Attila Bursics

Ano-rectal physiological changes after rubber band ligation and closed haemorrhoidectomy.

Objective  The effect of treatment for haemorrhoids on ano‐rectal physiology was studied in a prospective longitudinal follow‐up study.

Az emlőrák korszerű sebészi kezelése. III. Emlőrák-konszenzuskonferencia

Absztrakt Az emlőrak sebeszi terapiajat napjainkban es a jovőben is az egyre precizebb diagnosztikus modszerek es az egyre hatasosabb onkologiai kezelesi eljarasok hatarozzak meg. Az emlőmegtartas es az onkoplasztikai elvek alkalmazasa egyre szelesebb korű; az axilla sebeszi kezeleseben az őrszemnyirokcsomo-biopszia az elsődleges, az axillaris blokkdissectio (ABD) indikacioja tovabb szűkult, es a sugarkezeles bizonyos esetekben az ABD alternativaja lett. Kozlemenyunkben a III. Emlőrak-konszenzuskonferencia tartalmara epulve, a legfrissebb nemzetkozi tanulmanyok es szakertői javaslatokat figyelembe veve foglaljuk ossze az emlőrak sebeszi kezelesevel kapcsolatos ajanlasainkat.

Mikroszatellita-instabilitás előfordulása, intratumoralis heterogenitása, prognosztikus és prediktív potenciálja primer colorectalis carcinomák és párosított májáttéteik sebészi kezelését követően

Absztrakt Bevezetes: A vastagbeldaganatokra jellemző genetikai instabilitas megnyilvanulhat tobb uton: kromoszomalis instabilitas, mikroszatellita-instabilitas, illetve „CpG-island methylator phenotype”. Ezek pontosabb karakterizalasaval a rendelkezesre allo kezelesek elviekben optimalizalhatok lehetnek. Celkitűzes: A szerzők a mikroszatellita-instabilitas előfordulasat, heterogenitasat, prognosztikus es prediktiv potencialjat vizsgaltak 122 primer colontumor szisztematikusan szelektalt regioiban es 69 parositott majmetasztazisban. Modszer: Szoveti multiblokkok kialakitasa utan az MLH1, MSH2, MSH6 es PMS2 kifejeződeset vizsgaltak immunhisztokemiai modszerrel. Eredmenyek: A betegek 11,5%-a (14/122) rendelkezett mikroszatellita-instabil fenotipusu daganattal. A kulonboző tumorregiok feherjekifejeződeseben nem volt jelentős kulonbseg. A primer tumor–majmetasztazis parok eseteben 20,2%-ban a kettő mas mismatch repair statusba volt sorolhato. A relapsusmentes es teljes tulelest tekintve a mismatch repair statu...

Autoimmune pancreatitis mimicking pancreatic tumor

Autoimmune pancreatitis (AIP) is a rare disease of unknown pathomechanism. It belongs to the IgG4-related disease family and responds well to steroids, although the relapse rate can reach up to 20–30%. Differentiating AIP from the more common pancreatic cancer can be very challenging. About 20% of AIP is diagnosed postoperatively during final histological examination. Each of the investigative tools can add something to the definitive diagnosis; the question remains whether it is possible to prevent an unnecessary resection. Through our case we would like to demonstrate the differential diagnostic opportunities and present the literary background of this issue. In conclusion, we can state that whenever a focal pancreatic lesion is encountered AIP should always be considered.

Reszekábilis colorectalis eredetű májáttét esetén javasolt-e a preoperatív szisztémás kezelés? Onkosebészeti nézőpont

Surgical resection is still the only curative treatment for colorectal liver metastases, but this is one part of a complex therapy. Nowadays a patient with colorectal liver metastasis is not treated only by a surgeon or by an oncologist or even only by an invasive radiologist. Collective decisions, complement treatments give the only chance to treat these patients for longer time. Patients with colorectal liver metastases could be regarded as patients with chronic disease. Specially interesting are the various treatment options of resectable colorectal liver metastases. The efficiency and necessity of preoperative chemotherapy are still a hot spot in the treatment of resectable liver metastases. In this study, we try to summarize the international and local experiences and the current evidence of the use of preoperative chemotherapy in the treatment of colorectal liver metastases. Orv Hetil. 2018; 159(21): 823-830.

Új távlatok a végbélrák sebészetében: Transanalis teljes mesorectum excisio. Kezdeti eredményeink

Absztrakt: Bevezetes: Hazankban a colorectalis carcinoma a masodik leggyakoribb daganatos halalozasi ok. Legfontosabb prognosztikai tenyező a teljes tuleles szempontjabol az operabilitas, valamint a műtet technikai minősege. A vegbelrak műteti „gold standardja” a teljes mesorectum excisio, mely a betegek egy reszenel alkati sajatsagokbol es anatomiai viszonyokbol adodoan laparoszkopos modszerrel gyakran nehezen vagy inkomplett modon kivitelezhető. Egy uj műteti koncepcio, a transanalis teljes mesorectum excisio (TaTME) azonban megoldast jelenthet erre a problemara, felhasznalva a legmodernebb sebeszeti technika nyujtotta lehetősegeket. Celkitűzes: Az uj műteti technika hazai bevezetesenek, kezdeti tapasztalatainak bemutatasa. Modszer: Az uj eljarast Magyarorszagon az elsők kozott ket munkacsoport alkalmazta. Egyeves esetsorozatuk tapasztalatait retrospektive elemeztuk. Eredmenyek: A szerzői munkacsoportok osszesen 17 transanalis teljes mesorectum excisio (TaTME) műtetet vegeztek. Sulyos intra- vagy poszto...INTRODUCTION Colorectal cancer is the second most frequent cause of oncologic mortality. Its key prognostic factors are operability and surgical quality. Total mesorectal excision is the gold standard of rectal cancer surgery, however, it is hardly achievable with the laparoscopic technique in a number of cases due to anatomical issues. Transanal total mesorectal excision (TaTME) is a new operative concept, which may address this technical problem. AIM We aimed to present the initial Hungarian experiences with the new technique. METHOD Retrospective analysis of clinical data of the first year case series at two Hungarian centers initiating the technique. RESULTS A total of 17 transanal total mesorectal excision (TaTME) operations were performed at two centers. Major perioperative complications happened in two cases. There was no 30-day mortality. CONCLUSIONS Early Hungarian experiences with transanal total mesorectal excision (TaTME) give hope of a brand new era of rectal cancer surgery. Orv Hetil. 2018; 159(1): 16-22.

A transanalis megközelítés előnye a mély rectumdaganatok műtéteinél

Absztrakt A laparoszkopos rectumsebeszet ma mar igazoltan alternativaja a hagyomanyos műteti technikanak. Ugyanakkor tovabbra is problemat jelent a kismedence melyenek vizualizalasa, a megfelelő distalis reszekcios sik biztositasa, a rectumcsonk egyetlen varrogeppel tortenő lezarasa es ezaltal a biztonsagos anastomosis keszitese. A laparoszkopos es a transanalis megkozelites kombinaciojakent jott letre a transanal total mesorectal excision (TaTME), amely technikaval a vilagon eddig korulbelul 500 műtetet vegeztek. A TaTME a mely rectumtumorok sebeszetenek fenti problemaira kinal megoldast. A transanalis rectumcsonk kepzese biztonsagos reszekcios sik kialakitasat teszi lehetőve, megoldja a distalis csonk zarasanak problemajat, kivalo latasi viszonyokat garantal pont a felulről legnehezebben megkozelithető teruleten, igy a kismedencei idegfonatok megkimeleseben is eredmeny varhato tőle. Esetbemutatasunk egy neoadjuvans kezelest kovetően jelentősen zsugorodott meretű, az anusnyilastol 5 cm magassagban azonos...

Laparoscopic resection of a liver metastasis from segment VII. Case report

The technique and clinical results of liver surgery are constantly evolving in recent years, and this development felt most intensely in the field of laparoscopic liver surgery. Based on the results of comparative studies reported to date, laparoscopic surgery is not inferior to open surgery. Although a very small percentage of liver resections are performed with laparoscopic technique, clearly it has a role in oncological surgery. The minor, major, anatomical, or even multi-stage liver resections can be performed with laparoscopy. The previously general recommendation, that lesions in the front segments of the liver are recommended for the minimally invasive technique is currently outdated. The authors present the history of a 70-year-old female, who underwent complex oncosurgical treatment of a locally advanced rectum carcinoma and a pure laparoscopic resection of a solitary hepatic metastasis of segment VII. With this case report the authors want to underline that malignant lesions in the posterior segments of the liver can be removed safely with laparoscopy.

In depth evaluation of the prognostic and predictive utility of PTEN immunohistochemistry in colorectal carcinomas: performance of three antibodies with emphasis on intracellular and intratumoral heterogeneity

BackgroundPhosphatase and tensin homolog deleted in chromosome 10 (PTEN) loss of function is frequently detected in advanced colorectal cancer. Its detection is thought to have prognostic significance and it is being considered to predict responsiveness to anti-EGFR therapy. Unfortunately, while immunohistochemical assessment of PTEN expression is widespread, it lacks standardization and the results are hardly comparable across the available publications.MethodsRetrospectively collected, formalin-fixed and paraffin-embedded colorectal tumor tissue samples from 55 patients were combined into tissue microarray (TMA) blocks. We used three different PTEN antibodies to determine the frequency, intensity and intracellular pattern of PTEN immunohistochemical labeling: Neomarkers, Dako and CellSignaling. We evaluated the aforementioned parameters in selected regions of colorectal cancers and in their lymph node metastases by using three scoring methods that take into consideration both staining frequency and intensity (H1-H3-score). We also evaluated intracellular localization.ResultsThe Dako and CellSignaling antibodies stained predominantly cytoplasms, while the Neomarkers antibody specifically stained cell nuclei. PTEN H-scores were significantly lower in all tumor areas as compared to the normal colonic mucosa based on staining with the DAKO and CellSignaling antibodies. Intratumoral regional differences or differences between matching tumors and metastases were not detected with any of the antibodies. Neither Dako, neither CellSignaling, nor the Neomarkers antibodies revealed a significant correlation between PTEN expression and pT, Dukes/MAC and clinical stage. KRAS status, histological grade correlated with PTEN H-scores based on staining with the Neomarkers antibody. PTEN H-scores did not correlate with MMR status. PTEN H-scores did not show any correlation with relapse-free survival based on staining with either antibody.ConclusionsWhile PTEN expression decreased in colorectal cancer according to two antibodies, neither of the three applied PTEN antibodies could justify significant correlation with clinicopathological data, nor had prognostic value. Thus, we might conclude that immunohistochemical PTEN investigation remains a challenge requiring more standardized evaluation on larger number of cases to clarify its utility as a prognostic and predictive tool in CRC. The standardization of immunohistochemical method is key in the evaluation process, which is further discussed.