Jarmil Safranek

Esophageal stents for less invasive treatment of mediastinitis.

Introduction In spite of the progress in diagnosis and therapeutic options, esophageal perforation resulting in mediastinitis is a very serious condition with a high morbidity. Aim To evaluate the use of esophageal stents for the treatment of patients suffering from mediastinitis. Material and methods Retrospective (2008–2012) analysis of a group of patients requiring surgical treatment. The evaluation was focused on the cause of perforation, stent type and its parameters, the surgical method used, duration of stenting and total length of treatment. Results In total, 16 patients were treated by stenting. All patients were treated with the stent being placed across the defect in the esophagus. Mediastinitis was accessed and drained with the aid of a thoracotomy or thoracolaparotomy (8 cases), or using a combination of a laparotomy/laparostomy and pleural drainage (5 cases). The most basic interventions were either pleural or external cervical drainage (3 and 1 cases, respectively). One patient, in whom a stricture had developed at the healed perforation, was subjected to esophageal resection. Four patients died. The average period that the stent was left in situ was 53.7 days. The average period of hospitalization of those patients who survived was 53.4 days. Conclusions Using stents in therapy neither increased survival (mortality of 25%), nor decreased the length of therapy of patients once mediastinitis had developed. The main advantage of stenting is the preservation of the native esophagus and the reduced extent of surgical mediastinal drainage.

A complex oncosurgical approach to increasing the resectability of colorectal cancer metastases - a case report

AIM In this case report, the authors aim to demonstrate the success of recent methods in the radical treatment of a patient with primary inoperable liver and subsequent colorectal cancer pulmonary metastases. METHODS A 75 year old patient with inoperable bulky metastasis in the right hepatic lobe and insufficient future remnant liver volume was indicated for a stage procedure in the liver parenchyma. Embolization of the right branch of the portal vein was first performed with subsequent administration of stem cells into the contralateral liver lobe. Following compensatory growth of the left liver lobe, right-sided hepatectomy was performed with subsequent adjuvant oncological treatment. Six months after the surgery, a metastasis developed in the right pulmonary lobe which was solved by metastasectomy. RESULTS The patient, one year after the diagnosis of inoperable liver metastasis, is completely healthy and free of signs of disease recurrence. CONCLUSION A comprehensive oncosurgical approach using up-to-date diagnostic and treatment options may offer patients with metastatic colorectal cancer, radical treatment with the hope of long-term quality survival.