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Surgical resection remains the cornerstone for the curative treatment of oncological disease. In a situation when a tumour encases a critical arterial or venous structure, long term oncological control may be achieved only through careful preoperative planning within a multidisciplinary team incorporating oncological and vascular specialists. The present review addresses the principles in planning oncovascular surgery, describes the oncovascular procedure in pancreatic, liver, renal and endometriosis cancer as well as vascular involvement in retroperitoneal soft sarcoma and sarcoma in lower extremity. In conclusion, the present review highlights that major vessel involvement of a tumour mass should not necessarily be considered as a barrier to en bloc resection and hence curative oncosurgery procedure.

We present a case of a 100-year-old polymorbid patient with signs of bowel obstruction. After failure of conservative therapy computed tomography was performed, which revealed the course of the obstruction to be a gallstone in the terminal ileum. The gallstone was removed surgically without complications and the patient recovered well and had an uneventful postoperative course.

Higher incidence of injury in trauma patients older than 65 years is connected with growing morbidity and mortality, first of all in polytrauma. Incidence of preexisting diseases play a great role in development of postinjury reaction. There are risk factors for genesis of postinjury complications and also mortality of victims. Growing number of polytrauma patients older than 65 years admitted to Trauma Centre Faculty Hospital Královské Vinohrady was reason for evaluation of epidemiological data and their comparison with data regarding to victims younger than 65 years. In retrospective study was evaluated 239 injured patients with polytrauma, admitted in Emergency unit Department of anesthesiology and resuscitation. From overall number was 47 victims older than 65 years (29/61 %). 75 years was an average age in victims older than 65 years. Primary admission to Trauma Centre was in case of 42 (85 %) victims older than 65 years. Between causes of injury were most frequent traffic accidents and falls. Most frequent injury in geriatric patients was craniocerebral injury in 36 patients (76 %) and thoracic trauma in 38 patients (80 %). Skeletal fractures of extremities were found in 21 (44 %) victims. From comparison of APACHE II score in both group of patients (19 in group of younger patients vs. 27,2 in group of older victims) is possible to establish higher incidence of preexisting diseases in patients older than 65 years. Average ISS score evaluated serious of trauma was without statistic significant difference (22 vs. 21). Number of deaths was 42 (22 %) in group of victims younger than 65 years and 22 (47 %) in group of victims older than 65 years. Older victims (over 65 years old) were exposed higher mortality in comparison with younger patients. On the result of treatment participate preexisting diseases besides age. Mechanism of injury and from this resulting type of trauma in older population need new strategy in postinjury care. Performance of primary admission of older victims with polytrauma to Trauma Centre is tend to this strategy.

Due to population aging in developed countries, it has become necessary to prepare a functional health care plan for the elderly. One of the possibilities to improve postoperative outcomes and recovery in elderly patients is to perform common surgical procedures in the regime of one-day surgery. We compared elderly patients who underwent surgery in a large university hospital with elderly patients who underwent surgery in a facility dedicated to one-day surgery. The homogeneity and clinical outcomes of the two groups were statistically analyzed. Complications were assessed according to the Clavien-Dindo classification. There were no statistically significant differences in demographic data and pre-operative risk assessment (ASA). The one-day surgery group had fewer complications and a shorter average hospital stay. Advanced age is not the only criterion for assessing the biological state of the patient and therefore does not always necessitate surgical care in a university hospital setting with a high volume of acute and complicated cases. Many elderly patients will benefit from a more individualized approach and healthcare facilities that specialize solely in elective procedures. When indicating elderly patients for one-day surgery, their health status is more important than their calendar age.

As life expectancy increases in economically developed countries, there is an increasing need for medical care for the elderly. In surgical fields, this means that the number and spectrum of surgical interventions in elderly patients is increasing. Because of this special attention should be paid to the preoperative evaluation in these patients. Communication with the patient and relatives is crucial in order to decide on the extent of the surgical intervention and whether to treat these patients with curative or palliative intent. It is imperative that physicians understand the physiology of aging and its associated risks, as traditional perioperative risk assessment tools are insufficient in this patient group.

We present a case of a 93-year-old patient with colorectal carcinoma indicated to right hemicolectomy. Shortly before planned surgery patients condition was complicated by pulmonary embolism, deterioration and protracted bleeding from the tumor. After careful internal and preoperative preparation patient underwent right hemicolectomy with uncomplicated course of hospitalization and transferred back to internal department to internal, rehabilitation and nutritional care. Thanks to intensive perioperative care and despite the patient#39;s high age, the patient#39;s quality of life has not decreased in any way and enjoys good health.

Population aging is one of the most significant health problems of the 21st century and has led to an increased need for surgery in elderly patients. Only chronological age should not be decisive when indicating patients for elective procedures. Other objective findings should be taken into account too. The complex geriatric examination is an optimized, detailed and accurately defined method, which leads to better postoperative outcomes in elderly patients. In everyday practice it is sufficient to evaluate the mental, physical and nutritional state of the patient. The goal of our study was to evaluate the perioperative morbidity and mortality of elderly patients undergoing hepatopancreatobiliary procedures. In our retrospective study we evaluated prospectively collected data of patients who underwent surgical procedures between 2015 and March 2019. In total 245 patients underwent pancreatic procedures and 156 underwent hepatic procedures. Morbidity and mortality were evaluated in the first 75 postoperative days and classified according the Clavien-Dindo classification. Our results show that when surgical procedures are correctly indicated in elderly patients, acceptable postoperative morbidity and mortality can be achieved. Since the year 2018 we have been actively using prerehabilitation in our center and it has led to improved postoperative outcomes in elderly and high-risk patients.

Cholangiocellular carcinoma (CCC) is a malignant tumor harboring a poor prognosis, occurring in the liver, gallbladder and in extra- or intrahepatic biliary ducts. The article reviews the topic concerning CCC from the point of view of a surgical pathologist. The paper deals with classification of CCC into an intrahepatic/peripheral and hilar/extrahepatic subtype with different morphology, molecular features and prognosis; together with classical gross pathology, histopathology and natural history of CCC. Hilar and extrahepatic CCC share some biological characteristics with pancreatic ductal adenocarcinoma. The review comprises various types of precancerous lesions of biliary tract, summarizes updates in 8th edition of TNM classification and describes the routine issues concerning histopathological diagnostics of CCC, including immunohistochemistry and frozen section methods.

Cholangiocarcinoma is a relatively rare, highly fatal neoplasm originating from the biliary epithelium. Its only potentially curative treatment option is a radical surgical resection. The aim of our work was to evaluate the feasibility and the safety of intraoperative ERCP and direct cholangioscopy (SpyGlass) to assess the intraductal border of cholangiocarcinoma proliferation. The study ran from November 2015 to January 2018. The group included patients with histologically verified cholangiocarcinoma and, based on available examinations, the resectability of the tumor was assessed by a multidisciplinary team. In cases of indicated surgical resection we peroperatively performed ERCP with cholangioscopy SpyGlass and "diaphanoscopy" in all patients. The resectability was assessed on the basis of these examinations and the peroperative surgical findings. The resection procedure itself was performed only in 2 out of the total of 14 patients, as other patients were indicated for the implantation of metallic SEMS within the ERCP procedure in the operating room instead. To validate the cholangioscopic findings, we used our own criteria based on both the Monaco and other criteria. We divided the findings according to the presence or absence of ulceration, prominent polyposis, pathological vascularization (4 types), pressure defect with a coagulum in the presence of previous stent implantation, papillomatous changes or discolorations of the mucosa. Out of the total number of 14 patients only two patients were indicated for resection and in both cases R0 resection was achieved. The remaining patients were intraoperatively indicated for palliative implantation of SEMS based on the same unresectable finding during cholangioscopy and laparotomy. We demonstrated the technical feasibility and safety of direct peroperative cholangioscopy. Our results show that direct perioperative cholangioscopy is one of the methods which can contribute to a more accurate determination of tumor spread margins.

Cholangiocarcinoma is a cancer with very poor prognosis. The only potentially curative approach is surgical resection of tumor. However, the rate of local and distant recurrence after radical surgery is still high. Benefit of adjuvant therapy is not clearly defined, nevertheless patients at high risk of recurrence are indicated to chemotherapy or chemoradiotherapy. Locally advanced, unresectable disease can also be treated with chemotherapy alone, or with her combination with radiotherapy. Required radiation doses are relatively high, therefore it is necessary to use highly conformal radiation therapy. Treatment of metastatic disease is currently based on systemic therapy, combination of gemcitabine and cisplatin as standard of care. Benefit of targeted molecular therapy is not clear at present, but ongoing research in genetic profiling of tumor may help to improve current clinical practice. Patients with cholangiocarcinoma have to be discussed during multidisciplinary team meetings.

Cholangiocellular carcinoma is a relatively rare malignant tumor, originating from cholangiocytes, with poor prognosis and late diagnosis. It is a malignancy with a variable biological etiology, numerous genetic and epigenetic changes. Its incidence in the Czech Republic is about 1.4 per 100,000 people per year. For good prognosis and long-term survival, early diagnosis with surgical treatment is important. In these cases, a 5-year survival rate is about 20-40 %. In the early diagnosis imaging methods and histopathological verification play an essential role, whereas laboratory oncomarkers are not yet sufficiently accurate. The same applies for genetic markers. This leads to the search of new molecular targets and the high effort in the introduction of cytological and molecular-biological methods with high specificity and sensitivity into routine practice. Current early diagnosis is based on the use of efficient imaging methods. The use of genetic testing, and especially knowledge of the molecular basis of this disease, will be of a great benefit. The observation of the association between the genetic pathways, IDH1, RAS-MAPK etc., and genetic mutations of genes, such as TP53, KRAS, SMAD4, BRAF, IDH1/2, may be significant. From the molecular point of view, it is also interesting to monitor oncogenic potential in HBV/HCV infection.

Cholangiocarcinoma represents the second most common primary liver malignancy. Despite it comprises only 3 % of all gastrointestinal malignancies, its incidence has been increasing recently. Cholangiocarcinomas are hepatobiliary cancers with features of cholangiocyte differentiation and from clinical point of view they are classified anatomically as intrahepatic or extrahepatic form. The only curative treatment with aim of long term and disease-free survival is surgery - liver resection or liver transplantation. Current progress in perioperative treatment and increased surgical skills has changed old treatment algorithms and widen number of patients suitable for curative treatment. On the other hand, surgical intervention is connected with not negligible morbidity and mortality. A rigorous knowledge of the disease extent and all prognostic factors is main condition for proper treatment decision.

Visfatin is a newly recognized adipocytokine produced mainly in visceral fat tissue. Beside its effect on insulin receptor, it serves as proinflammatory cytokine and its level can be changed during inflammatory processes. The aim of the study was to analyze dynamics of serum visfatine level in early period after abdominal surgery and compare it with other proinflammatory markers.In prospective cross-sectional study 20 patients after elective laparotomic abdominal surgery (partial colectomy) were enrolled and dynamics of visfatin, leptin, resistin, adiponectin, TNF-α , IL-6 and CRP in period +12, +24, +48 and + 72 hours was monitored. Serum visfatin was elevated already in +24 hrs period after surgery comparing the culmination of serum level of TNF-α and IL-6 12-24 hrs later and CRP even 48-72 hrs later.Serum visfatin was elevated very early after abdominal surgery and thus its dynamic may be an early predictor of inflammatory processes namely in patients with visceral obesity.

Irreversible electroporation (IRE) is a new method of local therapy of malign tumours based on bioelectric effect of electrical current. Short electric pulses with high voltage create nano size-pores in tumour cell membranes resulting in apoptosis of the exposed cells. The purpose of our study was to verify the IRE technique performed percutaneously under CT navigation and to assess effects of application of this method in early stages of primary and secondary hepatic, pancreatic, renal and pulmonary tumours.From November 2011 to October 2012 IRE was performed with NanoKnife (by AngioDynamics) in the population of 15 patients - 6 males and 9 females. IRE was performed under total anaesthesia with 2-5 needle electrodes introduced under CT navigation in the tumour base. The results of the treatment were assessed on the basis of modified RECIST criteria applied in 1-, 3- and 6-month intervals. A control CT or MRI examination 6 months post IRE was undertaken by 10 patients. One patient died one month post IRE of pulmonary embolism, two refused to visit for the control examination and another two are still to undergo the examination after 6 months. Out of the 10 examined patients success of IRE was demonstrated in 7 cases (70.0%) and IRE failure in 3 patients (30.0%).IRE is a new, mini-invasive therapeutic method applicable to local treatment of malignant tumours in cases where surgical approach is technically unfeasible or excessively risky. On the basis of first experience in a small cohort of patients IRE performed under CT navigation appears to be an effective and safe ablation method with a large therapeutic potential. Its results will however need to be assessed within a longer time horizon and in a larger cohort of population.

Sepsis belongs among the most serious conditions and animal models of sepsis are the basic tools to investigate the pathophysiological response to this condition.A total of 16 adult minipigs with identical baseline parameters were randomized into two groups. In the sepsis group (n = 10), sepsis was induced using caecal ligation and puncture (CLP). The control group (n = 6) underwent laparotomy without CLP. Selected clinical and laboratory parameters as well as histological findings between the sepsis and control group were subsequently compared.All animals undergoing CLP developed diffuse peritonitis and sepsis. Compared to the control group, experimental animals showed significant increase of body temperature and heart rate (while) requiring noradrenaline to maintain their perfusion pressure. No significant differences in the monitored biochemical parameters (including C-reactive protein levels) between the two groups were found. Histological findings in organs of experimental animals were consistent with changes of organs seen in sepsis, i.e., centrilobular liver necroses, acute tubular renal necrosis, serous fibrinopurulent exudate, myocardial malacias, and pulmonary edema.Experimental caecal ligation with a predefined size of the perforation in the intestinal wall is a suitable model for assessing the pathophysiological changes occurring in the body in sepsis.