36 research outputs found
Endoskopinis ūminės storosios žarnos obstrukcijos gydymas
No full textKęstutis Adamonis, Dainius Pavalkis, Žilvinas Saladžinskas, Algimantas Tamelis
KMU Gastroenterologijos klinika, KMU Chirurgijos klinika
Šiuolaikis virškinimo trakto piktybinės obstrukcijos gydymas vis labiau tampa minimaliai invazinis. Ligoniai, sergantys storosios žarnos vėžiu, komplikuotu obstrukcija, į gydymo įstaigas patenka skubos tvarka, neretai sunkios būklės, ir nėra idealūs kandidatai chirurginei operacijai. Šiuolaikinėje medicinos literatūroje gausėja mokslinių straipsnių apie sėkmingą ir saugų endoskopiniu būdu įkišamų savaime išsiplečiančių metalinių stentų naudojimą proktologijoje. Nors stentai ir yra brangūs, tačiau proktologinis stentavimas yra rentabili procedūra, leidžianti ligoniams, sergantiems storosios žarnos vėžiu, komplikuotu ūminė storosios žarnos obstrukcija, išvengti neatidėliotinos operacijos, o esant nerezektabiliam vėžiui, – kolostomos. Straipsnyje aprašomas KMU Chirurgijos klinikoje atliktas pirmasis Lietuvoje sėkmingas endoskopinis ūminės žarnų obstrukcijos gydymas stentuojant žarnyną.
Prasminiai žodžiai: žarnyno obstrukcija, kolorektinis vėžys, endoskopija, stentavimas.
Acute colonic obstruction: endoscopical management
Kęstutis Adamonis, Dainius Pavalkis, Žilvinas Saladžinskas, Algimantas Tamelis
Management of malignant gastrointestinal obstruction presents a significant challenge. Most patients are in a profoundly decompensated state due to underlying malignancy and are not ideal candidates for invasive surgical procedures. In recent years, self-expandable metal stents have emerged as an effective and safe, less invasive alternative for the treatment of malignant intestinal obstruction. Although stents are expensive, the procedure appears to be cost-effective, since emergency surgery can be avoided in patients with acute bowel obstruction, and in those with advanced disease no resection of the colon is necessary. Here we report a retrospective analysis of a first self-expandable metal stent placed for colorectal obstruction at Kaunas Medical University Hospital, as well as review the literature published on self-expandable metal stent placement. Our first data confirm self-expandable metal stent efficacy in palliation of malignant intestinal obstruction.
Keywords: intestinal obstruction, colorectal cancer, endoscopy, endoluminal stenting
Preoperative chemoradiation versus short term radiation alone with delayed surgery for stage II and III resectable rectal cancer
No full textThe aim of the randomized controlled trial was to compare the results of two different treatment options for stage II and III resectable rectal cancer: preoperative chemoradiotherapy and short term radiotherapy with delayed surgery (6 weeks). The objectives of the study were as follows: 1. to perform systematic literature review and meta-analysis comparing preoperative chemoradiotherapy with short-term radiotherapy 2. to compare radical resection rates between the groups; 3. to compare sphincter saving procedure rates; 4. to compare morbidity and mortality rates; 5. to evaluate the rates of downstaging and the rates of complete response; 6. to assess the role of preoperative treatment on the number of lymph nodes and the number of metastatic lymph nodes detected in the tumor bearing specimen. Arms 1. chemoradiotherapy arm - radiotherapy 50Gy/25fr, 1.8-2Gy per fraction over 5 weeks with chemotherapy 5-Fu/Lv ( 400mg/m² 5-Fluouracil, 20mg/m² Leucovorine) during first and last week of radiotherapy ( surgery after 6-7 weeks). 2. short-term radiotherapy with delayed surgery arm – radiotherapy 25Gy/5fr, 5Gy per fraction over 5 days (surgery after 6-7 weeks). preoperative short term radiation group 5x5 Gy during 5 days and surgery after 6 weeks Inclusion Criteria: • histologically confirmed stage II and III rectal cancer less than 15 cm from anal verge • less than 80 years old • no other cancer during 5 years period • compensate cardiovascular, pulmonary, hepatic and renal functions
The comparative value of magnetic resonance tomography and computed tomography examinations for II and III stages of rectal cancer
No full textSUMMARY The aim and the goals of the study: To evaluate the precision of rectal cancer radiological diagnostics, comparing the rectal cancer stages before and after neoadjuvant therapy. Objectives of the study: 1. To evaluate the decrease of the II–III stages rectal cancer stage and size in the large fraction radiation treatment with delayed surgery group and combined small fraction chemoradiation treatment group by MRI and CT methods. 2. To assess and compare the precision of MRI and CT when determining the RC stages before and after the neoadjuvant treatment. 3. To assess the MRI and CT sensitivity and specificity when determining the RC response to the neoadjuvant treatment. 4. To evaluate the MRI–DW ADC numeric value margin, characteristic of rectal tumour tissue before and after the neoadjuvant therapy, as well as the trial sensitivity and specificity when assessing the RC response to the neoadjuvant therapy. Scientific novelty: This is the first randomized controlled trial in Lithuania assessing two methods of neoadjuvant treatment for stage II and III respectable rectal cancer Conclusions: 1. Statistically significant rectal tumour size, T and N stage reduction, as well as CRM variation were determined after the neoadjuvant treatment in the combined chemoradiation and large fraction radiation treatment groups by means of radiological diagnostics methods. 2. When assessing the neoadjuvant treatment effectiveness with examination before and after the neoadjuvant therapy, it was determined that tumour T variation evaluation is more precise when using MRI (the probability of T stage discrepancy is 3.36 vs. 3.16), and N stage variation evaluation is more precise when using CT (the probability of N stage discrepancy is 2.25 vs. 1.27), in comparison with the MRI trial. 3. When assessing the neoadjuvant treatment effectiveness by comparing radiological diagnostic methods with pathomorphological examination methods low sensitivity and specificity of the radiological examination methods were determined: the MRI sensitivity – 63.18% and specificity – 52.14% and CT, respectively – 63.74% and 61.94%. 4. The evaluation of residual tumour tissue after the neoadjuvant therapy MRI – DW showed high sensitivity and specificity indicators: sensitivity – 97.8%, specificity – 58.3%. Statistically significant tumour tissue before the neoadjuvant treatment and the recovered tumour tissue after the treatment ADC values were determined, respectively: 0.620×10–3 mm2/s and 1.080×10–3 mm2/s
Coloanal anastomosis in rectal cancer surgery
No full textPurpose. To determine the efficacy of proctectomy with coloanal anastomosis for adenocarcinoma of the lower third of the rectum, and to compare quality of life after colonal anatomosis with low anterior rectal resection. Material and methods. Twenty coloanal anatomosies were performed on 1996\u962001 in Kaunas Medical University Hospital. Coloanal anatomosis was performed due to 1 villous adenoma and 19 adenocarcinomas. Postoperative functional results and quality of life were assesed by questionnaire, which was sent by mail to 17 patients after coloanal anatomosis and randomly assigned to 35 patients after low anterior rectal resection. Questionnaire was answered by 10 patients (59%) after coloanal anatomosis and 23 patients (66%) after low anterior rectal resection. Results. Four general and 7 surgical complications occurred after coloanal anatomosis. Postoperative mortality was 15% (3 cases). Symptomatic anastomotic strictures revealed in 2 patients. The frequency of defecation 6 and more times per day after coloanal anatomosis were in 2 cases (20%) and after low anterior rectal resection in 3 cases (13%). In coloanal anatomosis group normal continence occurred in 40% of cases and after low anterior rectal resection \u96 in 65%. One patient had incontinence of solids after low anterior rectal resection. In 4 cases after low anterior rectal resection occurred stable urine dysfunction. In coloanal anatomosis group sexual dysfunction occurred in 30% of cases, after low anterior rectal resection \u96 in 22%. After both operations about 50% patients felt better. Hard social, emotional problems had only one patient with incontinence of solids. In other aspects quality of life was similar in both groups. Conclusions. Proctectomy with coloanal anastomosis is suitable and safe procedure to treat lower third rectal cancer, with functional results and quality of life similar to low anterior rectal resection
Laparoskopinė storosios žarnos chirurgija: pirmoji patirtis Lietuvoje
No full textGintarė Valeikaitė1, Juozas Stanaitis2, Nerijus Kaselis3, Eligijus Poškus4, Kęstutis Strupas4, Dainius Pavalkis1
1 Kauno medicinos universiteto klinikų Chirurgijos klinika;
2 Vilniaus universiteto Bendrosios ir plastinės chirurgijos, ortopedijos ir traumatologijos klinika;
3 Klaipėdos apskrities ligoninės Chirurgijos skyrius;
4 Vilniaus universiteto ligoninės Santariškių klinikų Pilvo chirurgijos centras,
Santariškių g. 2, LT-08661 Vilnius
El paštas: [email protected]
Įvadas
Šio straipsnio tikslas – įvertinti pirmąją laparoskopinės storosios žarnos chirurgijos praktiką Lietuvoje ir supažindinti su pasauline patirtimi.
Metodai
Sudarytas klausimynas išsiųstas keturiems pagrindiniams Lietuvos centrams, kuriuose atliekamos storosios žarnos laparoskopinės operacijos. Išnagrinėti 56 atliktų operacijų duomenys. Trisdešimt šeši (64,3%) pacientai buvo operuoti nuo vėžio: penkiolika – nuo riestinės, vienuolika – tiesiosios, keturi – kylančiosios, trys – aklosios, du – skersinės ir vienas – nusileidžiančiosios žarnos vėžio. Nuo nepiktybinių storosios ir tiesiosios žarnos ligų operuota dvidešimt (35,7%) pacientų: aštuoni – nuo divertikuliozės, aštuoni – tiesiosios žarnos iškritimo, keturi – pailgėjusios riestinės žarnos. Vidutinis moterų amžius – 64,9 metų, vyrų – 59,7 metų.
Rezultatai
Buvo atlikta septyniolika aukštų priekinių tiesiosios žarnos rezekcijų, vidutinė operacijos trukmė (VOT) – 203,9 min., penkiolika dešinių hemikolektomijų, VOT – 212 min., devynios kairios hemikolektomijos, VOT – 221,4 min., šešios riestinės žarnos rezekcijos, VOT – 194 min., trys riestinės ir tiesiosios žarnos rezekcijos, VOT – 220 min, aštuonios rektopeksijos, VOT – 179,5 min., viena tiesiosios žarnos ekstirpacija, VOT – 255 min. Visos žarnų jungtys buvo padarytos intrakorporaliniu būdu, išskyrus dešinę hemikolektomiją, kai jungtis padaroma išorėje per minilaparotominį pjūvį dešinėje pilvo sienos pusėje. Konversijos priežastys dviem atvejais buvo kraujavimas iš pasaito ir dviem atvejais – peraugęs į gretimus organus navikas. Vidutiniškai prieš operaciją ligoniai gulėjo 3,2 dienos, po operacijos – 8,3 dienos.
Išvada
Laparoskopinis metodas toliau vertinamas atliekant perspektyvųjį nacio nalinį tyrimą.
Reikšminiai žodžiai: laparoskopija, storoji žarna, chirurgija
First experience in laparoscopic colorectal surgery in Lithuania
Gintarė Valeikaitė1, Juozas Stanaitis2, Nerijus Kaselis3, Eligijus Poškus4, Kęstutis Strupas4, Dainius Pavalkis1
1 Kaunas University of Medicine, Clinic of Surgery;
2 Vilnius University Clinic of General, Plastic Surgery, Orthopedic and Traumatology;
3 Klaipėda City Hospital;
4 Vilnius University Hospital Santariškių Klinikos, Centre of Abdominal Surgery,
Santariškių 2, LT-08661 Vilnius, Lithuania
E-mail: [email protected]
Objective
To evaluate the first experience in laparoscopic colorectal surgery in Lithuania and to review the worldwild accepted practice.
Methods
A questionnaire was sent to four major centers performing laparoscopic colorectal surgery in Lithuania. Analysis of obtained data showed that 56 laparoscopic operations were performed. For colorectal cancer were operated 36 patients (64.3%): 11 for rectal, 15 for sigmoid, 4 for ascending colon, 3 for ceacal, 2 for transversal and 1 for descending colon cancer. For benign colorectal disease – 20 (35.7%): 8 for diverticular disease, 8 for rectal prolapse, 4 for constipation caused by sigmoid elongation. The mean age of males was 59.7 and of females – 64.9 years.
Results
There were performed 15 laparoscopic left hemicolectomies (the mean operative time (MOT) 212 min), 17 laparoscopic high rectal resections (MOT 203.9 min), 9 laparoscopic right hemicolectomies (MOT 221.4 min), 6 sigmoid resections (MOT 194 min), 3 sigmoid and rectal resections (MOT 220 min), 8 laparoscopic rectopexies (MOT 179.5 min) and one laparoscopic abdominoperineal resection, operative time 255 min. All the anastomoses were intracorporeal, except right hemicolectomies and sigmoid resections. The reasons for conversion were bleeding from mesenterium in 2 cases and advanced tumours in 2 cases. The mean preoperative stay was 3.2 and postoperative stay 8.3 days.
Conclusions
There could not be clear conclusions, and the laparoscopic method is being further evaluated by a prospective national trial.
Key words: laparoscopic colorectal surger
The Role of the regional (intraarterial) chemotherapy in the treatment of colorectal cancer metastatic to the liver
No full textThis focuses on review one of the methods of locoregional treatment \u96 intraarterial hepatic infusion. Metastatic hepatic malignancies are the leading cause of cancer death. Surgical resection of metastatic hepatic malignancies has been the only established treatment modality offering potential for cure. Although surgical resection has significantly improved survival, only 5\u9620 percent of patients with colorectal carcinoma metastatic to the liver are surgical candidates. Conventional systemic (intravenous) chemotherapy with fluoropirimidines is effective only for 10\u9621 percent of patients with metastatic colorectal carcinoma. The limitations of surgical resection and the limited efficacy and generalized toxicity of systemic chemotherapy have sparked considerable interest in intraarterial hepatic infusion and especially in combination of systemic and intraarterial chemotherapy
Anesthesia for ambulatory anorectal surgery
No full textThe prevalence of minor anorectal diseases is 4–5% of adult Western population. Operations are performed on ambulatory or 24-hour stay basis. Requirements for ambulatory anesthesia are: rapid onset and recovery, ability to provide quick adjustments during maintenance, lack of intraoperative and postoperative side effects, and cost-effectiveness. Anorectal surgery requires deep levels of anesthesia. The aim is achieved with 1) regional blocks alone or in combination with monitored anesthesia care or 2) deep general anesthesia, usually with muscle relaxants and tracheal intubation. Modern general anesthetics provide smooth, quickly adjustable anesthesia and are a good choice for ambulatory surgery. Popular regional methods are: spinal anesthesia, caudal blockade, posterior perineal blockade and local anesthesia. The trend in regional anesthesia is lowering the dose of local anesthetic, providing selective segmental block. Adjuvants potentiating analgesia are recommended. Postoperative period may be complicated by: 1) severe pain, 2) urinary retention due to common nerve supply, and 3) surgical bleeding. Complications may lead to hospital admission. In conclusion, novel general anesthetics are recommended for ambulatory anorectal surgery. Further studies to determine an optimal dose and method are needed in the group of regional anesthesia
Preoperative radiation with chemotherapy for rectal cancer: its impact on downstaging of disease and the role of endorectal ultrasound
No full textObjective. Preoperative adjuvant radiation combined with chemotherapy is a recent development in the management of patients with rectal cancer invading perirectal tissue and regional lymph nodes. This study was performed to assess the impact of preoperative adjuvant therapy in patients judged by endorectal ultrasound to have extramural invasion of rectal cancer and/or regional lymph node involvement on tumor regression in bowel wall T and lymph nodes N. The predictive value of ultrasound in staging wall penetration and lymph node involvement after preoperative adjuvant therapy was also assessed. Materials and methods. Fifty-one patients were selected by ultrasound to have preoperative irradiation (40–50 Gy over 5–6 weeks). In 29 patients this was combined with 5-fluorouracil chemotherapy. Assessments of ultrasound were compared with pathologic findings in the resected specimen in all patients. Results. Partial downstaging was seen in 37 (72.5%) patients with wall invasion T and in five (9.8%) of 51 patients with lymph node involvement N. Complete downstaging was achieved in one (2.0%) patient with wall invasion T and in 20 (39.2%) of 51 patients with lymph node involvement N. Positive predictive values of ultrasound after irradiation were 47 (92.2%) and 45 (82.2%) for wall penetration and lymph node status, respectively. Negative predictive values of ultrasound after irradiation were rare 3.9% and 5.9%, respectively. Conclusions. In the majority of patients with rectal cancer invading perirectal tissues or lymph nodes, lesions downstages by preoperative chemo radiotherapy. Endorectal ultrasound examination before and after chemo radiotherapy for rectal cancer is one of the most recommended in staging rectal cancer
