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The pathological stage of the cancer and presence of postoperative complications are the most important predictors of survival in older oncologic patients. Therefore, determining biological age, and risks connected with it, should be the key factor in the preoperative assessment. It may be accomplished by using a Geriatric Assessment (GA). However, it is not established which components are most useful for predicting short- and long-term postoperative outcomes in cancer patients undergoing high-risk abdominal surgery.A total of 334 consecutive cancer patients aged ≥70 years underwent elective abdominal surgery and were followed-up prospectively for 12 months. The preoperative GA consisted of eight domains: functional, physical activity, comorbidity, polypharmacotherapy, nutritional, cognition, mood, and social support. Logistic regression analyses were used to analyse the predictive ability.All components of GA were independent risk factors of 30-day major morbidity apart from ADL, BOMC, Polypharmacy (OR 0.6-1.3; p 0.001). However, ADL, TUG, the polypharmacy and the MOS-SSS turned out to be significant predictors of 30-day mortality (OR 0.72-1.46; p 0.001). In turn, only ADL, CDT and MOS-SSS were valid predictors of 12-months mortality (OR 0.46-0.85; p 0.001). Frailty (surrogate of the biological age), not the chronological age, were also independent predictors of all outcomes (OR 4.71-8.56 p 0.001).Not the chronological age but components of GA and frailty are significant predictors of both 30-day postoperative outcome and 12-months mortality in older cancer patients undergoing high-risk abdominal surgery.

Introduction The aim of this study was to compare the ability of eight frailty screening scores to predict short- (30-day major morbidity and mortality), long-term outcomes (12-month mortality) and to compare their accuracy for predicting frailty among older patients with cancer undergoing elective abdominal surgery with curative intent. Materials and methods Consecutive patients aged ≥70 years were enrolled prospectively. The diagnostic performance of eight screening tests were evaluated: The Vulnerable Elderly Survey (VES-13), Triage Risk Screening Tool (TRST), Geriatric 8 (G8), Groningen Frailty Index (GFI), abbreviated Comprehensive Geriatric Assessment (aCGA), Rockwood, Balducci and Fried score. Frailty was defined based on the Geriatric Assessment (GA) with two (2ID) or three impaired domains (3ID). Results The study included 269 consecutive patients; median age 78 (range 70–94) years. The prevalence of frailty based on the reference GA was: 40.9% (2ID), 34.2% (3ID) and using screening tools 40–75.5%. The area under the curve (AUC) for predicting the postoperative outcome was: 0.58–0.75 (30-day morbidity), 0.54–0.71 (30-day mortality) and 0.59–0.74 (12-month mortality), respectively, being the highest for the G8. The AUC for the frailty screening tests was: 0.67–0.85 (at the 2ID) and 0.63–0.83 (at the 3ID), being the highest for the aCGA. Conclusion The G8 was the best predictor of 30-day major morbidity, 30-day and 12-month mortality. It also had the highest sensitivity and negative predictive value in frailty screening, in case of both frailty definitions. In turn, the aCGA had the highest discriminatory ability in terms of frailty screening.

Objectives: Cancer morbidity rates have been increasing steadily. A longer lifespan and easier access to modern diagnostic and therapeutic methods are the main reasons for the growing number of cancer survivors. Additionally, some types of oncological treatment, such as radiotherapy or immunosuppression, may also increase the risk of secondary tumors. These factors have resulted in an increased incidence of primary multiple cancers. Multiple primary cancers are generally under­stood as either synchronous, in which the cancers occur at the same time, or metachronous, in which the cancers follow in sequence (for instance, more than 2 months apart).The results published in other studies show that between 2% and 15.8% of all cancer patients have more primary multiple cancers. Within this group with multiple primary cancers, some have bilateral breast cancer, and our study focuses on patients from this group. Material and methods: Our study describes 10 patients who were treated for bilateral synchronous breast cancer at the Cracow Branch of the Maria Sklodowska-Curie Memorial Cancer Center and Institute of Oncology during the years 1992–2014 and who developed another primary tumor after their treatment bilateral synchronous breast cancer. Results: In our discussion we present detailed data on the incidence of metachronous cancers in the 10 patients, including breast cancer, following the treatment of their other primary tumors. Conclusion: The 10 cases of our study, and clinical experiences and publications in general show how important it is for patients to continue medical follow-up after treatment of primary tumors, not only to detect recurrences as early as pos­sible, but also to diagnose any other malignancies occurring in other sites, including secondary, treatment-related tumors.

Typical medullary breast carcinoma (T-MBC) accounts for less than 1% of all malignant breast neoplasms, and immu­nohistochemically is characteristic of “triple-negative” breast carcinoma. The purpose of this study was to describe the clinical characteristics and treatment results for patients with T-MBC treated at a single institution, and discuss the controversial aspects of this very rare form of breast cancer. Analyses was performed in 120 patients with T-MBC who were treated between 1970 and 2005. These cases represent 1.1% of all (11 270) patients treated for breast cancer during this period. According to TNM classification, 26 patients (21.6%) were in stage I, 80 patients (66.7%) in stage II and 14 (11.7%) in stage III of clinically advanced breast cancer. Involved axillary lymph nodes occurred in just 10 (8.3%) of the patients, and in all cases metastases were observed in 1–3 lymph nodes. All the patients un­derwent primary surgery. Radical mastectomies were performed on 98 (81.6%) patients, while the other 22 (18.4%) underwent breast-conserving surgery (BCS). Radiotherapy was performed in 36 patients (22 after BCS and 14 after mastectomy). Patients with nodal involvement (10 patients) received adjuvant chemotherapy, and 8 patients with hormone receptor expression received hormonotherapy with tamoxifen. The 10-year DFS rate was 90%. Out of 120 patients with T-MBC, only 4 (3.3%) died from this cancer. We showed that none of the population, neither clinical nor microscopic, had a statistically significant influence on the 10-year disease-free survival rate. Our results are similar to others presented in literature.

This article presents methods and results of surgery and radiotherapy of brain metastases from non-small cell lung cancer (BMF-NSCLC). Patients with single BMF-NSCLC, with Karnofsky score ≥ 70 and controlled extracranial disease are the best candidates for surgery. Stereotactic radiosurgery (SRS) is recommended in patients with 1–3 BMF-NSCLC below 3–3.5 cm, with minor neurological symptoms, located in parts of the brain not accessible to surgery, with controlled extracranial disease. Whole brain radiotherapy (WBRT) following SRS reduces the risk of local relapse; in selected patients median survival reaches more than 10 months. Whole brain radiotherapy alone is a treatment in patients with multiple metastases, poor performance status, uncontrolled extracranial disease, disqualified from surgery or SRS with median survival 3 to 6 months. There is no doubt that there are patients with BMF-NSCLC who should receive only the best supportive care. There is a debate in the literature on how to select these patients.

Introduction : In recent years laparoscopic approach to liver resections has gained important attention from surgeons worldwide. The aim of this review was to compare the results of laparoscopic and open liver resections. Material and methods: We have performed a search in MEDLINE, EMBASE and the Cochrane Library databases. Studies comparing laparoscopic and open liver resections were included. Results : No randomized clinical trial were identified. In the 16 observational studies included in the analysis there were 927 laparoscopic and 1049 open liver resections. The laparoscopy group had lower blood loss (MD = 244.93 ml, p < 0.00001), lower odds of transfusion (OR = 0.35, p = 0.0002), lower odds of positive margins on pathology report (OR = 0.22, p < 0.00001), lower odds of readmission (OR = 0.36, p = 0.04), lower odds of pulmonary (OR = 0.38, p = 0.003) and cardiac complications (OR = 0.30, p = 0.02) and lower odds of postoperative liver failure (OR = 0.24, p = 0.001), but in many cases the results were based on a low number of events reported in included studies. Conclusion : Laparoscopic resection of liver yields complications rates comparable to open resection, but the results are based on low quality evidence from nonrandomised studies.

Wstep . Naciekający zrazikowy ( infiltrating lobular carcinoma — ILC) rak piersi stanowi 5%–10% wszystkich zlośliwych nowotworow piersi. Celem pracy jest przedstawienie charakterystyki kliniczno-patologicznej chorych na klasyczną postac ILC (C-ILC) oraz ocena skuteczności leczenia. Material i metody . Analizą objeto grupe 220 chorych leczonych z powodu C-ILC w latach 1980–2005. W tej grupie dominowal I–II stopien zaawansowania klinicznego (67,7% chorych). U 172 chorych (78,2%) średnica guza nie przekraczala 5 cm, a u 121 chorych (55%) nie stwierdzono przerzutow w wezlach chlonnych. Badania immunohistochemiczne wykazaly obecnośc ekspresji receptorow: estrogenowego (80,9%), progesteronowego (72,7%) i HER2/neu (3,7%). Zmiany wieloogniskowe w piersi stwierdzono w 14 przypadkach (6,4%). U wszystkich chorych przeprowadzono leczenie chirurgiczne: mastektomia (189 chorych — 85,9%), leczenie oszczedzające (31 chorych — 14,1%). Adiuwantowe leczenie polegalo na stosowaniu: radioterapii (141 chorych — 64,1%), chemioterapii (35 chorych — 15,9%) oraz horomonoterapii (120 chorych — 54,5%). Wyniki . W calej grupie 10-letnie przezycie bez objawow nowotworu wynosilo 65%. Przeprowadzona wieloczynnikowa analiza wykazala, ze niezaleznym czynnikiem prognostycznym jest stan mikroskopowy wezlow chlonnych pachowych. W czasie obserwacji stwierdzono rozwoj raka w drugiej piersi (19 chorych — 8,6%), przerzuty odlegle wystąpily u 55 chorych (25%). Wnioski . C-ILC wykazuje charakterystyczne cechy kliniczno-patologiczne, a przy zachowaniu wlaściwej kwalifikacji mozliwe jest przeprowadzenie leczenia oszczedzającego. Niezaleznym, niekorzystnym czynnikiem prognostycznym jest obecnośc przerzutow w wezlach chlonnych pachowych.

Background: The differences between primary and metastatic tumor cells might be important for treatment selection and prognostication. Materials & methods: Expression of ER, PR, HER2, CK5/6, EGFR, Ki-67, Ep-CAM, P-cadherin, CD24, CD44, ALDH was assessed immunohistochemically in primary tumor (T) and corresponding synchronous nodal metastases (LNM) in 156 invasive ductal breast cancer patients (T ≥1, N ≥1, M0). Results: Independent negative prognostic factors for disease-free survival were pN3, ALDH immunopositivity in LNM, nonluminal A subtype in LNM, reduction of Ep-CAM expression in LNM, lack of changes or enhancement of CK5/6 and ALDH expression in LNM. Discussion: Our results suggest that in some cases expression of markers in lymph node metastases might bring additional prognostic information to that obtained from primary tumor.

This is a protocol for a Cochrane Review (Intervention). The objectives are as follows: To assess the beneficial and harmful effects (in terms of morbidity, mortality, quality of life, and adverse events) of transarterial (chemo)embolisation compared with systemic chemotherapy in people with liver metastases of colorectal cancer origin.

Wstep. Chirurgia jest glowną metodą leczenia czerniaka skory. Skutecznośc leczenia zalezy od zaawansowania nowotworu. Wiekszośc czerniakow w Polsce wykrywana jest w stopniu > pT1a, dlatego u tych chorych nalezy wykonac biopsje wezla wartowniczego (sentinel node biopsy — SNB). Metoda ta w sposob precyzyjny określa zaawansowanie regionalne (wezlowe). Celem pracy byla ocena wczesnych wynikow leczenia u chorych na czerniaka skory poddanych SNB. Material i metody. W latach 2010–2012 w Klinice Chirurgii Onkologicznej Centrum Onkologii w Krakowie wykonano SNB u 115 chorych na czerniaka skory (72 kobiety i 43 mezczyzn). Przeprowadzono analize statystyczną wybranych parametrow wplywających na czas przezycia bezobjawowego. Wyniki. U 15 (13%) chorych stwierdzono przerzuty w SN. Wiekszą grubośc czerniakow stwierdzono w grupie, w ktorej SN zawieral przerzut (5,16 vs 3,87 mm, p = 0,08). W okresie obserwacji u 23 chorych wystąpil nawrot choroby w postaci odleglych przerzutow (17 chorych) lub wznowy lokoregionalnej (6 chorych). W grupie, w ktorej stwierdzono przerzut w SN, do nawrotu doszlo u 8 chorych (53%); w grupie, w ktorej SN nie zawieral przerzutu, nawrot stwierdzono u 15 chorych (15%). Stwierdzono, ze chorzy z nawrotem choroby mieli grubsze czerniaki (7,1 vs 3,53 mm, p = 0,03). Stwierdzono tez znamienną roznice pod wzgledem przebiegu krzywych przezycia bez objawow nowotworu (metoda Kaplana-Meiera) dla grupy z przerzutem oraz bez przerzutu w SN. Przeprowadzono analize niezaleznych czynnikow prognostycznych metodą Coxa. Stan SN oraz aktywnośc mitotyczna guza byly niezaleznymi czynnikami istotnie wplywającymi na przezycia bezobjawowe (p = 0,001). Wnioski. SNB jest efektywną metodą identyfikacji chorych na czerniaka z subklinicznymi przerzutami w regionalnych wezlach chlonnych. Grubośc czerniaka określana wg Breslowa jest istotnym czynnikiem ryzyka przerzutow w regionalnych wezlach chlonnych. Obecnośc przerzutu w SN oraz duza aktywnośc mitotyczna znamiennie zwiekszają ryzyko nawrotu choroby.

Aim of the study: To present the characteristics and clinical outcomes in 94 patients with mucinous breast cancer treated at the Oncology Centre in Krakow between 1952 and 2002. Material and methods: Stage I or II carcinomas were found in 66 patients (69.4%) of the presented group and in the remaining 28 patients (29.8%) stage III disease was diagnosed. In 27 cases regional lymph nodes were involved. All patients had been treated with surgery: mastectomy (90 patients) or breast-conserving treatment (4 patients). Radiotherapy was administered in 14 patients, adjuvant chemotherapy in 14 patients, and endocrine therapy in 39 patients. Results: The maximum follow-up was 257 months. Ten-year survival was as follows: 75.7% (overall survival), 82.5% (disease-free survival). During the follow- up, 4 patients developed local recurrence, 5 patients developed metastases. Second primary cancer was found in 8 patients. Conclusions: The presented results confirm the good prognosis in patients treated for mucinous breast cancer. The diagnosis of early-stage breast cancer based on mammography can allow breast-conserving treatment.

Wstep. Cewkowy rak piersi stanowi okolo 1–2% wszystkich nowotworow zlośliwych piersi. Zbudowany jest z dobrze zroznicowanych cewek o otwartym świetle, wyścielonych pojedynczą warstwą komorek nablonka. Celem pracy jest przedstawienie charakterystyki klinicznej oraz wynikow leczenia 67 chorych na cewkowego raka piersi w Centrum Onkologii w Krakowie w latach 1955–2002. Materialy i metody. W przedstawianej grupie u 62 chorych (92,5%) raka piersi rozpoznano w I lub II stopniu zaawansowania klinicznego. U 43 (64,2%) wielkośc guza nie przekraczala 2 cm. Regionalne wezly chlonne byly wolne od przerzutow u 52 (77,6%). Podstawową metodą leczenia byla chirurgia. Mastektomie wykonano u 60 chorych, a u pozostalych 7 — leczenie oszczedzające pierś. U 13 chorych po leczeniu chirurgicznym przeprowadzono uzupelniającą radioterapie. Stosowano rowniez uzupelniające leczenie systemowe (chemioterapie i/albo hormonoterapie). Wyniki. Okres obserwacji w prezentowanej grupie chorych wynosil maksymalnie 320 miesiecy. Odsetki 10-letnich przezyc wynosily: 83,8% (calkowite), 91,6% (przezycie bez objawow nowotworu). W trakcie obserwacji u 2 chorych (3%) stwierdzono rozwoj wznowy miejscowej. Przerzuty odlegle rozwinely sie u 5 chorych (7,5%), a u 8 chorych (11,9%) stwierdzono wspolistnienie innych pierwotnych nowotworow. Wnioski. Prezentowane wyniki potwierdzają dobre rokowanie u chorych leczonych z powodu cewkowego raka piersi. Charakterystyczne cechy biologiczne tego nowotworu stwarzają mozliwości wczesnego rozpoznania, to z kolei umozliwia przeprowadzenie leczenia oszczedzającego, ktore jest znaczącym czynnikiem wplywającym na jakośc zycia chorych na raka piersi.

Introduction. The continuously improving cancer detection at an early stage and improving survival rates have been observed and, therefore, patients are predisposed to detection of multiple primaries. It has been reported that the incidence of multiple primaries in breast cancer patients ranges from of 4% to 17%. Materials and methods. A group of 112 breast cancer patients with synchronous malignancies was presented. They constituted 0.09% of patients (118,952 cases) who were treated for breast cancer at the same time period, and made up 3.5% of all patients (3,176 cases) with multiple primary cancers, and 21.7% of all patients (517 cases) with breast cancer who developed multiple primaries. Results. The most frequent type of synchronous primary malignancy was breast cancer (63.4%) and 90.1% of them were diagnosed at the same time or within one month following the first breast cancer diagnosis. Among cases of non-breast synchronous primaries, female genital organ malignancies were predominant (36.6%). Synchronous breast cancer was diagnosed significantly earlier than non-breast cancers (mean time was 0.4 and 1 month, respectively, p = 0.0123). Better results in the group with synchronous contralateral breast cancer in comparison to synchronous breast and non-breast cancer were observed (5-year overall survival rates were 90.9% and 66.3%, respectively, and 5-year disease-free survival rate — 62.5% and 51.3%, respectively).

Acute Kidney Injury (AKI) is a serious early complications in patients with acute pancreatitis (AP) that signifcantly increases mortality rates compared to patients without AKI. The early diagnosis of AKI during its treatable phases and implementation of appropriate treatment protocols can improve outcomes for this group of patients. A promising biomarker for AKI is neutrophil gelatinase-associated lipocalin (NGAL).This study evaluated the diagnostic value of NGAL concentrations in serum and in urine for patients developing AKI as an early complication of AP compared to AP patients without AKI.The study group composed of 65 patients (34 men and 31 women) with a mean age of 62.2 ± 16 years with AP and hospitalized in the Surgery Department of the Direct Hospital in Sucha Beskidzka, Poland between January and December 2014. Serum NGAL (sNGAL) levels were measured with the BioVendor ELISA kit, and urine NGAL (uNGAL) with the Abbott ARCHITECT Analyzer.In the early phase of AP, 11 patients (17%) developed AKI, including 10 patients with stage 1 and one with stage 2. AKI was associated with more severe AP, higher BISAP scores, the need for more intensive treatment, longer hospital stays and higher mortality. Both serum and urine NGAL concentrations were signifcantly higher in patients with AKI throughout the study and signifcantly predicted AKI in simple and multiple logistic regression adjusted for age, sex and comorbidities. Serum and urine NGAL concentrations were signifcantly correlated with levels of serum urea, creatinine, urine albumin, and the maximum change in serum creatinine. Serum and urine NGAL levels also correlated positively with direct neutrophil counts and CRP concentrations throughout the study.The measurement of NGAL levels, particularly in urine, is simple, easy to interpret, routinely available, and clinically useful in the assessment of dynamic changes in kidney function for patients with AP.

Rak sromu plasuje się na czwartym miejscu wśród najczęstszych nowotworów narządów płciowych u kobiet (stanowi około 5% zachorowań na nowotwory z tej grupy). Histologicznie wyróżnia się zmiany pochodzenia nabłonkowego - w 90% jest to rak płaskonabłonkowy rogowaciejący - i nienabłonkowego. Większość raków sromu występuje w wieku pomenopauzalnym i ma związek z przewlekłą infekcją bakteryjną bądź wirusową (wirus brodawczaka ludzkiego). Chłonka ze sromu drenowana jest do trzech grup węzłów chłonnych pachwinowych i do węzłów biodrowych. W zależności od lokalizacji zmiany nowotworowej rak sromu przerzutuje jednostronnie lub obustronnie. Podstawowymi metodami leczenia pozostają chirurgiczne wycięcie oraz limfadenektomia pachwinowa powierzchowna i głęboka. W artykule zaprezentowano szczegółową budowę anatomiczną układu chłonnego pachwinowo-biodrowego, a także najpowszechniej wykorzystywane techniki operacyjne i najczęstsze powikłania zabiegu. Kluczowa dla przedstawienia wartościowego raportu patomorfologicznego jest współpraca z klinicystą. W szpitalach dysponujących własnym zakładem patomorfologii chirurg powinien przesłać materiał nieutrwalony, optymalnie - w sposób jałowy. W szpitalach bez zakładu patomorfologii preparat należy utrwalić. Aby patomorfolog mógł dokonać wiarygodnej oceny cechy pN - zgodnie z klasyfikacją TNM z 2010 roku - preparat operacyjny obejmujący pachwinowy układ chłonny powinien zawierać co najmniej sześć węzłów chłonnych. Podstawowe znaczenie dla osiągnięcia dobrych wyników leczenia mają poznanie budowy anatomicznej tego regionu i technik operacyjnych oraz prawidłowe przygotowanie preparatu do badania patomorfologicznego. Vulvar carcinoma is the fourth most prevalent cancer of genitals in women (accounting for 5% of all neoplasms from this group). Histologically, we differentiate epithelial neoplasms - in 90% of cases we are dealing keratotic squamous cell carcinoma - and non-epithelial ones. The majority of vulvar carcinomas occur at a postmenopausal age and are related to chronic bacterial or viral infection (human papilloma virus). Lymph from the vulva is drained to three groups of inguinal lymph nodes and to iliac lymph nodes. Depending on the location of a neoplastic lesion, vulvar carcinoma metastasizes unilaterally or bilaterally. The basic methods of treatment are surgical removal or inguinal lymphadenectomy - both superficial and deep. This article presents a detailed anatomy of the inguinal-iliac lymphatic system as well as the most widely used surgical techniques and the most common postoperative complications. Cooperation with the clinician is crucial to present a valuable pathology report. In hospitals with an anatomic pathology unit on-site, the surgeon should send a non-fixed material, and optimally - in sterile conditions. In hospitals without an anatomic pathology unit, the specimen must be fixed. For the pathologist’s assessment of pN stage - in accordance with the TNM classification of 2010 - to be reliable, the operative specimen comprising the inguinal lymphatic system must include at least six lymph nodes. Obtaining satisfactory management results requires a good knowledge of anatomy of this area and surgical techniques as well as a proper preparation of the specimen for pathologic examination. Рак вульвы занимает четвертое место среди наиболее распространенных раковых заболеваний половых органов у женщин (примерно 5% случаев рака в этой группе). Гистологически выделяют изменения эпителиального происхождения - в 90% это плоскоклеточный, роговеющий рак - и неэпителиального происхождения. Большинство случаев рака вульвы встречается у женщин после менопаузы и связано с хронической бактериальной или вирусной инфекцией (папилломавирус человека). Лимфа из вульвы отводится в три группы паховых лимфатических узлов и подвздошных узлов. В зависимости от локализации опухоли метастазы рака переходят на одну или обе стороны. Основными методами лечения остаются хирургическое удаление и паховая, поверхностная и глубокая лимфаденэктомия. В статье представлена подробная анатомическая лимфатическая пахово-бедренная система, а также наиболее часто используемые хирургические методы и наиболее распространенные осложнения процедуры. Ключевым для представления стоящего патологического доклада является сотрудничество с врачом. В больницах с собственной лабораторией патоморфологии хирург должен отправить нефиксированный материал, оптимально - в стерильных условиях. В больницах без патоморфологической лаборатории препарат необходимо фиксировать. Чтобы патоморфолог мог провести достоверную оценку pN - в соответствии с классификацией TNM с 2010 года - операционный препарат, охватывающий паховую лимфатическую систему, должен содержать как минимум шесть лимфоузлов. Существенное значение для достижения хороших результатов лечения имеет понимание анатомической структуры этой области и хирургических методов, а также правильная подготовка препарата к патологическому исследованию.

The immunophenotypic differences between primary and metastatic tumour cells could influence patient's treatment or/and the results of selected diagnostic procedures. That prompted us to investigate potential differences between primary tumours and corresponding synchronous lymph node metastases in the T  1/N+/M0 breast cancer patients. The investigated group consisted of 108 patients with invasive ductal breast cancer, who underwent radical surgery. The expression of ER, PR, HER2 as well as CK5/6, P-cadherin, EGFR and Ep-CAM was assessed immunohistochemically. Our data suggest that ER, PR, HER2, EGFR and CK5/6 are expressed conservatively, with some minor changes between primary tumour and simultaneous lymph node metastases. On the contrary, Ep-CAM and P-cadherin immunoreactivity in primary and metastatic cells varied significantly. This variation might exclude Ep-CAM and P-cadherin as potential diagnostic or therapeutic targets.

Despite the large number of clinical trials on breast cancer, patient-related factors such as perioperative anxiety and level of knowledge about the disease and treatment have not been included in mainstream research efforts. This randomized trial was performed to evaluate the impact of information, provided preoperatively, on anxiety and knowledge of women undergoing mastectomy for breast cancer.Sixty consecutive patients with breast cancer, admitted for a mastectomy, as primary treatment for breast cancer, with no previous cancer history, were randomized to receive structured information (short video about practical aspects of the hospital stay, surgical and adjuvant treatment) in addition to the routine informed consent procedure for surgery or the routine informed consent only. Anxiety and subjective knowledge levels were measured with the visual analogue scales; in addition, knowledge was assessed with a questionnaire.There was no significant effect of the additional information on perioperative anxiety or knowledge (subjective). Significantly more patients in the additional information group correctly listed all major available treatment options compared to the patients that received routine information (preoperatively 54% vs. 19%; p = 0.0101; 7 days postoperatively 50% vs.19%; p = 0.0367).Use of an informational video, preoperatively, did not significantly affect perioperative anxiety or subjective knowledge. Additional research is needed on effective delivery of disease- and treatment-specific information perioperatively.

Lymphangiogenesis is a potential indicator of cancer patients' survival. However, there is no standardisation of methodologies applied to the assessment of lymphatic vessel density. In 156 invasive ductal breast cancers (T  1/N+/M0), lymphatic and blood vessels were visualised using podoplanin and CD34, respectively. Based on these markers expression, four parameters were assessed: (i) distribution of podoplanin-stained vessels (DPV) - the percentage of fields with at least one lymphatic vessel (a simple method proposed by us), (ii) lymphatic vessel density (LVD), (iii) LVD to microvessel density ratio (LVD/MVD) and (iv) the expression of podoplanin in cancer-associated fibroblasts. Next, we estimated relations between the above-mentioned parameters and: (i) breast cancer subtype, (ii) tumour grade, and (iii) basal markers expression. We found that intensive lymphangiogenesis, assessed using all studied methods, is positively related to high tumour grade, triple negative or HER2 subtype and expression of basal markers. Whereas, the absence of podoplanin expression in fibroblasts of cancer stroma is related to luminal A subtype, low tumour grade or lack of basal markers expression. Distribution of podoplanin-stained vessels, assessed by a simple method proposed by us (indicating the percentage of fields with at least one lymphatic vessel), might be used instead of the "hot-spot" method.

Background Here, the treatment methods and results of patients with phyllodes tumor of the breast (PT) with distant metastases at a single institution are presented. Methods A retrospective analysis was performed on a group of 295 patients with PT treated from 1952 to 2010. Results Distant metastases developed in 37 (12.5 %) patients; 3/160 (1.9 %) patients had benign PT, 6/36 (16.7 %) were considered borderline, and 28/99 (28.3 %) had malignant PT. Most frequently, the metastases were located in the lungs; 28 (75.7 %), bone 7 (18.9 %), brain 4 (10.8 %), and liver 2 (5.4 %). Metastases occurred on overage 21 months (2–57) after surgery. Patients with lung metastases were generally treated with monochemotherapy or polychemotherapy. In one patient Testosterone and in two patients resection of metastases combined with Doxorubicin were used. Patients with bones or brain metastases were treated with palliative radiotherapy only or combined with Doxorubicin. The mean survival (MS) from diagnosis of distant metastases (DM) was 7 months (2–17). The longest mean survival in patients with bones metastases was 11.8 months, the worst survival was for patients with brain metastases—2.8 months. Hormone therapy appeared to have low efficacy (MS: 2 months) as well as monochemotherapy (MS: 3–5 months). Improved MS was obtained using Doxorubicin (7 months) and Doxorubicin with Cisplatin, Cyclophosphamide, or Ifosfamide (9 months). Conclusion The prognosis of patients with DM from PT is poor. The role of surgery and irradiation of such patients is very limited. There appears to be no role for the use of hormone therapy. This study showed that polychemotherapy with Doxorubicin and Ifosfamide suggest that it might be more effective than once thought.

Background: Treatment outcomes appear to be better for ovarian cancer (OC) patients carrying the BRCA1/2 germline mutation than for patients with sporadic OC. However, most published data are for North American, British and Jewish populations. There have been very few studies on treatment outcomes in Central and Eastern European patients with OC. The aim of this study was to analyse prognostic factors in Polish patients with BRCA1-dependent OC (BRCA1-OC). Methods: The records of patients with OC treated with surgery and chemotherapy at the Centre of Oncology in Kraków, Poland, between 2004 and 2009 were reviewed. Based on family history, a group of 249 consecutive patients fulfilling the criteria for risk of hereditary OC were selected and tested for the germline BRCA1 mutation. Response to combination therapy (surgery and chemotherapy) in the BRCA1-OC group was assessed based on clinical examination, imaging and serum CA125. Results: Germline BRCA1 mutations were detected in 69 of the 249 patients, but three of these patients failed to complete the study. Finally, 66 patients with BRCA1-OC were included in the study group. The median age of the study patients was 49.5 years. All had undergone primary or interval cytoreductive surgery and chemotherapy. Progression occurred in 48 (72.7 %) of the 66 patients and median time to progression was 20 months. The 5-year overall survival rate in was 43.9 % and median survival time was 32.3 months. On multivariate analysis, the endometrial subtype of OC and serum CA125 < 12.5 U/ml at the end of treatment were independent, positive prognostic factors for 5-year overall survival. Conclusion: Prognostic factors for favourable treatment outcomes in Polish patients with BRCA1-OC do not appear to differ from those in patients with sporadic OC. The incidence of the endometrial subtype of OC was relatively high (34.9 %) among women in the study. This was unexpected and has not been reported previously. This subtype of OC was an independent prognostic factor for favourable treatment outcomes.

This article presents methods and results of surgical treatment and radiation therapy of brain metastases in breast cancer patients (brain metastases from breast cancer BMF-BC). Based on the literature data, it was shown that patients with single BMF-BC, aged less than 65 years, with Karnofsky score (KPS) of 70 or more and with cured or controlled extracranial disease are the best candidates to surgical treatment. Irrespective of the extracranial disease control status, there are indications for surgery in patients with symptomatic mass effect (tumour diameter larger than 3 cm) and patients with obstructive hydrocephalus from their BMF-BC. Stereotactic radiosurgery (SRS) has some advantages over surgery, with similar effectiveness: it may be used in the treatment of lesions inaccessible to surgery, the number of lesion is not a limiting factor if each lesion is small (< 3) and adequate doses can be delivered, it is not contraindicated in patients with active extracranial disease, it does not interfere with ongoing systemic treatment, and it does not require general anaesthesia or hospitalisation. A disadvantage of SRS, as compared to whole brain radiotherapy (WBRT), in patients with BMF-BC is the possibility of subsequent development of new lesion in the non-irradiated field. Thus the majority of the BMF-BC patients are not good candidates to surgery or SRS; WBRT alone or combined with a systemic treatment still plays a major role in the treatment of these patients.

The aim of the study was to evaluate the possibility to use live anesthetized pigs as a model for laparoscopic liver resection. During two days laparoscopy course two trainees were operating on two live animals performing exposure of the liver, Pringle manoeuver, division of liver ligaments, dissecting of the structures inside the hepatoduodenal ligament, dissection of the hepatic veins and left lateral liver sectionectomy. Exposure of the liver and Pringle manoeuver were performed correctly within 50 and 35 minutes. Left lateral sectionectomy has been performed correctly within 2 hours. The full dissection of the hepatoduodenal ligament and exposure of the hepatic veins were judged as insufficient by experienced laparoscopic tutors. There was one injury to the suprahepatic vena cava that was managed laparoscopically. The porcine model can be used as an advanced training for laparoscopic liver surgery.

Transvaginal access is the most popular natural orifice translumenal technique in the minimally invasive surgery. Reviews on non-gynecological transvaginal approach morbidities reveal that rates vary greatly. A systematic review of transvaginal approach in non-gynecological intraabdominal procedures was carried out to assess the risk of complications. A systematic search was conducted using MEDLINE, EMBASE, PubMed, and the Cochrane Library from the inception of these databases to March 2012. The following keywords were searched: “transvaginal”, “NOTES”, “single incision”, and “single port”. From the total of 231 potentially eligible abstracts, 87 papers were retrieved and evaluated as fulfilling the eligibility criteria. The final analysis included 32 articles. The overall complications rate was 4.4 %, and complications related to the transvaginal port reached 2.4 %. Conversion rate to open surgery was 3.4 %. The incidence of postoperative urinary tract infection was 0.8 %. The mean operative time was 119 min. The mean hospital stay was 3.1 days (range 6 h–12 days). The technique of transvaginal access can offer several advantages for a patient and is associated with an acceptable rate of complications.

Sporadic breast cancer (SBC) is a common disease without robust means of early risk prediction in the population. We studied 282 females with SBC, focusing on copy number aberrations in cancer-free breast tissue (uninvolved margin, UM) outside the primary tumor (PT). In total, 1162 UMs (1–14 per breast) were studied. Comparative analysis between UM(s), PT(s), and blood/skin from the same patient as a control is the core of the study design. We identified 108 patients with at least one aberrant UM, representing 38.3% of cases. Gains in gene copy number were the principal type of mutations in microscopically normal breast cells, suggesting that oncogenic activation of genes via increased gene copy number is a predominant mechanism for initiation of SBC pathogenesis. The gain of ERBB2, with overexpression of HER2 protein, was the most common aberration in normal cells. Five additional growth factor receptor genes (EGFR, FGFR1, IGF1R, LIFR, and NGFR) also showed recurrent gains, and these were occasionally present in combination with the gain of ERBB2. All the aberrations found in the normal breast cells were previously described in cancer literature, suggesting their causative, driving role in pathogenesis of SBC. We demonstrate that analysis of normal cells from cancer patients leads to identification of signatures that may increase risk of SBC and our results could influence the choice of surgical intervention to remove all predisposing cells. Early detection of copy number gains suggesting a predisposition toward cancer development, long before detectable tumors are formed, is a key to the anticipated shift into a preventive paradigm of personalized medicine for breast cancer.

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

Wystąpienie przerzutów do mózgu u chorych na raka piersi (BMBC — brain metastases from breast cancer) związane jest z wyraźnie niekorzystnym rokowaniem. Mediana przeżycia u takich chorych waha się od 2 do 16 miesięcy, w zależności od wielu czynników prognostycznych oraz związanych z nimi możliwości leczenia. W piśmiennictwie prezentowane są czynniki prognostyczne ujawniające się w badaniach jedno- lub wieloośrodkowych, głównie, choć nie jedynie, w analizach wieloczynnikowych, oraz czynniki uwzględnione w indeksach prognostycznych, opracowanych dla chorych z przerzutami do mózgu z różnych nowotworów lub — w szczególności — dla chorych z BMBC. Zebrane i zweryfi kowane dane piśmiennictwa pozwalają uznać, że na chwilę obecną podstawowymi, powszechnie uznanymi czynnikami prognostycznymi u chorych z BMBC są: stan sprawności chorych oraz stan procesu nowotworowego poza mózgiem w momencie ujawnienia się przerzutów do mózgu (BM — brain metastases). Stan sprawności chorych oceniany jest prawie wyłącznie skalą Karnofsky'ego, natomiast stan procesu nowotworowego jest różnie defi niowany: czynny vs nieobecny, kontrolowany vs niekontrolowany, obecność przerzutów odległych poza mózgiem vs brak tych przerzutów itp. Niestety, stwarza to możliwość różnych interpretacji. Potencjalnymi czynnikami prognostycznymi prezentowanymi przez wielu autorów, ale nieuznawanymi powszechnie, są: wiek chorych, podtyp molekularny raka piersi oraz liczba BM. Wyniki przeprowadzonych analiz oceniających wartości poszczególnych indeksów prognostycznych wskazują, że pomimo niewątpliwych ich zalet, w praktyce klinicznej winny być stosowane z rozwagą u chorych z BMBC. The development of brain metastases from breast cancer (BMBC) relates to poor prognosis. The median survival rate averages from 2 to 16 months and depends on various prognostic factors and therapeutic possibilities. There are some prognostic factors which were found in trials as a results of multivariate analyses and factors from prognostic scores in patients with brain metastases. According to the literature the important prognostic factors are performance status and status of the disease outside the brain. Performance status usually is evaluated according to the Karnofsky scale. Whereas the disease status is estimated variously as: presence versus no disease, controlled or uncontrolled disease, presence or not of distant metastases outside the brain. Many authors revealed that age, molecular type of breast cancer and number of brain metastases are potential prognostic factors. Published results of analyses showed that the role of some prognostic factors is limited in patients with BMBC.

Surgery remains the mainstay of the treatment in patients with malignant phyllodes tumor of the breast (MPTB); however, the extent of surgery (breast conserving surgery [BCS] versus mastectomy) and the role of adjuvant radiotherapy have been controversial. We report a single institution's experience with MPTB. We discuss controversial therapeutic aspects of this rare tumor. Seventy patients with MPTB treated primarily with surgery were evaluated. The mean age was 50 years (21-76), and the mean size of the tumor was 6 cm. Thirty-four (48.6%) patients were treated with total mastectomy, and 36 (51.4%) were treated with BCS (lumpectomy or wide local excision). Microscopic surgical margins were free of tumor in all cases. In 64 (91.4%) patients, margins were ≥1 cm. Remaining 6 (8.6%) patients treated with BCS margins were

BACKGROUND Data from the literature suggests that the clinical picture of phyllodes tumor (PT) of the breast, as well as treatment options and perhaps therapy outcomes, have significantly changed. The aim of this work was to review these changes by analysis of consecutive patients with PT over a 55-year period at a single institution. MATERIAL AND METHODS From 1952 to 2007, 280 women with PT were treated surgically at the Maria Sklodowska-Curie Memorial Institute of Oncology, Cancer Center in Cracow. Age, size of breast tumor, microscopic type, extent of surgery, and therapy outcomes were compared between 2 groups: 190 patients treated from 1952 to 1991 vs 90 patients treated from 1992 to 2007. RESULTS The results show that the 1992-2007 group compared to the 1952-1991 included more patients

The hypothesis on cancer stem cells assumes the existence of small subpopulation of cells that possess the ability to undergo self-renewal and can give rise to the diversity of differentiated cells that form the tumour. It has been accepted that CD44(+)/CD24(-/low) phenotype is one of the features characterizing breast cancer stem cells. The aim of our study was to assess (1) prognostic significance of CD44/CD24 expression as well as (2) a relation between the above-mentioned phenotype and breast cancer subtypes [based on estrogen (ER), progesterone receptors, human epidermal growth factor receptor 2 and Ki67 status] and expression of selected markers such as fascin, laminin-5 gamma-2 chain, cytokeratin (CK) 5/6 and 8/18, epidermal growth factor receptor (EGFR), smooth muscle actin, P-cadherin and lymphocytic infiltration in invasive ductal breast cancer patients (T ≥ 1, N ≥ 1, M0), who underwent mastectomy followed by chemotherapy (with taxanes and/or anthracyclines) or/and hormonotherapy. We noted that most cancers with CD44-/CD24- and CD44-/CD24+ phenotype were ER positive. The majority of CD44-/CD24-, CD44-/CD24+ and CD44+/CD24- tumours were characterized by CK5/6 and EGFR negativity. In univariate analysis we demonstrated that patients with pN1/pN2 and with CD44 +/CD24- carcinomas had significantly lower risk of progression or cancer-related death than those with pN3 or tumours characterised by other CD44/CD24 expression patterns. We also found 100 % DFS in 12 patients with CD44+/CD24-/CK5/6+/ER- phenotype. Other analysed parameters were insignificant. We conclude that tumours with immunophenotypes: CD44+/CD24- and CD44+/CD24-/CK5/6+/ER- might be more sensitive for chemotherapy based on taxanes and/or anthracyclines.

BACKGROUND This study addresses the controversial prognostic and therapeutic aspects of phyllodes tumor of the breast. METHODS Records of 170 women with phyllodes tumor of the breast were reviewed. On the basis of the criteria proposed by Azzopardi and Salvadori et al., including estimation of tumor margin, growth of the connective tissue component, mitoses, and cellular atypia, the entire series was divided into three histotypes of phyllodes tumor, i.e., benign (92 cases, 54.1%), borderline (19 cases, 11.2%), and malignant (59 cases, 34.7%). Ninety-eight patients (57.6%) were treated by wide local excision (79 benign, 15 borderline, and 4 malignant), 43 (25.3%) by simple mastectomy (13 benign, 4 borderline, and 26 malignant), and 29 (17.1%) by radical mastectomy (all malignant). RESULTS Of the 170 treated patients, 141 (82.9%) survived 5 years without evidence of disease. In the Cox multivariate analysis the histotype of the tumor was the only independent prognostic factor: 5-year NED survival was observed in 95.7% of the patients with benign phyllodes tumor, 73.7% with borderline phyllodes tumor, and 66.1% with malignant phyllodes tumor. After a wide local excision 98.7% of the patients with benign tumor, and 80% with borderline tumor, were cured. Local recurrence was found in 14 patients (8.2%) (4 benign, 3 borderline, and 7 malignant); 10 of these underwent reoperation (7 wide local excision, 3 radical mastectomy) and survived 5 years NED. CONCLUSIONS The histotype of phyllodes tumor (benign, borderline, and malignant), assesed on the basis of the criteria proposed by Azzopardi and Salvadori et al., was the only prognostic factor in our group of patients. Based on the data from literature and our own observations, we observed that a wide local excision, with an adequate margin of normal breast tissue, is the preferred initial therapy for phyllodes tumor of the breast. Cancer 1996;77:910-6.

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

Objectives: We aimed at evaluation of the influence of the extent of axillary lymph node dissection, measured by the total number of lymph nodes harvested, on the drainage volume. We also looked at the lymph node positivity (N+) and the number of metastatic axillary lymph nodes as a potential prognostic factors in this regard. Material and methods: We have analysed the data of 63 patients (F/M: 62/1) with breast cancer, who underwent radical modified mastectomy in 2008-2009 in the single department of surgical oncology. Results: We observed no significant correlation between the 1) total number of axillary lymph nodes harvested during lymphadenectomy, 2) presence of metastatic lymph nodes (node positive disease), 3) number of metastatic axillary lymph nodes and: drainage volume on the day of surgery, drainage volume on three consecutive postoperative days and drainage volume from the day of surgery to drain removal. Conclusion: The extent of axillary lymph node dissection, measured by the total number of lymph nodes excised, did not influence drainage volume after radical modified mastectomy. Neither total number of metastatic lymph nodes excised nor the node positivity (N+) were associated with increased drainage volume after mastectomy with axillary dissection.

Paget disease (PD) of the nipple with coexisting intraductal (DCIS) and invasive carcinoma of the breast comprises 0.6-1.8% of all malignant epithelial neoplasms of this organ. Unlike invasive ductal carcinoma, there are many controversies concerning histological features of PD and the significance of the immunohistochemical characteristics of this neoplasm, which limits the optimal treatment protocols. Therefore, we decided to verify the immunohistochemical markers of PD basing on the retrospective analysis of postoperative material from 69 patients treated surgically. Microscopic examination revealed partial (7 cases) or total (62 cases) replacement of the squamous epithelium of the nipple with nests of atypical glandular cells spreading in an area ranging from 0.2 to 2.5 cm. DCIS coexisting with the PD lesions was present in all examined patients, and infiltrating carcinoma occurred in 31 (44.9%) patients. Both intraepidermal and DCIS components presented c-erbB2 overexpression. Positive estrogen and progesterone receptor staining was observed only in 7 (10.1%) and 2 (2.7%) tumours, respectively. Ki-67 proliferation index of PD cells ranged from 10% to 30%, whereas in DCIS it varied from 4% to 20%. The value of Ki-67 index exceeding 25% in the intraepidermal component of PD was associated with worse overall survival rate.

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

Local staging of malignancy, introduced in the past few decades into clinical practice, is based on the identification of the...

An outline of the history of rectal surgery since the XIX century to the present day has been presented. Evolution of the opinions in rectal surgery have been recalled. Development of surgical technique has been presented. Technical achievements in surgery, which pushed possibilities of surgical treatment in rectal cancer patients, has been described.

Angiosarcoma arising in the area of chronically lymphoedematous extremity is referred to as Stewart-Treves syndrome. In the world literature we can find about 400 cases of Stewart-Treves syndrome occurring after treatment for breast cancer. There are also occasional case reports of Stewart-Treves syndrome within chronically lymphoedematous upper extremity not related to breast cancer treatment and within chronically lymphoedematous leg. Treatment of choice is wide surgical resection with clear surgical margins. Adjuvant radiotherapy is advised. Treatment outcomes are generally poor. 5 year survival is estimated at 10%.

Between 1992 and 1999 at the Oncology Centre in Cracow 138 NSCLC patients after complete resection of the tumour with mediastinal/hilar node involvement were included in the prospective clinical trial. The analysis of the results did not show any improvement of survival in the postoperatively irradiated group. Three-year survival rates with no symptoms of disease in postoperative radiotherapy patients compared to surgery alone group were 30% and 29% respectively. In this study adjuvant radiotherapy significantly improved local recurrence rate from 28% in surgery only group to 9% in postoperatively treated patients.

In a retrospective analysis of 150 incompletely resected NSCLC patients treated with adjuvant external beam radiotherapy 32 (21.3%) survived 3 years with no symptoms of disease. Ipsilateral mediastinal/hilar lymph node involvement and macroscopic incomplete surgery were the prognostic factors that unfavourably influenced survival in Cox's proportional hazards model. Postoperative external beam radiotherapy was the efficient adjuvant treatment method in microscopically incompletely resected NSCLC, predominantly with no nodes involvement, but had no benefit in those with macroscopic incomplete surgery.