1. Awake craniotomy for operative treatment of brain gliomas - experience from University Medical Centre LjubljanaTilen Žele, Tomaž Velnar, Blaž Koritnik, Roman Bošnjak, Jasmina Markovič Božič, 2023, izvirni znanstveni članek Povzetek: Background. Awake craniotomy is a neurosurgical technique that allows neurophysiological testing with patient cooperation during the resection of brain tumour in regional anaesthesia. This allows identification of vital functional (i.e. eloquent) brain areas during surgery and avoidance of their injury. The aim of the study was to present clinical experience with awake craniotomy for the treatment of gliomas at the University Medical Centre Ljubljana from 2015 to 2019.Patients and methods. Awake craniotomy was considered in patients with a gliomas near or within the language brain areas, in all cases of insular lesions and selected patients with lesions near or within primary motor brain cortex. Each patient was assessed before and after surgery.Results. During the 5-year period, 24 awake craniotomies were performed (18 male and 6 female patients; average age 41). The patient’s cooperation, discomfort and perceived pain assessed during the awake craniotomy were in majority of the cases excellent, slight, and moderate, respectively. After surgery, mild neurological worsening was observed in 13% (3/24) of patients. Gross total resection, in cases of malignant gliomas, was feasible in 60% (6/10) and in cases of low-grade gliomas in 29% (4/14). The surgery did not have important negative impact on functional status or quality of life as assessed by Karnofsky score and Short-Form 36 health survey, respectively (p > 0.05). Conclusions. The results suggest that awake craniotomy for treatment of gliomas is feasible and safe neurosurgical technique. The proper selection of patients, preoperative preparation with planning, and cooperation of medical team members are necessary for best treatment outcome.
Ključne besede: awake craniotomy, surgery of gliomas, intraoperative neurophysiological testing, primary brain tumours, clinical experiences
Objavljeno v DiRROS: 25.07.2024; Ogledov: 96; Prenosov: 73
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2. Erector spinae plane block versus intercostal nerve block for postoperative analgesia in lung cancer surgeryPolona Gams, Marko Bitenc, Nenad Danojević, Tomaž Jensterle, Aleksander Sadikov, Vida Groznik, Maja Šoštarič, 2023, izvirni znanstveni članek Povzetek: Background. A recent trend in postoperative analgesia for lung cancer surgery relies on regional nerve blocks with decreased opioid administration. Our study aims to critically assess the continuous ultrasound-guided erector spinaeplane block (ESPB) at our institution and compare it to a standard regional anesthetic technique, the intercostal nerve block (ICNB).Patients and methods. A prospective randomized-control study was performed to compare outcomes of pa-tients, scheduled for video-assisted thoracoscopic (VATS) lung cancer resection, allocated to the ESPB or ICNB group. Primary outcomes were total opioid consumption and subjective pain scores at rest and cough each hour in 48 h after surgery. The secondary outcome was respiratory muscle strength, measured by maximal inspiratory and expiratory pressures (MIP/MEP) after 24 h and 48 h.Results. 60 patients met the inclusion criteria, half ESPB. Total opioid consumption in the first 48 h was 21.64 ± 14.22 mg in the ESPB group and 38.34 ± 29.91 mg in the ICNB group (p = 0.035). The patients in the ESPB group had lower numerical rating scores at rest than in the ICNB group (1.19 ± 0.73 vs. 1.77 ± 1.01, p = 0.039). There were no significant differences in MIP/MEP decrease from baseline after 24 h (MIP p = 0.088, MEP p = 0.182) or 48 h (MIP p = 0.110, MEP p = 0.645), time to chest tube removal or hospital discharge between the two groups.Conclusions. In the first 48 h after surgery, patients with continuous ESPB required fewer opioids and reported less pain than patients with ICNB. There were no differences regarding respiratory muscle strength, postoperative compli-cations, and time to hospital discharge. In addition, continuous ESPB demanded more surveillance than ICNB.
Ključne besede: erector spinae plane block, intercostal nerve block, postoperative analgesia, video-assisted thoracic surgery, thoracic anesthesia
Objavljeno v DiRROS: 25.07.2024; Ogledov: 93; Prenosov: 118
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3. Real-life long-term outcomes of upfront surgery in patients with resectable stage I-IIIA non-small cell lung cancerMarko Bitenc, Tanja Čufer, Izidor Kern, Martina Miklavčič, Sabrina Petrovič, Vida Groznik, Aleksander Sadikov, 2022, izvirni znanstveni članek Povzetek: Treatment of early-stage non-small cell lung cancer (NSCLC) is rapidly evolving. When introducing novelties, real-life data on effectiveness of currently used treatment strategies are needed. The present study evaluated outcomes of stage I–IIIA NSCLC patients treated with upfront radical surgery in everyday clinical practice, between 2010–2017. Data of 539 consecutive patients were retrieved from a prospective hospital-based registry. All diagnostic, treatment and follow-up procedures were performed at the same thoracic oncology centre according to the valid guidelines. The primary outcome was overall survival (OS) analysed by clinical(c) and pathological(p) TNM (tumour, node, metastases) stage. The impact of clinicopathological characteristics on OS was evaluated using univariable (UVA) and multivariable regression analysis (MVA). With a median follow-up of 53.9 months, median OS and 5-year OS rate in the overall population were 90.4 months and 64.4%. Five-year OS rates by pTNM stage I, II and IIIA were 70.2%, 60.21%, and 49.9%, respectively. Both cTNM and pTNM stages were associated with OS; but only pTNM retained its independent prognostic value (p = 0.003) in MVA. Agreement between cTNM and pTNM was 69.0%. Next to pTNM, age (p = 0.001) and gender (p = 0.004) retained their independent prognostic value for OS. The study showed favourable outcomes of resectable stage I–IIIA NSCLC treated with upfront surgery in real-life. Relatively low agreement between cTNM and pTNM stages and independent prognostic value of only pTNM, observed in real-life data, suggest that surgery remains the most accurate provider of the anatomical stage of disease and important upfront therapy.
Ključne besede: resectable NSCLC, upfront surgery, real-life data, overall survival, prognostic factors
Objavljeno v DiRROS: 25.07.2024; Ogledov: 109; Prenosov: 82
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4. Surgical treatment and fertility perservation in endometrial cancerNina Kovačević, 2021, pregledni znanstveni članek Povzetek: Endometrial cancer (EC) represents a high health burden in Slovenia and worldwide. The incidence is increasing due to lifestyle and behavioural risk factors such as obesity, smoking, oestrogen exposure and aging of the population. In many cases, endometrial cancer is diagnosed at an early stage due to obvious signs and symptoms. The standard treatment is surgery with or without adjuvant therapy, depending on the stage of the disease and the risk of recurrence. However, treatment modalities have changed in the last decades, considerably in the extent of lymphadenectomy. Conclusions. The gold standard of treatment for is surgery, which may be the only treatment modality in the early stages of low-grade tumours. In recent years, a minimally invasive approach with sentinel node biopsy (SNB) has been proposed. A conservative approach with hormonal treatment is used if fertility preservation is desired. If EC is in advance stage, high-risk histology, or high grade, radiotherapy, chemotherapy, or a combination of both is recommended.
Ključne besede: endometrial cancer, uterus, treatment, minimally invasive surgery
Objavljeno v DiRROS: 22.07.2024; Ogledov: 96; Prenosov: 23
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5. Completely resected stage III melanoma controversy : 15 years of national tertiary centre experienceBarbara Perić, Sara Milićević, Andraž Perhavec, Marko Hočevar, Janez Žgajnar, 2021, izvirni znanstveni članek Povzetek: Background Two prospective randomized studies analysing cutaneous melanoma (CM) patients with sentinel lymph node (SLN) metastases and rapid development of systemic adjuvant therapy have changed our approach to stage III CM treatment. The aim of this study was to compare results of retrospective survival analysis of stage III CM patients% treatment from Slovenian national CM register to leading international clinical guidelines. Patients and methods Since 2000, all Slovenian CM patients with primary tumour % TIb are treated at the Institute of Oncology Ljubljana and data are prospectively collected into a national CM registry. A retrospective analysis of 2426 sentinel lymph node (SLN) biopsies and 789 lymphadenectomies performed until 2015 was conducted using Kaplan-Meier survival curves and log-rank tests. Results Positive SLN was found in 519/2426 (21.4%) of patients and completion dissection (CLND) was performed in 455 patients. The 5-year overall survival (OS) of CLND group was 58% vs. 47% of metachronous metastases group (MLNM) (p = 0.003). The 5-year OS of patients with lymph node (LN) metastases and unknown primary site (UPM) was 45% vs. 21% of patients with synchronous LN metastasis. Patients with SLN tumour burden < 0.3 mm had 5-year OS similar to SLN negative patients (86% vs. 85%; p = 0.926). The 5-year OS of patients with burden > 1.0 mm was similar to the MLNM group (49% vs. 47%; p = 0.280). Conclusions Stage III melanoma patients is a heterogeneous group with significant OS differences. CLND after positive SLNB might still remain a method of treatment for selected patients with stage III.
Ključne besede: cutaneous melanoma, surgery treatment, sentinel node biopsy
Objavljeno v DiRROS: 17.07.2024; Ogledov: 124; Prenosov: 59
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6. Breast cancer risk based on adapted IBIS prediction model in Slovenian women aged 40-49 years : coul it be better?Tjaša Oblak, Vesna Zadnik, Mateja Krajc, Katarina Lokar, Janez Žgajnar, 2020, izvirni znanstveni članek Ključne besede: breast surgery, IBIS, prediction models, risk factors
Objavljeno v DiRROS: 12.07.2024; Ogledov: 94; Prenosov: 50
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7. Does regular quality control improve the quality of surgery in Slovenian breast cancer screening program?Andraž Perhavec, Sara Milićević, Barbara Perić, Janez Žgajnar, 2020, izvirni znanstveni članek Povzetek: The aim of our study was to evaluate the quality of surgery of Slovenian breast cancer screening program (DORA) using the requested EU standards. Furthermore, we investigated whether regular quality control over the 3-year period improved the quality of surgical management. Patients and methods. Patients who required surgical management within DORA between January 1st, 2016 and December 31st, 2018 were included in the retrospective study. Quality indicators (QIs) were adjusted mainly according to European Society of Breast Cancer Specialists (EUSOMA) and European Breast Cancer Network (EBCN) recommendations. Five QIs for therapeutic and two for diagnostic surgeries were selected. Additionally, variability in achieving the requested QIs among surgeons was analysed. Results. Between 2016 and 2018, 14 surgeons performed 1421 breast procedures in 1398 women. There were 1197 therapeutical (for proven breast cancer) and 224 diagnostic surgical interventions respectively. Overall, the minimal standard was met in two QIs for therapeutic and none for diagnostic procedures. A statistically significant improvement in three QIs for therapeutic and in one QI for diagnostic procedures was observed however, indicating that regular quality control improves the quality of surgery. A high variability in achieving the requested QIs was observed among surgeons, which remained high throughout the study period. Conclusions. Adherence to all selected surgical QIs in patients from screening program is difficult to achieve, especially to those specifically defined for screen-detected lesions. Regular quality control may improve results over time. Reducing the number of surgeons dedicated to breast pathology may reduce variability of management inside the institution.
Ključne besede: breast surgery, mammography, screening program, quality control
Objavljeno v DiRROS: 12.07.2024; Ogledov: 96; Prenosov: 35
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10. Health-related quality of life in Slovenian patients with colorectal cancer : a single tertiary care center studyJan Grosek, Jerica Novak, Katja Kitek, Alta Bajrić, Ana Majdič, Jurij Aleš Košir, Aleš Tomažič, 2019, izvirni znanstveni članek Ključne besede: health-related quality of life, colorectal cancer, colorectal surgery, Slovenia
Objavljeno v DiRROS: 05.07.2024; Ogledov: 127; Prenosov: 62
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