1,721,113 research outputs found
Tumor rupture during surgery for gastrointestinal stromal tumors: Pay attention!
No full textIn a recently published letter to the editor, we debated
the proposal by Coccolini et al to treat gastrointestinal
stromal tumors (GISTs) of the esophagogastric junction
with enucleation and, if indicated, adjuvant therapy.
We highlighted that, because the prognostic impact of
a T1 high-mitotic rate esophageal GIST is worse than
that of a T1 high-mitotic rate gastric GIST, enucleation
may not be adequate surgery for esophagogastric
GISTs with a high mitotic rate. In rebuttal, Coccolini et
al pointed out the possible bias in assessment of the
mitotic rates due to the lack of standardized methods
and underlined that the site and features of the tumor
need to be carefully considered in evaluation of the
risk-benefit balance. Here we confirm that, apart from
the problematic issue of mitotic counting, enucleation
should not be indicated for GISTs at any site to reduce
the risk of tumor rupture, which has been recently
considered to be an unfavorable prognostic factor, and
to avoid microscopic residual tumor
Nonclosure techniques and ductal decompression: a winning combination against the development of pancreatic fistula after distal pancreatectomy
No full text[No abstract available
Mesopancreas: A boundless structure, namely R1 risk in pancreaticoduodenectomy for pancreatic head carcinoma
No full textBackground The mesopancreatic resection margin after pancreaticoduodenectomy for carcinoma of the head of the pancreas is of great interest with respect to curative resection, since the neoplastic involvement of this margin was shown to be the primary site for R1 resection. In this review the current knowledges of the surgical anatomy of the so-called mesopancreas and the mesopancreas excision techniques are summarized. Methods References were identified by searching Pubmed database using the search terms "mesopancreas" and "meso-pancreatoduodenum" until June 2013 and through searches of the authors' own files. Five studies were included in this review. Results Original contributions with regard to the anatomy of the retropancreatic area and specific technical descriptions of so-called "total mesopancreas excision" provided by published studies are pointed out. Conclusions Because there is no "meso" of the pancreas, and due to the continuity of the mesopancreatic and para-aortic areas, surgical dissection should be extended to the left of the superior mesenteric artery and include the para-aortic area to achieve the most complete possible resection of the so-called mesopancreas and minimize the rate of R1 resections due to mesopancreatic margin involvement. This extended mesopancreatic resection cannot be accomplished en bloc even if the removal of the dissected mesopancreatic tissues is performed en bloc with the head, uncus, and neck of the pancreas, i.e., with the pancreaticoduodenectomy specimen
Ovarian malignancy with cytologically negative pleural effusions:Demons' or Meigs' pseudo-syndromes?
No full textThe impact of epithelial-mesenchymal transition on R1 status of the mesopancreatic resection margin after pancreaticoduodenectomy for pancreatic carcinoma: A research proposal topic
No full textCitologia peritoneale e determinazione dello stato linfonodale per la scelta dell’exeresi locoregionale nel carcinoma gastrico
Full text linkDoes antecolic reconstruction decrease delayed gastric emptying after pancreatoduodenectomy?
No full textDelayed gastric emptying (DGE) is a frequent complication after pylorus-preserving pancreatoduodenectomy (PpPD). Kawai and colleagues proposed pylorus-resecting pancreatoduodenectomy (PrPD) with antecolic gastrojejunal anastomosis to obviate DGE occurring after PpPD. Here we debate the reported differences in the prevalence of DGE in antecolic and retrocolic gastro/duodeno- jejunostomies after PrPD and PpPD, respectively. We concluded that the route of the gastro/duodeno-jejunal anastomosis with respect to the transverse colon; i.e., antecolic route or retrocolic route, is not responsible for the differences in prevalence of DGE after pancreatoduodenectomy (PD) and that the impact of the reconstructive method on DGE is related mostly to the angulation or torsion of the gastro/duodeno-jejunostomy. We report a prevalence of 8.9% grade A DGE and 1.1% grade C DGE in a series of 89 subtotal stomach-preserving PDs with Roux-en Y retrocolic reconstruction with anastomosis of the isolated Roux limb to the stomach and single Roux limb to both the pancreatic stump and hepatic duct. Retrocolic anastomosis of the isolated first jejunal loop to the gastric remnant allows outflow of the gastric contents by gravity through a "straight route"
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