PurposeA previous randomized study conducted by our group showed that application of gentamicin-collagen implant (GCI) into the pelvic cavity after total mesorectal excision (TME) reduced the incidence of distant metastases. Therefore, we decided to conduct a confirmatory study.MethodsPatients with rectal cancer were included in the study if they met the following criteria: adenocarcinoma of the rectum, preoperative short-term radiotherapy (5 × 5 Gy), and WHO performance score 0–1.ResultsOne hundred seventy-six patients were randomly assigned either to an experimental group in which GCI was applied (n = 81) or to a control group without GCI (n = 81). Median follow-up was 80 months. Cumulative incidence of distant metastases at 5 years was higher in the control group compared to the experimental group: 23.5 vs 8.6% (HR 2.4 [95% CI 1.1–5.5], P = 0.005). Overall survival (OS), disease-free survival (DFS), and cancer-specific survival (CSS) did not differ between the experimental group and the control group: HR 0.95 [95% CI 0.55–1.70], P = 0.864; HR 0.85 [95% CI 0.50–1.45], P = 0.548, and HR 0.5 [95%CI 0.22–1.22], P = 0.093, respectively. The predefined by the protocol subgroup analysis for yp stage III disease showed better DFS in the experimental group compared to the control group; HR 0.47 [95%CI 0.23–0.97], P = 0.042).ConclusionsThe results confirmed our previous finding that GCI applied in the pelvis significantly reduced the rate of distant metastases in patients after radical rectal cancer resection.Electronic supplementary materialThe online version of this article (10.1007/s00384-018-3045-3) contains supplementary material, which is available to authorized users.

Introduction.The aim of this study was to analyze the influence of surgical center experience on the long term survival of patients with locoregionally advanced gastric adenocarcinoma undergoing primary surgery, followed by complementary chemoradiotherapy according to MacDonald regimen. Material and methods. 154 patients treated surgically, including 75 (48.7%) at the Maria Sklodowska-Curie National Research Institute of Oncology (NIO-PIB) in Warsaw, and 79 (51.3%) outside this center. Both groups were retrospectively analyzed. The compared groups were statistically homogeneous. The following parameters were analyzed: age, gender, tumor differentiation, TNM VII (2010) staging, nodal index, radicality of surgical treatment, tumor type according to the Lauren classification, clinical stage, presence of prognostic factors, overall survival time. Results. Among those patients operated on at NIO-PIB, 71 (94.7%) patients underwent radical resection, 4 (5.3%) cases were microscopically non-radical resection had. There were no macroscopically non-radical resections (0%). For patients operated on outside NIO-PIB, 60 (75.9%) R0 resections, 15 (19%) R1 resections and 4 (5.1%) R2 resections were performed. The percentage of radical resections was significantly higher at NIO-PIB (p = 0.001). In 77% of patients operated on at NIO-PIB, disease progression in terms of feature could be established. This percentage for patients operated on outside the NIO-PIB was 54% and was significantly lower (p = 0.001). The probability of 5-year survival was 41.6% in total, with 45.3% for the group of patients operated on in the NIO-PIB and 38.0% for the group of patients operated on outside the NIO-PIB, respectively (p = 0.628). Conclusions. The quality of surgical treatment was significantly higher in NIO-PIB. The difference in 5-year overall survival (OS) between the compared groups is not statistically significant. Complementary treatment with chemoradiotherapy (CRT) according to MacDonald regimen reduces the shortcomings in the quality of surgical treatment in locoregionally advanced gastric adenocarcinoma.

Guzy hamartomatyczne gruczołów Brunnera występują niezwykle rzadko, stanowiąc zaledwie około 5% guzów dwunastnicy. Lokalizują się przede wszystkim w początkowym jej odcinku i rozpoznawane są przypadkowo w trakcie badań endoskopowych oraz obrazowych jamy brzusznej. Część z nich jest przyczyną wtórnych patologii układu pokarmowego, takich jak ostre i przewlekłe krwawienie (37%) lub wysoka niedrożność mechaniczna przewodu pokarmowego (37%), czy też rzadziej występujących, jak ostre zapalenie trzustki czy żółtaczka mechaniczna. Prezentujemy opis przypadku leczonej w naszym ośrodku 53-letniej chorej z nawracającymi epizodami krwawień do górnego odcinka przewodu pokarmowego, prowadzącymi do głębokiej anemizacji, których przyczynę rozpoznano z opóźnieniem. Chora w trakcie diagnostyki wymagała przetoczenia łącznie 14 j. koncentratu krwinek czerwonych. Brunneroma: a rare cause of obstruction and bleeding of the digestive tract. Case report Hamartomatic tumours of Brunner's glands are very rare and account for only 5% of tumours of the duodenum. Brunneromas are often diagnosed unexpectedly during endoscopic or radiological investigation. They may be the reason for digestive tract bleeding or duodenal obstruction. Brunneroma is an aetiological factor for acute pancreatitis and jaundice. We present the case of a 53-year old woman who had repeated episodes of digestive tract bleeding which cause secondary anemia. The cause of the bleeding was recogised when the patient was being given 14 units of packed red cells.