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BackgroundSubtotal gastrectomy with Billroth II reconstruction (SGB2) results in increased gastric pH and diminished gastric barrier. Increased gastric pH following PPI therapy has an impact on the gut microbiome, intestinal inflammation, and possibly patient health. If similar changes are present after SGB2, these can be relevant for patient health and long-term outcomes after surgery. The aim of the study is to investigate whether SGB2 is associated with specific changes in gut microbiome composition and intestinal inflammation.Patients and MethodsThis cross-sectional proof-of-concept study includes patients after SGB2 (n = 14) for early gastric cancer and their nongastrectomized in-house relatives as controls (n = 8). Fecal microbiome composition, intestinal inflammation (fecal calprotectin), gut permeability (DAO, LBP, sCD14), systemic inflammation (CRP) markers, and gastrointestinal symptoms are investigated. This study is registered at ClinicalTrials.gov (NCT03418428).ResultsMicrobiome oralization following SGB2 was defined by an increase inEscherichia–Shigella,Enterococcus,Streptococcus, and other typical oral cavity bacteria (Veillonella,Oribacterium, andMogibacterium) abundance. The fecal calprotectin was increased in the SGB2 group [100.9 (52.1; 292) vs. 25.8 (17; 66.5);p = 0.014], and calprotectin levels positively correlated with the abundance ofStreptococcus(rs = 0.639;padj = 0.023). Gastrointestinal symptoms in SGB2 patients were associated with distinct taxonomic changes of the gut microbiome.ConclusionsSGB2 is associated with oralization of the gut microbiome; intestinal inflammation and microbiome changes were associated with gastrointestinal symptoms. These novel findings may open gut microbiome as a new target for therapy to improve quality of life and general patient health in long-term survivors after SGB2.

Background. Usually adjuvant chemotherapy is started within 12 weeks of surgery, but the evidence on the commencing time is lacking. Our aim was to investigate the association of initiating post-surgery treatment within six weeks vs. six to ten weeks vs. more than ten weeks with survival. Methods. We analysed the association of treatment and its timing with survival among patients who were diagnosed and underwent surgery for stage II or III colon cancer from 2012 to 2013 at the National Cancer Institute, Lithuania. Results. Of the 86 patients, 78% were still alive on December 31, 2013. Patients who received chemotherapy within six weeks after surgery were more likely to survive. However, those who received chemotherapy 6–10 weeks after surgery had better survival (p – 0.014, hazard ratio 0.80, 95% CI 0.60–0.99) than those who began chemotherapy treatment more than ten weeks after surgery (p – 0.173 hazard ratio 0.55, 95% CI 0.12–0.99) Conclusions. The results from this study show that optimal timing of adjuvant chemotherapy for patients with resected colon cancer within six weeks and associated with better survival.

Endoscopic submucosal dissection (ESD) is a standard treatment option for early gastric cancer (EGC) in Asia; however, data about ESD efficacy in Western populations are limited. Furthermore, outcomes of EGC treatment after ESD or surgery have not been compared in Western cohorts. This study aimed to compare short-term and long-term results of ESD and surgery for EGC. This retrospective case–control study included patients with EGC treated in two largest cancer centers in Eastern Lithuania between 2005 and 2016. Propensity score nearest-neighbor 1:1 matching, based on clinicopathologic characteristics, was performed between patients who underwent ESD and surgery. The primary endpoint of the study was 5-year disease-free survival (DFS). Of 260 eligible patients, 42 (16.1%) underwent ESD. After matching, two well-balanced groups consisting of 42 patients in each were analyzed. The operation time (83 vs. 151 min., p = 0.001) and postoperative hospitalization stay (5.4 vs. 13.4 days, p = 0.001) was significantly shorter in the ESD group. 5-year DFS rate was significantly higher in the surgery group (97.6% vs. 77.5%, p = 0.002). However, this difference was reduced after exclusion of non-curative ESD cases (97.6% vs. 89.7%, p = 0.099). There was no significant difference in 5-year OS rate between the study groups (73.8% vs. 69.0%, p = 0.599). ESD might be an excellent alternative to surgery for EGC if curative resection is achieved. Non-curative ESD is associated with poor DFS and high rate of recurrence. Additional surgery should be recommended after non-curative ESD whenever treatment-associated risk is acceptable.

The aim of this study was to assess quality of life and bowel function in patients undergoing early vs. standard ileostomy closure. We retrospectively assessed patients from our previous randomized controlled trial. Patients with a temporary ileostomy who underwent rectal cancer surgery and did not have anastomotic leakage or other. Early closure (EC, 30 days after creation) and standard closure (SC, 90 days after creation) of ileostomy were compared. Thirty-six months (17–97) after stoma closure, we contacted patients by phone and filled in two questionnaires— The European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Core 30 (EORTC QLQ-C30) and low anterior resection syndrome (LARS) score. This index trial was not powered to assess the difference in bowel function between the two groups. All the patients in the SC group had anastomosis &lt, 6 cm from the anal verge compared to 42 of 43 (97.7%) in the EC group. There were no statistically significant differences between EC (26 patients) and SC (25 patients) groups in the EORTC QLQ-C30 and LARS questionnaires. Global quality of life was 37.2 (0–91.7, ±24.9) in the EC group vs. 34.3 (0–100, ±16.2) in the SC (p = 0.630). Low anterior resection syndrome was present in 46% of patients in the EC and 56% in the SC group (p = 0.858). Major LARS was found more often in younger patients. However, no statistical significance was found (p = 0.364). The same was found with quality of life (p = 0.219). Age, gender, ileostomy closure timing, neoadjuvant treatment, complications had no effect of worse bowel function or quality of life. There was no difference in quality of life or bowel function in the late postoperative period after the early vs. late closure of ileostomy based on two questionnaires and small sample size. None of our assessed risk factors had a negative effect on bowel function o quality of life.

The pandemic spread of the COVID-19 virus significantly affected daily life, but the highest pressure was piled on the health care system. Our aim was to evaluate an impact of COVID-19 pandemic management measures on cancer services at the National Cancer Institute (NCI) of Lithuania. We assessed the time period from 1 February 2020 to 31 December 2020 and compared it to the same period of 2019. Data for our analysis were extracted from the NCI Hospital Information System (HIS) and the National Health Insurance Fund (NHIF). Contingency table analysis and ANOVA were performed. The COVID-19 pandemic negatively affected the cancer services provided by NCI. Reductions in diagnostic radiology (−16%) and endoscopy (−29%) procedures were accompanied by a decreased number of patients with ongoing medical (−30%), radiation (−6%) or surgical (−10%) treatment. The changes in the number of newly diagnosed cancer patients were dependent on tumor type and disease stage, showing a rise in advanced disease at diagnosis already during the early period of the first lockdown. The extent of out-patient consultations (−14%) and disease follow-up visits (−16%) was also affected by the pandemic, and only referrals to psychological/psychiatric counselling were increased. Additionally, the COVID-19 pandemic had an impact on the structure of cancer services by fostering the application of modified systemic anticancer therapy or hypofractionated radiotherapy. The most dramatic drop occurred in the number of patients participating in cancer prevention programs, the loss was 25% for colon cancer and 62% for breast cancer screening. Marked restriction in access to preventive cancer screening and overall reduction of the whole spectrum of cancer services may negatively affect cancer survival measures in the nearest future.

Altered expression of miRNAs in tumor tissue encourages the translation of this specific molecular pattern into clinical practice. However, the establishment of a selective biomarker signature for many tumor types remains an inextricable challenge. For this purpose, a preclinical experimental design, which could maintain a fast and sensitive discovery of potential biomarkers, is in demand. The present study suggests that the approach of 3D cell cultures as a preclinical cancer model that is characterized to mimic a natural tumor environment maintained in solid tumors could successfully be employed for the biomarker discovery and validation. Subsequently, in this study, we investigated an environment-dependent miRNA expression changes in colorectal adenocarcinoma DLD1 and HT29 cell lines using next-generation sequencing (NGS) technology. We detected a subset of 16 miRNAs differentially expressed in both cell lines cultivated in multicellular spheroids compared to expression levels in cells grown in 2D. Furthermore, results of in silico miRNA target analysis showed that miRNAs, which were differentially expressed in both cell lines grown in MCS, are involved in the regulation of molecular mechanisms implicated in cell adhesion, cell-ECM interaction, and gap junction pathways. In addition, integrins and platelet-derived growth factor receptors were determined to be the most significant target genes of deregulated miRNAs, which was concordant with the environment-dependent gene expression changes validated by RT-qPCR. Our results revealed that 3D microenvironment-dependent deregulation of miRNA expression in CRC cells potentially triggers essential molecular mechanisms predominantly including the regulation of cell adhesion, cell&ndash, cell, and cell&ndash, ECM interactions important in CRC initiation and development. Finally, we demonstrated increased levels of selected miR-142-5p in rectum tumor tissue samples after neoadjuvant long course treatment compared to miR-142-5p expression levels in tumor biopsy samples collected before the therapy. Remarkably, the elevation of miR-142-5p expression remained in tumor samples compared to adjacent normal rectum tissue as well. Therefore, the current study provides valuable insights into the molecular miRNA machinery of CRC and proposes a potential miRNA signature for the assessment of CRC in further clinical research.

Introduction: Anastomotic leakage (AL) remains one of the most threatening complications in colorectal surgery with the incidence of up to 20%. The aim of the study is to evaluate the safety and feasibility of novel – trimodal intraoperative colorectal anastomosis testing technique. Methods and analysis: This multi-center prospective cohort pilot study will include patients undergoing colorectal anastomosis formation below 15 cm from the anal verge. Trimodal anastomosis testing will include testing for blood supply by ICG fluorescence trans-abdominally and trans-anally, testing of mechanical integrity of anastomosis by air-leak and methylene blue leak tests and testing for tension. The primary outcome of the study will be AL rate at day 60. The secondary outcomes will include: the frequency of changed location of bowel resection; ileostomy rate; the rate of intraoperative AL; time, taken to perform trimodal anastomosis testing; postoperative morbidity and mortality; quality of life. Discussion: Trimodal testing of colorectal anastomosis may be a novel and comprehensive way to investigate colorectal anastomosis and to reveal insufficient blood supply and integrity defects intraoperatively. Thus, prevention of these two most common causes of AL may lead to decreased rate of leakage. Study registration: Clinicaltrials.gov (https://clinicaltrials.gov/): NCT03958500, May, 2019.

BackgroundEwing’s sarcoma usually presents in paediatric patients with its primary location being bone tissue. Nevertheless, we present such an adult case which arises from the small intestine. We registered thirty one cases of such origin published so far excluding ours.Case presentationWe report a case of 30 year old female who was admitted due to the persistent anaemia. Whole body computed tomography scan revealed abdominal mass in her left upper abdominal compartment. Surgery on the mass originating from jejunum was performed, although due to extremely complicated postoperative period and rapid dissemination no additional therapy had been performed. The tumour was positive for CD99, ERG, CD56, Synaptophysin, PanCK, Cam5.2.ConclusionExtraosseus Ewing’s sarcoma is extremely rare entity, with poor prognosis.

Background The proportion of early gastric cancer stages is increasing, as is the incidence of gastric cancer among the elderly population. Therefore, this study was designed to analyze surgical treatment outcomes of T1-T2 gastric cancer in elderly patients. Methods A total of 457 patients with T1-T2 gastric cancer who underwent gastrectomy between 2005 and 2015 were enrolled in this retrospective study. Patients were classified into two groups according to age (

Įvadas Nors kolonoskopinių gaubtinės žarnos perforacijų dažnis nėra didelis, tačiau jos gali lemti sunkias komplikacijas ar net mirtį. Šios studijos tikslas buvo įvertinti kolonoskopinių gaubtinės žarnos perforacijų dažnį ir jų chirurginio gydymo rezultatus.Metodai Retrospektyviai buvo peržiūrėti duomenys pacientų, kuriems atliekant diagnostinę ar gydomąją kolonoskopiją Nacionalinia­me vėžio institute nuo 2007 m. sausio 1 d. iki 2016 m. gruodžio 31 d. įvyko gaubtinės žarnos perforacijos. Analizuoti pacientų demografiniai rodikliai, kolonoskopijos duomenys, informacija apie jų gydymą ir gydymo rezultatus.Rezultatai Iš viso Nacionaliniame vėžio institute minėtu laikotarpiu buvo atlikta 16 186 kolonoskopijos. Bendras kolonoskopinių gaubti­nės žarnos perforacijų dažnis siekė 0,14 % (23 iš 16 186 pacientų). Iš šių 23 perforacijų 20 atvejų buvo taikytas chirurginis gy­dymas. Daugiausiai perforacijų įvyko riestinėje žarnoje (12 atvejų). 11 atvejų defektas žarnoje buvo užsiūtas, 6 atvejais atlikta žarnos rezekcija su pirmine anastomoze. Viena mirtis įvyko dėl ūmios bronchopneumonijos išsivysčius dauginiam organų dis­funkcijos sindromui, kiti du pacientai, kuriems pasireiškė pilvo ertmės sepsis, mirė nuo kardiopulmoninio nepakankamumo.Išvados Jeigu kolonoskopinės gaubtinės žarnos perforacijos atvejais pavyktų išvengti operacijos ir ją lydinčių sunkių komplikacijų, tai leistų reikšmingai sumažinti kolonoskopijos komplikacijos padarinius. Visus pacientus prieš procedūrą būtina įspėti apie galimas komplikacijas, o gydytojai turi būti itin atidūs, jei pacientas priklauso didelės rizikos grupei.

To assess outcomes of surgical management for iatrogenic colonic perforations and risk factors of worse outcome.We reviewed the medical records of patients with colonic perforations during colonoscopies 2007 - 2016 at the National Cancer Institute. We collected patient demographic data, colonoscopic reports, perforations treatment and outcome.Perforation rate was 0.14% (23 of 16 186). Twenty were managed surgically. The most common location of perforation was the sigmoid colon in 12 cases (60%). The most used surgical technique was simple suture (11 cases - 55%), followed by resection with anastomosis (6 - 30%), and Hartman's procedure in 3 cases (15%). Postoperative morbidity and mortality rates were 45% and 15% - three patients died. No significant relationship between time to surgery (p=0.285), American Society of Anaesthesiologists (ASA) score (p=0.642) or patient age (p=0.964) and postoperative complication were found.Patients need to be informed of the complications of colonoscopy. We could not determine strong risk factors for worse outcomes.

Background Here we present the first cases of prostate cancer solitary metastasis to anal canal. Case presentation A 67-year-old male patient underwent radical prostatectomy with ilio-obturator lymphonodectomy in 2016 due to poorly differentiated ductal adenocarcinoma (Gleason 4 + 5(40%) = 9) pT3bN0. Two months later increasing PSA rate was noted and the patient started adjuvant intermittent androgen deprivation therapy combined with radiotherapy. Year after patient was admitted to the hospital complaining of dyschezia, pain in anal canal, and bloody stool. Digital rectal examination revealed an anal fissure with ulceration. A biopsy from ulcerated area showed poorly differentiated ductal adenocarcinoma of the prostate. Because there was no evidence of distant metastases on abdominal computed tomography (CT) scan and pelvic magnetic nuclear resonance imaging (MRI) and the only metastasis was in anal canal patient underwent laparoscopic abdominoperineal resection (APR). Postoperative course was uneventful and patient was discharged at postoperative day 7. Conclusions Our presented case is the first to describe prostate cancer solitary metastasis to anal canal and we always have to be aware of possible rare disease while assessing the patient with rectal bleeding. Biopsy most of the time is the only and the most reliable test to differentiate between the diseases.

Background and objectives A significant proportion of patients undergoing rectal cancer surgery receive a temporary ileostomy because of its benefits in case of anastomotic dehiscence. However, the best timing for closure remains unclear. Methods Early closure (EC; 30 days after creation) and standard closure (SC; 90 days after creation) of ileostomy were compared in a single-center randomized controlled trial conducted at National Cancer Institute (Vilnius, Lithuania). Patients with a temporary ileostomy who underwent rectal cancer surgery and did not have anastomotic leakage or other serious complications were randomized to early or standard ileostomy closure groups. Thirty days postoperative morbidity following ileostomy closure was the primary outcome of the study. Results The trial was prematurely terminated due to the safety reason after 86 patients were randomized to EC (43 patients) and SC (43 patients) groups. The overall 30 days postoperative morbidity rate was dramatically higher in the EC group (27.9% vs 7.9%; P = 0.024). Moreover, severe complications (Clavien-Dindo ≥3) were present only after EC of ileostomy in five (11.6%) patients. Conculsion Early closure of ileostomy at 30 days after radical rectal resection is not safe and should not be performed.

Key words: renal cell carcinoma, metastases to pancreas, metastases. Metastases of renal cell carcinoma to the pancreas are very rare and uncommon. Routine image follow – up play very important role in early detection of pancreatic metastases from renal cell carcinoma. We report the case of 75 years old man with Renal cell carcinoma metastasis to pancreas 13 years after nephrectomy. Successful surgical treatment, with pylorus-saving pancreatoduodenal resection and small bowel resection, was applied. We can state the fact, that long – term survival can be the result of surgical metastasectomy of pancreatic metastases from renal cell carcinoma.

Purpose – The purpose of this paper is to outline the Bill & Melinda Gates Foundation’s Global Libraries (GLs) initiative approach to advocacy and how it informs, guides, and integrates impact data to support sustainability of GL program results. Design/methodology/approach – The paper defines advocacy in the context of GL, and explores the GL grant planning process, tools, and collaboration between advocacy and impact specialists. Results are demonstrated through grantee examples that illustrate a variety of approaches to library advocacy using impact data at local, country, and regional levels. Findings – The paper demonstrates the importance of identifying community needs, designing impact measures to demonstrate how libraries help to address those needs, and the variety of ways impact evidence can be used to effectively advocacy for public libraries. This basic formula can be applied to advocacy efforts ranging from a broad national policy to a small incremental change in perceptions of libraries by local decision makers. Originality/value – This paper reinforces the essential link between library impact measurement data and successful advocacy.

BACKGROUND: Although the general postoperative mortality rate after gastrectomy is decreasing worldwide, it still varies in individual centers and regions of the world. The objective of our work was to analyze the postoperative mortality rate at the Institute of Oncology, Vilnius University over a period of 10 years. METHODS: All patients who underwent total and subtotal gastrectomy for gastric cancer between 2003-2012 were retrospectively analyzed. Comprehensive evaluation of postoperative mortality was done according to the age, sex, comorbidities, BMI, tumor stage, extent or resection and lymphadenectomy, splenectomy, neoadjuvant chemotherapy and stage of disease. The causes of death were also analyzed. RESULTS: The analysis of postoperative mortality for patients treated for gastric cancer in the period of 2003-2012 revealed that 1676 surgeries were performed with 54 lethal outcomes (3.22%). Complication rate was 20.58%. 1011 subtotal gastrectomies were performed with 24 lethal cases (2.37%). 30 patients died after 665 total gastrectomies (4.51%). The vast majority of deceased patients were older than 60 years (92.6%) and had advanced gastric cancer--stage III and IV (70.4%). 33 of 54 patients died from non-surgical complications (61.1%). Surgical complications accounted for 35.2% of dead patients, which totals 19 of 54 patients. Progression of cancer and cachexia caused the deaths of 3.7% of patients. CONCLUSIONS: Elderly age, comorbidities, advanced stage of tumor and disease, and more radical surgery are related with higher postoperative mortality. The most common cause of death was pulmonary arterial thromboembolism. Therefore, risk assessment of venous thrombosis and thromboembolism prophylaxis should be an important component of gastric cancer surgical treatment.

Lynch syndrome or hereditary nonpolyposis colorectal cancer is the most common of hereditary colorectal cancer and accounts for 1-3%. Lynch and Chapelle estimated that it accounts 5-8% for all colorectal cancers. It is an autosomal dominant syndrome characterized by predisposition of various cancers (colorectal, stomach, endometrial, ovarian, renal, small bowel, and hepatobiliary tract) at earlier age than in general population and occurs as a result of mutation in DNA mismatch repair genes. This article presents a rare clinical of a 61-year-old female diagnosed with extracolonic Lynch syndrome with six metachronous tumours acquiring in digestive tract during the period from 1993 to 2014 (over 21 years). No other cases of six primary malignancies in patient with Lynch syndrome have been reported in literature. Upon diagnosis of Lynch syndrome, it is important to screen patient for malignancies of different localization as this syndrome predisposes appearance of various cancers at earlier age than in general population.

Purpose:The available data concerning reduced glutathione (GSH) and glutathione S-transferase (GST) levels in colorectal cancer patients during the treatment process are contradictory and insufficient.Methods:Forty patients with metastatic colorectal cancer receiving FOLFOX4 chemotherapy with or without bevacizumab and 40 healthy volunteers were included in the study. Blood samples were taken before treatment, after 2 months and at the end of treatment in the patient group and once in the healthy volunteer group. The levels of GSH and GST in blood serum were evaluated by enzyme-linked immunosorbent assay (ELISA) according to the manufacturer’s instructions.Results:The serum level of GSH was significantly lower in colorectal cancer patients before treatment than in healthy volunteers (37.84 ± 19.39 μg/mL and 52.78 ± 19.39 μg/mL, respectively; pConclusions:GSH and GST levels change significantly during the treatment process and these changes depend on the response to treatment, treatment type, and site of metastases. Further analysis of the changes in GSH and GST levels during treatment would allow the assessment of the predictive potential of this molecular marker.

Background: Cancer of the left colon with obstruction (CLCO) is a serious disease. Many surgeons perform one-stage resection with the on-table wash-out of the colon. However, there is uncertainty c

Background. The outcomes after different low rectal resection types applied for rectal cancer treatment are still uncertain. The aim of the investigation was to evaluate long-term functional results, the rate of complications and post-operative lethality after rectum low resection operations (connection with J-pouch group: coloplasty – group 2 and “straight” anastomosis – group 3). Patients and methods. In 2003, a randomized study was started and completed on December 2007. The study included 82 patients (38 females and 44 males). The patients were randomized into three groups. They were suffering from cancer stage I–III. Results. There were no postoperative deaths after 82 resections with total mesorectal excision (TME) and low connection. The overall rate of postoperative complications was 28%, and the rate of anastomosis suture leakage was 11%. The rate of postoperative complications was 20.7% (6 patients) in group 1, 28.6% (6 patients) in group 2, 34.3% (11 patients) in group 3. The rate of complications was substantially higher in groups 2 and 3; however, this difference was statistically not significant (p = 0.2636). The functional results after 3, 6, 9, 12 and 24 months showed no statistical difference among the groups; moreover functional results after 24 months in all groups were similar (p = 0.046). Anastomosis with or without pouch does not influence postoperative lethality. The incidence of complications and suture leakage is higher in cases of straight anastomosis; however, this finding is not statistically significant. Necrosis was observed only in patients for whom anastomosis with pouches were performed. Conclusion. Comparison of functional results after 3, 6, 9, 12 and 24 months showed no statistically significant differences among the groups.The necrosis of pulled-down bowel was observed only in the pouch groups. Keywords: rectal cancer, anastomosis, J-pouch, coloplasty, functional results

Arnoldas Krasauskas 1 , Renatas Askinis 1 , Saulius Cicėnas 1,2 , Tamara Tyrina 1 , Ramūnas Ambrozaitis 1 , Eugenijus Stratilatovas 1 1 Vilniaus universiteto Onkologijos institutas, Santariskių g. 1, LT-08660 Vilnius El pastas: torakalinis@gmail.com 2 Vilniaus universiteto Medicinos fakulteto Reabilitacijos, sporto medicinos ir slaugos institutas Įvadas: Po rezekcinių operacijų stemplės ir skrandžio ar stemplės ir žarnos jungties nesandarumas yra grėsmingiausia komplikacija, pasireiskianti iki 27 % operuotų ligonių. Ji gali būti mirtina iki 9 % tokių ligonių dėl infekcijos ir negalėjimo valgyti. Nuo 2005 m. fistulei panaikinti pradėjome į jungties spindį implantuoti issipleciancius silikonu dengtus stentus. Darbo tikslas – įvertinti, ar sis būdas tinka pooperacinių fistulių sukeltoms komplikacijoms gydyti. Ligoniai ir metodai: Vilniaus universiteto Onkologijos institute nuo 2005 iki 2009 metų buvo atlikta 417 stemplės ir skrandžio rezekcinių operacijų dėl onkologinių ligų. Po skrandžio pasalinimo operacijų atsirado 2,87 % fistulių, po stemplės operacijų – 21,65 % fistulių. Per sį laikotarpį 15 ligonių buvo implantuota 21 stentas dėl pooperacinių jungties fistulių: 4 (26,67 %) ligoniams – po Akyama operacijų, 7 (46,67 %) – po Lewis operacijų ir 4 (26,7 %) – po gastrektomijos. Spindis buvo protezuojamas maždaug po 17 dienų nustacius fistule (nuo 3 iki 60 dienų). Buvo naudojami issipleciantys silikonu dengti plastikinio ar nitinolinio karkaso stentai. Dviem (13,3 %) ligoniams stentai keisti po 1 kartą ir dviem (13,3 %) – po 2 kartus. Rezultatai: Mircių po sių procedūrų nebuvo. Tiriant rentgenu 6 (40 %) ligoniams po stento implantavimo kontrastinio skyscio tekėjimo pro fistule nematyta, 4 (26,67 %) – gautas dalinis efektas, o 1 (6,67 %) – tik sumažėjes geriamojo kontrastinio skyscio kiekio pratekėjimas fistule. Vidutiniskai po 5 dienų (3–14 dienų) 3 (20 %) ligoniams stentai pasalinti dėl nestabilios jų padėties ir 1 (6,7 %) ligonei – dėl nestabilios stento padėties sukelto kraujavimo is jungties krastų. Dviem (13,3 %) ligoniams stentai pasisalino savaime, 1 (6,7 %) ligonei stentas pasalintas laparotomijos būdu, nes buvo įstriges terminalinėje klubinės žarnos srityje. Vienas (6,67 %) ligonis atvyko tik po vienerių metų dėl sutrikusio (IV°) rijimo, sukelto randinio susiaurėjimo. Jam stentas pasalintas laparotomijos būdu, suformuota nauja stemplės ir plonosios žarnos jungtis. Sesiems (40 %) ligoniams stentai pasalinti nelikus jungties nesandarumo vidutiniskai po 47 parų (29–127 dienų) endoskopinės procedūros metu. Isvados: Stemplės ir skrandžio ar stemplės ir žarnos jungties protezavimas implantuojant į spindį issipleciancius silikonu dengtus stentus yra saugus ir efektyvus būdas fistulių okliuzijai bei jų sukeltoms komplikacijoms gydyti. Vienuolikai (73,3 %) is 15 ligonių būklė pagerėjo dėl greiciau isnykusios infekcijos. Sesi (54,5 %) is 11 ligonių galėjo valgyti jau kitą dieną po procedūros. Dviem (13,3 %) ligoniams įdėjus stentą įvyko komplikacijų. Po 6 mėn. ir vėliau 4 (26,67 %) geros būklės ligoniams reikėjo chirurginės intervencijos galutinei fistulių sukeltų komplikacijų korekcijai. Pagrindiniai žodžiai: pooperacinė fistulė, stentavimas, savaime issipleciantis stentas. Treatment of postoperative esophagogastrostomy/esophagoenterostomy leaks by using self-expanding stents Arnoldas Krasauskas 1 , Renatas Askinis 1 , Saulius Cicėnas 1,2 , Tamara Tyrina 1 , Ramūnas Ambrozaitis 1 , Eugenijus Stratilatovas 1 1 Institute of Oncology, Vilnius University, Santariskių str., 1, LT-08660 Vilnius, Lithuania E-mail: torakalinis@gmail.com 2 Vilnius University, Faculty of Medicine, Institute of Rehabilitation, Sport Medicine and Nursing Background: Esophagogastrostomy/esophagoenterostomy leak is a major complication after esophagectomy or gastrectomy and could causes an up to 9 % postopertive mortality. Since 2005, we use self-expanding stents for the occlusion of anastomotic leaks. The objective is to analyse the usefulness of this method for the treatment of anastomotic fistulas. Patients and methods: From 2005 to 2009, 417 esophageal resections and gastrectomies for oncology patiens were made. After gastectomies, there were 2.87% and after oesophageal resection 21.65 % of anastomotic leaks. Twenty-one silicon-covered self-expanding stents were placed for 15 patients: for 4 patients (26.67 %) after Akyama type operations, 7 (46.67 %) after Lewis type operations and 4 (26.67 %) after gastrectomies. For 4 (26.67 %) patients, leaks were complicated with neck fistulas, 2 (13.3 %) with peritonitis, 8 (53.3%) with empyema and tracheoesophageal fistula. The median interval between detecting the fistula and stenting were 17 days (range, 3–60 days). We used silicon-covered plastic or nitinol armed self-expanding stents. For 2 (13.3 %) patients we replaced stents once and for 2 (13.3 %) twice. Results: Postinterventional esophagogram demonstrated full coverage of the leak in 6 (40 %) patients, and 1 (6.67 %) showed only a lower volume flow of the swallowed contrast. In 4 (26.67 %) patients, in the horizontal posistion we observed retrogradic contrast effusion. In 4 (26.67 %) patients, stents were removed on average after 5 days (range 3–14 days) of instability and for 1 (6.7 %) after a volatile situation caused by bleeding from the edges of the fistula. Two (13.3 %) stents moved down to gut, 1 (6.7 %) need laparotomy because it was stuck in the ileum terminale. One (6.67 %) patient came after 1 year with IV° dysphagia. We performed laparotomy to remove the stent and a new anastomosis to treat stenosis. Six (40 %) stents were removed during endoscopic procedures without residual leaks on average after 47 days (range 29–127 days). Conclusions: Silicon-covered self-expanding stent is an effective method of occluding postoperative esophagogastrostomy/esophagoenterostomy leaks. In 11 (73.3 %) of 15 patients, the condition improved because of accelerated healing of infectious complications. 6 (54.5 %) of 11 patients could begin eating next day after the procedure. There were only 2 (13.3 %) stent implantation-related complications. After 6 months and later in good condition 4 (26.67 %) patients had a surgical intervention for the final correction of fistulas-caused complications. Key words: esophagogastrostomy leaks, esophagoenterostomy leaks, self-expanding stents.

OBJECTIVE. To determine the effect of surgical treatment and red blood cell transfusion on the parameters of antioxidative and immune systems in patients with early and advanced stage colorectal cancer. MATERIAL AND METHODS. A total of 65 patients with colorectal cancer were included in the study. Three blood serum samples of each patient were tested comparing presurgical and postsurgical periods of 7 and 14 days. Malondialdehyde and total glutathione levels, activity of catalase and glutathione S-transferase were determined spectrophotometrically. The concentration of cytokines TGF-beta1 and TNF-alpha were determined by ELISA. RESULTS. Malondialdehyde and glutathione levels decreased in surgically treated patients with cancer of both stages while catalase activity decreased in patients with stage III cancer. Cytokine levels did not change after surgery. A decrease in malondialdehyde concentration was observed in the transfused patients with early stage cancer comparing postsurgical periods. Catalase activity was increased after surgery in patients with early stage cancer but was decreased during postsurgical periods in patients with advanced stage cancer. Cytokine levels increased at postsurgical periods in transfused patients with stage III cancer. Correlation between catalase activity and TNF-alpha level and between glutathione S-transferase activity and TGF-beta1 level was determined postsurgically in transfused patients with early stage cancer. CONCLUSIONS. Postsurgical period affected antioxidative system of patients with cancer of both stages while level of cytokines showed no differences. Transfusion determined distinct dynamics of antioxidative parameters due to cancer stage. Elevated cytokine levels in transfused patients with advanced stage cancer showed that the status of immune system was exacerbated. Antioxidative and immune systems were depressed in these patients. Correlation between antioxidative system parameters and cytokines in transfused patients of early stage cancer showed a relationship between two protective systems of the organism against malignant process.

Objective. To determine the effect of surgical treatment and red blood cell transfusion on the parameters of antioxidative and immune systems in patients with early and advanced stage colorectal cancer. Material and methods. A total of 65 patients with colorectal cancer were included in the study. Three blood serum samples of each patient were tested comparing presurgical and postsurgical periods of 7 and 14 days. Malondialdehyde and total glutathione levels, activity of catalase and glutathione S-transferase were determined spectrophotometrically. The concentration of cytokines TGF-beta1 and TNF-alpha were determined by ELISA. Results. Malondialdehyde and glutathione levels decreased in surgically treated patients with cancer of both stages while catalase activity decreased in patients with stage III cancer. Cytokine levels did not change after surgery. A decrease in malondialdehyde concentration was observed in the transfused patients with early stage cancer comparing postsurgical periods. Catalase activity was increased after surgery in patients with early stage cancer but was decreased during postsurgical periods in patients with advanced stage cancer. Cytokine levels increased at postsurgical periods in transfused patients with stage III cancer. Correlation between catalase activity and TNF-alpha level and between glutathione S-transferase activity and TGF-beta1 level was determined postsurgically in transfused patients with early stage cancer. Conclusions. Postsurgical period affected antioxidative system of patients with cancer of both stages while level of cytokines showed no differences. Transfusion determined distinct dynamics of antioxidative parameters due to cancer stage. Elevated cytokine levels in transfused patients with advanced stage cancer showed that the status of immune system was exacerbated. Antioxidative and immune systems were depressed in these patients. Correlation between antioxidative system parameters and cytokines in transfused patients of early stage cancer showed a relationship between two protective systems of the organism against malignant process.

The aim of this study was to evaluate the influence of cellular immunity parameters on overall survival of colorectal and gastric cancer patients after surgery. The parameters of cellular immunity (CD3+, CD4+, CD8+, CD20+, and CD16+) were determined by immunofluorescence method. Cox regression analysis showed no impact of the estimated preoperative and postoperative parameters of cellular immunity on overall survival of colorectal cancer patients and similarly of gastric cancer patients in stage II. However, the analysis showed that the survival of colorectal and gastric cancer patients in stage III depended on immunological parameters determined before surgery: CD3+ (P=0.007 and P=0.007, respectively), CD4+ (P=0.021 and P=0.011, respectively), and CD8+ (P=0.047 and P=0.007) counts. Only the survival of colorectal cancer patients depended on natural killer cell number (P=0.009). Kaplan-Meier analysis showed that patients with stage III colorectal and gastric cancer had better survival rates when absolute number of CD3+ lymphocytes, determined before surgery, was greater than 0.8 x 10(9)/L, CD4+--greater than 0.25 x 10(9)/L, CD8+--greater than 0.3 x 10(9)/L. Colorectal cancer patient survived longer when the number of natural killer cells CD16+ was more than 0.25 x 10(9)/L. This study suggests that higher levels of the absolute number of lymphocyte subsets before surgery have a beneficial effect on overall survival of gastric and colorectal cancer patients in stage III.

Stomach cancer is the second common cause of death in Lithuania and most countries of the world. Nevertheless, there were no reports of epidemiological studies on stomach cancer in Lithuania. Therefore, a hospital-based case-control study has been carried out in order to assess the associations between vegetables and fruits and risk of stomach cancer.Hospital-based case-control study included 379 cases with newly histologically confirmed diagnose of stomach cancer and 1137 controls that were free of cancer and stomach diseases. Cases and controls were matched by gender and age (+/-5 yr). Information on demographic variables, family history on cancer, life-style habits, such as diet, smoking, alcohol consumption, and physical activity was collected by a questionnaire. Conditional logistic regression was used to compute the odds ratio (OR) and their 95% confidence intervals (CI).After adjustment for other food items (vegetables, fruits, different types of meat, processed meat and fish, dairy and starchy products, coffee, green tea), that were related to outcome, smoking, alcohol use, family history on cancer, education level and residence, stomach cancer risk was inversely associated with consumption of raw vegetables such as cabbage (OR=0.24; 95% CI=0.10-0.57;or =1-3 times/month vs. almost never), carrots (OR=0.42, 95% CI=0.20-0.86; 1-6 times/week vs. almost never) and garlic (OR=0.59, 95% CI=0.37-0.96; 1-6 times/week vs. almost never). Protective effect has been observed for intake of broccoli (OR=0.52, 95% CI=0.28-0.98; 1-4 times/week vs.or =1-3 times/month). There were no statistically significant associations between stomach cancer risk and consumption of citrus or others fruits. In conclusion, higher consumption of raw vegetables such as cabbage, carrots, garlic as well as broccoli may decrease a risk of stomach cancer, whereas intake of citrus fruits has no relation with a reduced risk of the disease.

Surgical resection is indicated in potentially malignant pancreatic cystic neoplasms. Drainage operations are performed in large (5-6 cm) and/or symptomatic pseudocysts. Misdiagnosis results in a considerable delay in an appropriate treatment. Our aims were to compare clinical, morphological, biochemical features of cystic neoplasms and pseudocysts, in which diagnosis of cystic neoplasm was suspected preoperatively, and to determine characteristics, which could predict the misdiagnosis of cystic neoplasms as "pseudocysts".One hundred and thirty four patients were operated because of pancreatis cystic lesions (22 cystic neoplasms and 112 pseudocysts) between January 1999 and May 2004. Two groups of patients were evaluated retrospectively. Group I included 22 (10 serous and 8 mucinous cystoadenomas, 3 mucinous cystadenocarcinomas, 1 solid papillary tumor) resected neoplasms. Group II included 11 patients in whom neoplasm was suspected during investigation, but definitive diagnosis of pseudocyst was established. Clinical manifestation, morphologic characteristics and data of instrumental investigations were also compared. Preoperative and postoperative diagnoses were compared with histopathological findings.Women predominated in group I (67.2%) and men in group II (81.2%). Group I patients were older (mean age 57.9+/-14.55 versus 49.27+/-10.07 years). All pseudocysts were symptomatic. Two (9.1%) incidental cystic neoplasms and 2 drainage operations were performed previously because of misdiagnosed "pseudocysts" in other hospitals. Abdominal pain, 81.8% and 100%, and abdominal mass, 31.8% and 54.4%, were recorded most frequently, group I and group II respectively. Neoplasms (median diameter 59.6 mm) were mainly located in pancreatic head (31.8%) and body (36.4%). Most of pseudocysts (median diameter 71.1 mm) were located in pancreatic head (45.5%). Diagnostic sensitivity of ultrasonography (86.4%) and computed tomography scan (84.2%) was higher in group I than in group II (63.6% and 77.8%). Two serous oligocystic and 1 mucinous cystoadenomas were misdiagnosed as "pseudocyst" preoperatively. In one case malignancy of mucinous tumor diagnosed only postoperatively.Differentiating serous and mucinous cystoadenomas from pseudocysts may be difficult. Malignant neoplasms may be undetermined preoperatively. Resection should always be performed in instances where findings cannot be clearly identified.

Objective was to evaluate prognostic factors influencing the postoperative mortality after esophagectomy.The results of surgical treatment of 106 patients suffering from esophageal cancer were analyzed retrospectively. The presurgical risk factors in the surviving patients (group I, n=94) and in those patients, who died within the postoperative period (group II, n=12), were compared. The following indicators were analyzed: patients' age, body mass index, preoperative loss of body mass, tumor location, type and duration of operation, amount of blood transfused, ECG changes, changes in the lungs visible on chest X-ray, and spirometry indices. We examined the volume of forced expiration within the first second (FEV1), forced expiratory vital capacity (FVC), peak expiratory flow (PEF), Gaensler index (FEV1/FVC), Tiffeneu index (FEV1/VC) and amount of PaCO(2)in arterial blood.Postoperative mortality was 11.3%. The following statistically reliable differences in the indices of group I and group II patients were established: FEV1 (82.3% and 65.4%), Gaensler index (75.2% and 68.5%), PaCO(2)(37.4 mmHg ir 42 mmHg), radiographic changes in the lings (13.6%l and 61.2%), loss of body mass within the preoperative period (11.2% and 18.3%), lower albumin values (39.9 g/l and 30.5 g/l) and tumor localization within the upper third of the esophagus (22% and 68.8%). The leak of anastomosis - 11.8% and 82.8%.The postoperative mortality after esophagectomy mostly depends on the status of pulmonary function during the postoperative period, inadequate nutrition during the preoperative period and tumor localization in the upper third of the esophagus. Main complications after esophagectomy are pulmonary insufficiency and leak of anastomosis.

Objective of work was to evaluate efficacy of surgery for esophageal cancer with one-step gastric pipe reconstruction, to analyze postoperative complications, causes of deaths and patient's life expectancy. In 1992-2002 in Clinic of Surgery Vilnius University Institute of Oncology 213 patients underwent surgery for esophageal cancer; 177 patients (83.0%) were applied transthoracic approach, 34 patients (15.9%) transhiatal and 2 patients (0.9%) Lewis type operations. TNM of patients were T3N1M0 - 99 (46.4%), T2N1M0 - 17 (7.9%), T2N0M0 - 16 (7.5%), T4N2M0 - 54 (25.3%), T2-3N2M1 - 27 (12.6%). Patient performance status according to WHO scale was 0-2. The following postoperative complications were observed: vagus pneumonia - 52 (24.2%) patients, heart insufficiency- 13 patients (6.1%), aortal bleeding 3 (1.4%) patients, suture leakadge - 33 (15.4%) patients, injury of n. reccurentis 17 (7.9%) patients, pleurites 29 (13.6%). Postoperative mortality after transthoracic approach - 29.3%, transhiatal - 15%, Lewis resections - 0%. Median survival after transthoracic approach - 29 months, transhiatal - 34 months, Lewis resections - 39 months.Surgery for esophageal cancer is the most sufficient way of esophageal cancer treatment. Three-level lymphadenectomies postpone early relapses. Postoperative mortality varies from 15 to 29.3%, median survival from 29 to 39 months.

To view combined anesthesia benefits versus general anesthesia and to compare postoperative epidural analgesia and patient-controlled analgesia with intravenous morphine.Twenty four patients scheduled for elective thoracoabdominal esophagectomy were randomized to T (n=12) and K (n=12) groups. Group T patients received epidural analgesia with 0.125 percent bupivocaine and morphine after combined general-epidural anesthesia and group K patients received intravenous patient-controlled analgesia with morphine after general anesthesia. The patients were monitored for operation and extubation time, for postoperative pain and length of intensive care unite (ICU) stay.T group patients received 79 percents less narcotics than K group. At rest there were no differences in pain relief between the groups. Pain scores at mobilization showed a significantly lower value in the T group. Patients in T group were tracheally extubated earlier (mean 210 minutes vs 380 min.) after admission to the ICU and discharged from the ICU earlier (mean 2.3 vs 4.3 days).Combined anesthesia and epidural analgesia improve overall outcome, provide better postoperative pain relief, shorten the intubation time and intensive care stay in patients undergoing esophageal resection operations.

Background. The outcomes after different low rectal resection types applied for rectal cancer treatment are still uncertain. The aim of the investigation was to evaluate long-term functional results, the rate of complications and post-operative lethality after rectum low resection operations (connection with J-pouch group: coloplasty – group 2 and “straight” anastomosis – group 3).Patients and methods. In 2003, a randomized study was started and completed on December 2007. The study included 82 patients (38 females and 44 males). The patients were randomized into three groups. They were suffering from cancer stage I–III.Results. There were no postoperative deaths after 82 resections with total me-sorectal excision (TME) and low connection. The overall rate of postoperative compli-cations was 28%, and the rate of anastomosis suture leakage was 11%. The rate of post-operative complications was 20.7% (6 patients) in group 1, 28.6% (6 patients) in group 2, 34.3% (11 patients) in group 3. The rate of complications was substantially higher in groups 2 and 3; however, this difference was statistically not significant (p = 0.2636). The functional results after 3, 6, 9, 12 and 24 months showed no statistical difference among the groups; moreover functional results after 24months in all groups were similar (p = 0.046). Anastomosis with or without pouch does not influence postoperative le-thality. The incidence of complications and suture leakage is higher in cases of straight anastomosis; however, this finding is not statistically significant. Necrosis was observed only in patients for whom anastomosis with pouches was performed.Conclusion. Comparison of functional results after 3, 6, 9, 12 and 24months sho -wed no statistically significant differences among the groups.The necrosis of pulled-down bowel was observed only in the pouch groups.Key words: rectal cancer, anastomosis, J-pouch, coloplasty, functional results