Rusev P., Belev N., Djarov G.

MBAL- Eurohospital, Plovdiv

Epithelial ovarian cancer ( EOC ) is the fifth most common type of cancer among women. Ovarian carcinoma ( OC ) at an early stage has a high survival rate with surgery and chemotherapy , but 75% of patients had tumor exceeding the level of the pelvis (FIGO- stage III-IV) and long-term survival is low. Advanced OC is treated with a combination of cytoreductive surgery ( MDGs) and chemotherapy which offers improved survival . Purpose of surgery in these cases is to obtain a macroscopic tumor resection (complete cytoreduction ) of bolestta.Natsionalniya Cancer Institute US NOI ) gives a recommendation in 2006 stating that the intraperitoneal (IP) chemotherapy should be added to the treatment algorithm for patients with optimal cytoreduction . Despite the advantage of this approach IP chemotherapy has not become routine practice due to: greater toxicity , lack of experience in the placement and management of permanent catheter in difficulty distribution of drugs throughout the peritoneal cavity due to adhesions and anatomic retsesusi . In recent years , the maximum cytoreductive surgery combined with hyperthermic intraperitoneal chemotherapy ( HIHT ) has proven effective in the treatment of colorectal carcinomatosis and has adopted a standard for its treatment countries such as Germany , Italy, Spain and France. The procedure takes advantage of the benefits of local therapy and the synergistic effect of hyperthermia and increased concentration of cytostatic medikamenti.Naskoro results were published in the treatment advanced epithelial ovarian cancer with the MDGs and HIHT showing significant advantage when adding HIHT. The purpose of this presentation is to analyze the data available at the time and to perform basic principles that underpin HIHT.

Belev N., Atanasov B., Rusev P., Popov Sht., Krustev P.

MBAL- Eurohospital, Plovdiv

Intro.

Total mesorectal excision ( TME ) is a model of modern surgery leading to a small percentage of local recurrence and a better survival rate in patients with rectal cancer . For colon cancer benefits of laparoscopic surgery are categorically proven. It leads to faster vazstanovavane, less post-operative complications, better cosmetic results, in the same long-term survival. Laparoscopic rectal surgery generate similar benefits taking into account the short-term results. CLASSIC study showed more frequent involvement tsirkumferentsialniya margin, and sexual dysfunction in men after laparoscopic TME in the same oncological long-term results comparing open with laparoscopic TME. Currently we have a moderate level of proof for equal survival after laparoscopic TME and TME open. Due to some peculiarities in the design of seshtestvuvashtite studies and the fact that some results could be changed by current and further research this issue remains topical. To achieve uniform possible better results oncology neobhdimo is mandatory standardization of TME in an open , laparoscopic and robotic surgery

Material and Method:

For the period 03.2012-03.2015 in Ho MBAL of Eurohospital committed 197 surgical interventions on the occasion of rectal cancer. 118 (59 %) of them were operated by open method , and 79 (40%) patients have undergone laparoscopic interventions 77 (39 %) patients were operated on the occasion of distal rectal cancer after neoadjuvant treatment. In all open rectal operations was carried standardized TME . Protocol for standardization of laparoscopic TME work of 05. 2013.

Results:

We found involvement tsirkumferentsialniya margin at 3 patients with open patient group and in one patient with lapaparoskopic operation Distal resection edge is affected in two patients operated laparoscopically in R1 version and in one patient operated under the open method. LTME is characterized by better visualization when performing and less blood loss ( 160 ml against 250 ml ) , a longer duration of surgery, especially in men with distal rectal cancer is not detected more often affected sexual function after laparoscopic surgery.

Conclusion:

Laparoscopic TME is a safe and effective procedure performed by a team with a complete learning curve. Characterized by better perioperative outcomes in oncology same soundness comparing it with open TME. Standardization of laparoscopic TME can be a good kachestvota the operation, to improve results.

Belev N., Rusev P., Djarov G., Shopov N., Slavchev M., kolarov Hr.

MBAL- Eurohospital, Plovdiv, nikbel.vm@gmail.com

Intro: Peritoneal carcinomatosis in colorectal cancer is a common condition. Within 8 % -15 % of patients have developed carcinomatosis the peritoneum at the time of diagnosis of disease. Relapse in the peritoneum occurs in 50% of patients who had undergone curative surgery with or without chemotherapy. In 25% of these patients relapse peritoneum remains only place affected. The standard therapeutic approach includes palliative surgery, mostly on complications and systemic chemotherapy with or without modulation. The results that were obtained from the application of 5- ftururatsil are unsatisfactory 30% response , median survival of 9-12 months , and 3 year survival rate less than 5%. Although the use of biological agents for systemic treatment of peritoneal carcinomatosis results do not improve significantly, median survival 24 months.

Method: From 01.03.2015 in Hospital Eurohospital, launched a program for the treatment of peritoneal carcinomatosis Despite this evidence provided based on two major randomized controlled trials, the benefits of MDG + HIPH in the treatment of carcinomatosis of colorectal origin conclusions remain heterogeneous with survival from 22-60 months and 5 year survival 11% -48% ( in centers experienced 32% -51% ). In all studies reported better results for patients with limited carcinomatosis experienced TSRS + HIPH compared with patients treated with systemic chemotherapy with added including biologicals . (51 % vs 13% 5 year survival rate ) . These results are comparable to the complex treatment of liver metastases from colorectal cancer , which is why in many countries currently MDGs + HIPH is the main method of treating the peritoneal carcinomatosis in selected patients. All studies identified as independent prognostic factor SS- 0 , i.e. the ability to perform full cytoreduction at low peritoneal carcinomatosis index.

Discussion: The combination MDGs with HIPH is not indicated for all patients with colorectal peritoneal carcinomatosis . Patients with good a performance status, low peritoneal carcinomatosis index and lack of involvement Extraperitoneal where the possibility of full MDGs a real greatest benefit from treatment (40% 5- year survival ). Early detection of this group of patients , the timely dispatch to the appropriate center and proper conduct of the MDGs + HIPH is the key to cure them . In this sense svormirani groups of patients who may so achieve the desired result . These are all patients with recurrent colorectal cancer, Limited kartsinimatoza that can be removed , all perforated colorectal tumors , T4 carcinomas with germination to neighboring organs patients with positive cytology in colorectal cancer and intraoperative desiminatsiya , colorectal cancer with ovarian involvement . Because these conditions are recorded during the operation no consensus during the prilozheniv the MDGs + HIPH . Our protocol provides a quick approach after 30 days of operation and procedure postponed until the third month , during which time the patient conducts systemic treatment.

Conclusion: The selection of patients at high risk of developing such carcinomatosis and developed with no one, but a low peritoneal carcinomatosis index (PCI less than 20) is crucial for achieving better results . the addition of biological agents to the MDGs + hiph good scenarios for future studies. it is necessary systematization of clinical parameters and neklichni to offer adaptive individual mode of therapy in each patient with carcinomatosis.

Atanasov B., Belev N., Slavchev M., Shopov N., Bodurov I., Djarov G.

MBAL- Eurohospital, Plovdiv

Intro: Colorectal cancer is the third most common form of cancer, after lung cancer and breast cance. Its prevalence increases with age and increase the duration of life, more often sick men. In 2012 . in Bulgaria were registered 942 new cases of rectal cancer in men and 586 in women. Due to the characteristics of the location of the rectum in the pelvis, the treatment of rectal cancer differ materially from colon cancer. The differences are in terms of the aspects in the presentation , surgical strategies operations , volume and complexity of operatsiite , postoperative complications and oncological results. Neoadjuvant therapy is the standard method of choice for all patients with distal rectal cancers in the II-nd and III-rd stage . Laparoscopic surgery in these patients is an alternative to open surgery for some countries in Europe and Asia. Short-term oncologic outcomes of conventional and mini-invasive approaches are similar. Method: For the period 2012-2015 in Ho Hospital Evrohospital of Plovdiv were operated on 77 patients with low rectal carcinomas following a Neoadjuvant therapy. Male to 43 women- 34 Conventional surgical interventions were performed in 40 patients , laparoscopic procedures are taken to 37 . Minimally invasive surgery are divided into three groups- laparoscopic low and ultralow front rezektsii- 25; abdomino - perineal resection of the rectum with total mesorectal ekstsiziya- 8; transanal endoscopic mikrohirurgiya- 4 . Results: n 8 (10 %) patients received complete and almost complete pathological response of neoadjuvant therapy conducted . All patients in R0. Not found involvement tsirkumferentnite borders and distal margin none ill. As a result of neoadjuvant therapy , reducing tumor stage was reported in 19 patients , a reduction in tumor size to - 17 patients. In laparoscopic surgery is reported the following results : reduced blood loss (160 ml to 250 ml conventional ) ; longer operating time (165 min / 135 min ) ; faster recovery of bowel function and shorter hospital stay. Conclusions: Laparoscopic surgery in distal rectal cancer after neoadjuvant therapy a good and successful alternative to conventional surgical techniques . Their execution by experienced laparoscopic surgeons leads to low conversions a high percentage of organo -sparing operations free from infiltration tsirkumferentni borders and resection lines.