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Introduction Type II and III (paraoesophageal and mixed) hiatal hernia treatment remains a technically difficult procedure carrying a risk of complications and recurrence as high as 40%. Using synthetic meshes entails possible serious complications; efficacy of biologic materials remains unclear and requires further research. Aim The aim of the article was to present the centre’s experience of type II and III large hiatal hernia treatment using the ligamentum teres and to draw attention to potential benefits of conducted procedures. Material and Methods The study enrolled 6 patients: 3 women and 3 men aged 37-58 with radiologically and endoscopically confirmed large paraoesophageal hernias. The patients underwent Nissen fundoplication and hiatal hernia repair using the ligamentum teres. The patients were followed up for six months with subsequent radiological and endoscopic assessment. Results During the six-month follow-up no clinical or radiological characteristics of hiatal hernia recurrence were observed in the patients. Two patients reported symptoms of dysphagia; mortality was 0%. Conclusions Hiatal hernia repair using the vascularized ligamentum teres may constitute an effective and safe method of large hiatal hernia repair.

Epstein-Barr virus (EBV) is a common virus worldwide that is an etiologic agent in the development of many diseases, including cancer. Recent reports have shown the association of EBV with tumorigenesis in head and neck squamous cell carcinoma (HNSCC). Moreover, EBV has been reported to be present in tonsillar tissues, which suggests a close relationship between viral infections and tonsillar diseases, including chronic tonsillitis. The aim of the study was to analyze the prevalence of EBV DNA in 86 patients with HNSCC, in 70 patients with chronic tonsillitis, and in 144 healthy individuals (control group) and the associations between EBV infection and clinicopathological and demographic characteristics and the use of stimulants in all study groups. The objective of this study was also to analyze the prevalence of coinfection with human papillomavirus (HPV). After prior DNA isolation, EBV detection was performed using an EBV kit by real-time polymerase chain reaction. The prevalence of EBV infection in patients with HNSCC, patients with chronic tonsillitis, and the control group was 47.7%, 60%, and 24.3%, respectively. Compared to controls, a significantly higher prevalence of EBV in patients with chronic tonsillitis and HNSCC may suggest that EBV is a potential risk factor. No association was found between EBV infection and demographic or clinical data. Further studies are warranted due to inconclusive reports that were mainly related to geographic distribution, sample type, and detection technique. Considering the prevalence of the virus and the risk of serious diseases, attention should be paid to screening diagnosis and prevention of the infection.

Colorectal neuroendocrine neoplasm (CRNEN), especially rectal tumours, are diagnosed with increased frequency due to the widespread use of colonoscopy, including screening examinations. It is important to constantly update and promote the principles of optimal diagnostics and treatment of these neoplasms. Based on the latest literature and arrangements made at the working meeting of the Polish Network of Neuroendocrine Tumours (June 2021), this paper includes updated and supplemented data and guidelines for the management of CRNEN originally published in Endokrynologia Polska 2017; 68: 250-260.

Updated Polish recommendations for the management of patients with neuroendocrine neoplasms (NENs) of the small intestine (SINENs) and of the appendix (ANENs) are presented here. The small intestine, and especially the ileum, is one of the most common locations for these neoplasms. Most of them are well-differentiated and slow-growing tumours; uncommonly - neuroendocrine carcinomas. Their symptoms may be untypical and their diagnosis may be delayed or accidental. Najczęściej pierwszą manifestacją ANEN jest jego ostre zapalenie. Typical symptoms of carcinoid syndrome occur in approximately 20-30% of SINENs patients with distant metastases. In laboratory diagnostics the assessment of 5-hydroxyindoleacetic acid concentration is helpful in the diagnosis of carcinoid syndrome. The most commonly used imaging methods are ultrasound examination, computed tomography, magnetic resonance imaging, colonoscopy and somatostatin receptor imaging. Histopathological examination is crucial for the proper diagnosis and treatment of patients with SINENs and ANENs. The treatment of choice is a surgical procedure, either radical or palliative. Long-acting somatostatin analogues (SSAs) are essential in the medical treatment of functional and non-functional SINENs. In patients with SINENs, at the stage dissemination with progression during SSAs treatment, with high expression of somatostatin receptors, radioisotope therapy should be considered first followed by targeted therapies - everolimus. After the exhaustion of the above available therapies, chemotherapy may be considered in selected cases. Recommendations for patient monitoring are also presented.

After another meeting of experts of the Polish Network of Neuroendocrine Tumours, updated recommendations for the management of patients with gastric and duodenal neuroendocrine neoplasms, including gastrinoma, have been issued. As before, the epidemiology, pathogenesis and clinical symptoms of these neoplasms have been discussed, as well as the principles of diagnostic procedures, including biochemical and histopathological diagnostics and tumour localisation, highlighting the changes introduced in the recommendations. Updated principles of therapeutic management have also been presented, including endoscopic and surgical treatment, and the options of pharmacological and radioisotope treatment. The importance of monitoring patients with gastric and duodenal NENs, including gastrinoma, has also been emphasised.

In this paper, we present the current guidelines for the diagnostics and management of pancreatic neuroendocrine neoplasms (PanNENs) developed by Polish experts providing care for these patients in everyday clinical practice. In oncological diagnostics, in addition to biochemical tests, molecular identification with the use of NETest liquid biopsy and circulating microRNAs is gaining importance. Both anatomical and functional examinations (including new radiopharmaceuticals) are used in imaging diagnostics. Histopathological diagnosis along with immunohistochemical examination still constitute the basis for therapeutic decisions. Whenever possible, surgical procedure is the treatment of choice. Pharmacological management including biotherapy, radioisotope therapy, targeted molecular therapy and chemotherapy are important methods of systemic therapy. Treatment of PanNENs requires a multidisciplinary team of specialists in the field of neuroendocrine neoplasms.

Neuroendocrine neoplasms (NENs) constitute about 2% of all malignant neoplasms, and the angiogenesis process in these tumors is still of a great interest. Vasohibin-1 (VASH-1) is an angiogenesis inhibitor, while vascular endothelial growth factor A (VEGF-A) is one of the main factors promoting vascular formation. The subject of this study was to assess serum concentration of these factors in patients with diagnosed NEN and in control group. Methods. The study group consisted of 120 patients with diagnosed NENs, while the control group consisted of 69 healthy volunteers. The concentrations of VASH-1 and VEGF-A in serum were tested using the ELISA. We also analyzed the association of the concentration of these factors with demographic data (e.g., age and gender), body mass index (BMI), primary tumor location, histological grade, metastasis, clinical staging, selected biochemical parameters and markers of NENs, and information on smoking habits. Results. The mean concentration of VASH-1 was 218.8 ± 359.8 pg/ml in the study group and 973.1 ± 1239.4 pg/ml in the control group, that difference was statistically significant ( p < 0.05 ). In the NEN group, the highest concentration of VASH-1 was in patients with pancreatic NENs in relation to NENs with different location of the primary tumor ( p < 0.05 ). Negative correlation was found between the concentration of VASH-1 and serotonin ( r S = − 0.19 , p < 0.05 ). No statistically significant differences were observed for VEGF-A ( p = 0.658 ). Conclusions. Patients with NENs showed lower serum level of VASH-1 in comparison to healthy volunteers. The highest level of VASH-1 was observed in tumors localized in pancreas. This might reflect the relevant function of VASH-1 in NENs and requires further evaluation to further knowledge of angiogenesis in NENs. Furthermore, the serum concentration of VEGF-A showed no statistical differences and probably does not have diagnostic value in this group of patients.

The Hedgehog signaling pathway (Hh) probably plays a role in development and progression of pancreatic ductal adenocarcinoma (PDAC).In our study, 114 patients (83 with PDAC and 31 with chronic pancreatitis [CP]) after pancreatic surgery were enrolled. The immunoexpression of Sonic hedgehog (Shh), Smoothened (Smo), and Glioblastoma transcription factor 1 (Gli1) and Ki-67 were detected in tissue specimens.Mean (standard deviation) immunoexpression of all Hh pathway molecules was significantly higher in PDAC than in CP patients: Shh, 2.24 (0.57) versus 1.17 (0.25) (P0.01); Smo, 2.62 (0.34) versus 1.21 (0.23) (P0.01); and Gli1, 1.74 (0.74) versus 1.15 (0.72) (P0.01). Patients with a lower expression level (z score0) of Shh and Ki-67 have longer overall survival when compared with z score0 (15.97 vs 8.53 months [P = 0.0087] and 15.20 vs 5.53 months [P = 0.0004], respectively). In addition, Shh sensitivity in PDAC detection was 84.3%; specificity, 93.5%; positive predictive value, 97.2%; and negative predictive value, 69%.Our results suggest the prognostic role of the Hh pathway in PDAC and a role in the differential diagnosis with CP.

Introduction: Surgery remains the mainstay of treatment for liver tumors. Significant differences in complication rates between liver surgery centers have been reported ranging from 4.1% up to 47.7%. There have been little papers or studies on the impact of bile infection on postoperative complications in patients undergoing surgery for liver cancer. Aim: The aim of our study was to assess the etiology of bile infections in patients following liver resection and to evaluate its impact on complications and perioperative mortality. Materials and methods: The studied material consisted of 69 patients undergoing surgery for liver tumors at the Department of General and Transplant Surgery of the Medical University of Lodz between 2011 and 2013, when the intraoperative bile cultures were available. Results: The intraoperative bile cultures were positive for bacteria in 12 cases (18.75%), while in other cases the bile was sterile (n = 52). In 41.61% of cases, a methicillin-resistant strain was identified. Two patients presented with jaundice, associated with abdominal pain in one patient; other patients complained of abdominal pain only (jaundice: 16.67%; abdominal pain: 91.67%). In both cases, jaundice was not accompanied by any other typical symptoms of cholangitis; also, palliative surgery was performed in both cases. In patients with confirmed bile infection, jaundice was significantly more common (16.67% vs 0.00%; p = 0.033). Patients with sterile bile cultures reported weight loss significantly more often compared to patients with bile infection (26.90% vs 0.00%; p = 0.042). The hospital stay was longer in patients with bile infection (p = 0.138), whereas the hospitalization was significantly longer in patients infected with methicillin-resistant strains compared to both patients with sterile bile and those with bile infection with non-resistant strains. Conclusions: The causes and real incidence of asymptomatic bile infection remain unknown. Routine bile cultures in patients undergoing liver surgery may prevent complications by early modification of antibiotic regime considering the antibiogram, and identification of the most common causes of asymptomatic bile infection may translate to better preoperative antibiotic prophylaxis.

Introduction: Correct surgical technique and perioperative care are two factors that can reduce the number of complications, improve treatment outcomes and shorten the length of hospital stay. The introduction of enhanced recovery protocols has changed the approach to patient care in some centers. However, there are significant differences among centers, and in some the standard of care has remained unchanged.Aim: the goal of the panel was to develop recommendations for modern perioperative care in accordance with current medical knowledge in order to reduce the number of complications associated with surgical treatment. An additional goal was to optimize and standardize perioperative care among Polish centers.Materials and methods: the development of these recommendations was based on a review of the available literature from the PubMed, Medline and Cochrane Library databases from January 1, 1985 to March 31, 2022, with particular emphasis on systematic reviews and clinical recommendations of recognized scientific societies. Recommendations were formulated in a directive form and were assessed using the Delphi method.Results and conclusions: 34 recommendations for perioperative care were presented. They cover aspects of pre-, intra- and post-operative care. Implementation of the presented rules allows to improve the results of surgical treatment.

As a result of gallbladder cancer being rare, it is often an understudied disease. There is lack of information particularly about long-term outcomes after resection during either laparoscopic or open surgery techniques [4]. There is also little data on the ways in which surgical techniques can be improved to further aid patients diagnosed with gallstones or other indications for cholecystectomy, and resulting positive histopathology. Furthermore, there is a lack of general acknowledgement on the vitality of using plastic retrieval bags during cholecystectomy regardless of the histopathology. The case study at hand shows how critical a plastic bag can be during cholecystectomy in further preventing the risk of local or distant metastasis originating from the gallbladder. This is especially important as it is estimated that almost one third of patients who undergo curative intent surgery for gallbladder cancer develop a tumor recurrence. Specifically, our patient was found to have a distant recurrence occurring a year after the elective surgery, which is in range with the usual median recurrence of 9.5 months or within the first 12 months [5].lt;/brgt;lt;/brgt; Laparoscopic cholecystectomy is a common surgical procedure, and remains the gold standard for the management of benign gallbladder and biliary disease. While this procedure can be technically straightforward, there are some key factors that surgeons must take into consideration with one of them being whether to use a retrieval bag or not. According to the "Guidelines for the Clinical Application of Laparoscopic Biliary Tract Surgery" of the Society of American Gastrointestinal and Endoscopic Surgeons (SAGES), the use of a retrieval bag for gallbladder extractions is purely at the discretion of the surgeon [6]. Generally, plastic bags should be used when gallbladder cancer is suspected to minimize disseminating tumor cells, or in the case of acute cholecystitis, to avoid spillage of gallbladder contents including possible infected bile, stones or pus. While one study states that when a cholecystectomy is performed due to gallstones, generally, surgeons will only opt for a plastic bag if there are large gallstones, great inflammation or an edematous gallbladder [7, 8]. However, another article claims the adverse, with endoscopic bags being in fact used commonly in elective cholecystectomy, despite the increased cost and apparent benefit [7]. A major drawback, and possible reason why some surgeons may decide not to use retrieval bags could be due to the extra skills needed, or increased difficulty to the surgery. This could be due to the need for enlargement of port site incision, placement of the bag around the gallbladder, as well as the potential risk to abdominal organ damage during the insertion and retrieval of the bag [7]. Sometimes the decision not to use the bag is purely economic, especially in developing countries. Fortunately nowadays commercially available endobags become more inexpensive, and to the very little extent, increase final costs of laparoscopic cholecystectomy. However, in order to reduce these costs several studies have shown that sterile male condoms or surgical non-powdered gloves can be used [9].lt;/brgt;lt;/brgt; Umbilical port site recurrence is traditionally a major concern, however there is still little research around the exact mechanism responsible for port site recurrence. Port site metastasis is the most common form of parietal recurrence with all stages of gallbladder carcinoma being reported at any of the trocar sites. Historically it was proved that the risk of port site metastasis after laparoscopic removal of incidental gallbladder cancer remained at the level of 14-30% of all cases. Recent study conducted to assess the incidence of port site metastasis in incidental gallbladder cancer in the modern era (2000-2014) versus the historic era (1991-1999) proved that this incidence has decreased but is still relatively high to other primary tumors [10].lt;/brgt;lt;/brgt;It generally presents after latency, ranging from a few months to 3-4 years. Many factors can contribute to port site metastasis [9]. One of the most important is intraoperative spillage of bile from gallbladder wall perforation, which has been described in 30% of laparoscopic cholecystectomy cases, and it has been linked to port site metastasis [11]. Interestingly, local recurrence was noted only in a minority of patients, with distant sites such as the liver and peritoneum being the most common sites for disease recurrence [4].lt;/brgt;lt;/brgt; Some hypotheses suggest to elucidate the cause of port site metastasis, including direct "chimney stack effect" in which the cancer cells may spread along trocar wound [12]. However, recent studies indicated that the chimney effect may not be the key reason for port site metastasis after laparoscopy and other factors may play crucial role in the development of this phenomenon, such as biological invasiveness of cancer, local traumatic factors, as well as host immune response [13]. Current evidence suggests that carbon dioxide pneumoperitoneum does not enhance wound metastases following laparoscopic abdominal tumour surgery. Animal studies indicated that overall postoperative wound recurrence of cancer is not significantly different between routine and gasless laparoscopic surgery [14]. null Tissue specimens removed during surgery are examined both macroscopically and microscopically, and despite this, false negatives can still persist. While there is clear data pertaining to false negatives associated with biopsies done with FNA occurring in a staggering 11-41% to detect malignancy before surgery [15], there is little data for false negatives in the postsurgical setting. Although histopathological analysis is usually very reliable to exclude malignancy, it may fail. This is clearly evident with our case, where the result was false negative. The cause for false negativity could be due to, for example, improper sampling despite guidelines indicating that three samples ought to be taken from high-risk areas of the specimen [16]. With false positives being possible both in pre- and postsurgery biopsies, surgeons must be cautious and take this factor into account in their surgical approach [17].lt;/brgt;lt;/brgt; At present, the only method that is universally used to reduce the recurrence of gallbladder cancer is cholecystectomy as incision of port sites and the use of endoscopic bags have been variably used among surgeons. Moreover, the use of adjuvant therapy after cholecystectomy has not shown to decrease the rate of recurrence, however, patients who underwent chemotherapy treatment often did slightly better [4]. Port site metastases are independently associated with a worse prognosis. Resection of previous laparoscopy port sites is advised in patients with peritoneal carcinomatosis after cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (CRS/HIPEC) to ensure complete cytoreduction [18].lt;/brgt;lt;/brgt; It is clear from this standpoint that other solutions and ideas are needed. One of these could be permanent implementation of retrieval bags during cholecystectomies, especially due to the fact that it is not always possible to foresee the problems of retraction or to show a positive histopathological result in case of gallbladder rupture [4, 17]. In every cholecystectomy there is a risk of gallbladder perforation and spread of malignant cells. Perforation of the gallbladder is in fact a frequent complication during laparoscopic cholecystectomy, with a much higher risk of perforation in acute conditions like acute cholecystitis or gallbladder empyema. Some other methods that could be used to prevent dissemination of either gallbladder contents or malignant cells include clip application, rubber band ligation or endoscopic loop application. Rubber band ligation is especially good because it is considered as a safe, simple, inexpensive method, not increasing the duration of surgery [19]. Regardless of what method a surgeon decides to use to prevent cell dissemination during cholecystectomy, it is vital that one is used, and that the guidelines are amended. This case study provides the means for this, especially since a negative histopathological biopsy still does not exclude the possibility of traces of cancerous cells being undisclosed, allowing for a potential risk of port site metastases.

A crucial phase of modern biomarker discovery studies is selecting the most promising features from high-throughput screening assays. Here, we present the OmicSelector - Docker-based web application and R package that facilitates the analysis of such experiments. OmicSelector provides a consistent and overfitting-resilient pipeline that integrates 94 feature selection approaches based on 25 distinct variable selection methods. It identifies and then ranks the best feature sets using 11 modeling techniques with hyperparameter optimization in hold-out or cross-validation. OmicSelector provides classification performance metrics for proposed feature sets, allowing researchers to choose the overfitting-resistant biomarker set with the highest diagnostic potential. Finally, it performs GPU-accelerated development, validation, and implementation of deep learning feedforward neural networks (up to 3 hidden layers, with or without autoencoders) on selected signatures. The application performs an extensive grid search of hyperparameters, including balancing and preprocessing of next-generation sequencing (e.g. RNA-seq, miRNA-seq) oraz qPCR data. The pipeline is applicable for determining candidate circulating or tissue miRNAs, gene expression data and methylomic, metabolomic or proteomic analyses. As a case study, we use OmicSelector to develop a diagnostic test for pancreatic and biliary tract cancer based on serum small RNA next-generation sequencing (miRNA-seq) data. The tool is open-source and available at https://biostat.umed.pl/OmicSelector/

Częściowa resekcja pęcherzyka żółciowego (SC) to metoda leczenia stosowana w przypadku tzw. trudnej cholecystektomii. Pozwala minimalizować ryzyko uszkodzenia dróg żółciowych, w przypadku gdy z powodu dużego nacieku zapalnego niemożliwe jest bezpieczne wypreparowanie struktur w obrębie trójkąta Calota. SC jest jednak metodą obarczoną większym ryzykiem przecieku żółci, pozostawienia kamienia w kikucie pęcherzyka lub przesunięcia złogów do światła przewodu żółciowego wspólnego (PŻW) w porównaniu do całkowitej cholecystektomii. W pracy zaprezentowano przypadek 53-letniego mężczyzny, u którego wykonano SC z powodu znacznego nacieku zapalnego w okolicy kieszonki Hartmanna w przebiegu ostrego zapalenia pęcherzyka żółciowego. W przebiegu pooperacyjnym – z uwagi na przeciek żółci – wykonano ECPW z protezowaniem dróg żółciowych, a następnie pacjenta reoperowano, wycinając zapalnie zmieniony kikut pęcherzyka z zalegającym złogiem. Z powodu infekcji w ranie pooperacyjnej, z górnego i dolnego bieguna rany usunięto szwy i pozostawiono do gojenia przez ziarninowanie. Dzięki pozostawieniu szwów w centralnej części rany uzyskany efekt kosmetyczny gojenia jest zadowalający.

Introduction: We present the case of a primary spleen mucinous cystadenocarcinoma. Several cases of this primary tumor of the spleen have been described worldwide so far. These tumors are classified as mucinous cystic neoplasms (MCN) and occur mainly in the ovaries and pancreas. Case report: The case concerns a 45-year-old female patient with an accidentally diagnosed splenic tumor with approximately 20 cm in size. Histopathological examinations, following a splenectomy, confirmed the presence of mucinous cystadenocarcinoma.

Continuous progress in the diagnostics and treatment of neuroendocrine neoplasms (NENs), the emerging results of new clinical trials, and the new guidelines issued by medical societies have prompted experts from the Polish Network of Neuroendocrine Tumours to update the 2017 recommendations regarding the management of neuroendocrine neoplasms. This article presents the general recommendations for the management of NENs, resulting from the findings of the experts participating in the Fourth Round Table Conference, entitled "Polish Guidelines for the Diagnostics and Treatment of Neuroendocrine Neoplasms of the gastrointestinal tract, Żelechów, June 2021". Drawing from the extensive experience of centres treating these cancers, we hope that we have managed to formulate the optimal method of treating patients with NENs, applying the latest reports and achievements in the field of medicine, which can be effectively implemented in our country. The respective parts of this work present the approach to the management of: NENs of the stomach and duodenum (including gastrinoma), pancreas, small intestine, and appendix, as well as large intestine.

Objective: Pancreatic adenocarcinoma (PDAC) and mass forming chronic pancreatitis (CP) can be easily misdiagnosed due to their resemblances in clinical, radiological, and biochemical criteria. In our previous study, we reported a very high concentration of D-Dimers in portal blood in patients with pancreatic cancer which may help to differentiate malignant from benign pancreatic tumours. In this study, we aim to describe other portal and peripheral coagulation profiles of PDAC in comparison to CP patients, as well to test the hypothesis; thus, it is possible to distinguish pancreatic malignancy and benign tumour based on these parameters. Methods: We included retrospectively 115 patients with the absence of venous thromboembolism (VTE), qualified to surgical treatment due to pancreatic tumours, both PDAC and CP. Patients underwent surgery in General and Transplant Surgery Unit of Medical University of Lodz between December 2011 and February 2014. Patients with distant metastases diagnosed before or during the surgery were excluded. The coagulation profile, which includes fibrinogen, activated partial thromboplastin time (aPTT), prothrombin time (PT), and thrombin time (TT), was determined in blood samples from the portal and peripheral vein taken intraoperatively. Results: The fibrinogen level was higher and the aPTT index shortened in the peripheral and portal blood of the PDAC group, which reflects the well-known link between PDAC and general hypercoagulability. Furthermore, these effects are sex-specific. The mean age in the CP group was lower than in the PDAC group (54.63 ± 12.37 vs. 63.77 ± 3.23, p < 0.001) and correlated with the fibrinogen distribution in male patients with CP (portal r = 0.34; p = 0.07; peripheral r = 0.39; p = 0.04). We calculated sex-specific logistic regression models (male: peripheral aPTT and age, AUC: 0.795, female: portal fibrinogen and age, AUC: 0.805), both maintaining the good discrimination properties after V-fold cross validation (0.759, 0.742). Conclusions: Our study shows that the differences between coagulation profiles in PDAC and CP patients not only seems to be a reflection of gender-specific biological features, but also helps to discriminate between them. The main goal of the study was to explore the biology of pancreatic cancer and lay a solid base for further investigations of PDAC biomarkers. This paper is the first to describe the detailed coagulation profile in portal blood in patients with pancreatic solid tumors. At present, the clinical application of our results is not clear; however, we hope that it may improve our understanding of this complex disease.

lt;bgt;Introduction:lt;/bgt;Pancreatic cancer is a devastating disease, being the seventh cause of cancer-related deaths worldwide. Its aggressiveness is due to its specific biology and the late diagnosis of cancer. Therefore, the prognosis for patients suffering from this cancer is dismal, with 5-year overall survival rate of around 6-10%. Up to date, only a complete surgical resection of the cancerous entity warrants a significant improvement in patients' survival. Nevertheless, the pancreatic cancer's biology is still not fully elucidated, so that the accuracy of prognosis for certain patients is highly uncertain. Consequently, the importance of both clinical and basic research aiming to reveal the crucial molecular factors affecting long-term prognosis should be highlighted. There is a growing number of evidence that biomarkers of PC not only reflect the presence of tumor itself but also present a "hint" regarding its physiology. Thus the aim of this study was to assess the levels of commonly measured biomarkers and their influence on patients' overall survival.lt;brgt;lt;bgt;Materials and methods:lt;/bgt;The retrospective analysis of data on 129 patients admitted to our Department due to the diagnosis of pancreatic cancer was carried out. On the day of admission all the patients had their levels of CAlt;subgt;19-9lt;/subgt;, CAlt;subgt;125lt;/subgt;, CEA and CAlt;subgt;15-3lt;/subgt; measured. The overall survival (OS) was defined as time elapsing from the day of admission to the day of death. The Kaplan- Meier curves were built for all potential factors, Cox regression model was applied to carry out a multivariate analysis.lt;brgt;lt;bgt;Results:lt;/bgt;We retrospectively analyzed 129 patients with a mean age of 62 years. As many as 95 of them had an unresectable lesion and 34 underwent curative operation. In total, the analyzed patient group was characterized by a median survival of 7 months and 12 days. Cumulative 1-year, 2-year and 4-year survival rates were 35%, 16% and 15%, respectively. In univariate analysis, factors such as agegt;= 60, inoperable lesion, CAlt;subgt;19-9lt;/subgt;gt;= 200, CAlt;subgt;125lt;/subgt;gt;= 20 and Neutrophile to Lymphocyte Ratio (NLR)gt;= 5 were associated with a lower median OS. In multivariate analysis, three factors, CAlt;subgt;19-9lt;/subgt;gt;= 200, CAlt;subgt;125lt;/subgt;gt;= 20 and agegt;= 60, were found to be statistically significant. Indeed, patients possessing all of them noted much poorer outcomes regarding OS factors: 89 days versus 235 days for the other patients (log rank test P = 0.02).lt;brgt;lt;bgt;Conclusions:lt;/bgt;Our study fortifies the evidence that preoperative levels of CAlt;subgt;19-9lt;/subgt; and CAlt;subgt;125lt;/subgt; have a direct influence on the longterm OS. Interestingly, in our patient group, the correlation of biomarkers with OS was higher than that of resectability. However, our study has some limitations regarding, for instance, the lack of data on chemotherapy, comorbidities etc. In the view of recent molecular studies on mucin involvement in PC development, it provides a strong clinical evidence to prove their importance.

Nonalcoholic fatty liver disease (NAFLD), a very common comorbidity of obesity, may progress from simple steatosis to nonalcoholic steatohepatitis and liver cirrhosis. The aim of this study was to determine whether mast cells (MCs) participate in the pathogenesis of liver fibrosis in patients with NAFLD. Liver specimens collected either from obese subjects or the control group were prepared for histological examination. The patients were divided into groups depending on inflammation and fibrosis grade, and the mean total number of mast cells/mm2 and those located only in portal areas/ fibrous septa or within lobules were calculated for each grade. Mast cells were detected by pina-cyanol erythrosinate staining. There was a strong positive correlation between the number of mast cells, especially those located within portal areas and fibrous septa, and the liver fibrosis grade (r = 0.736, p

Aim: Fibrosis is observed both in pancreatic cancer (PDAC) and chronic pancreatitis (CP). The main cells involved in fibrosis are pancreatic stellate cells (PSCs), which activate alpha smooth muscle actin (αSMA), which is considered to be the best-known fibrosis marker. The aim of the study was to evaluate the expression of the αSMA in patients with PDAC and CP as the possible differentiation marker. Methods: We enrolled 114 patients undergoing pancreatic resection: 83 with PDAC and 31 with CP. Normal fragments of resected specimen from 21 patients represented the control tissue. The immunoexpressions of αSMA were detected in tissue specimens with immunohistochemistry (Abcam antibodies, GB). Results: Mean cytoplasmatic expression of αSMA protein in PDAC stromal cells was significantly higher compared to CP: 2.42 ± 0.37 vs 1.95 ± 0.45 (p < 0.01) and control group 0.61 ± 0.45 (p < 0.01). Strong immunoexpression of the αSMA protein was found in the vast majority (80.7%) of patients with PDAC, in about half (58%) of patients with CP, and not at all in healthy tissue. The expression of αSMA of different intensity was found in all patients with PDAC and CP, while in healthy tissue was minimal or absent. In PDAC patients, αSMA expression was significantly higher in tumors of diameter higher than 3 cm compared to smaller ones (p = 0.017). Conclusions: Presented findings confirm the significant role of fibrosis in both PDAC and CP; however, they do not confirm the role of αSMA as a marker of differentiation.

Human papillomavirus (HPV) is a virus with the potential to infect human epithelial cells and an etiological agent of many types of cancer, including head and neck cancer. The aim of the study was to determine the prevalence of HPV infection in patients with head and neck squamous cell carcinoma (HNSCC), patients with chronic tonsillitis, and healthy individuals, and to establish high- and low-risk HPV genotypes in these groups. The objectives also comprised the delineation of the relationship between the infection with high- or low-risk HPV subtypes and clinicopathological and demographic characteristics of the study groups. This study was composed of 76 patients diagnosed with HNSCC, 71 patients with chronic tonsillitis, and 168 cases without either of these conditions (the control group). HPV detection and identification of subtypes were performed on isolated DNA using a test which allowed detection of 33 common high-risk and low-risk HPV subtypes. The prevalence of HPV infection was 42.1%, 25.4%, and 37.5% in HNSCC, chronic tonsillitis, and control groups, respectively. HPV 16 was the most prevalent genotype in all groups and the non-oncogenic HPV 43/44 was frequent in HNSCC patients. This analysis provides insight into the prevalence of oral oncogenic and non-oncogenic HPVs in patients with head and neck cancer, patients with chronic tonsillitis and healthy individuals, and leads to the conclusion that further investigations are warranted to examine a larger cohort of patients focusing on high- and low-risk HPV genotypes. Efforts should be focused on screening and prevention strategies, and therefore, it is important to introduce tools for effective detection of HPV genotypes. Furthermore, given the role of vaccines against oral HPV infection, our observations lead to the suggestion that HPV vaccination should be of considerable importance in public health strategies.

The aim of this study was to assess the relationship between the results of the objective assessment of the vestibular organ in patients with peripheral vertigo with Hashimoto’s thyroiditis and thyroid hormone metabolism. Twenty eight women with Hashimoto’s thyroiditis and chronic vertigo were enrolled in the study. Patients underwent audiological assessment of hearing, Dix–Hallpike test, videonystagmography with caloric test, head impulse test (HIT) and cervical vestibular-evoked myogenic potentials (cVEMPs). Levels of thyroid hormones and anti-thyroid antibodies were determined. Relationships between age, weight, height, BMI and the results of the objective assessment of the vestibular organ were calculated. The mean age in the study group was 48 years, while the mean BMI was 26.425. The causes of peripheral vertigo in the study group were benign paroxysmal positional vertigo (BPPV) (n = 19), Meniere’s disease (n = 7) and vestibular neuronitis (n = 2). No correlation was found between age, weight, height, BMI and the results of thyroid function tests or the objective assessment of the vestibular organ. The study did not confirm the influence of thyroid metabolism (i.e., thyroid hormone levels or the increase in antithyroid antibodies) on the results of cVEMP or the directional preponderance in the caloric test.

These recommendations refer to the current management in pancreatic ductal adenocarcinoma (PDAC), a neoplasia characterised by an aggressive course and extremely poor prognosis. The recommendations regard diagnosis, surgical, adjuvant and palliative treatment, with consideration given to endoscopic and surgical methods. A vast majority of the statements are based on data obtained in clinical studies and experts' recommendations on PDAC management, including the following guidelines: International Association of Pancreatology/European Pancreatic Club (IAP/EPC), American Society of Clinical Oncology (ASCO), European Society for Medical Oncology (ESMO), National Comprehensive Cancer Network (NCCN) and Polish Society of Gastroenterology (PSG) and The National Institute for Health and Care Excellence (NICE). All recommendations were voted on by members of the Working Group of the Polish Pancreatic Club. Results of the voting and brief comments are provided with each recommendation.

Background Steroid induced diabetes (SIDM) is a frequently found clinical condition since steroid-based therapies continue to be widely used in hospital and ambulatory care. Recommended optimal treatment of SIDM includes similar glucose lowering strategies as in type 2 diabetes. This typical management cannot cure the disease, it can only control blood glucose. Recently, bariatric surgery has emerged as an effective treatment for type 2 diabetes mellitus. However, up to now, the usefulness of bariatric surgery in treatment of SIDM has not been evaluated. Case report 49-year-old female oncologic patient with steroid induced diabetes was referred for the surgical treatment to the Department of General and Transplant Surgery in November 2009 year. Six years earlier, she underwent successful oncologic treatment with cladribine and high doses of steroids due to hairy cell leukemia. Finally complete hematologic remission with normalization of morphology and reduction of spleen size has been obtained. Prior to the steroid treatment blood glucose and urine examinations were within normal range. Patient was non-obese and had no family history of diabetes. Nevertheless, patient developed diabetes secondary to corticosteroids therapy, poorly con-trolled by oral hypoglycemic agent (acarbosum), successfully converted to insulin therapy. On ad-mission to the Department of General and Transplant Surgery she was treated with 58 units of insu-lin per day. The patient was scheduled for Roux-en-Y gastric bypass (RYGB). Insulin was with-drawn immediately after the operation and within six months after the surgery plasma glucose and glycated hemoglobin (HbA1c-5.5%) levels reached and remained within normal range. Currently, eight years after surgery, body weight and BMI are 80 kg and 27.68 kg/m2, respectively. Plasma plasma glucose and glycated hemoglobin are also normal. Importantly, from oncological point of view, the patient has remained in continuous complete remission since October 2003. Conclusions Our report is the first to our knowledge describing the effect of gastric bypass surgery on SIDM in patient with prior hematologic malignancy. It proves that surgically altered anatomy of small intestine improves glucose homeostasis previously disturbed with pro-diabetic medication.

Background: Pancreatic adenocarcinoma remains one of the most lethal cancers. This is caused by its late manifestation and lack of extensively available, highly accurate diagnostic tools. The only recommended biomarker CA19-9 proves to be not accurate enough to establish a certain diagnosis. Therefore a standardization of usefulness of other biomarkers is essential. Consequently, our aim was to assess the specificity and sensitivity of Ca125 in comparison with CA19-9 by means of meta-analysis. The systematic review of combined tests (CA19-9+Ca125) was also carried out. Methods: We conducted a systematic search of Medline (via PubMed) and Ovid. After screening of abstracts and the assessment of full-texts, 9 studies (number of patients, n = 1599) were included in the meta-analysis. Hierarchical summary receiver under operator curve (hsROC) model was applied to estimate the diagnostic accuracy. Results: CA19-9 sensitivity and specificity were 0,748 (95%CI 0,676-0,809) and 0,782 (95%CI 0,716-0,836) respectively. These values were estimated on 0,593 (95%CI 0,489-0,69) and 0,754 (95%CI 0,817-0,668) for Ca125. Regarding the heterogeneity of studies we found a strong threshold effect for Ca125 and moderate one for CA19-9. Conclusions: Our meta-analysis did not prove the superiority of Ca125 in diagnosis of pancreatic adenocarcinoma. It should be nevertheless noted that analysed studies are encumbered with high heterogeneity mainly due to threshold effect. Moreover the sparsity of studies precludes accurate analysis of various factors’ influence. Therefore further research into Ca125 is warranted to fully elucidate its usefulness. The review of proposed combined tests shows that although CA19-9+Ca125 models are characterized by higher sensitivity, their usefulness is hampered by inferior specificity to than that of CA19-9 alone.

Colorectal cancer is a common malign disease of the gastrointestinal tract. The cancer survival rate depends on the stage of the disease at detection time. It is well known that several molecular mechanisms are involved in cancer and some molecules might affect or modulate neogenesis. The aim of the study was to assess the levels of sICAM-1, sELAM-1, TNFα and sTNFR1 protein in tumor and corresponding normal mucosa in a group of patients with colorectal adenocarcinoma and also associations of these parameters with demographic and clinical profiles of the patients. Tissue specimens were obtained during resection of neoplastic lesions. Protein levels were assayed in tissue homogenates by ELISA. The protein level of sICAM-1 in tumor was significantly increased in comparison to the corresponding normal mucosa (80.06 ng/mg vs 69.53 ng/mg, p=0.02). Furthermore, a significant positive correlation between sICAM-1 and sTNFR1 proteins levels in tumor (rs=0.58, p

BACKGROUND: The prognostic value of D-dimers concentration in portal blood in patients with pancreatic cancer has been established in several studies. Thyroid hormones and their receptors, especially T3 also seems to have a specific role in process of neoplasia and metastatic spread. OBJECTIVE: The aim of the study was to look for changes of thyroid hormones concentration between portal and peripheral blood. METHODS: We included prospectively 8 patients with pancreatic cancer, without liver dysfunction, qualified to surgical treatment. D-dimers, THS, fT3, fT4 concentration was determined in blood samples from portal and peripheral vein taken intraoperatively. RESULTS: The difference and quotient of portal and peripheral concentration of D-dimers, THS, fT3 and fT4 was calculated (D-dimer-; THS-; fT3-; fT4-d and -q). The level of D-dimers measured in portal blood was > 2700 ng/mL in 3 patients. The peripheral fT3 level was significantly higher In high portal D-dimers group. FT3 change coefficients showed strong statistically significant negative correlation with portal D-dimer concentration level. CONCLUSIONS: We suggest that fT3 or its receptors can influence progression of pancreatic malignancies. The results of this study are also a new evidence that both fT3 and portal D-dimers are biologically linked to intensity of local neoplastic process. Nevertheless, deeper knowledge about portal circulation probably constitute missing part in understanding nature of pancreatic neoplasia. Investigations both on larger group and in the field of basic sciences are needed.

Purpose. Evaluation of results after one-time incisional hernia repair (IHR) modo on-lay and abdominoplasty (Ab-pl) in patients after loss of weight following previous Roux-en-Y Gastric Bypass – RYGB and analysis of changes in quality of life (QL) in bariatric patients before RYGB, as well as before and after abdominal contouring operation. Material and Methods. Clinical analysis involved 20 patients with abdominal disfigurement (following RYGB, and massive weight loss) who underwent one-time IHR using on-lay method together with Ab-pl. We estimated postoperative results, as well as changes in QL, before RYGB and before and after abdominal contouring procedure (based on DAS 24 and SF-36 scales). Results. Complications - abnormal wound healing (infection, local necrosis) were found in two persons, seroma in 2 cases, respiratory decompensation in two, whereas dysesthesia in four patients (permanent - 2, transient – 2). Estimation of the quality of life revealed significant improvement in the functional, aesthetic and psychological aspects after one-time abdominal surgery. In relation to patient’s QL estimation before RYGB, we found improvement by 39.7 % and 61.6 % - aesthetically (DAS 24), 64.6 % and 94.9 % - functionally (in SF-36 physical dimension), 66.7 % and 78.9 % - psychologically ( in SF-36 mental dimension). Conclusions. One stage on-lay hernia repair and abdominoplasty is a safe method improving the functioning of patients. All stages of bariatric treatment resulted in gradual improvement of the quality of life. Reduction of the risk of BMI re-growth after bariatric surgery is related to the need for constant, specialized care for these patients, regardless of the stage of their postbariatric follow-up.

Introduction Frequency of detection of pancreatic cystic lesions increased recent years. The majorities are pseudocysts, the remaining cysts are mainly neoplasms. Proven risk of malignancy affects intraductal papillary mucinous neoplasms (IPMN) and mucinous cystic neoplasms (MCN). Material and methods 145 patients operated on at the Department of General and Transplant Surgery in Barlicki Hospital in Lodz, Poland, in 2007-2016 due to pancreatic cystic lesion. The type of surgery, histopathological diagnosis and basic demographic data were analyzed. Results Nonneoplastic cyst (mainly pseudocysts) was found in 66.9% of patients, neoplasms were detected in 33.1%. The mean age was significantly higher in patients with neoplasms than without neoplasm (57.06 years vs. 50.88 years, p = 0.009). Neoplastic cyst occurred more frequently in women (68.75% of women, 31.25% of men, p = 0.001), Nonneoplastic cyst was found significantly more often in men (64.95% of men, 35.05% of women, p = 0.001). Malignant tumor was found in 14.58% of neoplasms cases. Pancreatic resections in neoplastic cysts were performed in 77,08%. In patients with nonneoplastic cysts drainage operations were performed most frequently (80.41%). Conclusions Neoplastic cysts are more common in women. The average age in the group of patients with neoplasms is higher than in the group with nonneoplastic cysts. In women with pancreatic cystic lesion without history for pancreatitis, the probability of neoplasms diagnosis is high. Discussion Pancreatic cystic tumors are treated radically due to the lack of sufficiently sensitive and specific pre-operative examinations. The natural history of mucinous neoplasms (IPMN and MCN) ranges from dysplasia to cancer. There are no guidelines that could be in satisfactory way used in follow up patients with pancreatic cysts.

Background Delayed graft function (DGF) is a common complication following kidney transplantation and is associated with ischemia-reperfusion injury (IRI). Lymphocytes contribute to the pathogenesis of IRI and ischemia-reperfusion related delayed graft function Materials and Methods 135 Caucasian patients received a kidney graft from deceased heart-beating organ donors. We divided patients into 2 groups- patients with the eGFR>=30 on the 21st day post-transplantation (n=36) and patients with the eGFR=30 groups in the average lnLymphocytes (0,36 +/-0,6 vs -0,016 +/-0,74 respectively p=0,004) lnNLR ( 1,27 +/-0,92 vs. 1,73+/-1,08 p=0,016) lnLMR (1,01 +/-0,57 vs. 0,73 +/-0,64 p=0,02), lnPLR (4,97 +/-0,55 vs. 5,26 +/- 0,67 p=0,023) and CCR2% (-20,20 +/- 21,55 vs. -4,29 +/- 29,62 p=0,004 . On univariate analysis, factors of lnLymphocytes >=0,22 (OR=0,331 95%CI 0,151-0,728 p=0,006), lnLMR>=1,4 (OR=0,255 95%CI 0,072-0,903 p=0,034) were associated with worse graft function while lnNLR>=1,05 (OR=2,653 95%CI 1,158-6,078 p=0,021), lnPLR>=5,15 (OR=2,536 95%CI 1,155-5,566 p=0,02) and CRR2 (OR=3,286 95% CI 1,359-7,944 p=0,008) indicated better graft function Conclusion Higher absolute lymphocyte count (lnLymphocytes) and lnLMR as well as lower lnNLR and lnPLR were associated with lower eGFR on the 21st day after kidney transplantation. On multivariate analysis CRR2 in combination with either lnLymphocytes, lnNLR or lnPLR improved the accuracy of detecting patients with poor graft function.

Non-Hodgkin lymphomas (NHL) comprise a heterogeneous group of B-cell and T-cell neoplasms. Diffuse large B-cell lymphoma (DLBCL), the most common type of NHL, accounts for around 30-40% of NHL cases. However, primary hepatic location of NHLs is rare and constitutes 0.01% of all NHL cases. Due to this rarity and a lack of large randomized trails, it is still unclear what treatment should be used for primary hepatic DLBCLs. In this study, we report of a female patient with primary hepatic DLBCL who was successfully treated with neoadjuvant chemotherapy and surgery. We also shortly review the literature regarding surgical treatments for primary GI tract NHLs. Taking into account our experience and the current literature, surgical treatment with postoperative chemotherapy seems to be a feasible option for patients with focal primary hepatic DLBCLs.

This paper presents the updated Polish Neuroendocrine Tumour Network expert panel recommendations on the management of neuroendocrine neoplasms (NENs) of the stomach and duodenum, including gastrinoma. The recommendations discuss the epidemiology, pathogenesis, and clinical presentation of these tumours as well as their diagnosis, including biochemical, histopathological, and localisation diagnoses. The principles of treatment are discussed, including endoscopic, surgical, pharmacological, and radionuclide treatments. Finally, there are also recommendations on patient monitoring.

This study presents the revised Polish guidelines regarding the management of patients suffering from neuroendocrine neoplasms (NENs) of the small intestine and appendix. The small intestine, especially the ileum, is the most common location for these neoplasms. Most are well differentiated and slow growing. Their symptoms may be atypical, which can result in delayed or accidental diagnosis. Appendicitis is usually the first manifestation of NEN in this location. Typical symptoms of carcinoid syndrome occur in approximately 20-30% of patients suffering from small intestinal NENs with distant metastases. The main cause of death in patients with carcinoid syndrome is carcinoid heart disease. The most useful laboratory test is the determination of chromogranin A, while concentration of 5-hydroxyindoleacetic acid is helpful in the diagnostics of carcinoid syndrome. For visualisation, ultrasound, computed tomography, magnetic resonance imaging, colonoscopy, video capsule endoscopy, double-balloon enteroscopy, and somatostatin receptor scintigraphy may be used. A detailed his-tological report is crucial for the proper diagnostics and therapy of NENs of the small intestine and appendix. The treatment of choice is surgical management, either radical or palliative. The pharmacological treatment of the hormonally active and non-active small intestinal NENs as well as NENs of the appendix is based on long-acting somatostatin analogues. In patients with generalised NENs of the small intestine in progress during the SSA treatment, with good expression of somatostatin receptors, the first-line treatment should be radio-isotope therapy, while targeted therapies, such as everolimus, should be considered afterwards. When the above therapies are exhausted, in certain cases chemotherapy may be considered.

Neuroendocrine neoplasms/tumours (NENs/NETs) of the large intestine are detected increasingly often, especially rectal tumours, which is probably associated with the widespread use of screening colonoscopy. There is a growing body of evidence supporting the thesis that the NENs of the rectum and the NENs of the colon are two different diseases. Rectal NENs are usually small lesions, of low to moderate histological malignancy, associated with good prognosis, and most may be treated endoscopically. NENs of the colon, however, are often aggressive, poorly differentiated, associated with a poor or uncer-tain prognosis, and require surgical treatment. The management guidelines regarding these groups of patients are constantly changing. On the basis of the recent literature data and conclusions reached by the working meeting of the Polish Network of Neuroendocrine Tumours (December 2016), this study completes and updates the data and management guidelines regarding colorectal NENs published in Endokrynologia Polska 2013; 64: 358-368.

Prophylactic augmentation of the wound with mesh proposed by Kniepeiss et al is the world's first attempt to significantly reduce the risk of postoperative hernia in liver transplantation. Similar technique have been described 17 years ago in bariatric patients and confirmed by many studies in various clinical settings. The results of mesh hernia repair in patients on immunosuppressive therapy are not inferior from the data obtained from non- transplant surgery registers.To reduce the risk of using the mesh in patients scheduled for liver transplantation authors chose absorbable mesh, that maintains the mechanical strength of the wound for up to 18 months. Half of the incisional hernias have been diagnoses more than 3 years from the original procedure.For prevention of incisional hernias, there is no evidence to support the use of biologic/biosynthetic meshes.

Introduction: Tacrolimus (TAC) metabolism rate has the potential to impact graft function after kidney transplantation (KTx). We aimed to analyze the relationship between the early post-KTx TAC C/D ratio (blood trough concentration normalized by total daily dose) and kidney graft function in a 2-year follow-up. Methods: We retrospectively analyzed data from 101 post-KTx patients at 3, 6, 12, and 24 months after KTx to identify the C/D ratio cutoff value optimal for dividing patients into fast and slow TAC metabolizers. We investigated the relationship between their TAC metabolism rate and graft function. Results: Patients were divided based on the TAC C/D ratio at 6 months after KTx of 1.47 ng/mL * 1 mg. Fast metabolizers (C/D ratio p < 0.05 at each timepoint) and were significantly less likely to develop good graft function (estimated glomerular filtration rate ≥45 mL/min/1.73 m2) than slow metabolizers. Our model based on donor and recipient age, recipient sex and slow/fast metabolism status allowed for identification of patients with compromised graft function in 2-year follow-up with 66.7% sensitivity and 94.6% specificity. Conclusion: Estimating TAC C/D ratio at 6 months post-KTx might help identify patients at risk of developing deteriorated graft function in a 2-year follow-up.

1. Evaluation of results after one-time incisional hernia repair (IHR) modo on-lay and abdominoplasty (Ab-pl) in patients after loss of weight following previous Roux-en-Y Gastric Bypass – RYGB. 2. Analysis of differences in quality of life (QL) changes in bariatric patients before RYGB, as well as before and after abdominal contouring operation.tion.Clinical analysis involved 20 patients with abdominal disfigurement (following RYGB, and massive weight loss) who underwent one-time IHR using on-lay method together with abdominoplasty. We estimated postoperative results, as well as changes in QL, before RYGB and before and after abdominal contouring procedure (based on DAS 24 and SF-36 scales) in comparison with stage before surgeries.Complications - abnormal wound healing (infection, local necrosis) and pneumonia were found in two persons, seroma in two cases, whereas dysesthesia in four patients. We confirmed QL improvement in all aspects after each stage of treatment.1. One-stage on-lay hernia repair and abdominoplasty is a safe method improving the functioning of patients. 2. All stages of bariatric treatment resulted in gradual improvement of the quality of life. 3. High BMI in patients before onlay incisional hernia repair with abdominoplasty increases the risk of complications, which is connected with longer hospital stay.

Background Several recent studies provide evidence that D-dimer (DD) concentration in peripheral blood correlates negatively with overall survival (OS) in patients with pancreatic ductal adenocarcinoma (PDAC). Contrarily, there are recent evidence indicating that preoperative plasma fibrinogen, but not D-dimer might represent a prognostic factor in non-metastatic gastrointestinal cancers. Methods In a single-center prospective study, we enrolled 62 patients undergoing surgery for pathologically confirmed PDAC without detectable venous thrombosis. Intraoperatively, the sample of the blood from the portal vein was obtained. DD concentration in these samples was measured. Patients were followed postoperatively until time of death from any cause. Results We found that OS for patients with portal blood DD values above 2700 (ng/mL) (n = 22 from 62 patients) was higher by 158% than that for the patients (n = 42) with DD values ≤ 2700 (416 days versus 161 days, p = 0.05). On the contrary to the studies investigating DD concentration in peripheral blood, we have found that patients with higher DD level in the portal vein had longer mean OS than patients with lower ones. Conclusions Further investigation is necessary both to confirm our results in a larger patient population and to elucidate the mechanism for the correlation between portal blood D-dimer concentrations and survival time. Along with other authors, we conclude that portal circulation is characterized by unique, biological environment that requires further evaluation.