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New methods of in vivo monitoring and management of colonic anastomoses leak in experimental study
Kalvach, Jaroslav ; Pohnán, Radek (advisor) ; Kala, Zdeněk (referee) ; Klos, Dušan (referee)
The primary aim of the project was to assess two different minimally invasive techniques (Transanal minimally invasive surgical approach - TAMIS and endoscopic closure) in the treatment of colorectal anastomosis dehiscence on an experimental model. The secondary aim was to evaluate microdialysis (MD), and confocal laser endomicroscopy (CLE) as novel methods potentially suitable for postoperative monitoring of colo-rectal anastomosis. In the first step, large animal model of dehiscent colo-rectal anastomosis was developed. Two novel techniques of dehiscence closure were then compared with conventional surgical repair and laparotomy with anastomotic diversion. Thus 4 intervention groups and one untreated control group were included. Transanal repair using TAMIS and endoscopic closure were technically feasible with high healing rate. Both techniques reduced the incidence of intra- abdominal septic complications compared to control. With regards to secondary aim, colorectal anastomosis was monitored using MD and CLE before and after the induction of ischaemia. Moreover, intramural and serosal positioning of MD sensors were compared. Both methods revealed hypoperfusion of anastomosis promptly and were proven as suitable for early detection of impaired healing. Based on the results of this project, a...
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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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