Background/Aim: Breast-conserving surgery is a type of surgery used as a treatment option for breast cancer. It was introduced at the end of the 20th century following and in accordance with relevant clinical studies. With heightened public awareness of breast cancer and the introduction of new diagnostic procedures, despite the proven oncological safety of this type of surgery, a growing number of women choose to undergo total mastectomy. The aim of this study was to confirm the oncological safety of breast-conserving surgery performed on breast cancer patients at the University Clinical Centre of the Republic of Srpska. Methods: This study analysed 305 female patients with I and II stage of breast cancer, operated on between March 2009 and December 2013. One group of patients underwent breast-conserving surgery (BCS), followed by adjuvant radiation therapy and the other total mastectomy (MX). The patients were followed up for 5 years after the surgery. Analysed herein were the local-regional recurrence, distant metastases, disease-free survival and overall survival rates. Results: After a five-year follow-up, the local-regional recurrence rate for patients in the BCS group was 4.3 %, while for the MX group it was 4.2 %. The overall survival rate of patients in the BCS group was 90.9 %, as opposed to 89.1 % for MX patients. Conclusion: After a five-year follow-up, no statistically significant difference was observed between the two groups of patients regarding the local-regional recurrence (p = 0.967) and overall survival rates (p = 0.610). Breast-conserving surgery is an oncologically safe surgical treatment for breast cancer.

Background/Aim: Dehiscence of the colorectal anastomosis is one of the most serious complications in digestive surgery that is still present in a large percentage today, which significantly increases the cost of treatment and can lead to death. Due to all the above, early detection of anastomotic dehiscence is very important, as well as the decision on surgical treatment. Procalcitonin (PCT) is thought to be an important marker of inflammation and sepsis. Aim of this paper was to confirm PCT as a marker of great sensitivity in early diagnosis of anastomotic leakage. Methods: The study included patients who underwent surgery for colorectal cancer in the period from 2016 to 2020. Patients were operated according to an elective protocol and with an open surgical approach. In patients, PCT values were measured on the 2nd and 4th postoperative day (POD) to determine the association between elevated PCT values and the onset of dehiscence of the colorectal anastomosis. Results: A study was conducted in 118 patients in whom a stapler colorectal anastomosis was created. Colorectal anastomosis dehiscence occurred in 10 patients. In 4 patients with dehiscence, no re-surgical intervention was required, but they were taken care of by conservative methods. Repeated surgery was performed in 6 patients. In all patients with dehiscence, there was a multiple increase in the value of PCT above normal. Conclusion: PCT has high sensitivity and specificity (85 and 74 % respectively) as a marker in dehiscence of colorectal anastomosis. In this study it was found that PCT values were significantly correlated with the dehiscence of anastomo-sis 2nd POD and especially 4th POD.

Introduction: Gastrectomy is one of the most common surgical methods for the treatment of gastric cancer, which basically destroys the mechanism and digestion chemistry. Reconstruction after gastrectomy attempts to optimize the antireflux and nutritive component of the postgastrectomic syndrome.Objective: To determine which reconstructive method after gastrectomy has the optimal synthesis of antireflux and nutritional components.Patients and Methods: 111 patients were treated for gastric malignancies at the Surgical Clinic of the University Clinical Center in Banja Luka, which were operated with the intention of achieving curability.Results: Based on Fisher’s exact probability test there is no statistically significant difference (p> 0.05) in mortality compared to the restoration of digestive continuity after gastrectomy. Reflux oesophagitis is the dominant modality of morbidity in omega-loop reconstruction (p <0.05). There is no statistically significant difference (p> 0.05) in late dumping syndrome in patients relative to individual gastric substitution options. In the Hunt-Lawrence-Rodino pouch reconstruction option, there is no statistically significant difference (p> 0.05) in the participation of individual modalities of meal quantity in relation to the condition before the disease or the modality of the nutritional status. .Conclusion: The results indicate the antireflux component of reconstruction Roux en Y and the advantage of the nutritive component in the loop modification (the creation of the Hunt-Lawrence-Rodino pouch).

Introduction: Until recently, gastric cancer represented the most common visceral neoplasm. In Japan, the prevalence of disease is 58.4 per 100,000 inhabitants for men and 29.9 for women. Here, the incidence is lower. Gastrectomy is the most common surgical method of treating carcinomas of the stomach. Aim of the Study: To determine which method of reconstruction after gastrectomy improves the quality of life optimally. Patients and Methods: We analyzed 221 patient operated on for gastric cancer at the Surgical Clinic of the University Clinical Center in Banja Luka, and the subject of a detailed analysis of the 111 patients who were operated with the intention of achieving curability. Results: Reflux esophagitis is dominant modality in reconstruction wth omega loop (p <0.05). Analyzing GIQLI, we found dominant modality GIQLI II in the total gastrectomy and reconstruction options RY, while predominantly GIQLI III was registered in HLR reservoir reconstruction method (p <0.01). And two hours after the ingestion of a meal labeled with a radioisotope Tc99m in artificial gastric reservoir (HLR) showed signs of radioactivity (about 10% amount). “H0 performance” (AJCC / UICC) was the most frequently recorded in subtotal gastrectomy, while there was significant appearance of “H1” and “H2” modalities with the total gastrectomy statistically. In RY reconstruction, statistically significant was participation modalities “H1”, while “H1” performance (AJCC / UICC) was the dominant modality at the HLR options reconstruction with statistically significant frequency of occurrence (p <0.01). Conclusion: The results of the assessment of quality of life are comparable with the results of other statistical series. They confirm antireflux component Roux en Y reconstructions and its intestinoplications and highlight the advantage of the nutritional components loop modifications (creation pouch-a).

Breast cancer is a serious health problem. It is the most common cancer in women. The aim of this study was to estimate the concordance between ER, PR receptor and HER-2 immunohistochemistry assessment scores in pared CNB (core needle biopsy) and surgical specimens. Histological grade, oestrogen receptor (ER) status, progesterone receptor (PR) status, and human epidermal growth factor receptor-2 (HER2) status were evaluated in a blinded fashion in CNB and in surgical excision specimens. Absolute concordance rate between core needle biopsies and surgical specimens for histological grade was 50% with κ value (0,15) for ER 92% with κ value (0,79), PR 88% with κ value (0,73) and for HER2 96% with κ value (0,91). CNB can provide reliable information in evaluation of ER, PR and HER2 status in an invasive breast carcinoma. Ključne reči: breast cancer, core needle biopsy, oestrogen receptors, progesterone receptors, HER-2. Analiza odstupanja statusa hormonskih receptora i receptora za epidermalni faktor rasta 2 u uzorcima dobijenim iglenom biopsijom i hirurškim uzorkom kod obolelih od invazivnog karcinoma dojke Ljiljana Tadic Latinovic1, Zivka Eri2, Darko Jovic3, Aleksandra Salapura1, Jovan Culum3, Branislava Jakovljevic3, Ilija Baros1, Slavica Maric4 1 Department of Pathology, University Clinical Center of Republic of Srpska, Banja Luka, Republic of Srpska, Bosnia and Herzegovina 2 Canter for Molecular Genetics, Institute for Pulmonary Diseases, Sremska Kamenica, Republic of Serbia 3 Surgical Clinic “S-Tetik”, Banja Luka, Republic of Srpska, Bosnia and Herzegovina 4 International Medical CantersCentar za Radioterapiju Banja Luka, Banja Luka, Republic of Srpska, Bosnia and Herzegovina

Aneurysm of the visceral arteries is a rare condition and it represents around 1% of all arterial aneurisms. Aneurysm of the inferior pancreaticoduodenal artery represents around 2% of all visceral aneurysms. Aneurysm associated with occlusion of the coeliac trunk is very rare condition and there are only about 40 cases presented in the literature. In our study, we presented 56 year-old female admitted to hospital with obstructive jaundice. CT scan diagnosed tumor of the head of pancreas and CT angiography confirmed aneurysm of the inferior pancreaticoduodenal artery which was successfully operated at our clinic.

Introduction: Sentinel lymph node biopsy is a standard staging procedure in patients with early breast cancer. Aim of the study is a validation procedure of sentinel lymph node biopsy (SLNB) in our institution and comparison between two mapping techniques isotope mapping and methylene blue dye for lymphatic mapping. Material and methods: The study comprised 75 women with breast cancer of clinical stage T1-2N0M0. We analyzed patients from June, 2010 to March, 2013. In 39 patients, (Group A) lymphatic mapping technique was performed by using the peritumoral injection of 37MBq activity isotope (99m Technetium NANOCIS),and in 36 patients (Group B) mapping technique was performed by using the periareolar injection of 2-4 ml blue dye (Methylene blue 1%). Axillary dissection was performed in both groups after SLNB. Results: Out of 75 patients, sentinel lymph node was identified in 68 (90.7%). Identification rate was similar between the groups 89.7% (Group A), 91.7% (Group B). Accuracy rate was 97% between the groups, that is, Group A 97.1% and Group B 96.9%. In relation to the Group A (90.6%), sensitivity rate was slightly higher in the Group B 91.6%,. False negative rate of SLNB was higher in the Group A (9.1%) in relation to the Group B (8.3%). The average number of sentinel nodes detected in both groups was 1.2. Conclusion: The results of the study confirmed and validated both methods of lymphatic mapping techniques in SLNB. There were no significant statistical differences (p>0.05) in accuracy, sensitivity and false negative rate between these two groups.

Introduction In clinical practice, ascites treatment is, in majority of cases, unsatisfactory and followed by multiple complications. During the therapy, some side effects,in relation to therapeutic method, may occur. The aim of the study was to compare the level of tolerance and effectiveness of ascites therapy in applying abdominal puncture versus diuretics between two groups of patients to establish connection and differences in applied treatments. Patients and methods. There were 60 patients examined with ascites 3+ and 4+ divided into two equal groups. First group was treated by abdominal puncture several times a week while patients in the other group were administered diuretics either monotherapeutically or in combination. Majority of patients (86.7%) experienced no side effects after applied therapeutic protocol. 6,7% of patients experienced abdominal pain, 3.3% of them had cramps, ailment 1.7% and nausea 1.7% with no statistic difference between two groups of patients (p>0.05). Registered side effects were mild (5%) to moderate (8.3%), while only 1.7% of patients treated by abdominal puncture experienced leaking of ascitic fluid at the puncture site. Conclusion. No major statistic difference between groups of patients was recorded in relation to side effects and complications in applied ascites therapy (p>0.05). Abdominal puncture and diuretics were both equally well tolerated in hospital conditions. Potential risk in ascites therapy can be reduced to the smallest possible extent by intensive observation of the patient.

Epiphrenic diverticulum is a rare condition which produces disphagic problems. It occurs in one fifth of the total number of patients with esophageal diverticula. It is often associated with motility disorders such as hypertensive lower esophageal sphincter, achalasia and diffuse esophageal spasm. Increased intraluminal pressure is responsible for the prolapse of mucosa and submucosa through the muscle layer, and the consequently formation bag extensions (diverticula). We presented 55 year old female patient who had dysphagia, regurgitation and chest pain caused by retrosternal epiphrenic diverticulum who has successfully operated in our clinic. We performed open approach (left thoracotomy), and complex surgery: diverticulectomy, long esophagomyotomy and antireflux procedure (Belsey Mark IV). After 4 years patient is without symptoms of disphagia and in a good nuitrition.

Sažetak. Cilj rada bio je da se analiziraju rani rezultati operativnog liječenja bolesnika sa metastazama kolorektalnog karcinoma u jetri. Studijom su obuhvaćena 453 bolesnika operisana na Klinici za opštu i abdominalnu hirurgiju Kliničkog centra u Banjoj Luci u periodu od 01. aprila 2004. do 31. marta 2009. Metastaze u jetri imalo je 108 (23,84%) bolesnika. Kod 49 (45,37%) bolesnika one su bile sinhrone, a kod 59 (54,63%) metahrone. Kod 39 (36,11%) bolesnika postavljena je indikacija za hirurško liječenje, a kod 27 (25%) urađena je uspješna resekcija jetre. U grupi uspješno operisanih bilo je 14 (51,85%) žena, prosječne starosti 60,4 (46-75) godine i 13 (48,15%) muškaraca, prosječne starosti 66,8 (57-75) godina. Kod 16 (59,26%) bolesnika korišćena je desna subkostalna laparotomijska incizija, a kod 11 (40,74%) pristup po Makuchiju. Kod 6 (22,22%) bolesnika je urađena segmentektomija, kod 3 (11,11%) bisegmentektomija, kod 4 (14,81%) lijeva hepatektomija, kod 2 (7,41%) desna hepatektomija i kod 12 (44,44%) atipična resekcija jetre. Prosječno je operacija trajala 138 (75-265) minuta. Kod 15 (55,56%) opsežnih resekcija korišćena je tehnika hepatične vaskularne izolacije (kod 6 selektivno klemovanje portne trijade za resektovani lobus i kod 9 bolesnika intermitentno klemovanje hepatoduodenalnog ligamenta po Pringleu). Prosječno vrijeme hepatične vaskularne izolacije iznosilo je 30 minuta. Od ukupnog broja operisanih 16 (59,26%) bolesnika dobili su transfuziju krvi (u prosjeku 450 mL). Prosječna hospitalizacija je trajala 9,3 dana. Komplikacije su se javile kod 5 (18,52%) bolesnika, a nijedan bolesnik nije podlegao intraoperativno i postoperativno. Anatomske resekcije jetre sa selektivnom vaskularnom hepatičnom ekskluzijom i uz upotrebu harmoničnog skalpela ili uređaja za tkivno spajanje jesu uspješne i pouzdane metode sa minimalnim intrai postoperativnim komplikacijama.

Sažetak. Ekstenzivna hirurgija karcinoma jednjaka je najkomplikovaniji dio digestivne hirurgije i uglavnom je rezervisana za specijalizovane centre. Cilj rada bio je da se evaluiraju početna iskustva u ovoj zahtijevnoj hirurškoj problematici u Klinici za opštu i abdominalnu hirurgiju Kliničkog centra Banja Luka u petogodišnjem periodu. U periodu od 1. januara 2004. do 31. decembra 2008. godine operisan je 81 pacijent, od kojih je 61 (75,31%) imao palijativnu operaciju, a 20 operacija je urađeno s ciljem da se postigne eradikacija bolesti (R0 nivo) (25% stopa resektabilnosti). U grupi operisanih s ciljem eradikacije dominirali su muškarci (15 muškaraca i 5 žena), a većina oboljelih bila je starija od 50 godina (od 43 do 82 godine). Najčešća lokalizacija tumora bio je srednji i donji torakalni jednjak. Za supstituciju je u većini slučajeva korišćen želudac (oko 85%). Put transpozicije grafta bio je najčešće retrosternalni (za vratne anastomoze). Visoka supraaortalna intratorakalna anastomoza bila je najčešća opcija za rekonstrukciju tumora distalnog jednjaka (Ivor-Lewis) (65%). Stopa smrtnosti bila je 10%. Rani morbiditet, kod oko 60% operisanih, uglavnom su činile plućne komplikacije u vidu upala, atelektaza, izliva, pneumotoraksa. Prosječno vrijeme bolničkog liječenja bilo je 18 dana (od 15 do 25). Do trenutka objavljivanja rezultata, živih je pet pacijenata od kojih dvoje živi pet godina nakon operacije i nemaju znakova relapsa bolesti. Kod ostalih operisanih, prosječna dužina preživljavanja je 37 mjeseci (od 18 do 42) i svi su umrli od recidiva bolesti. Patohistološki nalazi pokazuju da prevladava skvamocelularni karcinom (60%), a ostatak su adenokarcinomi. Početna iskustva pokazuju stopu smrtnosti i prosječno preživljavanje koji su prihvatljivi i slični rezultatima drugih koji se rutinski bave ovom vrstom hirurgije.