the aim of the work was the clinical characteristics and analysis of preliminary results for surgical treatment of pancreatic neuroendocrine tumors (PNETs), based on own material. material and methods. In the period from 2005 to 2009, in the Department of Gastrointestinal Surgery, Silesian Medical University in Katowice, there were 27 patients (15 males and 12 females) treated surgically for pancreatic neuroendocrine tumours, constituting 65.86% (27/41) of all gastroenteropancreatic neuroendocrine tumours. Prior to the surgery, the following diagnostic examinations were performed: laboratory tests and imaging examinations (abdominal ultrasound and CT scan). The following tumour localisation was established: head of the pancreas -14, body of the pancreas -4, tail of the pancreas -5, body and tail of the pancreas -1, retroperitoneal space -4. There were found 24 (88.89%) primary tumours and 3 (11.11%) recurrences. The following methods of surgical treatment were applied: pancreatoduodenectomy -11, distal pancreatic resection with splenectomy -6, middle segment resection with anastomosis between the pancreatic tail and jejunal loop: Roux-Y procedure -1, pancreatic resection by Beger procedure -1, pancreatic head and body resection with splenectomy -1, tumour enucleation or local excision -4, exploratory laparotomy with specimen collection -3. Results. The mean hospitalisation period was 25 days (4 -78 days). The mean procedure duration was 4.2 hours (1.15-9.15 hours). Early post-operative complications were observed in 10 patients (37.04%). The following early complications were observed: intra-abdominal abscess -2, wound suppuration -2, pancreatic fistula -1, acute pancreatitis -1, pancreaticojejunal anastomosis leak -1, peritoneal cavity haemorrhage -1, acute cholangitis -1, adhesion obstruction -1, subobstruction -1, portal vein thrombosis -1, sepsis -1, fluid in pleural cavity -1, acute heart failure -1. There were performed 2 (7.41%) repeat surgeries: one due to adhesion obstruction and one due to peritoneal cavity haemorrhage. Death of 1 patient (3.71%) was recorded in the post-operative period due to acute heart failure. conclusions. Pancreatic neuroendocrine tumours constituted the majority of gastroenteropancreatic neuroendocrine tumours in the analysed patient group. Most commonly, PNETs were localised in the head of the pancreas. In the presented material, the mortality rate does not exceed 4%, similarly as in other renowned centres.

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The double-strand break DNA repair pathway, including and genes, is implicated in maintaining genomic stability and therefore could affect the pancreatic cancer risk. The aim of the present study was to evaluate the clinical significance of the and gene polymorphisms in patients with pancreatic cancer. The present study included 203 patients: 101 with pancreatic cancer and 102 healthy controls. The Arg188His and the Thr241Met gene polymorphisms have been studied in DNA isolated from blood samples. The associations of the analysed genotypes and clinical data at diagnosis have been evaluated. The frequencies of the genotypes of the Arg188His and Thr241Met polymorphisms did not differ significantly between patients and controls. The study did not identify a correlation between the and genes polymorphisms and tumor size or localisation. Analysed polymorphisms were also not associated with the gender and age of the patient, or the presence of regional or distant metastases. In conclusion, the present study did not suggest an association between the Arg188His and the Thr241Met polymorphisms and the clinical data of patients with pancreatic cancer.

Treatment of squamous cell carcinoma is associated with an increased risk of other primary malignancies, mainly within the head and neck, as well as in the oesophageal gastric graft. More frequent recognition of multiple primary cancers associated with esophageal cancer, both synchronous and metachronous, is associated with longer follow-up after radical cancer treatment for esophageal cancer and high quality diagnostic procedures, both before and after surgery. The paper reviews the available literature and describes the molecular basis of the formation of multiple primary tumors associated with squamous cell carcinoma of the esophagus.

Using the three different surgical techniques in the management of NP, depending on intra-operative assessment of necrosis, showed promising results. A flexible approach targeted at a single patient and tailored to the clinical course and intra-operative situation should be considered in the treatment of NP.

the aim of the study was to analyse early results after middle pancreatectomy based on our experience. Material and methods. During the period between 2008 and 2009, 154 pancreatic resections were performed at the Department of Gastrointestinal Surgery, Silesian Medical University in Katowice. The following procedures were performed: 109 (70.78%) pancreatoduodenectomies, 32 (20.78%) distal pancreatectomies, 9 (5.84%) middle pancreatectomies, 3 (1.94%) total pancreatic resections, and 1 (0.65%) subtotal pancreatic resection. Early results in case of nine middle pancreatectomies were subject to analysis. Results. Average hospitalization period amounted to 24.28 days (ranging between 8 and 57 days). Mean hospitalization period after surgery amounted to 20.71 days (ranging between 6 and 54 days). Average duration of the surgical procedure amounted to 3.6 hours (ranging between 2.25 and 4 hours). Wirsung's duct required drainage in 4 (44.4%) patients. Pancreatoenterostomy was performed in 5 (55.5%) patients. Early postoperative complications were observed in three (33.3%) patients. The most common complications included wound suppuration and intra-abdominal abscess development observed in two (22.2%) patients. Pancreatic fistula development during the postoperative period was observed in case of one (11.1%) patient. Other early postoperative complications included peritoneal cavity hemorrhage (1-11.1%) and pancreatic necrosis (1-11.1%). Two (2.22%) reoperations were required. Early postoperative mortality amounted to 0%. conclusions. Middle pancreatectomy operations performed in experienced centers are considered as safe procedures with a low rate of complications. The most common indication for middle pancreatectomy is the diagnosis of a benign pancreatic tumor. Key words: middle pancreatectomy, middle segment pancreatetomy, central pancreatectomy, median pancreatectomy * This work was supported by the European Community from the European Social Fund within the RFSD 2 project.The most common standard pancreatic resections, such as pancreatoduodenectomy and distal pancreatectomy are burdened with the risk of postoperative exocrine and endocrine pancreatic insufficiency, as well as complications connected with splenectomy (in case of distal resection). The presence of the abovementioned complications is connected with the depletion of the healthy pancreatic parenchyma during these procedures. Therefore, minimally invasive procedures play an increasing role in surgery, sparing the normal pancreatic parenchyma. In case of benign or border-line malignancy tumors middle pancreatectomies are performed more and more often (1-17).

Somatostatinoma is the rarest neuroendocrine tumor of the digestive tract. About 60% of somatostatinomas arise in the pancreas. This study presents a case of a 51-year-old male patient with tumor of the pancreas. Despite wide preoperative diagnostic examinations, it was impossible to determine the histological type of the tumor preoperatively. The patient was qualified for surgical procedure, during which the tumor was enucleated. The tumor was classified as somatostatinoma through immunohistochemical examination. The postoperative course was complicated by a small fluid collection, which arose in area of enucleation; the cistern was absorbed spontaneously. Currently, the patient is under surgical ambulatory care and is in general, in good condition.

Primary adenocarcinoma in the esophageal gastric graft is a rare complication diagnosed in patients with long-term survival. Most data concerning the diagnosis and treatment of patients with metachronic cancer in esophageal grafts is derived from Japan and South Korea. The diagnosis of cancer in esophageal gastric grafts in the European countries is rare. The study presented a case of a 66-year old male patient who, 30 months after an esophageal squamous cell cancer resection, was diagnosed with adenocarcinoma of the esophageal gastric graft. Despite control follow-up after the esophagectomy, cancer in the esophageal graft was detected during the stage that prevented performing radical surgery. The study presented the recommended diagnostic procedures and treatment options for esophageal gastric graft cancer, as well as review of available literature data.