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Introduction: In this case report an esophageal resection due to cancer was performed with a primary left colonic replacement, as the stomach was resected previously. Due to graft necrosis, the necrotized section of the colon was removed. One year later a long jejunal segment with a combined blood supply was used for secondary reconstruction. Even after the ligation of three straight branches, the Roux loop was not long enough to reach up to the neck, however the division of the arcade between the 2nd and 3rd straight branches lengthened it satisfyingly. Blood supply to the region of the farthest branch was provided from the internal mammary artery and venous drainage was provided by a saphenous vein graft to the external jugular vein. The continuity of the jejunal graft was preserved. The patient recovered uneventfully. If neither the stomach nor the colon routinely used for esophageal replacement are available due to anatomical reasons, previous surgeries, or complications, jejunal replacement can be the last resort. Jejunum is only suitable for safe esophageal replacement by either free transplantation or by supercharging. The procedure when a combined blood supply is provided for the jejunal replacement was named the hybrid-supercharged method.

Therapy for breast cancer today is characterised by ever more precise diagnostic methods and ever more effective oncological treatments, a trend which will certainly continue into the future. Breast preservation and the application of oncoplastic principles are increasingly popular. A sentinel lymph node biopsy in the surgical treatment of the axilla is primary, with the indication for axillary block dissection (ABD) narrowing and radiation therapy becoming an alternative to ABD in certain cases. This publication summarises our recommendations on the surgical treatment of breast cancer based on the content of the 3rd Breast Cancer Consensus Conference and considering the latest international studies and professional recommendations.

Introduction: Cervical oesophagus represents a critical location for squamous cell carcinoma, which usually requires extensive surgery (pharyngo-laryngo-oesophagectomy). In the last decade, neoadjuvant chemo-radiotherapy was reported to be beneficial in the treatment of locally advanced squamous cell oesophageal cancer., Methods: Between November 1997 and January 2012, 55 patients with locally advanced (T3-4) squamous cell oesophageal cancer received preoperative chemo-radiotherapy, where the tumour was localized in the upper third. Patients received preoperative irradiation of 3960 cGy in 180 cGy fractions and simultaneously Cisplatin and 5-FU chemotherapy. Restaging was carried out after four weeks and patients considered operable were underwent surgery., Results: In patients with cervical oesophageal cancer 35 of 55 (64%) underwent oesophageal resection or pharyngo-laryngectomy. In 16 out of 35 resected specimens (46%) complete histopathological remission (pCR) was observed. Perioperative mortality and anastomotic leaks were the same: 5/35 (14%). R0 resection rate was 82% and the 2- and 5 years survival rates were 41% and 18%. In 19 cases a larynx preserving pharyngo-oesophagectomy was performed and a free jejunal graft was used for reconstruction after a pharyngo-laryngectomy in 11 cases., Conclusion: The high rate of pCR (46%) confirmed that upper third oesophageal cancer has superior sensitivity to multimodal treatment. In 30 cases neoadjuvant chemo-radiotherapy was able to achieve tumour regression and render pharyngo-laryngo-oesophagectomy unnecessary.

Introduction: Various plastic surgery techniques were applied for oesophageal reconstruction in complicated cases. Myocutaneous flaps that are suitable to cover soft tissue defects of the neck may also be transferred and used for partial defects of the cervical oesophagus or securing a vulnerable suture line. Application of microsurgical techniques may also be useful in certain situations., Patients and Methods: Pectoralis major myocutaneous flap was used in 5 cases in our department between 1998 and 2012. Microsurgical techniques were used in 38 cases of esophageal reconstruction, which were 34 free jejunal grafts and 4 supercharged colon grafts., Results: 23 patients underwent primary reconstruction after pharyngolaryngectomy, while 15 patients had secondary reconstruction after failed previous operations or recurrence. When more experienced was gained free jejunal grafts were used for the cervical as well as thoracic oesophagus. Three grafts were lost, two of them were due to anastomotic thrombosis and one was due to severe MRSA wound infection., Conclusion: Complicated cases of oesophagus reconstructions may be successfully treated by the cooperation of oesophagus and plastic surgeons, which may result in an acceptable complication rate.

Introduction/aim: The importance of preoperative neoadjuvant (NA) systemic treatment in operable breast cancer has significantly increased in the last few years. The aim of our retrospective study was to determine the effect of NA therapy in breast cancer patients treated in our unit and analyze radiological and pathological response rates in the context of surgical treatment., Materials and Methods: One hundred and fourteen cases of breast cancer with NA therapy were analyzed and clinical data were collected from March 2007 to December 2010. Twenty-two patients received NA treatment for inoperable tumours. As far as operable cancers (92 patients), the indications for NA treatment were high tumour grade, presence of axillary metastasis and relatively young age. 5-Fluorouracil-Epirubicin-Cyclophosphamid or Taxotere-Epirubicin regimens were administered in 6 cycles followed by radiological evaluation and surgery. Herein, we compared the preoperative staging with the pathological results after surgery., Results: NA therapy resulted in complete regression in 17% of patients, significant regression in 21%, while moderate regression was achieved in 43% of patients. No regression was detected in 19%. The decrease in T stage was not followed by decrease in N stage in significant number of cases. Moreover, in some cases NA therapy caused complete radiological regression, while histologically it still remained positive. In certain cases, breast conserving surgery was feasible due to down-staging caused by NA therapy., Conclusion: NA therapy was effective primarily in decreasing tumour size; however, it was less effective on axillary lymph node metastases. Due to the presence of the residual DCIS component, the volume of resection could not be decreased as much as down-staging of the invasive cancer would have permitted.

Oncologic surgery and pTNM staging require systemic removal of the locoregional lymphnodes. While the optimal extent and therapeutical and/or prognostic value of the lymphadenectomy/sampling are debated organ by organ and (sub)speciality by (sub)speciality, relevance of the lymphnode sytem-tumor concept itself is beyond doubt. Loss of information and existence of traps on the "surgical field-microscope" pathway is an international phenomenon, calling for solution. An integrated sterile and disposable lymphnode tray system is presented here for applications in the different fields of cancer surgery of the upper GI tract, retroperitoneum (gynecology, urology) and ear-nose-throat surgery.

The authors report the case of a colon adenocarcinoma developed on the neck at the anastomosis of the skin tube and colon 44 years following a corrosive oesophageal injury. This patient suffered a moderately severe oesophageal, stomach and laryngeal injuries due to drinking hydrochloric acid 44 years ago. He underwent serial laryngoplasties, then needed a tracheostomy, oesophagectomy, pyloroplasty and ileocolon transposition. An antethoracal oesophagus formation was performed with ileocolon and skin tube amendment. 44 years later an ulcerated adenocarcinoma developed in the transposed colon, which was resected and the ability to swallow was reinstated by the transplantation of an isolated jejunal segment using microvascular anastomosis.

Introduction: The incidence of cicatricial carcinoma of the scarred esophagus in patients with corrosive injuries is relatively high. Therefore, the necessity to resect the diseased oesophagus was raised as opposed to carry out a simple by-pass reconstruction only., Case Report: A 56-year-old female patient with a past medical history of lye consumption presented with a stricture of the esophagus. She underwent resection of the diseased esophagus with mediastinal colon interposition. 28 years after surgery the patient had symptoms of progressive dysphagia and loss of weight caused by scar cancer of the esophagus. After neoadjuvant chemo-radiotherapy, resection of the remainder oesophagus was performed with free jejunal transplantation. On postoperative day 14 the patient had been discharged with no complications and good swallowing function., Conclusion: In our case, scar cancer developed 28 years after oesophageal resection and more than 50 years after the corrosive injury. This case is another argument for simple bypass.

Aim: The aim of this study was to compare the efficiency of the preoperative combined chemo-radiotherapy in the treatment of locally advanced squamous cell carcinoma in different locations of the oesophagus., Methods: Between 1997 and 2005, 102 patients with locally advanced (T3-4) squamous cell oesophageal cancer received preoperative chemo-radiotherapy. In 40 cases, the tumour was localised in the upper-third (Group I), while in 62 cases, in the middle-third of the oesophagus (Group II). Survival rates of patients receiving neoadjuvant therapy were compared with a historical control group. In addition, Group I and Group II were compared to each other, as well., Results: survival rate was significantly better after neoadjuvant therapy (p:0.0042) Resection was performed in 70% of the patients from Group I, and in 50% of those complete pathological remission (pCR) was observed. The perioperative morbidity and mortality rates were 43% and 14%, respectively. As far as Group II, 69% of the patients underwent oesophageal resection, with a perioperative mortality of 18% and morbidity rate of 62%. pCR was observed only in 7% of the cases. The median survivals (21 and 22 months) and the R0 resection rates (82 and 84%) were similar in the two groups. The pCR subgroup showed a significantly better survival rate., Conclusion: In this study, we demonstrated that preoperative chemo-radiotherapy increases survival in locally advanced oesophageal cancer. A significantly higher rate of complete response was observed in patients with upper-third oesophageal cancer. It seems that this group has superior sensitivity to multimodal treatment; therefore, our results support a new prognostic factor in oesophageal cancer treatment.

Authors replaced the esophagus with anisoperistaltic left colon because they had no other possibilities. In this case twenty-one years ago after an esophageal injury the patient underwent gastric resection, removal of the esophagus and replacement with a skin tube created from a myocutaneous flap. Unfortunately the right colon earlier had been removed after an unsuccessful replacement. Twenty-one years later carcinoma developed in the skin tube therefore the tumour was removed and anisoperistaltic left colon was used as a "new esophagus". The pulled up left colon was supplied by the left colic artery and supercharged by a vascular anastomosis on the neck. Authors would like to present that esophageal replacement with anisoperistaltic left colon is a feasible method if no other therapeutic option remains.

We performed 26 reconstructions after emergency esophago-gastrectomy for corrosive injury during 13 years (1992-2004). Substernal replacement with pedicled colon graft was performed in 22 patients. Multi-stage operations were performed in 4 patients, two free jejunal grafts were applied after unsuccessful colon replacement. In two patients reconstruction could be completed only with a skin tube. Two patients died in the postoperative period. We do not support one stage reconstruction in corrosive injuries, and we suggest that the ideal time for reconstruction is around two months after esophago-gastrectomy.