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Copyright of Lithuanian Surgery / Lietuvos Chirurgija is the property of Vilnius University and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

The US inter group study INT 0116 in 2001 and UK NCRI MAGIC Trial in 2005 with better results of combined treatment of gastric cancer provoked a discussion which continues until now. We have experience in neoadjuvant treatment of gastric cancer since 1980, and our attitude towards it is reserved. Materials and methods. We present the data collected in our three studies. The first one was a randomized study of patients with stage III gastric cancer performed in 1980-1990. The results of neoadjuvant chemotherapy and surgery were compared with those of surgery alone. The second was a randomised study of patients with stage III gastric cancer, performed in 1996-1999 to assess the value of neoadjuvant chemotherapy. In our third study we analysed patients after radical surgical treatment in 1987-1996. Results. The period of recurrence and three-year survival was longer in the neoadjuvant chemotherapy group, while the 5-year survival showed no statistically significant difference in our first study. In our second study, the median survival of patients in the neoadjuvant chemotherapy group was 49.5 months and in group II (without chemotherapy) 50.5 months. The difference was not statistically significant (p > 0.05). In our third study we analysed patients after radical surgical treatment in 1987-1996. Stage III gastric cancer patients received adjuvant chemotherapy -- Mayo clinic regimen 5 FU/LV. The median survival was 43.2 months. Conclusions. The value of adjuvant treatment in the early stages of gastric cancer after R0 D2 surgery is disputable. Neoadjuvant chemotherapy should be used to achieve R0 surgery when resectability is impossible without it. [ABSTRACT FROM AUTHOR]

Copyright of Acta Medica Lituanica is the property of Vilnius University and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

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

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

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

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

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

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

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