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Optimization of preoperative and surgical treatment of carcinoma of the esophagus and esophagogastric junction: The use of PET/CT in the diagnosis and evaluation of the effectiveness of preoperative chemotherapy and the technique of anastomotic construction as a factor of postoperative complications after esophagectomy
Haruštiak, Tomáš ; Stolz, Alan (advisor) ; Šimša, Jaromír (referee) ; Vrba, Radek (referee)
Key words: adenocarcinoma of the esophagus and esophagogastric junction, neoadjuvant chemotherapy, PET/CT, histopathological response, technique of esophagogastric anastomosis, anastomotic leak, anastomotic stricture Previous studies have shown that preoperative chemotherapy of locally advanced AEG is beneficial only for patients with a good histopathological response, the so-called responders. The aim of the first part of the thesis was to prospectively verify whether positron emission tomography (PET/CT) could be used for early identification of histopathological non- responders, who could be spared ineffective neoadjuvant treatment. Our study did not prove that the early metabolic response, expressed as the percentage change of the consumption of glucosis on PET/CT performed before (PET1) and 12 to 22 days after the start of the first cycle of preoperative chemotherapy (PET2) correlated with the histopathological response in the resection specimen in the entire population of 90 patients. In a post hoc explorative analysis we found the correlation between metabolic and histopathological response in a subgroup of patients with PET2 performed ≤16 days after the start of the therapy, but this hypothesis needs to be prospectively validated. Our study suggests that PET/CT performed after the first...
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Surgeon's view on pulmonary vessels variations
Stolz, Alan ; Pafko, Pavel (advisor) ; Wechsler, Jan (referee) ; Vobořil, Zbyněk (referee)
Our investigation deals with the configuration of the arteries as they arise from the pulmonary artery. According to our study, we found variations from classical anatomical branching of pulmonary vessels. The patterns of pulmonary arterial supply to the right upper lobe have been studied in 100 laboratory and surgical specimens. The commonest single pattern consisted of 3 vessels, an anterior trunk, posterior and anterior ascending artery. The commonest pattern in middle lobe, encountered in 57% of the cases, consisted of 2 vessels. The superior segments of the lower lobes were supplied by single arterial branch in 80% of individuals. The number of arteries supplying the left upper lobe varied from 3 to 5, with most lobes receiving 4 branches in 50% of cases. Surgeons usually ligate and divide the right inferior pulmonary vein without meticulous attention to its tributaries when performing right lower lobectomy when its trunk is long enough to divide safely. Our study identified variations of middle pulmonary vein. In this cases blockage of venous return from middle lobe vein in patients who have the anatomic variation of middle lobe vein drainage can lead to severe lung edema, which may cause infection or respiratory distress, postoperative complications that can be life-threatening. The branching pattern...
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