Leszek Kutwin

Assessment of quality of life in patients with non-operated pancreatic cancer after videothoracoscopic splanchnicectomy

Introduction Pancreatic tumours are a crucial medical issue. The majority of patients report sick in the late stage of carcinoma clinical advancement, which considerably limits the possibility of surgical treatment. Pancreatic cancer patients with no other alternative but palliative treatment constitute a large group. Aim To assess pain intensity levels and quality of life of pancreatic cancer patients after videothoracoscopic splanchnicectomy. Material and methods Between 2001 January and 2010 November in the Department of Thorax, General Surgery and Oncology of the Medical University of Lodz 262 patients with pancreatic tumours were hospitalized. In 121 cases grade 3 and grade 4 tumours were observed. Hundred and twenty-one videothoracoscopic procedures of sympathetic trunk and ganglion excision were performed in 89 patients. Results Before the procedure the pain intensity level according to VAS was 5.66 (3.9-7.2; SD 1.24) in the trial group and 5.46 (4.1-7.1; SD 1.15) in the control group. The quality of life average assessment in both groups did not differ statistically (p = 1.07) and was 46.3 (32-66; SD 0.92) in patients before the operation and in the control group 50.3 (41-63; SD 0.75). On the 7th postoperative day the pain intensity on average was 2.33 (1.2-3.9; SD 0.78) and 4.57 (3.6-5.5; SD 0.69) respectively. One week after the procedure the quality of patients’ life was estimated at 64.1 (39-83; SD 1.38) and in the control group at 52.2 (42-65; SD 0.71); the differences are significant (p < 0.05). Thirty days after the procedure 12 patients did not take any painkillers (13.5%), and in the others a considerable decrease of the taken drugs was observed. On average, the pain intensity was estimated at 1.78 (0.6-3.6; SD 0.68). The quality of life, on the other hand, improved considerably in relation to the state prior to the procedure, but increased insignificantly in relation to the state on the 7th postoperative day to 70.9 (52-88; SD 1.14). Conclusions Splanchnicectomy is a safe method of cancer pain treatment in patients with advanced pancreatic tumours. Videothoracoscopic excision of visceral nerve thoracic section contributes to the statistically significant decrease of cancer pain intensity and considerably improves the quality of patients’ lives.

Comparison of early results of surgical treatment in patients with pancreatic cancer.

UNLABELLED Pancreatic tumours are a serious medical and social issue. Patients come to the doctor too late, when the disease is well advanced. The most frequently applied method of surgical treatment is pancreatoduodenectomy (Whipple procedure). The most frequently used technique of pancreatoduodenectomy is the Child-Waugh method. The procedure can be performed in a classic way or as modified by Traverso (with preservation of the pylorus). MATERIAL AND METHODS Between August 2008 and June 2011, in the Department of Thoracic, General and Oncologic Surgery of Medical University in Łódź, a total of 79 patients with pancreatic tumours were hospitalized. In 61, pancreatoduodenectomy was performed. The patients were divided into two groups, depending on the diagnosis and the procedures performed: group 1 comprised patients in whom the pylorus was resected (n = 43); group 2 comprised patients in whom the pylorus was preserved (Traverso-Longmire procedure; n = 18). RESULTS Mean duration of surgery was about 3 hours and 50 minutes in both groups. Mean duration of hospitalization after the procedure was 15.6 days in group 1 and 12.2 days in group 2 (p < 0.05). Early complications (within 30 days of the procedure) were observed in 33.2% of patients in both groups. Blood transfusion was necessary in 21% of patients in group 1 and 28% of patients in group 2 (p>0.05). CONCLUSIONS There are specific indications for each method of surgical treatment, however, it seems that both techniques of pancreatic resection can be recommended as standard surgical treatment, and the number of complications after both procedures is similar.

Chest reconstruction using a custom-designed polyethylene 3D implant after resection of the sternal manubrium

Introduction Resection of manubrium or body of the sternum is associated with a necessity of chest wall reconstruction. Large sternal defects require the use of different types of implants to ensure acceptable esthetic effect for the patient and chest stabilization. Aim The purpose of this case report is to present a novel method of reconstruction of manubrium removed due to renal cancer metastasis to the sternum. Case We present the case of a patient, who had underwent right nephrectomy for clear cell kidney cancer, diagnosed with a metastatic tumor in the sternum resulting in destruction of manubrium. The patient undergone tumor resection with primary reconstruction with an individual prosthesis. Sternal defect was filled with a personalized, computed tomography scan-based 3D-milled implant made of polyethylene. Results Sternal reconstruction was uneventful. The patient endured surgery well, and has been under surveillance in outpatient clinic, without any respiration disorders, implant movement or local recurrence. Conclusion Custom-designed sternal implants created by 3D technique constitute an interesting alternative for previous methods of filling defects after resection of a tumor in this location.

Repair of postpneumonectomy bronchopleural fistula using pedicled pericardial flap supported by fibrin glue

Effective closure of the postpneumonectomy bronchopleural fistula (PBF) with the use of different techniques still remains a challenge for thoracic surgeons. The aim of this study was to evaluate the efficacy of modified method of PBF closure using pedicled pericardial flap (PPF) supported by fibrin glue (FG). The efficacy of the late PBF closure with the use of two surgical methods was compared. In 10 patients, the edges of the PBF were covered with FG and PPF. In the second group of nine patients, myoplasty was used to close the bronchial fistula. Postsurgical follow‐up was for 1 year. In the first group, the healing of the fistula was achieved in 100% of the cases, whereas in the second, myoplasty group, healing was achieved in only 66·67% of the cases. The number of complications was similar in both groups. Pericardial flap supported by fibrin glue can be an effective method adjunctive to the treatment of PBF in selected patients.

Strangulation of a Meckel’s diverticulum in a femoral hernia (Littre’s hernia)

Femoral hernia is usually presented as a flexible, round, domed shape lying on the medial side of the thigh about 2–3 cm below the inguinal ligament. Among the external hernias, femoral hernia is the second most common inguinal hernia. Its prevalence reaches 20%. Among all inguinal hernias, femoral hernias are characterised by a high level of incarceration and strangulation. This can be as high as 60%. We would like to present a case of 71-year-old patient who was admitted to the Clinic urgently due to strangulation of Meckels diverticulum in a right-sided femoral hernia. Strangulation of Meckels diverticulum in femoral hernia is an extremely rare entity. It was described for the very first time in 1700 by Littre.