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.

Background: Breast carcinoma recurrence appears in 5%-30% of cases, after the completion of breast cancer treatment. Recurrence appears on thoracic wall (chest wall), on the skin, on the breast tissue remaining after the surgery, equal sided axillary lymph nodes, supraclavicular lymph nodes or on the internal mammary lymph nodes. Recurrence often stays undetected by clinical examination, while it can be detected by ultrasound and punctured under ultrasound control. Cytological confirmation of malignant cells represents a signal to commence a specific recurrence treatment. Methods: Aspiration puncture under ultrasound control has been performed within 128 patients. Only 38 patients, out of 128, did not have distant metastasis at the moment of recurrence detection, so the recurrence was sur- gically removed and was subjected to the histopathological analysis. The results of definite histopathological analysis were compared to the clinical results and cytological results, which had been obtained preoperatively. Results: 31 patients, out of above mentioned 38 patients, have had breast carcinoma recurrence, while 7 patients have had benign tumor lesion. Clinical diagnoses were correct in 47.4% of cases, and incor- rect for 52.6%. False positive finding result happened in 7.89% cases and false negative finding result happened in 39.47% cases. Ultrasound diagnoses were correct for 86.84% of patients and incorrect for 13.16% of patients. Cytological analysis of material obtained by aspiration puncture under ultrasound control produced correct diagnoses for 86.84% of patients. 13.16% of patients had inconsistent cyto- logical and histopathological findings result. Cytological analysis has detected malignant cells for 5.26%, but the recurrence was not histopathologically confirmed, which points that the results were falsely positive. Falsely negative results were confirmed for 7.89%. Conclusion: Clinical examination was reliable for 52.6% of patients examined. Cytological analysis of material obtained by ultrasound-controlled puncture was reliable for 86.84% of patients examined. Aspiration puncture followed by cytological analysis gave falsely negative result for 7.89% of patients examined, while clinical examination gave falsely negative result for 39.47% of patients examined. Aspiration puncture gave falsely positive result for 5.26%, and clinical examination gave falsely positive result for 7.89%. Aspiration puncture is simple, easy to perform, without damaging effect for the patient or the medical personnel, it is not expensive and it is significantly more reliable than clinical examination itself for detection of breast carcinoma recurrence.