Classical colorectal cancer surgery has been considered the gold standard in the surgical treatment of this disease for decades. Advances in technology and modern medicine have led to the emergence and progression of minimally invasive surgery in the treatment of this malignancy. Surgical procedures differ in relation to the localization of the tumor, as well as in relation to the pathways of hematogenous and lymphogenic spread of the disease. These surgical procedures are applied to the same extent during both classical and laparoscopic surgery. Regarding the indications for the laparoscopic approach in the elective treatment of colorectal cancer, there are no differences compared to classical colorectal surgery. The specificity of the method of work and visualization in laparoscopic colorectal surgery has developed the existence of two characteristic approaches: a) the lateral approach is taken from the classical-open colorectal surgery (“lateral-to medial approach”). It implies that the operation itself begins with the separation and preparation of the adjacent lateral peritoneum from the colon (rectum), and only then is the vascular structures approached from the medial side; b) medial-to-lateral approach, is an approach where after the creation of the pneumoperitoneum and access to the abdomen, the operation begins with the preparation of vascular elements (a.mesentericae inferior and v.mesenterice inferior, for example), and only then access to the lateral associated peritoneum. Most laparoscopic surgeons apply a more medial approach given the numerous advantages of this approach over the medial one that have been proven in comparative analyzes of these two approaches on a large sample of patients. At the same time, these studies did not show statistically significant differences in terms of postoperative complications, mortality, and malignant recurrence rate between the two approaches.

The debate of proponents of laparoscopic and classical colorectal surgery is still ongoing, especially on the oncological principles of colorectal malignancy treatment. For now, there are promising results in terms of the adequacy of laparoscopic surgery in the treatment of this disease. The study involved 60 patients with acceptable generalized operability and a diagnostically verified malignant neoplasm of colorectum. Patients were divided into two groups of 30 patients: patients who were operated with open and laparoscopically assisted colorectal surgery. Two groups of factors were collected and analyzed for all patients. The first group of factors was known preoperatively and the second group of factors was known postoperatively. There was no significant differences between the two groups concerning the age, sex, ASA score, preoperative hemoglobin values, blood type. Both groups were the most represented in the rectum cancer. The largest number of patients was G2 grade 49.1%. Surgical margins were negative for cancer in all examined patients. There was a statistically significant difference, in terms of a larger number of removed lymph glands in open surgery treated patients. The average number of lymph nodes removed laparoscopically was 14 (range 5-40), while in the classic-open group number was 20 (range 8-44). Laparoscopic group were able to retrieve >12 LNs in 70% of the cases while in classic-open group were able to retrieve >12 LNs in 93% of the cases. The third stage of the disease was significantly more prevalent in the classical group of patients than in laparoscopic group of patients (17: 7 patients). The average volume of the removed tumor in the laparoscopic group is 73 cm3, while in the classical group the average volume is 99 cm3. Our results show that classic-open and laparoscopic approaches in colorectal cancer surgery are associated with the retrieval of greater than 12 LNs, therefore both are adeqate for safe oncological treatment of this disease. With classic-open colorectal surgery, we are still able to retrive more matching LNs, compared to laparoscopic surgery.

Savremeni svetski stavovi podrazumevaju limfadenektomiju kao terapijsku proceduru koja je integralni deo radikalne hirurgije karcinoma želuca. Ona se izvodi u pokušaju da se hirurgija malignoma učini što radikalnijom. Cilj svake hirurške procedure je potpuno uklanjanje tumora i svakog tkiva koje njime može biti zahvaćeno. Težnja radikalne hirurgije je u eradikaciji maligne bolesti, a limfadenektomija bitno doprinosi ovom cilju. Limfadenekotmija kod gastričnog karcinoma podrazumeva disekciju limfnih nodusa prve, druge grupe, što se smatra standardnom limfadenektomijom D2. Pored hirurškog načina lečenja karcinoma želuca, koji je ostao dominanatan, u poslednje vreme se razvijaju novi modaliteti lečenja želuca. I pored isticanja u prvi plan značaj hirurškog lečenja i sistematske limfadenektomije, kriterijumi koje je dalo Japansko udruženje za gastrični kancer od 2010g. razlikuje i druge modalitete lečenja gastričnog karcinoma. Karcinome želuca možemo tretirati: endoskopski, laparoskopski, klasičnom hirurškom resekcionom operacijom, hemioterapijom (koja može biti preoperativna i postoperativna) i palijativnom hirurgijom. Svaki od ovih modaliteta lečenja utiče na bolji ishod bolesti pacijenata. Izbor adekavtnog tretmana pacijenta sa karcinomom želuca zavisi od stepena uznapredovalosti maligne bolesti.

Lymph node metastasis in patients with colorectal carcinoma is bed prognostic factor. High level of CEA and CA 19-9 tumor markers before surgery have had a high sensitivity and also is a combination of high specification, especially in late stage cases. Considering that, general attention was to proof a correlation between level of CEA and CA 19-9 tumor markers before surgery and number of nodal metastasis in these patients. Our study included 102 patients with colorectal carcinoma. We measured level of CEA and ca 19-9 tumor markers before surgery and compared it with number of dissected lymph node metastasis after surgery as same as comparing with Duke’s stage of carcinoma. Average level of CEA tumor marker before surgery was 44,59 μg/mol. Lowest rate was 0,8 μg/mol ant the higher was 551 μg/mol. Average level of CA 19-9 before surgery was 258, 8696 U/mol. Average number of dissected lymph nodes per patient was 14,62 within average 2,5895 was nodal metastasis. There is a high statistically signification between CEA and CA 19-9 tumor markers level before surgery and level of Duke’s classification stage after surgery. Number of nodal metastasis is correlated with level of CEA before surgery. Level of CA 19-9 before surgery is not statistically significant for number of nodal metastasis. During this examination we noticed a high increasing of CEA and CA 19-9 tumor marker levels before surgery in patients with C2 Duke’s stage with more than 4 lymph nodal metastasis found after surgery. In this patients level of CEA was higher 45,78 μg/ml comparing with patients in C1 Duke’s stage who have had CEA level 6,07 μg/ml. In patients with C2 Duke’s stage average value of CA 19-9 was extremely high – 71 U/ml. High level of CEA and CA19-9 is statistically significant for staging of colorectal malign disease as same as for number of nodal metastasis.