Extended Radical Surgery Research Articles

Unnecessary Extended Surgical Resection for Xanthogranulomatous Cholecystitis Mimicking Gallbladder Carcinoma: A Case Report

The Xanthogranulomatous Cholecystitis (XGC) is frequently misdiagnosed as Gallbladder Carcinoma (GBC) and usually undergoes an extended radical surgery. Sometimes XGC might have a coexistent GBC. The dilemma still exists concerning the differential diagnosis in clinical practice, and the final diagnosis has to be dependent on the histological examination. This case shows us the diagnostic difficulty of XGC pre-operatively and the resemblance, especially radiological, with GBC, which led to unnecessary extended surgical resection surgery.

Locally recurrent rectal cancer: oncological outcomes with different treatment strategies in two tertiary referral units.

The optimal treatment for patients with locally recurrent rectal cancer (LRRC) is controversial. The aim of this study was to investigate different treatment strategies in two leading tertiary referral hospitals in Europe. All patients who underwent curative surgery for LRRC between January 2003 and December 2017 in Catharina Hospital, Eindhoven, the Netherlands (CHE), or Karolinska University Hospital, Stockholm, Sweden (KAR), were studied retrospectively. Available MRIs were reviewed to obtain a uniform staging for optimal comparison of both cohorts. The main outcomes studied were overall survival (OS), local re-recurrence-free survival (LRFS), and metastasis-free survival (MFS). In total, 377 patients were included, of whom 126 and 251 patients came from KAR and CHE respectively. At 5 years, the LRFS rate was 62.3 per cent in KAR versus 42.3 per cent in CHE (P = 0.017), whereas OS and MFS were similar. A clear surgical resection margin (R0) was the strongest prognostic factor for survival, with a hazard ratio of 2.23 (95 per cent c.i. 1.74 to 2.86; P < 0.001), 3.96 (2.87 to 5.47; P < 0.001), and 2.00 (1.48 to 2.69; P < 0.001) for OS, LRFS, and MFS respectively. KAR performed more extensive operations, resulting in more R0 resections than in CHE (76.2 versus 61.4 per cent; P = 0.004), whereas CHE relied more on neoadjuvant treatment and intraoperative radiotherapy, to reduce the morbidity of multivisceral resections (P < 0.001). In radiotherapy-naive patients, neoadjuvant full-course chemoradiation confers the best oncological outcome. However, neoadjuvant therapy does not diminish the need for extended radical surgery to increase R0 resection rates.

Solitary Plasmacytoma of The Sternal Stalk: A Case Report and Literature Review

Background: It has been reported that sternal neoplasms are a rare disease, accounting for about 1% of primary bone neoplasms, of which about 60% are malignancy, mostly occurring in the manubrium sternum. Case presentation: We reviewed a 77-year-old man with a solitary plasmacytoma of the sternal stalk presenting with pain in the anterior chest wall by examining a preoperative diagnosis of sternal manubrium malignant bone tumor. We performed extensive sternal manubrium tumor resection + bilateral partial costal cartilage resection + bilateral clavicular head resection + cervical lymph node dissection + thoracic reconstruction, and the postoperative recovery was perfect. Conclusion: We report a rare case of solitary plasmacytoma of the manubrium sternum successfully treated by extensive radical surgery for the manubrium tumor. Although rare, the disease should be identified, examined, and treated early to avoid serious complications.

Surgical treatment of locally recurrent rectal cancer: a narrative review.

ObjectiveTo summarize the recent literature on surgical treatment of locally recurrent rectal cancer (LRRC).BackgroundLRRC is a heterogeneous disease that requires a multidisciplinary treatment approach. The treatment and prognosis depend on the site and type of recurrence. Radical resection remains the primary method for achieving long-term survival and improving symptom control. Preoperative chemoradiotherapy can reduce tumor volume and improve the R0 resection rate. Surgeons must clearly understand pelvic anatomy, develop a detailed preoperative plan, adopt a multidisciplinary approach for the surgical resection of the tumor as well as any invaded soft tissues, vessels, and bones, and ensure proper reconstruction. However, extended radical surgery often leads to a higher risk of postoperative complications and a low quality of life.MethodsWe searched English-language articles with keywords “locally recurrent rectal cancer”, “surgery” and “multidisciplinary team” in PubMed published between January 2000 to October 2020.ConclusionsLRRC is a complex problem. Long-term survival is not impossible following multidisciplinary treatment in appropriately selected LRRC patients. The management of LRRC relies on a specialist team that determines the biological behavior of the tumor and evaluates treatment options through multidisciplinary discussions, thereby balancing the surgical costs and benefits, alleviating postoperative complications, and improving patients’ quality of life.

Conservative surgical management of Juvenile Central Cemento- Ossifying Fibroma of anterior mandible. - Case report and literature review

Cemento-ossifying fibroma (COF) is a benign neoplasm that arises from the periodontal membrane which contains multipotential cells that are capable of forming cementum, lamellar bone and fibrous tissue. Juvenile cemento-ossifying fibroma is a type of fibro osseous lesion which contains cementoid tissue and developed in first two decades of life. Majority of the juvenile COF are aggressive in nature that necessitates extensive radical surgery to prevent the recurrence. This case report describes the conservative surgical management of juvenile cemento- ossifying fibroma in an 8 year old child with the preservation of permanent teeth and long term follow up. Key words: Anterior mandible, Cemento-ossifying fibroma , Fibro osseous lesion, Juvenile osseous neoplasm, Periodontoma

Laparoscopic surgery for oncologic extended resection of T1b and T2 incidental gallbladder carcinoma at a high-volume center: a single-center experience in China.

Surgical treatment is still the most effective treatment for gallbladder cancer. For the patients with stage T1b and above, the current guidelines recommend the extended radical operation, and oncologic extended resection can benefit the survival of the patients. The laparoscopic approach is still in the early phase, and its safety and oncological outcomes are not well known. To evaluate the technical feasibility and oncological outcomes of laparoscopic surgery for oncologic extended resection of early-stage incidental gallbladder carcinoma. This study included 18 male and 32 female patients. Twenty patients underwent laparoscopic oncologic extended resection and 30 patients underwent open oncologic extended resection. All of the patients had R0 resection. A laparoscopic approach was associated with less intraoperative blood loss (242 ± 108.5 vs 401 ± 130.3; p < 0.01) and shorter duration of postoperative hospital stay (6.2 ± 2.4 vs 8.6 ± 2.3; p < 0.01). There was no statistically significant difference between two groups for lymph nodes yield (5.4 ± 3.5 vs 5.8 ± 2.1; p > 0.05), incidence of lymphatic metastasis (15% vs 16.67%; p > 0.05), residual disease (20% vs 23.3%; p > 0.05), and postoperative morbidity (15% vs 20%; p > 0.05). During follow-up time of median 20.95 (12-29.5) months, no significant difference was found between the two groups for early tumor recurrence (10% vs 13.33%; p > 0.05) and disease-free survival (p > 0.05). Laparoscopic surgery may offer similar intraoperative, perioperative, and short-term oncological outcomes as an open oncologic extended resection for incidental gallbladder carcinoma.

Complications and 5-year survival after radical resections which include urological organs for locally advanced and recurrent pelvic malignancies: analysis of 646 consecutive cases.

Extensive multi-visceral resection, including components of the urinary tract, is often required to achieve clear resection margins, which is now well established as a key predictor of long-term survival for locally advanced pelvic tumours. The aims of this study were to analyse major morbidity and factors predicting complications and long-term outcomes following a urological procedure within extended radical resections. Data were collected from prospective databases at two high-volume institutions specialising in extended radical resections for locally advanced and recurrent pelvic malignancies between 1990 and 2015. The primary endpoints were general major complications (Clavien-Dindo ≥ 3) and factors influencing complications and overall survival after urological resection. A total of 646 consecutive patients requiring an extended radical resection for locally advanced or recurrent pelvic malignancies were identified. The median age was 63years (range 19-89years) and the majority were female (371; 57.4%). A urological resection was performed as part of the resection in 226 patients (35.0%). The overall 30-day major complication rate was significantly higher in the urological intervention group (23%; n = 52) compared to the non-urological group (12.9%; n = 54 patients; p = 0.001). Intestinal anastomotic leak (p = 0.001) and intra-abdominal collections (p = 0.001) were more common in the urological cohort. Ileal conduit formation was an independent predictor of major morbidity (OR 1.95; 95% CI 1.24-3.07; p = 0.004). Independent prognostic markers for poor 5-year survival following urological procedures were recurrent tumour, cardiovascular disease, previous thromboembolic event and postoperative pulmonary embolism. Extended radical resections which include a urological resection are associated with significantly more major morbidity than those without urological resection. Ileal conduit formation is independently associated with the development of major morbidity. Five-year overall survival is no different for patients who had or did not have urological resection as part of extended radical surgery for locally advanced or recurrent pelvic malignancy.

Злокачественные опухоли наружного и среднего уха

It is described the clinical case of a 38-year-old patient with concomitant psoriatic arthritis. He was directed to the Otolaryngology department of Ulyanovsk Regional Clinical Hospital with a diagnosis of Acute bilateral perforated purulent otitis media complicated by external one. Parotid left lymphadenitis. . In the medical history: the first treatment with complaints of pain in the left ear in March 2019, received treatment, there was a positive change. Return visit in October 2019. In connection with the deterioration of his condition, he was sent to the Ulyanovsk Regional Clinical Hospital. Upon admission, he complained of discharge from the left ear, aching pain in the ear, headache, the presence of a tumor-like formation in the lateral surface of the neck on the left, facial asymmetry, intense pain in the right ear, bloody discharge from the right ear canal, presence of formation at the entrance in the right ear canal, weakness, dry mouth. The results of computed tomography and X-ray studies of the mastoid processes according to Schuller showed signs of a destructive process in the region of the temporal, sphenoid bones, and the mastoid process on the left. An ultrasound of the soft tissues of the neck on the left revealed fluid formation and an altered lymph node in the submandibular region. The extended radical surgery on the left ear with mastoidotomy was done to the patient. It was performed lancing of the abscess of lymph nodes of the neck on the left. It was done a biopsy of various sections of the middle and outer ear on the left intraoperatively and the formation of the external ear canal on the right. According to the results of a histological examination it was revealed the growth of squamous cell carcinoma in the external ear canal and middle ear on the left, in the ear canal on the right. After a consultation at the Regional Clinical Oncology Center, the following diagnosis was made: “Cancer of the mucous membrane of the middle ear of the left in stage IV (T4N1M0). External ear cancer on the right in stage IV (T4N0M0). Type II diabetes mellitus. Psoriatic polyarthritis. It was recommended chemoradiation treatment. Thus, we observed a bilateral malignant process in the ear the first time over many years.

Salvage resection of advanced mediastinal tumors.

The surgical treatment of locally advanced mediastinal tumors invading the great vessels and other nearby structures still represent a tricky question, principally due to the technical complexity of the resective phase, the contingent need to carry out viable vascular reconstructions and, therefore, the proper management of pathophysiologic issues. Published large-number series providing oncologic outcomes of patients who have undergone extended radical surgery for invasive mediastinal masses are just a few. Furthermore, the wide variety of different histologies included in some of these studies, as well as the heterogeneity of chemo and radiation therapies employed, did not allow for the development of clear oncologic guidelines. Usually in the past, surgical resections of large masses along with the neighbouring structures were not offered to patients because of related morbidity and mortality and limited information available on the prognostic advantage for long term. However, in the last decades, advances in surgical technique and perioperative management, as well as increased oncologic experience in this field, have allowed radical exeresis in selected patients with invasive tumors requiring resections extended to the surrounding structures and complex vascular reconstructions. Such aggressive surgical treatment has been proposed in association or not with adjuvant chemo- or radiotherapy regimens, achieving encouraging oncologic results with limited morbidity and mortality in experienced institutions. Congestive heart failure or impending cardiovascular collapse due to the compression by the large mass are the most frequent immediately life-threatening problems that some of these patients can experience. In this setting, medical palliation is usually ineffective and an aggressive salvage surgical treatment may remain the only therapeutic option.

Sciatic and Femoral Nerve Resection During Extended Radical Surgery for Advanced Pelvic Tumours: Long-term Survival, Functional, and Quality-of-life Outcomes.

To report survival, functional, and quality-of-life (QoL) outcomes after extended radical resection for advanced pelvic tumors with en bloc sciatic or femoral nerve resection. Advanced pelvic tumors involving the sciatic or femoral nerve have traditionally been considered inoperable. Small studies have suggested acceptable functional outcomes can be achieved after pelvic exenteration with en bloc sciatic nerve resection. Consecutive patients who underwent extended radical pelvic surgery with en bloc resection of the sciatic or femoral nerves at a single center were included. Of 713 radical pelvic resections, 68 patients (9.5%) had en bloc sciatic or femoral nerve resection. Complete sciatic, partial sciatic, and complete femoral nerve resection was performed in 26 (38%), 38 (56%), and 4 patients (6%), respectively. Overall and major postoperative complication rates were 63% and 40%, respectively. R0 resection was achieved in 65% of patients, which translated to 55% and 76% overall and local recurrence-free 5-year survival in those with colorectal cancer. Twenty-two (96%) and 25 (92%) patients could mobilize independently after complete and partial sciatic nerve resection, respectively. Physical QoL was significantly lower at 6 months after surgery compared with baseline (P = 0.041), but returned to baseline at 12 months (P = 0.163). There was no difference in mental or overall QoL at 6 or 12 months compared with baseline. En bloc sciatic and femoral nerve resection can be performed during extended radical pelvic resections with morbidity and survival outcomes comparable with existing exenteration literature, including in patients with recurrent rectal cancer. Physical QoL may be impaired after surgery, but returns to baseline by 12 months.

Clinical Trials in Management of Anaplastic Thyroid Carcinoma; Progressions and Set Backs: A Systematic Review.

ContextAnaplastic thyroid carcinoma (ATC) is associated with rapid tumor growth and extremely poor prognosis. Although ATC is found in only 2% of all thyroid carcinomas, it accounts for up to 50% of thyroid cancer mortality.ObjectiveTo understand the effect of different treatment modalities upon anaplastic thyroid cancer outcomes.MethodsA systematic review of studies from 1995 to 2017 was performed employing the search terms “anaplastic thyroid” and “treatment” in PubMed. Studies comparing patients receiving any type of therapy for ATC and measuring either survival as primary outcome or the percentage of patient surviving more than 1 year as secondary outcome were included for review. We did not limit sample size or subject condition. A total of 40 articles were returned from our database search, of which 25 met the inclusion criteria.ResultsA review of the 25 published studies indicated that early multidisciplinary approaches using extensive radical surgery, in combination with adjuvant chemo-radiation using either docetaxel/pacitaxel or cisplatin, provided the best chance of disease control. Targeted multi-tyrosine kinases inhibitors helped to limit disease progression. Also, the finding of foci of differentiated thyroid cancer within the anaplastic tumor was associated with increased long-term survival.ConclusionsATC remains a fatal disease. Despite aggressive therapy the median survival has not significantly changed over the last 20 years. However, the percentage of patients surviving longer than 1 year continues to increase. Novel approaches incorporating multiple targeted therapy and immune therapies are critically needed.

Aggressive Surgical Management of Gallbladder Cancer: Long-Term Results From a Retrospective Study of 315 Chinese Patients

Objective To investigate the best surgical treatment for the gallbladder cancer patient. Summary of Background Data Until now, aggressive surgery for advanced gallbladder cancer has been controversial. In this study, we analyzed gallbladder cancer patients' data retrospectively to find out which is the best surgical treatment for the patient. Methods From 2009 to 2013, 315 cases of gallbladder carcinoma were identified. Data were analyzed retrospectively. The review included analysis of survival rate, postoperative complications, operative mortality rate, and correlation between local extent of the primary tumor and frequency of nodal metastases. Results Postoperative complications occurred in 15 patients (6.2%). A total of 3% of patients who underwent a radical surgery procedure had complications, but in the extended radical surgery group, it was 9.8%. Operative mortality rate was 4.94%. No lymph node metastases were found in patients with T1 tumors. Nodal involvement in patients with T3 (55.22%) and T4 (82.50%) tumors was significantly higher than that in patients with T2 tumors (44.12%). In patients with stages I and II cancers, the radical resection group had a better survival rate than the simple cholecystectomy group. In patients with stage III cancer, the extended radical surgery group and radical surgery group showed better survival rates than others. In patients with stage IV cancer, the extended radical surgery group showed a 4% survival rate at 2 years, but others group had a 0% survival rate. Conclusions Simple cholecystectomy may decrease the long survival rates in patients with stages I and II cancer. In more advanced stages, extended radical resection should be performed if R0 resections can be achieved.

Management of Anaplastic Thyroid Carcinoma: the Fruits from the ATC Research Consortium of Japan.

Anaplastic thyroid carcinoma (ATC) accounts for only 1 to 2% of all thyroid carcinomas, but it is one of the most lethal neoplasms in humans. To obtain further insights into this "orphan disease," we have established the ATC Research Consortium of Japan (ATCCJ) in 2009. It represents a multicenter registry for ATC that have been treated in Japan. To date, 67 institutions have taken part in the collaborative research system and over 1,200 cases have been accumulated in its database. Using this big data, several retrospective studies were carried out to evaluate 1) prognostic factors to determine initial treatment policy, 2) significance of extended radical surgery for Stage IVB cases, 3) characteristics of ATC incidentally found on pathological examination and 4) pathological features of ATC with long-term survival. Moreover, the ATCCJ has conducted an investigator-initiated, nationwide, prospective clinical trial since 2012; namely, the feasibility, safety and efficacy study of weekly paclitaxel administration for patients with ATC (UMIN: 000008574). Revised Japanese guidelines for treatment of thyroid tumors are going to adopt the recommendations from the results of this research. Since 2016, the ATCCJ has started the phase II study assessing the efficacy and safety of lenvatinib, a newly developed tyrosine kinase inhibitor for ATC (UMIN: 000020773). Our nationwide clinical trial network will strengthen the activity to recruit orphan disease patients and may discover new strategies to conquer this dismal malignancy in the near future.

Time to initiation or duration of S-1 adjuvant chemotherapy; which really impacts on survival in stage II and III gastric cancer?

Surgical resection with S-1 adjuvant chemotherapy (AC) is the standard of care for stage II-III gastric cancer (GC). However, it is unclear if time to initiation and duration of S-1 AC impact on survival. A multi-institutional GC database identified 498 patients who were treated with S-1 AC after D2 or more extended radical surgery for stage II-III gastric cancer. Patients were divided into four groups according to the interval between surgery and initiation of AC and the duration of AC as follows: group A (n=226), who received AC earlier (≤6weeks) and for longer (≥6months) after surgery; group B (n=160), who received AC later (>6weeks) and for longer after surgery; group C (n=46), who received AC earlier but for a shorter period (<6months) after surgery; and group D (n=66), who received AC later and for a shorter period after surgery. Prognostic factors for overall survival (OS) were investigated using multivariate analysis. The 5-year OS was 69.5%. Pathological stage II disease (hazard ratio (HR), 0.334; 95% confidence interval (CI), 0.215-0.499), with an OS of 85.8% versus 60.5% for stage III disease, as well as a longer duration (≥6months) of S-1 (HR, 0.498; 95% CI, 0.355-0.706), with an OS of 74.3% versus 53.0% for a shorter duration (<6months) of S-1, were identified as significant prognostic factors for long-term survival. Time to initiation was not associated with OS. A duration of S-1 AC of ≥6months, but not time to initiation within 6weeks, impacts on OS in stage II-III gastric cancer.

The method of surgical sanation of infralabyrinthine-apical cholesteatoma of the petrous part of the temporal bone

The relevance of the study is determined by the location of cholesteatoma in the petrous part of the temporal bone and its close contact with the vital structures of the temporal bone, which makes impossible the complete excision of cholesteatoma matrix without its damaging. The work presents a method of surgical sanitation of infralabyrinthine-apical cholesteatoma of the petrous part of the temporal bone in the patients with stage 4 of chronic sensorineural hearing loss and subject to the spread of cholesteatoma to the cochlea. The method includes postauricular approach, the extended radical operation with the removal of cells of the cellular path of the temporal bone down the formation, skeletonization of the facial nerve canal, removing the cochlea, hypotympanum sinuses and infralabyrinthine cellular path to the top of the petrous part of the temporal bone, sanitation of the trepanation cavity and closing of the tympanic part of auditory tube by the auto-cartilage and fascial flap. Intraoperative monitoring of the facial nerve is performed simultaneously with the facial nerve canal skeletonization, using needle electromyography with the drill until the occurrence of the threshold events at the current of 0.8 mA to 0.5 mA, and after the sanitation of the generated trepanation cavity plastic extension of the external ear canal is performed, while in the postoperative period trepanation cavity is managed open. The method reduces the risk of relapse. The results of the treatment were evaluated by means of otomicroscope examination, temporal bone MLSCT, the middle ear MRI. The article provides assessment of the results of treatment of 3 patients at the period of 6 months through 2 years.

FEATURES OF OTOGENIC INTRACRANIAL COMPLICATIONS AT THE PRESENT STAGE

A retrospective analysis of treatment was made in 127 adult patients with acute and chronic otitis media complicated by suppurative-inflammatory pathology of the brain. Purulent meningitis was revealed in 52 (40.9%) of hospitalized patients. Meningoencephalitis was often diagnosed in the cases of acute otitis media (15.4%) and in cases of chronic otitis (22.7%). The otogenic brain abscess was detected in 13.5% of otitis media cases and it was noted to be twice frequent (33.3%) in cases of purulent otitis media. The patients 124 (97.6%) have been operated. An extended mastoidotomy and antromastoidotomy were performed in the acute purulent otitis media. An extended radical operation on the ear was applied in case of chronic otitis media. Performance of craniotomy and complete removal of the abscess using modern systems of neuronavigation showed a higher clinical efficacy as compared with transtemporal approach during sanitizing intervention on the ear including the opening and abscess drainage in surgery of otogenic abscesses of the brain.

Management of Vulvar Cancer.

Vulvar cancer is an uncommon malignancy and accounts for around 5% of all gynecologic cancers. Incidence rates have increased for young adults and may be linked to increasing HPV prevalence. Treatment of vulvar cancer has evolved from 'en-bloc' surgery with high morbidity to more conservative approaches without compromising oncological safety. In recent years sentinel node evaluation has been advocated in early stage cancers to reduce complications of inguino-femoral lymphadenectomy. Minimising extent of radical excision for the vulvar growth and separate incisions for groin dissection have reduced the number of wound breakdowns, infection, lymphocoele and chronic lymphedema but complication rate is still as high as 60%. Incorporating sentinel node evaluation into clinical practice has brought down complications to less than 10% for both lymphedema and wound infection. Role of imaging is increasing in vulvar cancer, especially for locally advanced disease as a result of transition from exenterative and extensive surgery to use of neoadjuvant chemoradiation and a less moribund approach to management. Locally advanced vulvar cancer includes large primary tumors or locally advanced disease i.e. FIGO stages III and IV. Treatment decision here is still a challenge as there is no standard recommended treatment strategy. Neoadjuvant chemoradiation is an effective modality for locally advanced vulvar cancer, as it reduces tumor size and renders the lesion operable. Primary chemoradiation without post treatment surgery has been used as an alternative treatment to avoid extensive radical surgery and complex reconstructive procedures.

PWE-308 Pelvic exenteration for primary advanced and locally recurrent rectal cancer: outcomes and experience at a single institution

<h3>Introduction</h3> Pelvic exenteration is a potential curative treatment for primary advanced rectal cancer (PARC) and locally recurrent rectal cancer (LRRC). The aim of such extensive radical surgery is to achieve clear resection margins. <h3>Method</h3> A retrospective study was performed of pelvic exenteration procedures carried out between 2004 and 2014 in St Thomas’ Hospital for PARC and LRRC. Factors evaluated included age, sex, neo-adjuvant therapy, type of operation, intraoperative blood loss, resection margins, 30day morbidity and mortality and overall survival. <h3>Results</h3> Pelvic exenteration was performed in 71 patients. 51 patients were treated with neoadjuvant chemoradiation. Of the 71 patients, 52 had total, 6 had anterior and 13 had posterior pelvic exenteration; sacrectomy was performed in 4 patients. Thirty nine (39) patients (27males) with median age 61(29–80) years underwent pelvic exenteration for PARC and thirty two (32) patients (10 males) with median age 62(41–80) years had pelvic exenteration for LRRC. The median blood loss was 3700 ml (range 150015000) for PARC and 3750 ml (range 1500–15000) for LRRC. A complete resection (R0) was achieved in 67.6% of all patients; 74.4% for patients with PARC and 59.4% for patients with LRRC. Major complications (Clavien-Dindo, Grade III-IV) were 35.9% and 34.4% respectively. One patient died within 30 days. Overall survival was 32.5 months for PARC and 21.1 months for LRRC. <h3>Conclusion</h3> Pelvic exenteration is associated with considerable morbidity but low mortality and acceptable overall survival, in the absence of other effective treatment modalities. Careful preoperative assessment and a multidisciplinary approach make this extensive surgical technique safe and feasible in an experienced centre. <h3>Disclosure of interest</h3> None Declared.

MULTIDISCIPLINARY APPROACH IN THE TREATMENT OF PATIENTS WITH RECTAL CANCER

Surgical treatment is the "gold standard" in the treatment of patients with rectal cancer. The aim of surgical treatment is to minimize the rate of local recurrence, the occurrence of which depends largely on the quality of procedures. Relationship between the tumor and own fascia of the rectum is the cornerstone in the choice of treatment strategy. Even using modern surgical techniques, most tumors of the rectum below the peritoneum should be treated using preoperative radiotherapy. Preoperative radiation can reduce the incidence of local recurrence and to create conditions for increasing the number of sphincter-preserving operations. The degree of tumor regression after chemoradiation is directly correlated with survival and local recurrence. Tumor regression creates prerequisites for decrease of postoperative complications and mortality related to the implementation of extensive radical surgery in patients with a tumor of the rectum. The use of standardized systems for the assessment of tumor regression can provide valuable information for centers specializing in the treatment of patients with such pathology. MRI of the pelvic organs is a very effective tool in the initial evaluation of the degree local and regional spreading of colorectal cancer including relationship to the mesorectal fascia. Difficulties in predicting of complete pathologic regression of the tumor by MRI are associated primarily with the problem of differential diagnosis between tumor and post-radiation changes in the rectal wall and surrounding tissues. A multidisciplinary approach provides the accuracy of staging and facilitates the development of an optimal treatment strategy in patients with rectal cancer.

Thoughts of Families of Patients Undergoing Extended Radical Surgery for Cancer of the Head and Neck Followed by Reconstruction Using Free-Tissue Transfer

Thoughts of Families of Patients Undergoing Extended Radical Surgery for Cancer of the Head and Neck Followed by Reconstruction Using Free-Tissue Transfer