{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2024,10,1]],"date-time":"2024-10-01T04:23:53Z","timestamp":1727756633307},"reference-count":33,"publisher":"Akademiai Kiado Zrt.","issue":"3","content-domain":{"domain":["akjournals.com"],"crossmark-restriction":true},"short-container-title":["MaSeb"],"published-print":{"date-parts":[[2024,9,30]]},"abstract":"<jats:sec><jats:title>Bevezet\u00e9s<\/jats:title><jats:p>A lok\u00e1lisan el\u0151rehaladott vagy recid\u00edv kismedencei daganatok kezel\u00e9s\u00e9re a tot\u00e1lis (TPE) vagy parci\u00e1lis kismedencei exenter\u00e1ci\u00f3 (PPE) lehet az egyetlen kurat\u00edv m\u0171t\u00e9t, mely a beteg t\u00fal\u00e9l\u00e9s\u00e9t n\u00f6velheti. A mortalit\u00e1scs\u00f6kken\u00e9s ellen\u00e9re a morbidit\u00e1s m\u00e9g mindig magas, az R0 reszekci\u00f3 el\u00e9r\u00e9se sokszor neh\u00e9z.<\/jats:p><\/jats:sec><jats:sec><jats:title>Anyag \u00e9s m\u00f3dszer<\/jats:title><jats:p>Retrospekt\u00edv m\u00f3don elemezt\u00fck az oszt\u00e1lyunkon 2016. 09. 01. \u00e9s 2022. 10. 31. k\u00f6z\u00f6tt v\u00e9gzett kismedencei exenter\u00e1ci\u00f3 (PE) m\u0171t\u00e9ti adatait a morbidit\u00e1s, mortalit\u00e1s, specimenhisztol\u00f3gia tekintet\u00e9ben. Az \u00e9letmin\u0151s\u00e9g\u00e9t az EORTC\u2013QLQ-C30 \u00e1ltal\u00e1nos \u00e9s CR29 vastagb\u00e9l m\u0171t\u00e9tekhez adapt\u00e1lt k\u00e9rd\u00e9ssor seg\u00edts\u00e9g\u00e9vel m\u00e9rt\u00fck.<\/jats:p><\/jats:sec><jats:sec><jats:title>Eredm\u00e9nyek<\/jats:title><jats:p>32 betegen t\u00f6rt\u00e9nt PE. 20 (62,5%) volt n\u0151 \u00e9s 12 (37,5%) f\u00e9rfi. A medi\u00e1n \u00e9letkor 60 \u00e9v volt (41\u201382 \u00e9v, IQR: 13). 7\u2009m\u0171t\u00e9t laparoszk\u00f3pos (21,8%) \u00e9s 25 nyitott m\u00f3don t\u00f6rt\u00e9nt (78,2%). 27 esetben (84,3%) primer lok\u00e1lisan el\u0151rehaladott \u00e9s 5 (15,7%) esetben pedig recid\u00edv, lok\u00e1lisan el\u0151rehaladott v\u00e9gb\u00e9l tumor miatt v\u00e9gezt\u00fck a m\u0171t\u00e9tet. A 13 TPE-b\u0151l (40,6%), 8 supralevatoricus, z\u00e1r\u00f3izom megtart\u00e1ssal (SLTPE) \u00e9s 5 infralevatoricus, z\u00e1r\u00f3izom elt\u00e1vol\u00edt\u00e1ssal (ILTPE) t\u00f6rt\u00e9nt. Supralevatoricus poszterior exenter\u00e1ci\u00f3t (SLPPE) 16 esetben (50%), infralevatoricus poszterior exenter\u00e1ci\u00f3t (ILPPE) 3 esetben (9,4%) \u00e9s S4\/5 szint\u0171 sacrum reszekci\u00f3t 5 esetben (15,6%) v\u00e9gezt\u00fcnk. A\u00a0kiterjedt medencei \u00e9s g\u00e1ti defektus z\u00e1r\u00e1sa egy vagy k\u00e9toldali gluteus maximus musculocutan lebeny alkalmaz\u00e1s\u00e1val 6 esetben t\u00f6rt\u00e9nt (18,75%), anasztom\u00f3zist 15 betegn\u00e9l (46,87%) k\u00e9sz\u00edtett\u00fcnk. A vizelet-devi\u00e1ci\u00f3 minden esetben izol\u00e1lt ileum szegmentum alkalmaz\u00e1s\u00e1val t\u00f6rt\u00e9nt Bricker szerint. R0 reszekci\u00f3t 27 (84,3%), R1 reszekci\u00f3t 2 (6,25%) esetben igazolt a sz\u00f6vettani vizsg\u00e1lat, m\u00edg 3 esetben (9,375%) R2\u00a0reszekci\u00f3 t\u00f6rt\u00e9nt. A medi\u00e1n m\u0171t\u00e9ti id\u0151 170 perc volt (60\u2013360 perc, IQR: 97,5). Clavien Dindo \u2265 3 sz\u00f6v\u0151dm\u00e9nyt \u00f6sszesen 8 esetben (25%) \u00e9szlelt\u00fcnk. Has\u0171ri t\u00e1lyog 2 esetben, b\u00e9lelz\u00e1r\u00f3d\u00e1s 1 esetben, rektum csonk nekr\u00f3zis 1 esetben, v\u00e9konyb\u00e9l-perfor\u00e1ci\u00f3 1 esetben, ureters\u00e9r\u00fcl\u00e9s 1 esetben, beforgatott gluteus maximus musculocutan lebeny r\u00e9szleges elhal\u00e1sa 1 esetben \u00e9s biol\u00f3giai h\u00e1l\u00f3 f\u00f6l\u00e9 nyelezett gracilis izomlebenylebeny elhal\u00e1sa 1 esetben fordult el\u0151. Egy beteget vesz\u00edtett\u00fcnk el 30 napon bel\u00fcl (3,1%) posztoperat\u00edv has\u0171ri v\u00e9rz\u00e9s okozta hypovolemias shock miatt. \u00c1tlagos k\u00f3rh\u00e1zi tart\u00f3zkod\u00e1s 14,4\u00a0nap volt (7\u201339 nap, SD: 9). A medi\u00e1n t\u00fal\u00e9l\u00e9s 16,5 h\u00f3nap (0,67\u201374 h\u00f3nap, IQR: 28,5), a medi\u00e1n betegs\u00e9gmentes t\u00fal\u00e9l\u00e9s 15,5 h\u00f3nap (0,67\u201374 h\u00f3nap, IQR: 29) volt. A QLQ-CR29 vastagb\u00e9l m\u0171t\u00e9tekhez adapt\u00e1lt \u00e9letmin\u0151s\u00e9g felm\u00e9r\u00e9s alapj\u00e1n a funkcionalit\u00e1st 73%-nak, a panaszokat pedig 15%-nak m\u00e9rt\u00fck.<\/jats:p><\/jats:sec><jats:sec><jats:title>K\u00f6vetkeztet\u00e9sek<\/jats:title><jats:p>A kezdetben palliat\u00edv m\u0171t\u00e9tk\u00e9nt v\u00e9gzett beavatkoz\u00e1s kurat\u00edvv\u00e1 v\u00e1lt. A radioter\u00e1pia n\u00f6veli a negat\u00edv reszekci\u00f3s sz\u00e9l val\u00f3sz\u00edn\u0171s\u00e9g\u00e9t, ami szignifik\u00e1ns prediktora a betegs\u00e9gmentes t\u00fal\u00e9l\u00e9snek (DFS), ugyanakkor pedig a morbidit\u00e1s, sz\u00f6v\u0151dm\u00e9nyi kock\u00e1zat n\u00f6vel\u00e9s\u00e9nek is a leggyakoribb szignifik\u00e1ns oka. A\u00a0PE potenci\u00e1lisan kurat\u00edv m\u0171t\u00e9t lehet lok\u00e1lisan el\u0151rehaladott v\u00e9gb\u00e9ldaganatok eset\u00e9n t\u00fal\u00e9l\u00e9si el\u0151nnyel \u00e9s lok\u00e1lis recid\u00edva cs\u00f6kken\u00e9ssel, elfogadhat\u00f3 \u00e9letmin\u0151s\u00e9ggel.<\/jats:p><\/jats:sec>","DOI":"10.1556\/1046.2024.30001","type":"journal-article","created":{"date-parts":[[2024,9,30]],"date-time":"2024-09-30T15:20:28Z","timestamp":1727709628000},"page":"71-77","update-policy":"http:\/\/dx.doi.org\/10.1556\/policypage.crossmark.crossref.2","source":"Crossref","is-referenced-by-count":0,"title":["Kismedencei exenter\u00e1ci\u00f3 \u2013 \u00e9rdemes v\u00e1llalni a\u00a0nagyobb kock\u00e1zatot?"],"prefix":"10.1556","volume":"77","author":[{"given":"\u00c1d\u00e1m","family":"Bart\u00f3k","sequence":"first","affiliation":[{"name":"B\u00e1cs-Kiskun V\u00e1rmegyei Oktat\u00f3k\u00f3rh\u00e1z, Kecskem\u00e9t, \u00c1ltal\u00e1nos Seb\u00e9szeti Oszt\u00e1ly, Magyarorsz\u00e1g"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Korn\u00e9l","family":"Vajda","sequence":"additional","affiliation":[{"name":"B\u00e1cs-Kiskun V\u00e1rmegyei Oktat\u00f3k\u00f3rh\u00e1z, Kecskem\u00e9t, \u00c1ltal\u00e1nos Seb\u00e9szeti Oszt\u00e1ly, Magyarorsz\u00e1g"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"L\u00e1szl\u00f3","family":"Venczel","sequence":"additional","affiliation":[{"name":"B\u00e1cs-Kiskun V\u00e1rmegyei Oktat\u00f3k\u00f3rh\u00e1z, Kecskem\u00e9t, \u00c1ltal\u00e1nos Seb\u00e9szeti Oszt\u00e1ly, Magyarorsz\u00e1g"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"L\u00e1szl\u00f3","family":"Sikorszki","sequence":"additional","affiliation":[{"name":"B\u00e1cs-Kiskun V\u00e1rmegyei Oktat\u00f3k\u00f3rh\u00e1z, Kecskem\u00e9t, \u00c1ltal\u00e1nos Seb\u00e9szeti Oszt\u00e1ly, Magyarorsz\u00e1g"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"425","reference":[{"key":"B1","article-title":"Bowel cancer incidence","author":"Cancer Research UK","year":"2009","unstructured":"Cancer Research UK. 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