OETDK.

BevezetésA hemodialízis, illetve peritoneális dialízis átmenetileg képesek vese kiválasztó funkcióját helyettesíteni, azonban mind életminőségben, mind életévek számában megoldást a veseátültetés jelent. A műtét azonban jelentősen nagyobb kockázatta járhat, mint egy vesepótló kezelés. Tudományos munkám során arra voltunk kíváncsiak, milyen arányban kényszerülünk a beültetett graft eltávolításra, milyen indikációk mentén, valamint mit ajánl az irodalom.Anyagok és módszerek2015. és 2025. között a Debreceni Egyetem Klinikai Központ (DEKK) Sebészeti Klinikáján vesetranszplantált populációt vizsgálatuk (n=409) retrospektív, betegdokumentáció alapú adatgyűjtéssel. Az adatok tárolásához és statisztikai elemzéshez SPSS szoftvert használtunk. Irányadásképp egy korábbi, 2004-2015-ös időszakot vizsgáló tanulmányukat is felhasználtuk.EredményekVese allograft nefrektómiák (AN) száma csökkenő tendenciát mutatott a vizsgált időszakban. Indikáció körökben pedig a tervezett AN aránya (26,1%) minimálisra csökkent, az akut esetek aránya (73,9%) nőtt. AN után a betegek 30%-a került ismételten transzplantációra. Az AN nélkül második vesét kapott populáció graft túlélése rosszabb, mint az AN után újra transzplantáltaknak.KonklúzióAz AN egy kockázatos műtét, mely gondos tervezést igényel. Indokolt esetben azonban a beteg jól jár egy elektív AN elvégézével, amennyiben ezt követően egy következő vesetranszplantációban részesül.

Témavezető: Dr. Illésy Lóránt

Bevezetés: Az emlődaganat a leggyakrabban előforduló daganatos megbetegedés a nők körében. Mortalitása az utóbbi évtizedben csökkenő tendenciát mutat, amely az egyre korszerűbb és hatékonyabb multidiszciplináris kezelésnek köszönhető. A betegségben érintettek életminősége is egyre nagyobb hangsúlyt kap, melynek szerves része az emlők onkoplasztikai sebészeti ellátása. Célkitűzés: Kutatásunk célja az onkoplasztikai eljárások áttekintése, valamint a Debreceni Egyetem Sebészeti Klinikáján ilyen típusú műtéten átesett betegek vizsgálata. Ennek során a páciensek demográfiai adatainak, a daganatok biológiai tulajdonságainak, valamint a sebészi ellátás részleteinek áttekintése és összefüggések vizsgálata a nemzetközi irodalmi adatok függvényében. Módszerek: Kutatásunkban retrospektív módon vizsgáltuk a Debreceni Egyetem Sebészeti Klinikáján 2021-2024 között operált emlő daganatos betegeket. A kutatásba masztektómián átesett és rosszindulatú daganattal kezelt betegeket vontuk be. Elemeztük a daganatok típusát, elhelyezkedését, szövettani tulajdonságait, BRCA-státuszát, az áttétképzést, TNM stádiumot, esetleges neoadjuváns kezelést, az axilla sebészi ellátását, a rekonstrukció típusát és a szövődmények előfordulását. Eredmények: A vizsgált időszakban 148 rekonstrukciós műtétre került sor, amely az elvégzett masztektómiák 19,3%-a. 109 esetben (73,6%) azonnali és 39 esetben (26,4%) halasztott rekonstrukciót végeztek. Azonnali műtéteknél 71 esetben (65,1%) implantátumot és 38 esetben (34,9%) expandert alkalmaztak. Halasztott során 5 alkalommal (12,8%) latissimus dorsi myocutan lebenyt (LDM), a fennmaradó 34 esetben (87,2%) pedig expandert alkalmaztak. A betegek átlagéletkora 57,7 év volt. A tumorok elhelyezkedését illetően az esetek 48,9%-át képezték a multicentrikus és multifokális daganatok, amelynek felismerése a képalkotó eljárások fejlődésének tulajdonítható. A négy év rekonstrukciós műtéteinek 14,2%-ában fordult elő szövődmény, 2021-ben 20%, 2022-ben 19%, 2023-ban 6,5%, majd 2024-ben 16,7% volt az adott években. Következtetések: Az emlők rekonstrukciós műtéteire egyre nagyobb az igény, ezen technikák jól tolerálhatóak, a súlyos szövődmények aránya relatíve alacsony. A megfelelő sebésztechnikai eljárást személyre szabottan, plasztikai sebész bevonásával kell választani a beteg igényeit is figyelembe véve. Ez biztosíthatja a legjobb esztétikai eredményt és a beteg elégedettségét. A különböző eljárások azonos eredményességgel alkalmazhatók.

Témavezető: Dr. Kósa Csaba Gábor

Introduction: Perianal fistulas are a common colorectal condition arising from various aetiologies, including abscess formation, inflammatory bowel disease, trauma, or malignancy. According to the World Health Organization (WHO), their prevalence is estimated at 1.7–2.3 cases per 10,000 people. Management remains complex and often involves a two-stage surgical approach, with reported success rates of approximately 65–70%. In recent years, platelet-rich fibrin (PRF; an autologous, fibrin-based biomaterial concentrated with platelets) has been an increasingly utilised option for treatment of the perianal fistulas. PRF forms a gel-like matrix capable of releasing key growth factors such as PDGF, VEGF, and fibrinogen, all of which support tissue healing. This study aims to introduce Western European PRF techniques to the Hungarian clinical setting and to assess early and longer-term outcomes using locally collected patient data.Materials and Methods: Between 1st April 2025 - 31st May 2025, a total of 20 patients were enrolled for PRF surgery. Inclusion criteria were age over 18 years, confirmed perianal fistula, and suitability for PRF application. All patients presented with MRI-proven (contrast enhancement, dedicated fistula protocol) inter- or transsphincteric perianal fistula tracts. Seton and curette fistula surgeries were performed two weeks earlier in every case. The PRF procedures were standardized and performed by three qualified proctologists. In all cases, the internal fistula orifice was closed using a Z-suture. Postoperative assessment was carried out (with regular surgical check-ups) using a standardized 30-day form, documenting demographics (age, gender, BMI, smoking), previous non-perianal and perianal surgeries, postoperative pain, as well as any unexpected events.Results: 17 male and 3 female patients were operated on. The median age was 41.5 (25-59) years. The median surgical time was 15.5 (10-31) minutes. Minor, non - significant postoperative bleeding occurred in four cases. No major complications or unexpected adverse events were observed throughout the follow-up period. Evaluation of 6 month control MRI studies is in progress.Conclusion: PRF demonstrates promising potential as an adjunctive therapy for perianal fistulas, supported by encouraging postoperative outcomes. With its short learning curve and expanding clinical applications, PRF may represent a valuable addition to fistula management strategies in Hungary.

Témavezető: Dr. Kolozsi Péter

Introduction: Pancreatic cancer (PDAC) is the fourth leading cause of cancer-related mortality worldwide. Even in resectable cases, the average 5-year patient survival remains only 20-30%. This study investigates the factors which can contribute to the short and long-term outcomes after surgery for PDAC.Patients and Methods: We collected data from a retrospective cohort of 150 patients evaluated for pancreatic lesions at the Institute of Surgery, University of Debrecen, between 2022.01.01-2025.08.31, of whom 68 underwent surgical intervention for pancreatic cancer. Patient characteristics, diagnostic steps, details of operative techniques, postoperative outcomes, and neoadjuvant and adjuvant treatments were analyzed.Results: Tumors were localized to the pancreatic head in 48 cases (70.6%), body in 16 cases (23.5%), and tail in 4 cases (5.9%). Preoperative biopsy was performed in 31% of the cases but confirmed malignancy in only 57% of those cases. Among the 68 operated patients, 37 patients (54.4%) underwent resection, and 30 (45.6%) had exploration only; 25 cases (36.8%) were unresectable and 14 cases (20.6%) were inoperable due to distant metastases. Resections included pancreatoduodenectomy (n=10), distal pancreatectomy (n=14), and total pancreatectomy (n=13). Operative approaches included 61 open surgeries, 2 laparoscopic procedures, and 5 conversions after laparoscopic exploration. R0 and R1 margins were achieved in 30 and 7 cases, respectively. Postoperative complications occurred in 39.7% of patients, including Clavien–Dindo grade V (11.8%) and grade IV (3%). Clinically relevant pancreatic fistula developed in 7 patients. Survival was significantly influenced by undergoing resection combined with adjuvant therapy. The 1-, and 3- year patient survival was 14% and 0% in unresectable cases without adjuvant therapy, 71.3% and 21.2 % in unresectable cases with adjuvant therapy, 30% and 0% in resectable cases without adjuvant therapy, and 82.8% and 43.8% in resectable cases with adjuvant therapy, respectively (p<0.001).In conclusion, successful resection combined with adjuvant therapy remains a key predictor of improved postoperative and long-term survival in PDAC. Equally important is the prevention and optimal management of postoperative complications—particularly pancreatic fistula—is essential to ensure timely initiation and continuation of adjuvant therapy, improving patient outcomes.

Témavezető: Dr. Zádori Gergely és Dr. Tóth Dezső

Pancreatic cystic lesions (PCLs) span from being benign cysts with negligible malignant potential to invasive cancers. Selecting patients for resection requires accurate preoperative classification to balance oncologic safety against surgical risk. Despite advances in imaging and endoscopic evaluation, distinguishing benign from high-risk or malignant cysts remains challenging.We collected data from a retrospective cohort of 150 patients evaluated for pancreatic lesions at the Institute of Surgery, University of Debrecen, between 2022.01.01-2025.08.31, of whom 19 underwent surgical intervention for PCL.We examined patient demographics, diagnostic steps, preoperative/postoperative diagnosis, operative details and postoperative outcomes (Clavien–Dindo grading).Among 19 patients who underwent surgery for pancreatic cystic lesions, 4 (21.05%) were diagnosed with mucinous cystic neoplasm (MCN), 4 (21.05%) with intraductal papillary mucinous neoplasm, 3 (15.78%) with unspecified cyst, 6 (31.57%) with serous cystic neoplasm and 2 (10.52%) with solid pseudopapillary neoplasm preoperatively. However, only 12 patients were confirmed to have PCL on final histology. These included IPMN in 1 patient (8.33%), MCN in 2 (16.67%), MCN with invasive tumor in 3 (25.00%), SCN in 5 (41.66%) and solid pseudopapillary neoplasm in 1 (8.33%). Of these 12 patients, final histology confirmed 7 malignant and 5 benign cases and one of them had neuroendocrine tumor as preoperative diagnosis but post operative diagnosis was concluded to be SCN. Other postoperative diagnosis include PanIN (n=1), PDAC (n=3), chronic pancreatitis (n=2) and neuroendocrine tumor (n=2). Resections included Whipple procedure (n=3), body-tail resection with splenectomy (n=9), body-tail resection without splenectomy (n=2), total pancreatectomy (n=1), total pancreatectomy with splenectomy (n=1), enucleation (n=1) and multivisceral resection (n=1). Operative approaches consisted of 12 open surgeries, 5 laparoscopic procedures, 1 robotic surgery and 2 conversions from laparoscopy. Postoperative complications occurred in 40% of patients, including Clavien–Dindo grade V event in 10%. In conclusion, substantial mismatch exists between preoperative diagnosis and final pathology. This highlights the diagnostic challenges of PCLs. Inaccurate diagnosis may lead to overtreatment of benign lesions or missed opportunities to resect lesions with malignant potential.

Témavezető: Dr. Zádori Gergely és Dr. Dezső Tóth

Introduction: Non-small cell lung cancer (NSCLC) often requires surgical intervention, with sleeve lobectomy offering parenchyma-sparing alternatives to pneumonectomy, potentially improving quality of life while maintaining oncologic efficacy. This study compares preoperative complications, recurrence, disease-free survival (DFS), and overall survival between these procedures using institutional data from 2009-2020.Aim/Objective: To evaluate short- and long-term outcomes of sleeve lobectomy (n=10) versus pneumonectomy (n=20) in NSCLC patients, focusing on 30-day mortality, complications, recurrence rates, DFS, and survival.MethodsRetrospective review of 30 patients undergoing curative-intent resection for NSCLC (TNM stages T1a-T4, N0-N3, M0). Data included age, stage, tumour location, complications (e.g., atrial arrhythmia, pneumonia, reoperation), 30-day mortality, follow-up duration, DFS, and survival. Statistical analysis involved descriptive comparisons; Kaplan-Meier estimates were feasible for survival trends. ​Results: Sleeve lobectomy resulted in a median overall survival of 84 months, significantly longer than the 8 months observed in the pneumonectomy group (p = 0.001). One-year survival rates were 80% for sleeve lobectomy and 20% for pneumonectomy, while three-year survival rates were 70% versus 7%, respectively. Thirty-day mortality was 0% after sleeve lobectomy and 40% after pneumonectomy (p = 0.051). Complication rates were 30% for sleeve lobectomy and 53% for pneumonectomy (p = 0.414), and recurrence rates were 0% and 27%, respectively (p = 0.125). These findings demonstrate significantly better long-term survival and lower early mortality after sleeve lobectomy compared to pneumonectomy for NSCLC.ConclusionsSleeve lobectomy is a safe, effective alternative to pneumonectomy in NSCLC patients, with lower perioperative risks and promising survival, supporting parenchyma preservation strategies. Larger prospective studies are needed to confirm oncologic equivalence.

Témavezető: Dr. Gergely Kóder

Background: Most breast cancers are invasive ductal or lobular carcinomas; together they account for >85-90% of cases. A heterogeneous group of rare breast tumours, including special histologic carcinoma subtypes and non-epithelial neoplasms, make up the remainder. Because each variant is uncommon, evidence is limited and management is often extrapolated from conventional breast cancer or soft-tissue sarcoma guidelines. This review summarizes the main rare breast tumour types, with particular focus on mesenchymal lesions and dermatofibrosarcoma protuberans (DFSP) of the breast.Methods: We performed a narrative review of the literature on rare breast tumours using recent WHO classifications and PubMed-indexed case series and reviews, and integrated data from a case of breast DFSP from our department. Special histologic carcinomas, phyllodes tumours, desmoid-type fibromatosis and primary breast sarcomas, including DFSP, were included.Results: Special type of carcinomas such as tubular, cribriform, mucinous, papillary, adenoid cystic and secretory types are typically low-grade and often hormone-receptor positive, resulting in favourable prognosis with the possibility of less intensive therapy. Metastatic carcinoma and certain triple-negative variants demonstrate higher-grade morphology, chemo-resistance and poorer outcomes. Among non-epithelial tumours, phyllodes lesions and primary breast sarcomas each constitute <1% of breast neoplasms and require wide excision with negative margins rather than axillary lymph node dissection. DFSP is an exceptionally rare dermal sarcoma of the breast, slow-growing yet locally infiltrative, strongly CD34-positive, and prone to recurrence if inadequately excised. Management relies on radical surgery excision, while radiotherapy or imatinib may be considered for recurrent, margin-positive or unresectable disease.Conclusion: Rare breast tumour differ widely in behaviour and treatment, making accurate histological identification essential. Recognizing when a tumour requires margin-focused surgery rather than standard breast cancer protocols can significantly improve patient outcomes. Continued case reporting, data collection and collaboration are necessary to strengthen treatment strategies for these uncommon neoplasms.

Témavezető: Prof. Dr. Tamás Dinya