Klinika Chirurgii Onkologicznej

Klinika Chirurgii Onkologicznej

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PubMed | Klinika Chirurgii Onkologicznej, Klinika Onkologii and Zaklad Patologii Nowotworow
Type: Journal Article | Journal: Ginekologia polska | Year: 2014

Apocrine breast cancer is a rare type of neoplasm and accounts for approximately 0.3-4% of all breast cancers. It most frequently diagnosed in women over the age of 50.The purpose of the study was to present the clinical characteristics and treatment outcomes of 53 patients treated from apocrine breast cancer at the Oncology Center in Krakw between 1955 and 2002..Stage I or II carcinomas were found in 37 patients (69.8%) of the study group and 16 patients (30.2%) were classified as stage II. Node metastases were observed in 27 patients (50.9%). Surgery constituted the primary method of treatment and was used in all patients. Forty-nine patients underwent mastectomy and 4 underwent breast conserving surgery Post-operative radiotherapy was given to 16 patients. Chemotherapy and hormonal therapy were also used--in 20 and 26 cases, respectively.The follow-up period in the study group was maximum 207 months. The 10-year survival rates were as follows: 75.9% (overall survival) and 58.1% (disease-free survival). It was shown that positive lymph nodes highly affected symptoms-free free survival. During follow-up, 7 patients developed local recurrence, 16 patients developed distant metastases. Second primary malignancies were found in 5 patients.Our findings confirm good prognosis in patients treated for apocrine breast cancer similar to invasive ductal carcinoma.


Komorowski A.L.,Hospital Virgen del Camino | Komorowski A.L.,Hospital Juan Grande | Moran-Rodriguez J.,Hospital Juan Grande | Kazi R.,Royal Marsden Hospital | Wysocki W.M.,Klinika Chirurgii Onkologicznej
International Journal of Surgery | Year: 2012

Purpose: To evaluate the frequency and anatomic presentation of sliding inguinal hernias as well as to analyze the technical difficulties during surgery and recurrence rate. Methods: During 18 months we have recorded in a prospective manner data on all patients operated in one hospital for non-complicated inguinal hernia. All patients suspected of sliding variant have had their hernia sac opened and the sliding organ identified. All repairs were done using tension free technique. One year after discharge a telephone interview was performed with all patients to verify if they are free of recurrence. Results: 464 patients were electively operated on for inguinal hernia during the study period. Sliding variant was diagnosed in 16 patients (3,4%). The sliding organs were: sigmoid colon in 10 patients (62,5%), urinary bladder in 2 patients (12,5%), appendix in 2 cases (12,5%) and caecum in 2 cases (12,5%). The tension free repair according to Lichtenstein or Rutkow-Robbins technique was performed in all cases. No major surgical complication was recorded. During 18 months follow-up we have seen one recurrence 3 months postoperatively. Conclusions: The sliding inguinal hernia is a rare finding. The risk of injury of sliding organ is minimal. If tension free technique is used, the risk of recurrence is similar to that of patients with non-sliding inguinal hernia. © 2012 Surgical Associates Ltd.


Skorzewska M.,Klinika Chirurgii Onkologicznej | Stepak E.,Oddzial Chirurgii Ogolnej | Polkowski W.P.,Klinika Chirurgii Onkologicznej
Nowotwory | Year: 2011

Melanoma is considered to be one of the most malignant human neoplasms, characterized by a steadily increasing morbidity rate, which remains a challenge for modern oncology. Despite the significant progress in prevention, diagnosis and molecular biology, the practical use of this knowledge is still limited and surgery remains the main method of treatment. A particularly unfavorable clinical course is observed in patients with metastatic melanoma. Median survival in stage IV melanoma is 6-10 months, 2-year survival is less than 10%, and 5-year survival does not exceed 5%. Despite efforts aimed at developing new strategies which would improve survival, the results have not changed for more than two decades. This is related to the limited number of cytostatic drugs available for systemic melanoma treatment and the relative resistance of melanoma cells to most therapeutic agents. In clinical practice, the most widely used drug is dacarbazine, with the highest, but still unsatisfactory, response rate reaching some 20%. The lack of effective therapies calls for the exploration of different therapeutic paths, both medical and surgical. Some hopes of new modalities are associated with the theory of melanoma immunogenicity. Currently it is believed that immunomodulation may be the solution for effective treatment of melanoma and it should be noted that new drugs, scheduled to be registered by the FDA for the treatment of metastatic melanoma, are immune system stimulating agents. Although targeted therapies are still not a standard of treatment and their use is mainly limited to clinical trials, they appear to be the future of effective treatment of metastatic melanoma. In this review we present the current methods of treatment of metastatic melanoma.


Wichtowski M.,Oddzial Chirurgii Onkologicznej i Ogolnej i | Murawa D.,Oddzial Chirurgii Onkologicznej i Ogolnej i | Litwiniuk M.,Oddzial Chemioterapii | Kufel-Grabowska J.,Oddzial Chemioterapii | And 2 more authors.
Nowotwory | Year: 2016

Introduction. Electrochemotherapy (ECT) is an ablation method based on a reversible electroporation combination with concurrent chemotherapy (intravenous administration or directly into the tumour). This method has been used in the treatment of primary skin tumours (carcinomas, melanomas) and secondary malignancies (e.g. breast cancer metastases) which were unfit or unresponsive to a different type of treatment. It is a palliative method aimed at improving the quality of life. Material and methods. Between February and May 2015 seven patients with metastatic breast cancer to the skin and subcutaneous tissue, and one patient with recurrent melanoma in the skin after groin lymphadenectomy, underwent the ECT procedure. Results. For the patients treated by ECT, there were a total of 10 procedures for 50 target lesions. Seven patients underwent one course, one patient received three courses because of extension of the lesions. In 87.5% of the lesions good local effect as a complete or partial remission was observed. Patients remain under close observation and control. Conclusions. The results show that ECT is an effective and safe therapeutic option for the treatment of unresectable skin malignances, especially in the case of prior use of other available methods of cancer treatment. © Polskie Towarzystwo Onkologiczne.


Imko-Walczuk B.,Oddzial Dermatologii Pomorskie Centrum Traumatologii | Ankudowicz A.,Oddzial Dermatologii Pomorskie Centrum Traumatologii | Jaskiewicz J.,Klinika Chirurgii Onkologicznej | Lizakowski S.,Klinika Nefrologii | And 2 more authors.
Przeglad Dermatologiczny | Year: 2011

Cancer is one of the main causes of death after successful organ transplantation. The constantly rising number of patients living with transplanted organs, but at the same time higher morbidity rate, aggressive, rapid development of malignant tumours and unfavourable prognosis, require a special oncological approach in this population. In the group of patients with transplanted organs, skin cancers are the most common malignancies and present an atypical clinical picture different than in the group of immunocompetent patients. In the discussed population skin cancers - squamous cell carcinoma as well as basal cell carcinoma - are the most common types of tumours. Kaposi's sarcoma, melanoma, lymphoma, anogenital cancer, Merkel cell cancer and other rare tumours may occur more often in patients receiving immunosuppressive therapy. It is essential to become familiar with the features and clinical distinctness of these malignancies in patients with transplanted organs, in order to recognize them in the very early stage of neoplastic process.


Wysocki W.M.,Klinika Chirurgii Onkologicznej | Burzynski T.,Oddzial Chirurgii Ogolnej i Onkologicznej | Mitus J.,Klinika Chirurgii Onkologicznej
Nowotwory | Year: 2011

Aim: To determine the influence of selected clinical factors on drainage volume after radical mastectomy for breast cancer in the first postoperative day (DO) and first three postoperative (TPD) days. Material and method: Prospective analysis of 318 patients (315 females i 3 males; mean age 61.2 years) operated on for breast cancer (Madden radical mastectomy). Operative technique was similar in all cases. The diabetes was present in 7,9% participants, preoperative chemotherapy was used in 14.8%, INR >1,1 in 35.5%, intraoperative frozen section was performed in 9.7% patients, dissection was performed with scalpel in 36.2% patients (in the remaining group electrocautery was used), in 79.4% compressive dressing was applied to the surgical site. Results: In DO drainage volume was significantly higher in patients operated on with scalpel dissecting technique compared to electrocautery (184.5 vs. 160.6 ml, p=0.017). In DO no significant influence of the following factors on the drainage volume was observed: age; body mass index (BMI); ASA classification; diabetes; preoperative chemotherapy; intraoperative frozen section; compressive dressing on the surgical site; INR >1.1. In TPD drainage volume was significantly higher in patients operated on with scalpel dissecting technique compared to electrocautery (606.7 vs. 543.8 ml, p=0.009); higher BMI (<20, 20-24.99, 25-29.99 and ≥30 kg/m2: 477.7 vs. 491.3 vs. 570.3 vs. 634.0 ml, p<0.00001) and higher ASA classification (I vs. II vs. III grade: 502.3 vs. 584,4 vs. 580.3 ml; p=0.005). In TPD no significant influence of the following factors on the drainage volume was observed: age; diabetes; preoperative chemotherapy; intraoperative frozen section; compressive dressing on the surgical site; INR >1,1. Higher drainage volume in TPD was significantly associated with breast volume (cup of bra size: A vs. B. vs. C vs D vs DD, E and EE, respectively: 438,8 vs. 554,0 vs. 560,8 vs. 615,7 vs. 622,5 ml, p=0.035), larger perimeter measured under the bust (p<0.0001) and longer surgery duration (p<0.0001; every 30 minutes longer duration increased daily drainage output by mean 24 ml. Conclusions: Significantly higher drainage volume in DO and TPD after radical mastectomy was associated with dissection using scalpel compared with electrocautery. Moreover higher drainage volume in TPD was associated with: higher BMI, higher ASA classification, greater breast volume, larger perimeter measured under the bust and longer surgery duration.


Herman Prof. K.,Klinika Chirurgii Onkologicznej | Sliwczynski A.,Medical University of Lódz | Wysocki W.M.,Klinika Chirurgii Onkologicznej
Nowotwory | Year: 2014

Introduction: The National Health Fund Patients' Therapy Registry was analysed with special focus on the treat- ment outcomes, therapy options and costs. Patients and methods. 43,738 patients were diagnosed (for the first time) with breast cancer in Poland in 2005-2007. Outcomes. The overall relative 5-years survival was 79.8% (range 75.3%-82.4% in voivodeships). Chemotherapy was given to 69.4% of patients (range 59.3%-87.6% in voivodeships). Differences between voivodeships with reference to irradiation rate was almost double (range 32.4%-63.0%). Differences between voivodeships with reference to the ratio of surgically treated patients (reflecting differences in the disease stage at the diagnosis) and differences in the rate of sentinel node procedure (reflecting quality of surgery in the area) were significantly related to the treatment outcomes. There were significant differences in the treatment costs between voivodeships (from 20,000 to 41,000 PLN) which were not significantly related to the survival rate. Conclusions: There has been a significant improvement in treatment outcomes in Poland for breast cancer patients. Large differences in outcomes, therapy options and costs between voivodeships may reflect lack of adherence to therapy guidelines and suboptimal reimbursement of treatment costs. © Polskie Towarzystwo Onkologiczne.


Recent development in the surgical technique, reduced invasiveness and extensiveness of surgery, improvement in the safety of surgery was not accompanied by significant progress of preoperative psychological care. Still many cancer patients complain on unsatisfactory communication with health care professionals and suboptimal information. The aim of the study was to analyze sources of knowledge on the disease and treatment and to assess the efficacy of physician-patient communication. Additional aim of the study was to evaluate the willingness to use breast prosthesis and to undergo breast reconstruction etc. The study population consisted of 58 consecutive women admitted for mastectomy for breast cancer. Nurses and female doctors were excluded, as well as patients treated for other malignancies in the past. Main source of knowledge about disease and surgery among participants was the cancer surgeon (ca. 75%). It needs to be underlined that family doctors were only marginally pointed out as sources of oncological information (< 10%). On the other hand significant proportion of participants pointed out mass media as the source of information (ca. 40%). On the day before surgery most of the participants (95%) correctly described surgery ("removal of breast and armpit lymph nodes"). Significantly less women correctly listed all major treatment option for breast cancer (surgery, chemotherapy, radiotherapy, hormonal therapy). It was observed, that most the patients (87%) declared will to use breast prosthesis. Additionally it was noted, that most of participants (68%) was not planning to undergo breast reconstruction.


Introduction: The overall risk of ipsilateral breast tumour recurrence (IBRT) following breast conserving therapy (BCT) ranges from 2% to 35%. Total mastectomy is uniformly recommend for IBRT following BCT. However evidence released recently suggests that there may be a change in clinical practice in the near future. Material and methods: The Pubmed database for 1990-2013 was searched and we included articles on IBRT for early breast cancer patients after breast conserving therapy. Only selected articles, published in English or German, were reviewed. Results: The risk of IBRT after BCT in the last three decades gradually decreased from 10-15% to a few percent. Local excision of IBRT is not associated with higher risk of second local recurrence, when compared to "salvage" total mastectomy (7-32% vs 4-32%). Local excision of IBRT with re-irradiation brings promising results. In recent studies the risk of a second IBRT in re-excised and re-irradiated cases ranged from 0% to 3% and is this not worse when compared to the currently reported risk of first IBRT following breast conservation. Conclusions: This review shows that clinical practice is to perform (apart from widely recommended total mastectomy) also local excision of IBRT following BCT. In recent years re-irradiation is more commonly used. The risk of second IBRT does not seem to be higher than the local recurrence risk following "salvage" total mastectomy. Local excision of IBRT appears to be particularly promising in small, late and hormonal receptors showing positive IBRT. Treatment for IBRT needs to be verified in properly designed prospective comparative studies.


PubMed | Klinika Chirurgii Onkologicznej
Type: Journal Article | Journal: Przeglad lekarski | Year: 2011

Recent development in the surgical technique, reduced invasiveness and extensiveness of surgery, improvement in the safety of surgery was not accompanied by significant progress of preoperative psychological care. Still many cancer patients complain on unsatisfactory communication with health care professionals and suboptimal information. The aim of the study was to analyze sources of knowledge on the disease and treatment and to assess the efficacy of physician-patient communication. Additional aim of the study was to evaluate the willingness to use breast prosthesis and to undergo breast reconstruction etc. The study population consisted of 58 consecutive women admitted for mastectomy for breast cancer. Nurses and female doctors were excluded, as well as patients treated for other malignancies in the past. Main source of knowledge about disease and surgery among participants was the cancer surgeon (ca. 75%). It needs to be underlined that family doctors were only marginally pointed out as sources of oncological information (< 10%). On the other hand significant proportion of participants pointed out mass media as the source of information (ca. 40%). On the day before surgery most of the participants (95%) correctly described surgery (removal of breast and armpit lymph nodes). Significantly less women correctly listed all major treatment option for breast cancer (surgery, chemotherapy, radiotherapy, hormonal therapy). It was observed, that most the patients (87%) declared will to use breast prosthesis. Additionally it was noted, that most of participants (68%) was not planning to undergo breast reconstruction.

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