[New trends in the surgical treatment of axilla in breast cancer]

Oncosurgical treatment of breast tumors involves the removal of metastatic axillary lymph nodes. In the last 30 years, the diagnosis and treatment of axillary lymph nodes have also undergone significant changes. The introduction of sentinel lymph node biopsy in 1993 made axillary block dissection with high morbidity safely omitted in a significant proportion of patients, and similarly, the staging of breast tumors and thus oncology and complex treatment became significantly more accurate. Shortly after the introduction of sentinel lymph node biopsy, intraoperative examination of sentinel lymph nodes (e.g. imprint cytology) also appeared, which significantly reduced the number of surgeries performed in the two sessions, thereby significantly reducing patient burden and surgical costs. The results of our study indicate that axillary block dissection is required in the treatment of axilla in an ever-decreasing group of patients and this proportion will decrease further in the future, with the increasing use of alternative axillary radiotherapy. The imprint cytological examination of sentinel lymph nodes taking into account current guidelines, no longer provides demonstrable benefits and its routine use is not justified. According to the latest international recommendations, intraoperative examination of the sentinel lymph node may be indicated in connection with mastectomy (when postoperative radiotherapy is not planned) and after neoadjuvant treatment. Our results suggest that the detection of suspected lymph nodes during preoperative axillary ultrasound may predict the stage of the disease. Based on our research results confirm that in patients receiving neoadjuvant therapy, in addition to the preoperative size of the tumour (≤20 mm, P = 0.002), the preoperative size of the lymph node (≤15 mm, P = 0.04) may also be used to predict that the stage of the disease is N0-1.

[Preoperative systemic treatment of locally and locoregionally advanced high-risk endometrial cancer]

Introduction: Endometrial cancer is the most common invasive gynecologic malignancy in developed countries. The best survival rates are expected after surgical removal, thus the aim of a complex treatment is to achieve resecability in locally and locoregionally advanced disease. Aim: The primary purpose of this study was to evaluate if the neoadjuvant systemic treatment leads to better overall survival compared to irradiation solely. Method: From January 2015 to December 2018, we enrolled 28 patients diagnosed with irresecable, locally and locoregionally advanced high-risk endometrial carcinoma. Patients were treated by neoadjuvant paclitaxel-carboplatin, then radical hysterectomy, bilateral oophorectomy and lymphadenectomy were performed. Results: After administration of 6 cycles of carboplatin-paclitaxel, the control MR test showed tumor shrinkage in all patients. Complete resection was achieved in the case of every patient. Tumor residuum in lymph nodes was verified in 4 cases by pathological evaluation. The 2-year survival and the 2-year progression-free survival rates were 65,1% and 66,1%, respectively. The median overall survival was 16,5 months. Conclusion: Neoadjuvant treatment can be an effective approach in providing the conditions for complete tumor resection, which may result in survival advantage. Despite multimodal treatment, prognosis is poor. Orv Hetil. 2020; 161(11): 425-433.

[Appleby procedure - an option for surgical treatment of pancreatic body tumour infiltrating the celiac axis]

CASE PRESENTATION

After neoadjuvant oncological therapy the surgical treatment of distal pancreatic tumour - infiltrating the celiac axis and the stomach - was reported. During the operation resection of the trunc, distal pancreatectomy, splenectomy, total gastrectomy, resection of the left adrenal gland and cholecystectomy were carried out. The patient's clinical course was uneventful, only transient alteration of liver functions was detected. Histological work-up revealed R1 resection, so adjuvant oncological therapy was decided.

DISCUSSION

Distal pancreatic tumours are frequently inoperable. Infiltration of the celiac axis was similarly considered, however there is a chance for radical operation by the resection of the trunc, when the pancreaticoduodenal arcade will provide the arterial blood supply to the liver. Based on the above case the operative technique and the relevant questions were discussed. In pancreatic tumour and arterial infiltration the preoperative chemotherapy is absolutely recommended, because there is a chance for radical surgery in case of good response.

[Changes in the clinicopathological features of surgically treated lung cancer around the millennium]

INTRODUCTION

Lung cancer is the most common malignant tumor in Europe and Hungary. In 2010, 10 557 new cases were registered in Hungary; 80-85% of these cases were associated with smoking.

AIM

In our work we analyzed the data of lung cancer patients of the last 15 years retrospectively.

METHOD

We examined the demographic characteristics, the histological type, the stage of the lung cancer, the type of the surgical procedure used, other supplemental treatment and survival retrospectively.

RESULTS

Lung cancer has occurred 50 per cent more often among females in the last decade. This growth is due to the increase of adenocarcinoma cases. Thanks to the improving diagnostic modalities and the routine follow-up of oncological patients, the number of I/A cases has been doubled recently and the preoperative staging and physical condition check-up have become more accurate. Neoadjuvant treatment has been introduced, the proportion of sublobar resections has risen, the ratio of pneumonectomy and sleeve lobectomy has become equal, so many previously unresectable cases turned to be resectable and the tolerance of adjuvant therapy has also improved. Videothoracoscopic lobectomy has become an everyday practice, leading to a decrease in the operative stress on patients.

CONCLUSION

In spite of this development, the five-year survival has not changed significantly, staying around 50%. Orv Hetil. 2018; 159(10): 391-396.

[Treatment results of patients with rectum tumor in a city hospital]

INTRODUCTION

Two hundred and three patients were operated on with rectal malignancy between 2007 and 2014 in our surgical department.

METHODS

Of these, patients who had cancer within 16 cm of the anal verge were included. 73 patients received neoadjuvant treatment and 130 patients were treated with primary resection. The specimens were graded by the Dworak and the Rödel regression score system.

RESULTS

We found strong response in 45 patients and pathologic complete remission in three patients. 5-years survival was compared in the two groups operated between 2007 and 2009. While the overall survival rates were just the same, we can report that response to neoadjuvant therapy is a strong predictor of disease free survival. The incidence of loco-regional recurrence was lower in patients who received neoadjuvant treatment compared to the ones who underwent primary resection. Postoperative complications, incidence of anastomotic leakage were also analysed. We did not find increase in the postoperative complications in the group of patients with neoadjuvant treatment.

[Neoadjuvant treatment as a limiting factor to rectal ultrasonography]

INTRODUCTION

Rectal ultrasonography is a basic method for staging rectal cancer. Tissue changes after neoadjuvant treatment alter the accuracy of the method.

AIM

The aim of the authors was to assess the accuracy of rectal ultrasonography after preoperative chemo-radiotherapy compared to the initial staging accuracy.

METHOD

Rectal ultrasounds performed between 2006 and 2014 were assessed retrospectively. Ultrasonographic and pathological T and N stages were compared both in case of initial staging (control group) and re-staging.

RESULTS

T staging was accurate in 70% in the control group and in 61% in re-staging. Rate of overstaging was 31% after neoadjuvant treatment. None of the ypT0 cases were identified. N staging accuracy was 64% in the control group and 61% in re-staging.

CONCLUSIONS

Neoadjuvant treatment impairs the accuracy of rectal ultrasound. The role of re-staging with rectal ultrasonography is debatable in the assessment of the efficacy of oncological treatment and surgical planning. Orv. Hetil., 2016, 157(30), 1193-1197.