LAPAROSCOPIC APPENDECTOMY DOES NOT INCREASE THE RATE OF NEGATIVE APPENDECTOMY along with a lower rate of perforated appendicitis - RESULTS IN 1899 PATIENTS at Zagreb UHC

SUMMARY – Laparoscopic appendectomy is the method of choice of many professional societies owing to its many advantages. The question arises whether surgeons urge more easily to laparoscopic exploration due to its less invasiveness, faster recovery and adequate exploration of the entire abdominal cavity than to observation in unequivocal cases. This retrospective analysis (2009-2016) included 1899 patients undergoing laparoscopic (lap) or gridiron intra-abdominal approach treated at Zagreb University Hospital Centre. The analysis included total negative appendectomy, negative-negative appendectomy (normal appendix and no other pathology found), and negative-positive appendectomy (normal appendix but another pathology found) in children (≤16 years) and adults. There was no statistically significant difference in the rates of negative appendectomy (children) – lap vs. open (p=0.24); negative appendectomy (adults) – lap vs. open (p=0.15); negative-negative appendectomy (children) – lap vs. open (p=0.36); negative-negative appendectomy (adults) – lap vs. open (p=0.21); negative-positive appendectomy (children) – lap vs. open (p=0.53); negative-positive appendectomy (adults) – lap vs. open (p=0.56); and laparoscopy group negative appendectomy in children vs. adults (p=0.56). There was a statistically significantly higher perforation rate with the open approach in total (p<0.0001), in children (p<0.0001) and in adults (p=0.02). There was no statistically significant difference between adults and children in the perforation rate with laparoscopic approach (p=0.24) and perforation rate with open approach (p=0.29). Results confirmed that there was no statistically significant difference in the rate of negative appendectomy in all subgroups. It is concluded that laparoscopic appendectomy should be offered as the method of choice in any patient population with suspicion of acute appendicitis.

[CANCER PATIENTS FOLLOW-UP – CROATIAN SOCIETY FOR MEDICAL ONCOLOGY CLINICAL GUIDELINES Part IV: planocellular head and neck cancer, oesophageal cancer, gastric cancer, colorectal cancer]

Treatment of oncological patients must be based upon multidisciplinary approach, and takes place in specialized oncological centers. By the end of a specific oncological treatment further follow-up is being managed mostly by the oncologists, but the role of the general practitioners becomes more important every day and therefore should be precisely defined. Nowadays, most of the existing follow-up guidelines are not being based on prospective studies, yet on the expert’s opinion of a precise oncological center or specialists. The aim of the Croatian Society of Medical Oncology (CSMO) with these recommendations is to standardize and rationalize the diagnostic procedures’ algorithm in follow–up of oncological patients after primary treatment, in patients with planocellular head and neck cancer, oesophageal cancer, gastric cancer and colorectal cancer.

[CANCER PATIENTS FOLLOW-UP – CROATIAN SOCIETY OF MEDICAL ONCOLOGY CLINICAL GUIDELINES Part III: neuroendocrine neoplasms, hepatocellular carcinoma, pancreatic cancer, cancer of the bile ducts]

The treatment of oncological patients must be based upon multidisciplinary approach, and takes place in specialized oncological centers. By the end of a specific oncological treatment further follow-up is being managed mostly by the oncologists, but the role of the general practitioners becomes more important every day and therefore should be precisely defined. Nowadays, most of the existing follow-up guidelines are not based on prospective studies, but on the experts opinion of individual oncological centers or specialists. The aim of the Croatian Society of Medical Oncology (CSMO) with these recommendations is to standardize and rationalize the diagnostic procedures algorithm in the follow-up of oncological patients after primary treatment, in patients with neuroendocrine neoplasms, hepatocellular carcinoma, pancreatic cancer and cancer of the bile ducts.

[First synchronous liver resection as a part of cytoreductive surgery, peritonectomy and HIPEC in Croatia--case report]

We present a case of a 37-year-old female, with large adenocarcinoma of transverse colon, and metastases in spleen, liver, peritoneum, greater omentum, gall bladder and right adnexa. She was transferred to our Hospital, and extensive elective cytoreductive surgery with intraabdominal hyperthermal chemotherapy (HIPEC) was performed. Couple of months later, she was operated on for a newly evidenced secondary nodus in liver segment VII, and metastasectomy was performed. Throughout entire postoperative period she was receiving cyclic chemotherapy. At this point, 2 years from the first operation, she was without evidenced recurrence of the disease. Aggressive cytoreductive surgery with multiorgan resection, peritonectomy, HIPEC and adjuvant chemotherapy which was proved to be a feasible option in some patients, with synchronous liver resection (LR) proved to be feasible and beneficial for patients with three or fewer liver metastases. This is the first liver resection included in usually performed cytoreductive surgery and HIPEC in Croatia.