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The aim of this study was to evaluate the short- and long-term results and risk factors of liver surgery in patients over the age of 70 following liver resection for colorectal liver metastases. A total of 650 patients with an average age of 63.8 ± 9.3 years were evaluated. We compared groups of patients younger and older than 70 years of age. Time of hospitalisation, 30-day postoperative morbidity and mortality, overall and recurrence-free survival, the number and largest diameter of metastases, small and large liver resections, and the interval between primary colorectal and liver surgery were evaluated according to the results of liver resections. Length of hospitalisation, 30-day postoperative morbidity and mortality, and long-term results did not differ between groups of patients. Pulmonary embolism and confusion had a higher incidence in patients ≥70 years old (p

Background In patients with colorectal liver metastases, the possibility for radical liver resection can be limited by oxaliplatin-induced sinusoidal obstruction syndrome (SOS). This study investigates the potential of mesenchymal stem cells (MSC) to improve the outcome of liver resections in pigs with SOS. Materials and methods SOS was induced in all animals (n=20) on day 0. Animals in the experimental group (n=8) received allogeneic MSC on day 7. Liver resection was performed in all animals on day 14 and the animals were observed until day 28. Ultrasound volumetry, biochemical analysis and histological examination of liver parenchyma was performed during the follow-up period. Results Six animals from the control group died prematurely, while all animals survived in the experimental group. According to histology, biochemical analysis and ultrasound volumetry, there were no significant differences between the groups documenting the effect of MSC. Conclusion Single dose allogeneic MSC administration improved survival of animals with SOS undergoing partial liver resection. Further experiments with different timing of liver resection and MSC administration should be performed to investigate the effect of MSC in more detail.

Background/Aim: Patients with unresectable liver colorectal cancer metastases are treated with neoadjuvant chemotherapy often accompanied by biological therapy aimed at reducing the mass of metastases and thus increasing the chances of resectability. Bevacizumab comprises an anti-VEGF (vascular endothelial growth factor) humanized IgG monoclonal antibody that is used for biological therapy purposes. It acts to inhibit angiogenesis, thereby slowing down the growth of metastases. Due to its being administered systematically, bevacizumab also exerts an effect on the surrounding healthy liver parenchyma and potentially limits the process of neovascularization and thus regeneration of the liver. Since the remnant liver volume forms an important factor in postoperative morbidity and mortality following a major hepatectomy, we decided to study the effect of bevacizumab on vascular and biliary microarchitecture in healthy liver parenchyma and its ability to regenerate following major hepatectomy. Materials and Methods: We performed an experiment employing a large animal model where a total of 16 piglets were divided into two groups (8 piglets in the control group and 8 piglets in the experimental group with bevacizumab). All the animals were subjected to major hepatectomy and the experimental group was given bevacizumab prior to hepatectomy. All the animals were sacrificed after 4 weeks. We performed biochemical analyses at regular time intervals during the follow-up period. Histological examination of the liver tissue was performed following sacrifice of the animals. Results: No statistical difference was shown between groups in terms of the biochemical and immunohistochemical parameters. The histological examination of the regenerating liver tissue revealed the higher length density of sinusoids in the experimental group. Conclusion: Bevacizumab does not act to impair liver regeneration following hepatectomy.

Simple Summary Clear cell renal cell carcinoma (CCRCC) is well known for intra-tumoral heterogeneity. However, there are limited data focusing on the inter-tumoral and inter-metastatic heterogeneity of CCRCC. In one study, primary and metastatic tumors were classified as clear cell type A or B subtypes, using nanostring expression technology. It was found that primary and metastatic tumors of CCRCC differed in nearly one half of patients. Approximately one quarter of metastatic tumors display inter-metastatic heterogeneity. Another study, using an immunohistochemical assay, found inter-metastatic tumor heterogeneity of BAP1 in only 1 of 32 patients (3%). Comparing gene expression across patient-matched primary-metastatic tumor pairs, 98% had concordant BAP1 status. We aimed to review published data and to examine mutation profile variability in primary and multiple pulmonary metastases (PMs) in our cohort of four patients with metastatic CCRCC. Abstract (1) Background: There are limited data concerning inter-tumoral and inter-metastatic heterogeneity in clear cell renal cell carcinoma (CCRCC). The aim of our study was to review published data and to examine mutation profile variability in primary and multiple pulmonary metastases (PMs) in our cohort of four patients with metastatic CCRCC. (2) Methods: Four patients were enrolled in this study. The clinical characteristics, types of surgeries, histopathologic results, immunohistochemical and genetic evaluations of corresponding primary tumor and PMs, and follow-up data were recorded. (3) Results: In our series, the most commonly mutated genes were those in the canonically dysregulated VHL pathway, which were detected in both primary tumors and corresponding metastasis. There were genetic profile differences between primary and metastatic tumors, as well as among particular metastases in one patient. (4) Conclusions: CCRCC shows heterogeneity between the primary tumor and its metastasis. Such mutational changes may be responsible for suboptimal treatment outcomes in targeted therapy settings.

AIM The aim of this study was to evaluate the utility of selected tumor markers for the detection of lung cancer recurrence during follow-up. PATIENTS AND METHODS The study group consisted of 109 patients and 109 healthy controls. The following biomarkers were selected: Carcinoembryonic antigen; cytokeratin fragment 19; neuron-specific enolase; tissue polypeptide-specific antigen; cytokeratin fragments 8, 18 and 19; insulin-like growth factor 1; pro-gastrin-releasing peptide; and 25-hydroxyvitamin D. The biomarkers were assessed individually or using a multivariate analysis. RESULTS Carcinoembryonic antigen [area under the receiver operating characteristics curve (AUC)=0.6857, p

Background/Aim: Anastomotic leakage is a feared complication in colorectal surgery. Postoperative peritoneal adhesions can also cause life-threatening conditions. Nanofibrous materials showed their pro-healing properties in various studies. The aim of the study was to evaluate the impact of double-layered nanofibrous materials on anastomotic healing and peritoneal adhesions formation. Materials and Methods: Two versions of double-layered materials from polycaprolactone and polyvinyl alcohol were applied on defective anastomosis on the small intestine of healthy pigs. The control group remained with uncovered defect. Tissue specimens were subjected to histological analysis and adhesion scoring after 3 weeks of observation. Results: The wound healing was inferior in the experimental groups, however, no anastomotic leakage was observed and the applied material always kept covering the defect. The extent of adhesions was larger in the experimental groups. Conclusion: Nanofibrous materials may prevent anastomotic leakage but delay healing.

Background/Aim: As the population ages, there are increasing findings of coincidental diseases such as abdominal aortic aneurysm (AAA) and intra-abdominal, retroperitoneal malignancy. The aim of this study was to propose an optimal treatment procedure for these patients. Patients and Methods: Over a twenty-year-period, surgery was performed on a total of 1,098 patients with AAA and 32 (2.9%) patients with AAA and intra-abdominal, retroperitoneal malignancy: 18 renal, 6 colorectal carcinomas, 3 carcinomas of the small intestine, 3 primary liver tumours, 1 stomach carcinoma and 1 teratoma. The median age of patients was 72.5 years, there were 20 men (62.5%) and 12 women (37.5%). A one-stage procedure was performed on 19 patients (59.4%), and a two-stage procedure on 13 (40.6%) patients. Results: The average time of hospitalization was 12.4±6.9 days (median=11.0 days) for one-stage procedure, for a two-stage procedure 21.3±9.3 days (median=20.0 days), p=0.0045. Seven patients (21.9%) died within 30 days after the operation. All the deaths were in the group of one-stage procedures (p=0.0252). The 1-, 3- and 5-year overall survival for patients following one-stage and two-stage procedures was 61.0/56.3/51.5% and 89.0/79.9/53.0% respectively (p=0.1199). Conclusion: Symptomatic disease must be resolved first. Two-stage procedures are the method of choice and offer better short-term results compared to one-stage procedures.

Background/Aim: Portal vein embolization (PVE) with autologous stem cells application (aHSC) is a method for future liver remnant volume (FLRV) increase. The aim of the study was to evaluate the positivite and negativite aspects of the method in clinical practice. Patients and Methods: PVE with aHSC application was used in 32 patients with colorectal liver metastases and insufficient FLRV. Preoperative number of colorectal liver metastases (CLMs) was 5.2±3.6, CLMs volume 70.1±102.3 mm(3). Results: FLRV growth occurred after 2-3 weeks in 31 (96.9%) patients, with volume increase from 528.2±170.5 to 715.4±143.3 ml (p=0.0001). Postoperative thirty days mortality, morbidity was 0% and 3.1%, respectively. Insufficient FLRV growth occurred in one patient. R0 liver resection was performed in 27(87.1%) patients. CLMs volume progression was in 5 (15.6%) patients from 680.0±59.4 to 723.1±57.1 ml (p=0.01). One and two-year overall survival were 88% and 62.9% respectively. Six and twelve-month recurrence-free survival rates were 50.7% and 39.6% respectively. Conclusion: PVE with aHSC application is a safe and useful method for FLRV growth. It significantly increases secondary CLMs resectability. However, it can cause CLMs progression. Liver resection should, therefore, be performed as soon as possible after achieving optimal increase of FLRV.

Background Accumulated endovascular aneurysm repair (EVAR) procedures will increase number of patients requiring conversion to open repair of abdominal aortic aneurysms (AAA). In most cases, patients undergo late open surgical conversion (LOSC), many months, or years, after initial EVAR. The aim of this study is to analyze results of LOSC after EVAR in elective and urgent setting, including presenting features, surgical techniques, as well as to review the clinical outcomes and their predictors. Methods Retrospective review of all consecutive patients undergoing LOSC after EVAR was performed at three distinct, high volume, vascular centers. Patients that required primary conversion within 30 days after EVAR have not been included in this study. Between January 1st 2010 and January 1st 2017 total of 31 consecutive patients were treated. LOSC were performed either in elective or in urgent setting, thus dividing patients in two groups. Primary outcome was 30-day mortality and secondary postoperative complications. Results LOSC rate after EVAR was 4.51%. Most common indication for LOSC was type I endoleak (N.=20, 64.51%). All patients that presented with ruptured AAA had some form of endoleak (type I endoleak was present in five from six cases). Most common site for aortic cross-clamping was infrarenal (51.61%). Stent-graft was removed completely in 18 patients (58.06%) and partially in 13 (41.93%). 30-day mortality rate was 16.12% (5 patients) and most common cause of death was myocardial infarction (60%). Following univariate factors were isolated as predictors for 30-day mortality: preoperative coronary artery disease, chronic obstructive pulmonary disease, urgent LOSC, prolonged time until LOSC, ruptured AAA, supraceliac clamp, higher number of red blood cell transfusion, postoperative myocardial infarction, and prolonged intubation (more than 48 hours). Conclusions LOSC seems to be safe and effective procedure when preformed in elective manner. On the other side, urgent LOSC after EVAR is associated with very high postoperative mortality and morbidity. Endoleak remains the main indication for open conversion. Further studies are necessary to standardize timing and treatment options for failing EVAR.

BACKGROUND Portal vein embolization (PVE) and PVE with autologous mesenchymal stem cell application (PVE-MSC) increases future liver remnant volume (FLRV). The aim of this study was to compare both methods from the aspect of FLRV growth, progression of colorectal liver metastases (CLM), CLM resectability and long-term results. PATIENTS AND METHODS Fifty-five patients with CLM and insufficient FLRV were included in the study. FLVR growth and CLM volume were evaluated using computed tomography. Liver resection was performed in patients with FLVR >30% of total liver volume. RESULTS In the PVE (N=27) group, FLRV growth was observed in 23 patients (85.2%) and in 100% of patients in the PVE-MSC (N=28) group (p

BACKGROUND/AIM Melanoma represents one of the most aggressive forms of cancer. With the rapid increases in the incidence of melanoma in the United States, Australia and Europe over the last decades, melanoma has been considered an epidemic cancer in these areas. The aim of our study was to evaluate the utility of osteoprotegerin (OPG), osteopontin (OPN), epidermal growth factor (EGF) and vascular endothelial growth factor VEGF for the diagnosis and prognosis of melanoma. PATIENTS AND METHODS Overall, 322 individuals were assessed: 183 melanoma patients and 139 healthy individuals. Melanoma patients were divided into four subgroups according to the Breslow score. OPN, OPG, EGF, and VEGF were determined in each plasma sample. RESULTS The serum levels of the following biomarkers were statistically significantly higher in the melanoma group compared to the control group: OPG and, OPN (p

BACKGROUND/AIM Tumour-infiltrating lymphocytes (TILs) and Granzyme B play crucial roles in immune reactions against colorectal carcinoma (CRCa). The inhibitor of Granzyme B is Serpin B9. The aim of this study was to evaluate the effect of immunohistological parameters of TILs on the prognosis of CRCa and presence of lymph node metastasis. PATIENTS AND METHODS A total of 152 patients who underwent surgery for CRCa were analyzed, including 63 patients in cohort stage II, according to the Union for International Cancer Control (UICC), and 89 patients in cohort UICC stage III. The TIL pattern was classified as peritumoural (PTL), intratumoural (ITL), intrastromal (ISL) or Crohn-like, and immunohistological staining of TIL and cancer cells was also performed. RESULTS A significantly higher density of CD8+ and CD4+ TILs was observed in the UICC II group, and significantly higher densities of CD4+ TILs were observed in the UICC II group in all distinguished patterns. In the same cohort, higher numbers of CD57+ cells and FoxP3+ TILs and Granzyme B levels were observed. In cohort UICC III, there was a higher density of ISL, PTL CD8+, CD25+ TILs and cancer cells showed staining for Serpin B9. CD57, Granzyme B and CD8 were demonstrated as positive prognostic factors of overall survival, and CD57 and CD4+ TILs were demonstrated as positive prognostic factors of recurrence. CONCLUSION TILs and CD57 are promising prognostic factors of CRCa. The association of Serpin B9 with lymph node metastasis reveals a potential mechanism for tumour resistance to immune reaction.

Aim The aim of this study was to evaluate the clinical contribution of protein induced by vitamin K absence (PIVKA-II) for hepatocellular carcinoma (HCC) diagnostics and compare it with alpha-foetoprotein (AFP), a routinely used tumour marker. Materials and methods A total of 332 participants were enrolled in this study: 64 with HCC, 48 with liver metastases of colorectal cancer origin, 42 with liver cirrhosis and 178 healthy individuals. Serum levels of PIVKA-II were measured using the chemiluminescent assay of the Architect 1000i System (Abbott, USA) and AFP levels using the chemiluminescent assay by DxI 800 (Beckman Coulter, USA). Results PIVKA-II achieved better clinical sensitivity than AFP and the difference in this sensitivity was statistically significant. PIVKA-II achieved the best sensitivity (96.9%) in distinguishing between the HCC and control groups with the proposed cut-off value of 60 mAU/ml. Conclusion Our recommendation is for addition of PIVKA-II to the routine panel of HCC tumour markers.

Background/aim Hepatic epithelioid haemangio-endothelioma (HEHE) is a very rare malignant tumor of vascular origin and uncertain biological behaviour that is difficult to diagnose using preoperative radiology diagnostic techniques. Patients and methods The authors present here two patients with HEHE of different extent. The first patient had a generalised form of disease, with involvement of the liver, lungs and bones and was treated with a combination of bevacizumab and capecitabine. The second patient had a localised form of disease involving the liver and this was resolved using a combination of liver resection and radiofrequency ablation. In both patients, the radiology work-up before surgery was non-specific and metastases of another malignant process were considered. The definitive histological diagnosis was made by the pathologist on the basis of immunohistochemical analysis that demonstrated the presence of CD31, CD34 and calmodulin-binding transcription activator 1 (CAMTA 1). Results Both patients remain in an overall good condition 27 and 5 months respectively following treatment for HEHE. Conclusion Preoperative radiological diagnosis of HEHE is difficult and immunohistochemical examination of the tumor tissue sample remains the key diagnostic tool. Radical surgical resection or liver transplantation is the method of choice in patients with localised liver involvement.

Ultrasound and CT angiography are common diagnostic methods of abdominal aortic pathologies. In the last decade, hybrid methods (PET/CT, PET/MRI) have become more common in this diagnostic algorithm. Originally they were indicated in malignancies or inflammatory processes. Currently, efforts are developed to visualize possible local inflammatory activity in the aortic wall and thus to assess a certain#8220;disease activity#8221; with the goal to anticipate further development of aortic pathology. The aim of our study was to analyze potential benefits of hybrid methods in predicting abdominal aortic pathology progression.In this prospective, open-label, observational study we examined 75 patients referred to PET/CT (N=61) or PET/MRI (N=14) due to any aortic pathology in 2015-2017. The patients included those with abdominal aortic aneurysm (AAA) (N=48; 64%), aortitis (N=5; 6.7%), aortic dissection (N=4; 5.3%), patients undergoing EVAR (N=6; 8%), patients with excessive atherosclerosis (N=7; 9.3%), patients with concomitant AAA and retroperitoneal fibrosis (N=4; 5.3%) and patient with an intramural hematoma (N=1; 1.3%). The minimum follow-up period was 6 months (0.5-2.5 years). Clinical symptoms, aortic diameter, growth rate and CRP levels were analyzed during the follow-up and correlation with PET/CT or PET/MRI findings was evaluated.Increased metabolic activity in the aorta was found in 25 of the 75 examined patients (33.3%). Based on statistical analysis there were no associations between increased activity based on PET/CT or PET/MRI in the aortic wall and disease symptoms or progression.Our results provide no evidence that hybrid methods can predict further development of pathological findings in the abdominal aorta. PET/CT- or PET/MRI-based activity did not correlate with disease symptoms, AAA progression rate or dissection, either. Our results are also supported by some recent literature data.

Background: In clinical medicine, little is known about the use of allografts for portal vein (PV) reconstruction after pancreaticoduodenectomy (PD). Portal and caval systems are physiologically different, therefore the properties of allografts from caval and portal systems were studied here in a pig model. Materials and Methods: PD with PV reconstruction with allogeneic venous graft from PV or inferior vena cava (IVC) was performed in 26 pigs. Biochemical analysis and ultrasonography measurements were performed during a 4-week monitoring period. Computer simulations were used to evaluate haemodynamics in reconstructed PV and explanted allografts were histologically examined. Results: The native PV and IVC grafts varied in histological structure but were able to adapt morphologically after transplantation. Computer simulation suggested PV grafts to be more susceptible to thrombosis development. Thrombosis of reconstructed PV occurred in four out of five cases in PV group. Conclusion: This study supports the use of allografts from caval system for PV reconstruction in clinical medicine when needed.

BACKGROUND/AIM Treatment of colorectal cancer (CRC) does not reflect immune interactions between tumours and macro-organisms. Serpin B9 is known as an inhibitor of Granzyme B. The aim of this study was to evaluate the impact of the expression of Serpin B9 in CRC and healthy colon tissue on prognosis. PATIENTS AND METHODS This retrospective study included 74 CRC patients in all stages. Analysis of gene expression was performed with quantitative polymerase chain reaction with reverse transcription using specific primers and master mix Xceed qPCR SG. Expression was normalized to the reference genes GAPDH, ACTB, and PSMC. RESULTS Increased expression of Serpin B9 in healthy tissue was significantly associated with longer overall survival (OS). This association was found both in all patients and in the group of patients with distant metastases. CONCLUSION The presented results support previous evidence of positive influence of the interaction between immune system and tumour on the prognosis of CRC.

The aim of the study was to evaluate the ability of following biomarkers as diagnostic tools and risk predictors of AAA: C-reactive protein, interleukin-6, pentraxin-3, galectin-3, procollagen type III N-terminal peptide, C-terminal telopeptide of type I collagen, high-sensitive troponin I, and brain natriuretic peptide. Seventy-two patients with an AAA and 100 healthy individuals were enrolled into the study. We assessed individual biomarker performance and correlation between the AAA diameter and biomarker levels, and also, a multivariate logistic regression was used to design a possible predictive model of AAA growth and rupture risk. We identified following four parameters with the highest potential to find a useful place in AAA diagnostics: galectin-3, pentraxin-3, interleukin-6, and C-terminal telopeptide of type I. The best biomarkers in our evaluation (galectin-3 and pentraxin-3) were AAA diameter-independent. With the high AUC and AAA diameter correlation, the high-sensitive troponin I can be used as an independent prognostic biomarker of the upcoming heart complications in AAA patients. Authors recommend to add biomarkers as additional parameters to the current AAA patient management. Main addition value of biomarkers is in the assessment of the AAA with the smaller diameter. Elevated biomarkers can change the treatment decision, which would be done only based on AAA diameter size. The best way how to manage the AAA patients is to create a reliable predictive model of AAA growth and rupture risk. A created multiparameter model gives very promising results with the significantly higher efficiency compared with the use of the individual biomarkers.

Background/aims Liver cystadenomas are rare conditions accounting to approximately 5% of all cystic lesions. The aim of our study was to establish a new diagnostic and complex therapeutic approach. Materials and methods In all, 12 female patients primarily diagnosed with cystadenoma of the liver were evaluated. Enucleation of the cystadenoma was performed in six (54.5%) and liver resection in four (33.3%) patients. Due to the localization, complete enucleation or radical liver resection could not be performed in two patients. Results In three patients, grade III-a complications were recorded after surgery. The 30-day mortality was 0%. The length of hospitalization was 27 (7-52) days. Malignant transformation occurred in two patients with incomplete removal of the cystadenoma. In both cases, carbohydrate antigen 19-9 serum levels were elevated during the follow-up period. The first patient died 28 months after primary surgery. The second patient failed to attend any further appointments. The remaining patients are in the good conditions, with no signs of recurrence. Conclusion The only possible treatment of cystadenomas is their radical surgical removal. Any other incomplete surgical treatment is insufficient and associated with a high risk of malignant transformation. For patients in whom R0 resection or complete enucleation cannot be performed for technical reasons, liver transplantation should be considered.

BACKGROUND/AIM The results of surgical treatment of breast cancer liver metastases (BCLM) remain suboptimal. The search for perioperative prognostic factors could help determine high risk groups of patients. The aim of study was to evaluate the significance of tumour markers (TM) on long-term treatment results. PATIENTS AND METHODS Liver surgery was carried out in 32 women for BCLM. The perioperative serum levels of CEA, CA19-9, TPA, TPS, CYFRA 21-1 and TK were determined. RESULTS Preoperative levels of CA19-9 were significant for overall survival (OS)(p

AIM The aim of this study was to evaluate the ability of tissue polypeptide-specific antigen (TPS), carcinoembryonic antigen (CEA), and cancer antigen 15-3 (CA 15-3) to predict relapse in breast cancer patients, when the measurement of biomarkers is performed within 6 months after surgery. PATIENTS AND METHODS Four hundred and seventy-two patients with breast cancer were evaluated. TPS, CEA, and CA 15-3 were measured in months 1, 3, and 6, after surgery. Disease recurrence was recorded between 7-12 months after surgery. Disease recurrence occurred in 60 patients, while 412 patients remained in recurrence-free status. RESULTS TPS levels of the recurrence group differed statistically significantly in the first and sixth month after surgery compared to recurrence-free group (p=0.0339, AUC=0.6056; p

Concerns regarding postoperative complications following liver resection for colorectal liver metastases (CLMs) in elderly patients may lead to preference for conservative therapy. The aim of this study was to evaluate the role of patient age in the development of postoperative complications.Surgical complications were evaluated in 712 patients who underwent surgery for CLMs over the past 13 years. Seventy-two patients (10.1%) were aged ≥75 years and 640 (89.9%)75 years. The significance of the type of liver resection, preoperative American Society of Anesthesiologists classification (ASA), Child-Pugh classification,body mass index, quality of liver tissue and preoperative oncological treatment for the development of postoperative complications were evaluated.We did not find any difference in the incidence of early postoperative complications between the two groups of patients. A preoperative ASA score of 3.4 (p0.001) was the principal factor for developing postoperative complications in patients aged ≥75 years. Postoperative complications in patients with an ASA score of 3.4 were more frequent when the body mass index was26 kg/mPatient age does not represent a contraindication to liver resection for CLMs. An ASA score of 3 or 4 and a body mass index26 kg/m

Background: Radiofrequency thermal ablation (RFA) is a minimally invasive, image guided technique for destroying tumour cells without damage to adjacent healthy tissue. It is used for partial or complete ablation of non resectable lung cancers and cancers of metastases to lung, providing an effective, relatively safe option for patients ineligible for surgery. We describe our experience with it. Methods: In 2005 and 2006, we performed radiofrequency ablation of 7 lung lesions in 6 patients. RFA was done percutaneously under image guided CT scan in 5 patients and in one patient during thoracotomy when we found a radically unresectable tumor necessitating debulking. CT lung screening was performed after 6 months and PET/CT was done within 12 months. Results: In the course of the screening, we diagnosed regression in 2 patients, a stationary state in 2 cases and local tumor progression in 2 patients, using computed tomography within 6 months after RFA. Using PET/CT within 12 months, we diagnosed non-ablation and liver metastases (there were none before) in one of the two patients with a stationary state diagnosed by means of CT before and recurrence of primary tumor in another patient. In one case of diagnosed regression, we diagnosed tumor progression. The patients survived an average of 30 months (range 9 to 60 months). Conclusion: RFA of lung tumors is an easy method with little patient discomfort. It can be performed percutaneously using guided CT under general anaesthesia. RFA of lung tumors possibly alone or in combination with oncology treatment can prolong patient life.

Introduction: In spite of the progress in diagnosis and therapeutic options, esophageal perforation resulting in me- diastinitis is a very serious condition with a high morbidity. Aim: To evaluate the use of esophageal stents for the treatment of patients suffering from mediastinitis. Material and methods: Retrospective (2008-2012) analysis of a group of patients requiring surgical treatment. The evaluation was focused on the cause of perforation, stent type and its parameters, the surgical method used, duration of stenting and total length of treatment. Results: In total, 16 patients were treated by stenting. All patients were treated with the stent being placed across the defect in the esophagus. Mediastinitis was accessed and drained with the aid of a thoracotomy or thoracolaparotomy (8 cases), or using a combination of a laparotomy/laparostomy and pleural drainage (5 cases). The most basic interventions were either pleural or external cervical drainage (3 and 1 cases, respectively). One patient, in whom a stricture had devel- oped at the healed perforation, was subjected to esophageal resection. Four patients died. The average period that the stent was left in situ was 53.7 days. The average period of hospitalization of those patients who survived was 53.4 days. Conclusions: Using stents in therapy neither increased survival (mortality of 25%), nor decreased the length of ther- apy of patients once mediastinitis had developed. The main advantage of stenting is the preservation of the native esophagus and the reduced extent of surgical mediastinal drainage.

The current survival of patients with breast cancer liver metastases (BCLM) after systemic oncological treatment is between 22 to 27 months [1, 2]. The proper indication for surgical treatment of BCLM is still a matter of discussion [3, 4]. We evaluated the risk factors of surgical treatment of BCLM in 21 women with an average age of 50.9 ±8.9 years. The interval between the breast and the liver surgery was 4.0 ±2.8 years. Local recurrence was observed in 6 (28.6%) patients. The primary tumour was a ductal carcinoma in 12 (57.1%) cases, a lobular carcinoma in 6 (28.6%) cases and another type in 3 (14.3%) cases. The primary tumour was oestrogen receptor positive in 14 (66.7%) cases, and progesterone receptor positive in 10 (47.6%) cases. Both receptor types were positive in 15 (71.4%) and both were negative in 2 (9.5%) patients. Fourteen patients had a solitary BCLM, and 7 patients had more metastases. The average sum of BCLM diameters was 5.2 ±3.8 cm. Extra-hepatic metastases were present in 6 (28.6%) patients. We performed 11 (52.4%) liver resections and 10 (47.6%) radiofrequency ablations (RFA). In 3 patients, a lymphadenectomy of the hepato-duodenal ligament, because of the presence of positive lymph nodes, was performed. We studied the effects of patients’ age, time interval between the breast cancer and BCLM surgery, the type of surgical procedure, histopathological findings of the primary tumour, the number and overall diameter of BCLM, the presence of resectable extra-hepatic metastases, and local tumour recurrence after primary breast cancer surgery on patients’ overall (OS) and progression-free survival (PFS). The 1-, 3- and 5-year OS for patients treated with resection or RFA was 89.6, 85.7 and 14.3%; and 79.6, 45.5 and 11.4%, respectively (NS). Younger patients (< 50) were at greater risk in terms of both OS (HR = 4.163, 95% CI: 1.146–15.118, and p < 0.02) and PFS (HR = 4.303, 95% CI: 1.056–17.531, and p < 0.01). An interval ≥ 4 years between the primary procedure and BCLM surgery had a protective effect in terms of OS (HR = 4.738, 95% CI: 1.287–17.441, and p < 0.01) and PFS (HR = 5.088, 95% CI: 1.496–17.303, and p < 0.005). Negative status of ER and PR in the primary tumour was a negative factor for PFS (HR = 21.475, 95% CI: 1.907–241.843, and p < 0.0003). The presence of extra-hepatic surgically resectable metastases had a negative impact on OS (HR = 5.078, 95% CI: 1.437–17.949, and p < 0.005). If the overall diameter of the BCLM was ≥ 3.5 cm, then PFS was significantly worse (HR = 9.999, 95% CI: 1.257–79.513, and p < 0.009). The other studied factors did not have any impact on OS or PFS (Table I). Table I Patients characteristic and prognostic factors The surgical treatment of BCLM remains the method of choice in a selected group of patients. The short time interval between the breast and BCLM surgery, presence of extra-hepatic metastases, an overall large BCLM diameter, especially in younger patients, and negative status for both hormone receptors represent significant risk factors, and in such cases the decision to proceed with surgical treatment of BCLM should be weighed on an individual basis by a multi-disciplinary team.

Introduction Portal vein embolization (PVE) may increase the resectability of liver metastases. However, the problem of PVE is insufficient growth of the liver or tumor progression in some patients. The aim of this study was to evaluate the significance of commonly available clinical factors for the result of PVE. Material and methods Portal vein embolization was performed in 38 patients with colorectal liver metastases. Effects of age, gender, time between PVE and liver resection, oncological therapy after PVE, indocyanine green retention rate test, synchronous, metachronous and extrahepatic metastases, liver volume before and after PVE, increase of liver volume after PVE and the quality of liver parenchyma before PVE on the result of PVE were evaluated. Results Liver resection was performed in 23 (62.2%) patients within 1.3 ±0.4 months after PVE. Tumor progression occurred in 9 (23.7%) patients and 6 (15.8%) patients had insufficient liver hypertrophy. Significant clinical factors of PVE failure were number of liver metastases (cut-off – 4; odds ratio – 4.7; p < 0.03), liver volume after PVE (cut-off 1000 cm3; odds ratio – 5.1; p < 0.02), growth of liver volume after PVE (cut-off 150 cm3; odds ratio – 18.7; p < 0.002), oncological therapy administered concomitantly with PVE (p < 0.003). Conclusions Negative clinical factors of resectability of colorectal cancer liver metastases after PVE included more than four liver metastases, liver volume after PVE < 1000 cm3, growth of the contralateral lobe by less than 150 cm3 and concurrent oncological therapy.

Aortic graft infections (AGI) are serious complications of open and endovascular types of surgery with an incidence rate of 0.6-3 %. AGI are associated with 30-60 % perioperative mortality and 40-60 % morbidity rate with limb amputation rates between 10 % and 40 %. The economic cost of AGI is substantial. At the time of aortic reconstruction, almost 90 % of patients have one or more predisposing factors for AGI. The diagnosis is based on clinical symptomatology, laboratory markers, microbial cultures, and imaging modalities. The general principle of surgical treatment lies in the removal of infected graft, debridement of infected periprosthetic tissues, and vascular reconstruction by in situ or extra-anatomic bypass with long-term antibiotic therapy. The conservative treatment is used only for selected patients with endograft infection. This review summarizes the current knowledge about the incidence, predisposing factors, etiology, diagnosis, treatment options, and prevention of aortic vascular graft and endograft infections. With the growing number of endovascular procedures we can expect more cases of infected aortic endografts in patients with severe comorbidities in the near future, where the recent radical surgical approach (graft excision, debridement, and new revascularization) cannot be used. Therefore the less invasive, sophisticated and individualized treatment strategies will have to be used in search of the best therapeutic approach to each specific patient (Fig. 4, Ref. 82).

The aim of the study was to assess the degree to which tissue polypeptide antigen (TPA) and tissue polypeptide-specific antigen (TPS), as well as carcinoembryonic antigen (CEA), can assist in the detection of distant metastases.We assessed 157 patients with colorectal and breast cancer divided into two groups. The first was a group of patients with cancer at stages 1, 2 and 3; the second was a group of patients with cancer at stage 4 with metastasis.We found significantly higher levels of all biomarkers in the metastatic group compared to the group with cancer at stages 1-3 (p0.0001). The calculated area under the receiver operating characteristic (ROC) curve was 0.9929 for TPS, 0.9337 for TPA and 0.7234 for CEA. The cut-off was calculated for each biomarker at 95% specificity, TPS cut-off=255 IU/l (sensitivity 95%), TPA cut-off=200 IU/l (sensitivity 70%) and CEA cut-off=18 μg/l (sensitivity 37%).We suggest combining CEA with TPS or TPA in the detection of distant metastases or using only cytokeratins. This approach can significantly increase the quality of detection of the metastatic process.

MicroRNAs have the potential to become valuable predictive markers for gastric cancer. Samples of biopsy tissue, routinely taken from gastric cancer patients undergoing palliative chemotherapy, constitute suitable material for microRNA profiling with the aim of predicting the effect of chemotherapy. Our study group consisted of 54 patients, all of whom underwent palliative chemotherapy based on 5-fluorouracil (5-FU) or 5-FU in combination with platinum derivatives between 2000 and 2013. The expression of 29 selected microRNAs and genes BRCA1, ERCC1, RRM1 and TS, in gastric cancer tissue macrodissected from FFPE tissue samples, was measured by quantitative RT-PCR. The relationship between gene expression levels and time to progression (TTP) and overall survival (OS) was analysed. From the set of the 29 microRNAs of interest, we found high expression of miR-150, miR-342-3p, miR-181b, miR-221, miR-224 and low levels of miR-520h relate to shorter TTP. High levels of miR-150, miR-192, miR-224, miR-375 and miR-342-3p related to shorter OS. In routinely available FFPE tissue samples, we found 6 miRNAs with a relation to TTP, which may serve as predictors of the effectiveness of palliative treatment in gastric cancer patients. These miRNAs could also help in deciding whether to indicate palliative chemotherapy.

The first aim of this study was to search for new biomarkers to be used in gastric cancer diagnostics. The second aim was to verify the findings presented in literature on a sample of the local population and investigate the risk of gastric cancer in that population using a multivariant statistical analysis.We assessed a group of 36 patients with gastric cancer and 69 healthy individuals. We determined carcinoembryonic antigen, cancer antigen 19-9, cancer antigen 72-4, matrix metalloproteinases (-1, -2, -7, -8 and -9), osteoprotegerin, osteopontin, prothrombin induced by vitamin K absence-II, pepsinogen I, pepsinogen II, gastrin and Helicobacter pylori for each sample.The multivariate stepwise logistic regression identified the following biomarkers as the best gastric cancer predictors: CEA, CA72-4, pepsinogen I, Helicobacter pylori presence and MMP7.CEA and CA72-4 remain the best markers for gastric cancer diagnostics. We suggest a mathematical model for the assessment of risk of gastric cancer.

Worldwide, colorectal cancer (CRC) is the third most common cancer, with the highest mortality rates occurring in Central Europe. The use of chemotherapy to treat CRC is limited by the inter-individual variability in drug response and the development of cancer cell resistance. ATP-binding cassette (ABC) transporters play a crucial role in the development of resistance by the efflux of anticancer agents outside of cancer cells. The aim of this study was to explore transcript levels of all human ABCs in tumours and non-neoplastic control tissues from CRC patients collected before the first line of treatment by 5-fluorouracil (5-FU)-containing regimen. The prognostic potential of ABCs was evaluated by the correlation of transcript levels with clinical factors. Relations between transcript levels of ABCs in tumours and chemotherapy efficacy were also addressed. The transcript profile of all known human ABCs was assessed using real-time polymerase chain reaction with a relative standard curve. The majority of the studied ABCs were down-regulated or unchanged between tumours and control tissues. ABCA12, ABCA13, ABCB6, ABCC1, ABCC2 and ABCE1 were up-regulated in tumours versus control tissues. Transcript levels of ABCA12, ABCC7 and ABCC8 increased in direction from colon to rectum. Additionally, transcript levels of ABCB9, ABCB11, ABCG5 and ABCG8 followed the reverse significant trend, i.e. a decrease in direction from colon to rectum. The transcript level of ABCC10 in tumours correlated with the grade (P = 0.01). Transcript levels of ABCC6, ABCC11, ABCF1 and ABCF2 were significantly lower in non-responders to palliative chemotherapy in comparison with responders. The disease-free interval of patients treated by adjuvant chemotherapy was significantly shorter in patients with low transcript levels of ABCA7, ABCA13, ABCB4, ABCC11 and ABCD4. In conclusion, ABCC11 may be a promising candidate marker for a validation study on 5-FU therapy outcome.

Liver metastases occur in 60-80% of patients with colorectal carcinoma. The only potentially curative method is surgical resection, with an operability of 20-25%. The main reason for such low resectability is insufficient future liver remnant volume (FLRV). Portal vein embolization (PVE) alone is associated with failure in up to 40% of patients. A new method that could lead to acceleration of FRLV growth appears to be combination of PVE and application of hematopoietic stem cells (HSCs). The aim of our study was to evaluate the importance of growth factors and interleukins for FLRV growth after PVE and HSC application and also their possible effect on growth of colorectal liver metastases.From June 2010 to July 2014, PVE was combined with application of adult HSCs in 16 primarily inoperable patients with colorectal liver metastases. We determined the serum levels of growth factors [hepatocyte growth factor (HGF), vascular endothelial growth factor (VEGF), insulin-like growth factor 1 (IGF-1), insulin-like growth factor binging protein 3 (IGF-BP3), epidermal growth factor (EGF), transforming growth factor (TGFα), tumor necrosis factor (TNF)] and interleukins (IL2, -6, -8 and -10) at given time intervals by immunoanalytic methods. The growth of FLRV was evaluated by multidetector computed tomography at intervals of 1 week until sufficient growth of FLRV.We were able to perform radical surgery in 13 primarily inoperable patients (81.4%). The average FLRV growth was 23.1% (range=21.9-38.6%); from an initial FLRV of 30.5% (range=20.6-39%) to 40.1% (range=29-48%) before resection. The combination of levels of EGF, HGF, VEGF, IGF, TGFα and IL2,-6,-8 appears to be crucial for predicting operability. IL8 was statistically significant for the growth of colorectal liver metastases, and TGFα, IL2, and IL8 are important for a longer disease-free interval.

Background Breast cancer liver metastases (BCLM) are often considered as a sign of a systemic disease with little hope of therapeutic success. The aim of study was to assess the possibilities and determine the limits of the surgical treatment of BCLM. Method: 646 patients were operated for malignant and benign lesions of the liver between 1999 and 2010. Liver surgery for BCLM was performed in 21 women of the average age of 48.5 years (33-71). The average time from the primary surgery for breast cancer till BCLM diagnosis was 4.7 years (2 months - 9 years). BCLM were solitary in 17 and in four cases multiple. Patient selection for liver surgery was based on sufficient future remnant liver volume, the absence of systemic non-resectable tumor dissemination and response to chemotherapy. The authors performed six right-sided hepatectomy, four segmentectomies, three left lobectomies, one metastasectomy, six radiofrequency ablations (RFA), one combined procedure -liver resection and RFA. Histological examination revealed ductal carcinoma in fourteen and lobular carcinoma in seven cases. All patients were treated with the curative adjuvant chemotherapy after surgery. The data were statistically evaluated by statistical software Statistica 9.0. Results: 30 - days mortality rate was 0%. One patient had a complicated hepatectomy with iatrogenic bile duct injury. According to statistical analysis the probability of patients survival twelve, resp. thirty months after surgery was 100, resp. 66.7% and the probability of the tumor relapse anywhere in the body was at the same time intervals 0, resp. 71. 5%. Conclusion: Liver surgery combined with the adjuvant chemotherapy are a therapeutic methods of choice for highly selected patients with metastases limited to the liver and objective response to neoadjuvant chemotherapy. The study was supported by the research projects IGA MZ NS 9727 and IGA MZ NS 102 40. Citation Information: Cancer Res 2011;71(24 Suppl):Abstract nr P2-15-06.