PURPOSE: Tumor markers are substances found in blood and other biological fluids if tumor is present in the body. They can be produced by tumor itself or can be results of cancer - body relation. They may be used in the follow-up of cancer patients to identify tumor recurrence. Pre-treatment levels have prognostic tool and could signalize persistence of minimal residual disease despite radical surgery. METHODS: We operated on 52 patients with upper GI malignancy (32 with gastric cancer and 20 with pancreatic cancer). Blood samples were taken before surgery and peritoneal samples immediately after laparotomy before any manipulation with tumor. All samples were examined by standard biochemical technique and the level was compared with a stage of the disease. RESULTS: Patients suffering from gastric carcinoma of stage I and II had higher level of both markers in sera then in the peritoneal cavity, however most of them were within physiological range. Patients in stage III and IV had average marker levels in the peritoneal cavity higher than in sera. Number of positive findings was increasing according to the stage of the disease. The peritoneal levels of both markers varied extremely in higher stages. In patients suffering from pancreatic carcinoma the CEA levels both in sera and peritoneal cavity were parallel but peritoneal levels were slightly higher in stages III and IV. Ca 19 - 9 was more sensitive for pancreatic cancer. The percentage of positive findings was higher in sera but the level of Ca 19 - 9 was higher in the peritoneal cavity. The number of positive findings again correlated with the stage of the disease. CONCLUSIONS: Levels of tumor markers in sera could signalize inoperability of tumor (Ca 19 - 9 in cases of pancreatic carcinoma); peritoneal levels could predict R1 resection especially in gastric cancer patients and risk of early peritoneal recurrence of the disease. Difference between the levels in the peritoneum and sera may signalize the route of dissemination (hematogenous and intraperitoneal).
In operations where the rectum must be mobilized, frequently haemorrhage from presacral venous plexuses occurs. If the haemorrhage is massive, this is a serious complication, which may threaten the patient's life. In those instances we use a "drawing-pin" to arrest haemorrhage. The possibility to use a "drawing-pin" is not generally known and therefore the authors present their clinical experience with this method.
The submitted review deals with the diagnosis and treatment of severe forms of toxic colitis from the gastroenterological and surgical aspect. The author emphasizes the importance of early diagnosis of the disease and early onset of conservative treatment which, however, should not exceed 72 hours without obvious improvement of the patient's condition. For surgical intervention the method of choice is subtotal colectomy with ileostomy and a mucous fistula of the rectosigmoid. In cases of early intervention the lethality is less than 10%; when the operation is late (frequently with complications) it is 30% or more. Better information of medical professionals on the disease is desirable.
The authors present a group of 23 patients where splints were used in the loops of the small intestine. The group is divided into two sub-groups. The first one comprises patients where the splint was inserted because of relapsing ileus of the small intestine after previous surgical operations. The second sub-group comprises patients where this operation was performed either preventively or as part of a primary operation or as part of a reoperation called for by complications immediately preceding operation. The internal splint is inserted via jejunostomy and through the loops of the small intestine it is guided by means of a sutured Foley catheter which after proper insertion of the splint is left in the caecum. The authors emphasize the importance of effective decompression of the small intestine during the early postoperative period which is made possible by suction of the ileous contents through lateral openings of the inserted probe. After three years' work, using this method, the authors confirm that it gives good results.
Severe peritonitis is a frequent condition characterized by high morbidity and mortality rates. Topical negative pressure (TNP) laparostomy could improve the results of the treatment, provided that the adverse events of this method are reduced. The aim of our study was to prove, in a prospective randomized study, that the primary use of TNP laparostomy reduces morbidity and mortality when compared to primary abdominal wall closure after the index surgery for severe peritonitis. The possibility of the abdominal wall fascial closure significantly influencing morbidity was the main topic of this study.Between 9/2009 and 9/2011,57 patients with severe peritonitis were included in the study at the Department of Surgery of the Bulovka Faculty Hospital; 28 of them were randomized to the TNP laparostomy group and 29 to the primary closure group. The two groups did not differ in age, gender, polymorbidity and severity of peritonitis.The length of hospital stay was similar in both groups (median: 22 days; range 10-171 days) in the intervention group and 23 days (range 3-71) in the control group (p = 0.89). The mortality rate was significantly lower in the TNP laparostomy group in comparison with the primary closure group (3 patients, 11% vs. 12 patients, 41%; p = 0.01). A complete closure of the abdominal wall including fascia and complete abdominal wall healing was achieved in 80% of survivors in the TNP group, compared to 29% in the primary closure group (p = 0.01). No enteral fistula occurred in any surviving patients from both groups. The overall length of abdominal wall healing was significantly shorter in the TNP group (median: 7; 7-94 days, versus 30; 7-223; p = 0.04).Primary TNP laparostomy is an effective and safe method in the treatment of severe peritonitis. Keeping good clinical practice, especially using dynamic suture as early as after the index surgery and the timely closure of laparostomy as soon as the indication disappears (according to relevant criteria) leads to a significantly higher abdominal wall healing rate, icluding fascial closure, than after peritonitis treatment without laparostomy.
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.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.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.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.
Zielsetzung: Ziel der vorliegenden Untersuchung ist es, unsere Ergebnisse mit der aggressiven chirurgischen Zellreduktion und intraperitonealen hyperthermen Chemoperfusion bei Patienten mit Peritonealkarzinomatose verschiedenen Ursprungs darzustellen. Patienten und Methodik: Zwischen 1999 und 2002 wurden in der Chirurgischen Klinik des Universitätshospitals Bulovka 28 Patienten wegen einer peritonealen Dissemination maligner Tumoren operiert. Bei diesen wurden eine Peritonektomie bzw. Debulking durchgeführt und zusätzlich eine intraperitoneale perioperative hypertherme Chemoperfusion vorgenommen. Die Perfusion erfolgte mit einer Elektrolytlösung, der Mitomycin C oder Cisplatin bzw. Carboplatin zugesetzt waren, wobei für 90 Min. eine Hyperthermie von 41 bis 43 °C angestrebt wurde. Ergebnisse: Die Gesamtmorbidität des Verfahrens betrug 85,7 %, die 30-Tage-Letalität 10,7 %. Von 19 Patienten, bei denen das Debulking komplett vorgenommen werden konnte, sind bisher 3 in einem Zeitraum von 3 Monaten bis 3,5 Jahre postoperativ verstorben. Folgerung: Die Peritonealkarzinomatose wurde bisher als ein inkurabler Zustand angesehen. Eine zunehmende Zahl von klinisch-experimentellen Untersuchungen belegt jedoch den therapeutischen und prophylaktischen Nutzen der Peritonektomie zusammen mit einer perioperativen hyperthermen Chemoperfusion bei diesen Patienten. Die Technik sollte weiter evaluiert werden.
Východiska: Pseudomyxom peritonea je vzácné nádorové onemocnění charakterizované různým stupněm malignity, produkcí mucinu a gelatinózních hmot.Jeho rozvoj je velmi často spojován s rupturou mucinózních nádorů apendixu a ostatních mucinózních nádorů trávicího traktu a ovaria.Pseudomyxom peritonea je obvykle dělen do tří skupin -low-grade, highgrade a high-grade s výskytem buněk pečetního prstene.Rozsah onemocnění je určován pomocí skórovacího systému PCI (peritoneal carcinoma index).Klinický obraz je značně variabilní, závisí na rozsahu onemocnění.S progresí vývoje nádorových hmot se postupně rozvíjí typický nález "jelly belly" -"syndrom rosolovitého břicha".Diagnostika je založena na stanovení předoperačního PCI pomocí zobrazovacích metod, zejména pak výpočetní tomografie.Metody: Od 90.let 20.století se uplatňuje metoda Paula H. Sugarbakera založená na maximálním možném odstranění nádorových hmot, tzv
