BackgroundTo validate a new practical Sepsis Severity Score for patients with complicated intra-abdominal infections (cIAIs) including the clinical conditions at the admission (severe sepsis/septic shock), the origin of the cIAIs, the delay in source control, the setting of acquisition and any risk factors such as age and immunosuppression.MethodsThe WISS study (WSES cIAIs Score Study) is a multicenter observational study underwent in 132 medical institutions worldwide during a four-month study period (October 2014-February 2015). Four thousand five hundred thirty-three patients with a mean age of 51.2 years (range 18–99) were enrolled in the WISS study.ResultsUnivariate analysis has shown that all factors that were previously included in the WSES Sepsis Severity Score were highly statistically significant between those who died and those who survived (p < 0.0001). The multivariate logistic regression model was highly significant (p < 0.0001, R2 = 0.54) and showed that all these factors were independent in predicting mortality of sepsis. Receiver Operator Curve has shown that the WSES Severity Sepsis Score had an excellent prediction for mortality. A score above 5.5 was the best predictor of mortality having a sensitivity of 89.2 %, a specificity of 83.5 % and a positive likelihood ratio of 5.4.ConclusionsWSES Sepsis Severity Score for patients with complicated Intra-abdominal infections can be used on global level. It has shown high sensitivity, specificity, and likelihood ratio that may help us in making clinical decisions.

Background. Laparoscopy or its combination with endoscopy is the next step for "difficult" polyps. The purpose of the paper was to review the outcomes of the laparoscopic approach to the management of "difficult" colorectal polyps.Materials and methods. From 2006 to 2016, 58 patients who underwent laparoscopic treatment for "difficult" polyps that could not be treated by endoscopy at the National Cancer Institute, Lithuania, were included. The demographic data, the type of surgery, length of post-operative stay, complications, and final pathology were reviewed prospectively.Results. The mean patient was 65.9 ± 8.9 years of age. Laparoscopic mobilization of the colonic segment and colotomy with removal of the polyp was performed in 15 (25.9%) patients, laparoscopic segmental bowel resection in 41 (70.7%) cases: anterior rectal resection with partial total mesorectal excision in 18 (31.0%), sigmoid resection in nine (15.5%), left hemicolectomy in seven (12.1%), right hemicolectomies in two (3.4%), ileocecal resection in two (3.4%), resection of transverse colon in two (3.4%), and sigmoid resection with transanal retrieval of specimen in one (1.7%). Two patients (3.4%) underwent laparoscopicassisted endoscopic polypectomy. The mean post-operative hospital stay was 5.7 ± 2.4 days. There were four complications (6.9%). All patients recovered after conservative treatment. The mean polyp size was 3.5 ± 1.9 cm. Final histopathology revealed hyperplastic polyps (n = 2), tubular adenoma (n = 9), tubulovillous adenoma (n = 31), carcinoma in situ (n = 12), and invasive cancer (n = 4).Conclusions. For the management of endoscopically unresectable polyps, laparoscopic surgery is currently the technique of choice.

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Background. Usually adjuvant chemotherapy is started within 12 weeks of surgery, but the evidence on the commencing time is lacking. Our aim was to investigate the association of initiating post-surgery treatment within six weeks vs. six to ten weeks vs. more than ten weeks with survival. Methods. We analysed the association of treatment and its timing with survival among patients who were diagnosed and underwent surgery for stage II or III colon cancer from 2012 to 2013 at the National Cancer Institute, Lithuania. Results. Of the 86 patients, 78% were still alive on December 31, 2013. Patients who received chemotherapy within six weeks after surgery were more likely to survive. However, those who received chemotherapy 6–10 weeks after surgery had better survival (p – 0.014, hazard ratio 0.80, 95% CI 0.60–0.99) than those who began chemotherapy treatment more than ten weeks after surgery (p – 0.173 hazard ratio 0.55, 95% CI 0.12–0.99) Conclusions. The results from this study show that optimal timing of adjuvant chemotherapy for patients with resected colon cancer within six weeks and associated with better survival.

Įvadas / tikslas Ranka asistuojamoji laparoskopinė chirurgija (HALS) į klinikinę praktiką įdiegta jau beveik tris dešimtmečius. Ji jungia atviros chirurgijos ir laparoskopinės (minimaliai invazinės) chirurgijos būdus. Nepaisant paskelbtų duomenų, chirurgų bendruomenė vis dar skeptiškai žvelgia į šią hibridinę laparoskopijos formą. Straipsnio tikslas – apžvelgti vieno centro 10 metų patirtį taikant HALS metodiką.Metodai Tai retrospektyvioji duomenų analizė. Apžvelgti 473 pacientai, gydyti Nacionaliniame vėžio institute dėl kolorektalinės pato­logijos nuo 2006 m. sausio iki 2016 m. liepos mėn. Šie pacientai buvo operuoti HALS būdu.Rezultatai Pacientų amžiaus vidurkis buvo 64,14 ± 9,75 metai. Moterų – 240 (50,73 %), vyrų – 233 (49,27 %). Vidutinė hospitalizacijos tru­kmė buvo 6,92 dienos (nuo 2 iki 34 d.). Histologinio tyrimo duomenimis, vidutinis pašalintų limfmazgių skaičius 16,97 ± 12,10. I, II, III ir IV stadijų grupes sudarė atitinkamai 142 (30,02 %), 139 (29,35 %), 153 (32,35 %) ir 36 (7,61 %) pacientai. Trims pa­cientams patologija buvo gerybinė. Segmentinės kolektomijos atliktos 53 % pacientų, tiesiosios žarnos rezekcijos – 45,3 % pacientų, kitos operacijos sudarė 1,7 %. Pakartotinės intervencijos prireikė 10 pacientų (2,11 %). Komplikacijų dažnis buvo 6,55 %, 2 pacientai (0,42 %) mirė.Išvada HALS yra saugi ir efektyvi technika, kuri leidžia pasinaudoti visais laparoskopinės kolektomijos privalumais bei minimaliai invaziniu būdu gali būti pritaikyta sudėtingais klinikiniais atvejais.