
- Check Tag
- lidé MeSH
- mužské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- kazuistiky MeSH
