Department Of Oncological Surgery Research Articles

Existential experiences and perceptions of death among children with terminal cancer: An interpretative qualitative study

Background: Exploring the experience and understanding of death in children with terminal cancer is important to provide them with appropriate care. However, most studies have focused on the perspectives of parents and healthcare professionals, and few have focused on the end-of-life experiences of children. Aim: To advance the understanding of end-of-life experiences and perceptions of death in children with cancer. Design: Interpretative qualitative study using semi-structured interviews. Data were analyzed using reflexive thematic analysis. Setting/participants: The study was conducted at the department of oncological surgery, Children’s Hospital, Zhejiang University School of Medicine. Ten children aged 8–17 with terminal cancer were included in the study. Results: Four major themes (and eight sub-themes) were identified from the findings: (1) helplessness in the face of death (loneliness, loss of control); (2) desire to connect with the world they left (reluctantly to be forgotten, sense of self-worth); (3) perceptions and attitudes toward death (separating from loved ones, embracing death); (4) expectations of future life (promoting comfort, fulfilling wishes). Conclusions: Children with terminal cancer have a strong sense of loneliness and a desire to connect with the world they have left behind. Differences in children’s perceptions and attitudes about death suggest that healthcare professionals should focus on their experiences and needs and provide personalized palliative care services to children and their families to improve their quality of life.

The role of the Academician of ASMDM C. Țîbîrnă in the development of oncological surgery in various locations (head/neck, thoracoabdominal, liver surgery, etc.)

The idea of the state scientific program comes under the name „Modern personalized surgery in the diagnosis and complex treatment of tumors in children”. On March 24-25, 2022, at the Academy of Sciences of Moldova, the National Scientific Conference with International Participation „Modern Personalized Surgery for Adults and Children. Surgery of the future”, dedicated to the Honorary Member of the ASM, university professor, illustrious surgeon Constantin Țîbîrnă, founder of the local surgery. C. Țîbîrnă, being a polyvalent surgeon, during his activity developed local oncological surgery in various locations (head-neck, thorocoabdominal, liver surgery, etc.). The following were analyzed: indices of mortality incidence and cancer prevalence in the Republic of Moldova during the years 1980-2020.Thus, during this period there was a clear increase in morbidity rates due to malignant tumors in the Republic of Moldova. In 1980, about 5860 of primary patients (149.0 per 10 0000 population) were registered. Over 30 years, in 2020 the number of patients will increase to 9391 (264.4 per 100,000 habitants). Mortality during this period had a stable increase. In 1980, 3515 patients died for malignant tumors (95.0 per 100,000 population), in 2020 mortality rates increased to 4867(136.9 per 100,000 population).Regarding the prevalence indices, it should be mentioned that in 1980, 26,715 of patients (668.3% 000) were registered in the Cancer Registry of the Republic of Moldova. In 2020, the prevalence indices was doubled - 50,980 (1433.9‰000). This index demonstrates to us the efficiency of the oncological assistance of the Oncological Institute team in the treatment of cancer in the Republic of Moldova.The existence of the European Society of Oncological Surgery (ESSO) as well as the World Federation of Surgical Oncology Societies (WFSOS) confirms the recognition of the specialty of oncological surgery.About 7,700 patients are treated annually for surgery. In the oncology clinic more than 65% perform typical operations. Wide and combined surgeries prevail in university clinics (360 patients). In his activity, the famous surgeon C. ȚÎbîrnă perfected the oncological surgery in the torocoabdominal region, at the Republican Clinical Hospital (prof. N. Gladun, acad. V. Hotineanu and prof. A. Hotineanu). In the Oncology Clinic he developed new methods of surgical treatment of local tumors spread in the head and neck region (acad. Gh. Ţîbîrnă and associate professor A. Țîbîrnă). As a result he proposed:To include in the current nomenclature of the Ministry of Health - „Overspecialization in cancer surgery”, which will create the legal framework for the operation of this specialty.To organize the Oncological Surgery Society of the Republic of Moldova and the oncological surgery department within USMF „N. Testemitanu”.

Chemoembolization as a minimally invasive treatment of primary malignant liver cancer

Background: Hepatocellular carcinoma (HCC) is the most common type of liver cancer and one of the most malignant neoplasms with high incidence and mortality in humans worldwide. The complex nature of the disease and its high resistance to systemic therapies result in poor prognosis for patients with advanced HCC. Case Report: In March 2017, the patient was admitted to the Department of Oncological Surgery, where a non-anatomical tumor resection was performed. Three years later, the patient developed a single change in segment 8 of the liver that was a relapse of the neoplastic process. Based on the Bracelon Criteria, the patient was qualified for the 1st stage of chemoembolization using the Seldinger method. In the presented patient as a result of the applied treatment, the neoplastic process was stabilized. Conclusion: The chemoembolization treatment that was applied to the presented patient turned out to be the correct treatment option. After only the first stage of chemoembolization, the patient regressed the neoplastic lesion.

Risk factors of non-sentinel lymph node metastasis in 443 breast cancer patients with sentinel lymph node-positive.

Axillary lymph node dissection is the standard surgical procedure for breast cancer patients with sentinel lymph node (SLN) positive. In clinical practice, axillary lymph node dissection may be an unnecessary treatment for some breast cancer patients with non-sentinel lymph node (NSLN) negative. The aim of this study was to analyze the risk factors of NSLN metastasis in breast cancer patients with SLN positive. Four hundred fifty-six clinical early stage breast cancer patients with SLN positive were collected and analyzed in the oncological surgery department of Fujian Provincial Hospital during 2013 to 2018. All these patients underwent surgical treatment. The average age and tumor size of 443 patients with SLN positive breast cancer were (49.8 ± 10.8) years and (2.42 ± 0.94) cm. Univariate analysis showed that the size of primary tumor, the number of positive SLN, the number of negative SLN, the ratio of positive SLNs, and the type of metastases in SLN were the influencing factors of NSLN metastasis. Multivariate regression analysis showed that primary tumor size T > 2 cm (P < .001, OR = 2.609), the positive number of SLNs ≥3 (P = .002, OR = 5.435), the ratio of positive SLNs ≥ 50% (P = .017, OR = 1.770), and SLN macrometastases (P < 0.001, OR = 16.099) were independent risk factors for NSLN metastasis. Combined with the 4 independent risk factors, the area under the curve to predict NSLN metastasis was 0.747 > 0.7. For clinical early breast cancer with positive SLN, primary tumor size T > 2 cm,the positive number of SLNs ≥ 3, the ratio of positive SLNs ≥ 50%, and SLN macrometastases could predict NSLN metastasis well, and guide surgery to avoid overtreatment.

Comparative Analysis of Postoperative Complications of Sentinel Node Identification Using the SentiMag® Method and the Use of a Radiotracer in Patients with Breast Cancer.

(1) Background: The purpose of the study was a retrospective, comparative assessment of complications of the surgical sentinel node biopsy (SNB) procedure in breast cancer using the radiotracer method and the SentiMag® method on groups of patients after 3.5 years of use. (2) Methods: The material was a group of 345 patients with primary surgical breast cancer who underwent the SNB procedure with the use of a radiotracer in combination with wide local excision (WLE), simple amputation (SA) with SNB and an independent SNB procedure in the period from May 2018 to January 2021 in the Department of Oncological Surgery. Of the patients who were monitored in the Hospital Outpatient Clinic, 300 were enrolled. The analyzed group was compared in terms of the occurrence of the same complications with the group of 303 patients also operated on in our center in the period from January 2014 to September 2017, in which SN identification was performed using the SentiMag® method. (3) Results: The most common complications found were sensation disorders in the arm, which occurred in 16 (14.1%) patients using the radiotracer method, SentiMag®-11 (9.9%). By comparing the complication rate between the methods with the radiotracer (n = 300) and SentiMag® (n = 303), no significant differences were found. (4) Conclusions: Sentinel node (SN) identification using the radiotracer method and the SentiMag® method are comparable diagnostic methods in breast cancer, with a low risk of complications.

The population-based study of oncology surgery department service during COVID-19 pandemic in Indonesia Single Center Hospital

Background: The COVID-19 pandemic has posed an unprecedented threat to global healthcare delivery. Moewardi Hospital was appointed by the government of Indonesia to be a COVID-19 one of regional hospital by June 2020. Other than COVID-19 cases, the hospital also provides care for other diseases which also provides care for oncology patients. The aim of the study: to assess the impact of the social restriction on oncology services in this hospital. Materials and Methods: This study compares the number of patients undergoing oncology surgery in the Central Surgery Unit and the number of patients attending the Outpatient Surgical Oncology Unit in March to July 2020 with the number of patients in the same timeframe in the previous year (2019). Results: The number of oncology operations in the Central Surgery Unit of Moewardi Hospital declined substantially during the 5-month pandemic period compared to the same period in the previous year, 2019 (p&lt;0.001). There was also a significant drop in the number of patients attending the outpatient surgical oncology clinic during the pandemic period compared to the previous year (p&lt;0.001) The lowest number of oncology surgeries occurred in April 2020, which was 20 patients. The lowest number of patients visited was 170 outpatients in March 2020. Thyroid and skin cancer cases were the most notable decline in surgical oncology cases in the Central Surgery Unit. The largest number of outpatients in the outpatient surgical oncology clinic during the COVID-19 pandemic was mammae and thyroid cancer. Conclusions: There was a decline in surgical oncology activities, which culminated in a significant decrease in surgical oncology patients in the Central Surgery Unit and the patient visit to the Moewardi Hospital outpatient oncology clinic during the COVID-19 pandemic.

The prevalence of hypoparathyroidism after thyroid surgery depending on the diagnosis, the extent of the procedure, and the presence of parathyroid glands in the postoperative examination.

Introduction Postoperative hypoparathyroidism can be one of the complications associated with total thyroid removal due to cancer or benign goitre. Purpose The paper aimed to evaluate the prevalence of hypoparathyroidism in patients operated on due to thyroid cancer and nodular goitre, including procedures performed between January 2015 and March 2019 at the Department of Oncological Surgery of the Medical University of Silesia in Katowice. Material and methods The studied group consisted of 595 patients operated on due to cancer and benign nodular goitres. Calcium and phosphate metabolism was assessed using PTH and ionised calcium tests four hours after the surgery. Ionised calcium was checked 30 days after the procedure. Patients who had borderline or below-normal PTH levels in the postoperative period were also subjected to PTH testing after 30 days. In patients with low PTH levels, supplementation with calcium and vitamin D3 was introduced after the surgery. Results Compared to patients operated on for benign goitres, persons diagnosed with cancer were significantly more likely to have PTH levels below 15 pg/ml and serum ionised calcium levels below 4 mg/dl after 30 days following the surgery. The recovery rate was 65.05% vs 82.6% (p < 0.003) and 64.2% vs 84.25% (p < 0.001). The results were similar among patients who underwent lateral and central lymphadenectomy - 33.3% vs 67.3% (p < 0.021) and 25.6% vs 67.6% (p < 0.018). In patients with mild goitres, no significant differences in the recovery rate were observed - 82.6% vs 92.8% (p < 0.327) and 84.25% vs 92.3% (p < 0.437). Patients in whom parathyroid glands were found in the postoperative material were significantly more likely to have decreased PTH and calcium levels after 30 days following the procedure. The recovery rate was 64.1% vs 78.9% (p < 0.027) and 58.06% vs 80.8% (p < 0.004). Conclusions Hypoparathyroidism is not an uncommon occurrence after thyroidectomy, even in facilities with extensive experience in this matter. Compared to total thyroid removal due to benign goitre, surgery for cancer with associated central and lateral lymphadenectomy significantly increases the risk of postoperative hypoparathyroidism. In surgical practice, it is reasonable to conduct routine Ca and PTH level checks after the procedure and 30 days following thyroidectomy.

Prediction of lymph node involvement in epithelial ovarian cancer by PET/CT, CT and MRI imaging

Objective: The aim of this study is to detect retroperitoneal metastatic lymph nodes in epithelial ovarian cancer with preoperative imaging methods (MRI, CT, 18F-FDG PET/CT). Material and method: Patients with epithelial ovarian cancer followed by the Akdeniz University Faculty of Medicine Gynecologic Oncology Surgery Department registered in the hospital’s electronic file system, who had undergone pelvic and/or paraaortic lymphadenectomy, and having undergone at least one imaging method (MRI, CT, PET/CT), were included in the study. Based on the data available, 89 patients were included in the study. Lymph node metastasis in the histopathology reports of these patients was accepted as the gold standard. The presence of lymph nodes on the imaging modalities (MRI, CT, PET/CT) was regarded as positive and was compared with the gold standard pathological lymph node metastasis. By doing so, the accuracy, specificity, sensitivity, PPV and the NPV of the imaging methods in predicting lymph node metastasis were calculated. Findings: Thirty-eight (42.7%) of 89 patients included in our study were at stage 3C. Based on the data, while 85 of the 89 patients included in the study obtained had undergone pelvic and paraaortic lymphadenectomy, four patients had undergone only pelvic lymphadenectomy. Of the patients, 73 had undergone a CT, 20 had undergone a PET/CT and 12 had undergone an MRI. The sensitivity, specificity, PPV, NPV and the accuracy of CT regarding all nodal involvement was 62%, 52%, 57%, 57%, and 57%, respectively. The PET/CT’s values were 63%, 66%, 70%, 60% and 65%, respectively. The sensitivity, specificity, PPV, NPV and the accuracy of PET regarding paraaortic nodal involvement alone were 50%, 91%, 80%, 73% and 75%, respectively. Conclusion: According to the data we obtained, it is challenging to decide whether to perform systemic pelvic and paraaortic lymphadenectomy based on imaging modalities (MRI, CT, PET/CT), and hence, further investigation is needed for more accurate imaging techniques.

Case report: Subcutaneous fungal cyst resembling as benign tumor

Background: Subcutaneous fungal infections are caused by penetration of the causative fungi into the subcutaneous layer and usually localized. Phaeohyphomycosis is mycotic infection, which can caused by different fungal organism and commonly presenting as subcutaneous cysts. The diagnosis can obly be made by histopathological examination, and the entity should be considered in the clinical differential diagnosis of every cystic lesion in the skin. Case description: Subcutaneous fungal infections are caused by penetration of the causative fungi into the subcutaneous layer and usually localized. We report a 65 years old woman with chief complaint of mass at gluteal sinistra with tenderness pain since 4 month before admission and come to the oncology surgery department. Physical exam are single nodule at gluteal sinistra, tenderness pain, no difference in skin color. Laboratory findings are normal hemoglobin and leucocyte. CT scan with contrast showed enhancing solid mass 2.06 × 4.95 cm at gluteal sinistra. Biopsy excision of the mass, pathological finding are atypical and pleomorphic cell, hyperchromatic, eosinophilic cytoplasm, foamy macrophage, hyphae and microspore separated until mature fat tissue and muscle, also found giant cell and xanthoma cell. After that we confirmed with Periodic Acid Schiff (PAS) stain. So, the patient come to Tropic Infection department. A diagnosis of phaeohypomycotic cyst was made. Discussion:The term of phaeohypomycotic was described by Allejo et al. in 1974. The most common lesion are cutaneous and subcutaneous cyst resembling as benign tumor, sebaceous or abscess. It saprophytes and occurring in soil, decaying in wood, and vegetation. Phialopora are the most common isolated fungi. Infection is usually as a result of traumatic implantation. In this case there is no history of trauma, but the trauma could be so trivial and not noticed. Surgical procedure is the only way to remove the subcutaneous cyst. But, it should be followed with antifungal therapy. In this case we give 6 months treatment with itraconazole 200mg b.i.d. and give significant outcome and no recurrence. Conclusion: This case emphasizes the importance of considering subcutaneous fungal cysts in the differential diagnosis of subcutaneous cystic nodules, especially on the extremities.

Kompleksowa opieka pielęgniarska nad chorą z rozpoznaniem raka piersi

Breast cancer is the most frequently diagnosed cancer among both Polish and foreign women and is the main cause of their premature mortality. The aim of the manuscript was to present nursing activities focused on providing professional care for a patient diagnosed with breast cancer. The study covered a woman, aged 47, a resident of the Sanok poviat, who was diagnosed with right breast cancer in 2015 and underwent the necessary surgical treatment at the Oncological Surgery Department of the Specialist Hospital in Brzozów along with subsequent adjuvant treatment. The case study method was used. Patients diagnosed with breast cancer have many nursing problems both in the preoperative and postoperative periods. Many of those problems are of psychological nature. The nurse’s individual approach to a patient allows for effective minimization and prevention of many of such problems. Nursing activities undertaken in relation to the patient had a major effect on her general condition. During the patient’s stay in the hospital, she was provided with a sense of safety and well-being. The patient’s deficient knowledge in the field of independent postoperative wound care and adjuvant treatment was supplemented. Proper provision of comprehensive nursing care for oncological patients is possible thanks to the constantly acquiring and updating knowledge in the field. Due to the constantly growing number of patients diagnosed with breast cancer, it is necessary to raise nursing care standards.

Giant fibroma of the retroperitoneal space, complicated by inferior vena cava compression syndromе

Background. Inorganic retroperitoneal tumors (IRT) are neoplasms that have no organ affiliation and develop from soft tissues located in the ret­roperitoneal space (adipose, connective, vascular, nervous), as well as from embryonic elements. IRT account for 0.03 to 1.0 % of all human neoplasms. Malignant IRT account for up to 70 %, while benign – up to 30 %. Operations for retroperitoneal tumors are accompanied by a high risk of intra- and postoperative complications [3]. With large retroperi­toneal tumors the main difficulties are compression syndrome of the ab­dominal cavity, the syndrome of compression of the inferior vena cava, difficulties of mobilizing of the tumor due to a small surgical maneuver and large size of the tumor.&#x0D; Purpose. Introducing the clinical course peculiarities of giant tumors of the retroperitoneal space and possible intra- and perioperative compli­cations to the medical community.&#x0D; Materials and methods. Clinical case of patient A., 44 years old, who was treated in the oncology surgery department of SO «Grigoriev Institute for Medical Radiology and Oncology of the National Academy of Medi­cal Sciences of Ukraine».&#x0D; Results. Removal of the tumor of the retroperitoneal space with techni­cal difficulties was performed. In the postoperative period after surgery, bleeding from a varicose vein of the abdominal wall. Surgical treatment was performed: relaparotomy, hemostasis. The term of supervision is 3 years, there is no data for recurrence.&#x0D; Conclusions. If IRT is additionally accompanied by a syndrome of in­ferior vena cava compression, it is necessary to carry out careful hemo­stasis intraoperatively, and to conduct active supervision in the nearest postoperative period for control of possible bleeding after filling of earlier «empty» vessels.

Analysis of disease free survival in cutaneous melanoma patients subject to sentinel lymph node biopsy.

&lt;b&gt;Introduction:&lt;/b&gt; Cutaneous melanoma is estimated for 2% of malignant neoplasms occurring in humans. It is characterized by a high level of malignancy and low sensitivity to cytostatic drugs. The incidence of cutaneous melanoma is increasing in Poland. The lymphatic system is the most common route of dissemination of this neoplasm. The appearance of a sentinel node biopsy technique has made it possible to identify patients with a regionally advanced disease. It is a minimally invasive method with a small percentage of complications. &lt;br&gt;&lt;b&gt;Aim: &lt;/b&gt;Analysis of disease free survival (DFS) in cutaneous melanoma patients with sentinel lymph node biopsy. &lt;br&gt;&lt;b&gt;Material and methods:&lt;/b&gt; The analysis included 222 patients with cutaneous melanoma treated in the Department of Oncological Surgery in 2010-2015, who underwent a sentinel node biopsy. The study group consisted of 136 women and 86 men, the average age of patients was 59 years. Patients were qualified for sentinel node biopsy based on clinical evaluation and ultrasound of regional lymph nodes. The average follow-up was 25.1 months. About 2 hours before surgery, patients received a radioisotope, then lymphoscintigraphy SPECT was performed. Additionally, they were administered the Patent Blue dye in the operating room. &lt;br&gt;&lt;b&gt;Results:&lt;/b&gt; The sentinel node was identified in 217 patients (98%), and the average sentinel nodes were 2.25. Twenty-seven patients (12%) had a metastasis in sentinel nodes. In this group, the duration of symptom free survival was significantly shorter. Sentinel node status and age of the patient were independent factors affecting the prognosis of disease free survival. &lt;br&gt;&lt;b&gt;Conclusions:&lt;/b&gt; Sentinel node biopsy is a precise method to identify patients with cutaneous melanoma who have metastasis to regional lymph nodes, as well as the most important prognostic factor.

CUTANEOUS METASTASES UNVEILING BREST CANCER – THERAPEUTIC AND DIAGNOSTIC CONSIDERATIONS

Metastatic cutaneous lesions are seen more commonly in breast cancer than in any other malignancy in women. Secondary breast cancer happens when cancer cells spread from the breast to other parts of the body. Sometimes breast cancer cells can spread to the skin. This can happen through the blood or lymphatic system. The presence of skin metastases signifies widespread systemic disease and a poor prognosis. The chest wall, the abdomen, the back, and the upper extremities are common sites.We present the case of a 69-year-old woman presented to our Surgery Department in June 2019, after appearing in the Dermatology Department a week ago, for the appearance of multiple subcutaneous painless, hardened, skin-colored nodules spread to the cervical region, anterior chest walls and upper limbs. Anatomopathological examination of the skin biopsy, performed on the anterior face of the left arm, showed dermal fragment with neoplastic, suggestive for lobular breast carcinoma (stage IV). The patient was referred to the oncological surgery department where our patient underwent a left total mastectomy and sentinel lymph node biopsy. The technique of mastectomy was the Madden technique. The surgery has no healing character, being more a necessity intervention that seeks to avoid the complications of the local evolution of the disease, such as ulceration, hemorrhage or suppuration, the possibility of applying the other forms of treatment (radiotherapy and / or polychemotherapy), elimination of a source of permanent metastatic sowing thus leading to more efficient treatment.

Hypertension and chronic kidney disease is highly prevalent in elderly patients with colorectal cancer undergoing primary surgery.

Colorectal cancer (CRC) is a common and lethal disease. Hypertension is the most commonly reported comorbidity among cancer patients. Data on its incidence and prevalence is very scarce. The aim of the study was to evaluate the prevalence of hypertension and chronic kidney disease (CKD) in a cohort of 100 consecutive patients with CRC undergoing primary surgical treatment. The pilot study included 100 consecutive patients with CRC undergoing primary surgery with curative intent within 1 year in the Department of Oncological Surgery in Białystok, Poland. No neoadjuvant therapy was administered before the surgery. The prevalence of hypertension was 62% among the patients studied. Sixty-five percent of the patients were older than 65 years and hypertension was present in 78% of these elderly patients. The prevalence of CKD was 15%, while that of diabetes was 23%. All CKD patients were older than 65 years of age. The hypertensive patients were more likely to be older and anemic with higher serum fibrinogen, which reflects a general inflammatory state. Elderly hypertensive patients had significantly higher creatinine levels, lower estimated glomerular filtration rate (eGFR) levels (p < 0.001) and lower platelet counts. It is of the utmost importance for oncology patients to have any hypertension diagnosed and treated appropriately in order to prevent complications so they may continue their therapy with the least interruption or discontinuation of treatment and to ensure the best possible outcomes.

The relationship between HER2 overexpression and angiogenesis in gastric cancer.

In gastric cancer, HER2 protein overexpression is considered to be conducive to the higher proliferation activity of the tumor cells. Tumor formation is associated with angiogenesis in order to secure an abundant supply of oxygen and glucose to cancer cells. The aim of the study was to assess if HER2 overexpression is related to higher microvessel density (MVD) in the tumor stroma.The archival samples of primary tumor from 144 consecutive patients that underwent gastric resection for cancer between August 1, 2006 and December 31, 2013 in the Department of Oncological Surgery of Medical University of Gdańsk were analyzed. CD34 was used as a marker of MVD in the tumor stroma. Both CD34 and HER2 protein expressions were tested by immunohistochemistry.The assays were unsuccessful to estimate HER2 in 10 cases and CD34 in 14 cases due to technical reasons. The results were obtained for 128 patients. HER2 0 and HER2 1+ were considered negative, while HER2+ and HER2 3+ were recognized as positive. Mean MVD (mean number of vessels in the visual field) was 32.4 (median 29.5). Microvessel density was insignificantly higher in HER2 positive tumors. The slight difference was also seen between IHC 2+ and 3+ groups. The differences did not reach the level of statistical significance.Statistical analysis performed in our study did not reveal the significant relationship between HER2 overexpression on the tumor cells and MVD in the tumor stroma.

HEREDITARY DIFFUSE GASTRIC CANCER: GENETIC ASPECTS AND PROPHYLACTIC TOTAL GASTRECTOMY

For patients with an identified germline E-cadherin-1 (CDH1) mutation, prophylactic gastrectomy is the treatment of choice to eliminate the high risk of developing diffuse gastric cancer. The case report describes a rare case of hereditary diffuse gastric cancer (HDGC) associated with CDH1 gene mutation, which is reported in the Russian population for the first time. In 2013, a 28-year- old woman was referred to Clinical Oncogenetics Laboratory with a family history of gastric cancer. Molecular genetic analysis revealed CDH1 gene mutation. The lifetime risk of cancer in mutation positive members is more than 80. Histological examination of gastric biopsy specimens obtained during endoscopy revealed isolated signet ring cells in the lamina propria. Spleenpreserving D2-lymphodissection and total gastrectomy with Roux-en-Y reconstruction with a jejunal reservoir formation were performed at the Abdominal Oncology Surgery Department.

Analysis of postoperative morbidity and mortality following surgery for gastric cancer. Surgeon volume as the most significant prognostic factor.

IntroductionSurgical resection is the only potentially curative modality for gastric cancer and it is associated with substantial morbidity and mortality.AimTo determine risk factors for postoperative morbidity and mortality following major surgery for gastric cancer.Material and methodsBetween 1.08.2006 and 30.11.2014 in the Department of Oncological Surgery of Gdynia Oncology Centre 162 patients underwent gastric resection for adenocarcinoma. All procedures were performed by 13 surgeons. Five of them performed at least two gastrectomies per year (n = 106). The remaining 56 resections were done by eight surgeons with annual volume lower than two. Perioperative mortality was defined as every in-hospital death and death within 30 days after surgery. Causes of perioperative deaths were the matter of in-depth analysis.ResultsOverall morbidity was 23.5%, including 4.3% rate of proximal anastomosis leak. Mortality rate was 4.3%. Morbidity and mortality were not dependent on: age, gender, body mass index, tumour location, extent of surgery, splenectomy performance, or pTNM stage. The rates of morbidity (50% vs. 21.3%) and mortality (16.7% vs. 3.3%) were significantly higher in cases of tumour infiltration to adjacent organs (pT4b). Perioperative morbidity and mortality were 37.5% and 8.9% for surgeons performing less than two gastrectomies per year and 16% and 0.9% for surgeons performing more than two resections annually. The differences were statistically significant (p = 0.002, p = 0.003).ConclusionsAnnual surgeon case load and adjacent organ infiltration (pT4b) were significant risk factors for morbidity and mortality following major surgery for gastric cancer. The most common complications leading to perioperative death were cardiac failure and proximal anastomosis leak.

Breast Cancer Surgery in Images

As a picture speaks more than a thousand words, we tried to reflect, at least in part, on our surgical day-to-day practice on the 2nd Oncological Surgery Department of "Prof. Dr. Al. Trestioreanu" Bucharest Institute of Oncology in the field of breast cancer. And how could we not talk about imaging in breast cancer, when one of the reasons for low breast cancer mortality at present is early detection, which is performed through imaging investigations. Mammographic screening is recognized as a success in this area (Fig. 1), but moreover, mammary ultrasound, a newer addition to this domain, also allows the detection of infraclinical cancers (Fig. 2). The localization of these infraclinical lesions can be obtained preoperatively by mammographic technique using a harpoon (Fig. 3). Under ultrasound guidance we can not only puncture cysts (Fig. 4), but also perform mammary biopsies for suspicious lesions.

New single nucleotide polymorphisms (SNPs) in homologous recombination repair genes detected by microarray analysis in Polish breast cancer patients.

Breast cancer is the most common cause of malignancy and mortality in women worldwide. This study aimed at localising homologous recombination repair (HR) genes and their chromosomal loci and correlating their nucleotide variants with susceptibility to breast cancer. In this study, authors analysed the association between single nucleotide polymorphisms (SNPs) in homologous recombination repair genes and the incidence of breast cancer in the population of Polish women. Blood samples from 94 breast cancer patients were analysed as test group. Individuals were recruited into the study at the Department of Oncological Surgery and Breast Diseases of the Institute of the Polish Mother's Memorial Hospital in Lodz, Poland. Healthy controls (n=500) were obtained from the Biobank Laboratory, Department of Molecular Biophysics, University of Lodz. Then, DNA of breast cancer patients was compared with one of the disease-free women. The test was supported by microarray analysis. Statistically significant correlations were identified between breast cancer and 3 not described previously SNPs of homologous recombination repair genes BRCA1 and BRCA2: rs59004709, rs4986852 and rs1799950. Further studies on larger groups are warranted to support the hypothesis of correlation between the abovementioned genetic variants and breast cancer risk.

Satisfaction with Life and Social Factors in Decision-Making Proces on Breast Reconstruction in Women after Mastectomy.

Comparative analysis comprised patients after mastectomy, who decided on breast reconstruction (40) and those who did not undergo reconstructive surgery (40). The study was conducted in the Department of Plastic, Reconstructive and Aesthetic Surgery, Medical University of Lodz and Department of Oncological surgery and Breast Diseases ICZMP, Łódź, between 2013-2015. In the study the question whether higher satisfaction with life prompts decision on breast reconstruction was investigated. The Satisfaction with Life Scale (SWLS) was used, as well as an original questionnaire. The correlations between statistical parameters were evaluated using the chi-square test. We have demonstrated differences between the level of satisfaction with life in patients who decided to undergo breast reconstruction and those who did not choose reconstructive surgery. The discrepancies may reflect differences in the system of values and level of satisfaction with life before reconstructive treatment and also point to potential effect of these factors on the decision to undergo surgery. 1. Differences in cognitive structures between 'Amazons' determine the decision on reconstructive treatment. 2. Transfer of information between the therapeutic team and women after mastectomy is not satisfactory. 3. Higher level of satisfaction with life has a positive effect on the decision of breast reconstruction.