1,721,025 research outputs found
The liver hemangioma: laparoscopic challenge. -European Association for Endoscopic Surgery
No full textMalignant ascites: pathophysiology and treatment.
No full textMalignant ascites (MA) accompanies a variety of abdominal and extra-abdominal tumors. It is a primary cause of morbidity and raises several treatment challenges. MA has several symptoms, producing a significant reduction in the patient’s quality of life: loss of proteins and electrolyte disorders cause diffuse oedema, while the accumulation of abdominal fluid facilitates sepsis. Treatment options include a multitude of different procedures with limited efficacy and some degree of risk. A Pubmed, Medline, Embase, and Cochrane Library review of medical, interventional and surgical treatments of MA has been performed. Medical therapy, primarily paracentesis and diuretics, are first-line treatments in managing MA. Paracentesis is widely adopted but it is associated with significant patient discomfort and several risks. Diuretic therapy is effective at the very beginning of the disease but efficacy declines with tumor progression. Intraperitoneal chemotherapy, targeted therapy, immunotherapy and radioisotopes are promising medical options but their clinical application is not yet completely elucidated, and further investigations and trials are necessary. Peritoneal–venous shunts are rarely used due to high rates of early mortality and complications. Laparoscopy and hyperthermic intraperitoneal chemotherapy (HIPEC) have been proposed as palliative therapy. Literature on the use of laparoscopic HIPEC in MA includes only reports with small numbers of patients, all showing successful control of ascites. To date, none of the different options has been subjected to evidence-based clinical trials and there are no accepted guidelines for the management of MA
Prognostic value of the seventh AJCC/UICC TNM classification of non-cardia gastric cancer.
No full textPeritoneal citology as prognostic factor for recurrences in node-negative advanced gastric cancer.
No full textIs the routine dissection of lateral lymph nodes really necessary after mesorectal excision for clinical stageII/III lower rectal cancer?
No full textWe have read with extremely interest the article of Fujita
et al. “Mesorectal Excision With or Without Lateral
Lymph Node Dissection for Clinical Stage II/III Lower
Rectal Cancer (JCOG0212) A Multicenter, Randomized
Controlled, Noninferiority Trial” published on Annals of
Surgery.
The guidelines of Japanese Society for Cancer of the
Colon and Rectum (JSCCR) for the treatment of colorectal
cancer recommend lateral lymph node dissection (LLND)
for clinical Stage II/III Lower Rectal: “Lateral lymph node
dissection is indicated when the lower border of the tumor is
located distal to the peritoneal reflection and the tumor has
invaded beyond the muscularis propria”. In effect, a study of
JSCCR reported that “the incidence of lateral lymph node
metastasis was 20.1% among patients whose lower rectal tumor
border was located distal to the peritoneal reflection and whose
cancer invaded beyond the muscularis propria. After performing
lateral lymph node dissection for this indication, it is expected that
the risk of intrapelvic recurrence decreases by 50%, and 5-year
survival improves by 8% to 9%”. Otherwise in Western
countries, surgical societies do not suggest to perform
LLND in patients without clinically suspected lateral pelvic
lymph node metastasis.
In Japan lateral pelvic lymph node metastasis is
considered to be a localized disease, differently in West
this same problem is considered to be a systemic disease
associated with a very poor prognosis. For these reasons,
in Japan prophylactic LLND is performed in all patients
with for Clinical Stage II/III Lower Rectal Cancer for
reducing local recurrence and improving survival. In
Western countries, lateral pelvic lymph node metastases
have been considered a systemic neoplastic spread and for
this reason the oncologists treated the lateral pelvic lymph
node metastases only by chemoradiation therapy. Other
reasons of this behaviour were including the few number of
lateral pelvic lymph node metastasis, the negligible survival
impact of LLDN over chemoradiation therapy and the high
post-operative morbidity associated at LLND.
This trial of Fujita represents the high Evidence Basic
Medicine milestone in the controversies between East and
West in rectal cancer surgery. Nowadays, the neoadjuvant
chemo-radiotherapy and the successively TME is the choice
treatment for clinical Stage II/III Lower Rectal Cancer in
Western countries, the goals are to reduce the risk of cancer
recurrence and to shrink the cancer prior to surgery.
The role of neoadjuvant chemo-radiotherapy on lateral
pelvic lymph node metastasis in advanced low rectal
cancer remains unclear. Nowadays, in literature there are
few reports about the oncologic outcome of patients with
lateral pelvic lymph node metastasis underwent neoadjuvant
chemo-radiotherapy.
Recently some European societies guidelines suggest the neoadjuvant
chemo-radiotherapy and TME with LLND in T3-Ta rectal
tumours with involved lateral pelvic lymph node (obturator,
internal iliac nodes).
The conclusions are the same:
lateral pelvic lymph node metastasis cannot be eradicated
completely by neoadjuvant chemo-radiotherapy, for these
reasons the Authors recommended to perform LLND
for the reduction of local recurrence at lateral pelvic
lymph node.
Fujita et al. included only patients with no clinical
evidence of lateral pelvic lymph node enlargement and
lateral pelvic lymph nodes less than 10 mm in short-axis
diameter as detected on MDCT or MRI were defined
as negative nodes; this last choice in the inclusion
criteria is very important because the patients enrolled are
homogeneous and the risk of local recurrence at lateral
pelvic lymph node is the same. Differently, Yamaoka
reported a different optimal cut-off value for determining
metastasis: 6.0 mm, with a sensitivity of 78.5% and
specificity of 82.9% . In effect, Fujita et al. reported
that lateral pelvic lymph node metastasis was identified in
26 patients (7.4%) in TME with LLND group, “suggesting
that the diagnostic accuracy of clinical lateral pelvic lymph node
metastasis might not have been sufficient”.
A lot of surgeons researched the factors associated with
lateral pelvic lymph node recurrence after TME curative
resection of rectal cancer.
Actually, Fujita et al. demonstrated the effectiveness of
TME with LLDN; but, a new RCT is needed for evaluate
the patients underwent neoadjuvant chemo-radiotherapy
and TME with or without LLND. The challenge of the
new researches is to define the optimal indication for
perform LLND and an accurate selection of patients,
especially in the case of patients underwent neoadjuvant
chemo-radiotherapy
Late migration of a covered stent into the stomach after repair of a splenic artery pseudoaneurysm
Full text linkWe would like to report our experience of a rather rare complication that occurred in a 76-year old patient tree years after endovascular repair of a splenic artery pseudoaneurysm with a covered stent. Three years after stent insertion, the patient complained of mild abdominal pain and melena; it was revealed endoscopically that the covered stent has eroded the stomach wall and migrated into the stomach. The splenic artery is the most common location among the spectrum of potential presentation sites of visceral arteries aneurysms and pseudoaneurysms. Endovascular treatment with the use of coils or stents is the first option due to lower morbidity and mortality than open surgery. Endovascular repair may also lead to complications and patients need to be followed up in order to confirm aneurysm sealing, and exclude late complication. Minor stent graft migration may occur in the long term, however extra vascular migration is extremely rare
Neoadjuvant chemotherapy in locally advanced gastric adenocarcinoma: our experience in the elderly
No full textRole of FDG-PET/CT in follow-up of patients treated with resective gastric surgery for tumour
No full textINTRODUCTION:
Gastric cancer has a poor prognosis and a high rate of recurrences after surgery. The optimal method for assessing early recurrences is not defined: conventional imaging (ultrasonography, CT and MRI) have difficulty in detecting them, because they don't give information regarding metabolic features or tumor response to chemotherapy. Actually 18F-fluorodeoxyglucose positron emission (18FDG-PET) has several indications for the primary staging and the follow-up of colon-rectal, lung, breast, neck cancers and lymphoma, but its clinical role in gastric cancer is not assessed. Our study analyzes the role of 18FDG-PET integrated with CT scan in the detection of gastric cancer recurrence.
MATERIALS AND METHODS:
We retrospectively reviewed 50 patients which underwent follow-up 18FDG-PET/CT from 2006 to 2009 after radical surgery for gastric adenocarcinoma. Each study was repeated every 6 months for the first two years after surgery and every 12 months for the subsequent three years.
RESULTS:
18FDG-PET/CT was positive for suspected neoplastic disease in 29 (58%) and negative in 21 (42%) patients, with 3 false positive and 3 false negative results. 18FDG-PET/CT showed highly effectiveness in early detection of recurrences, as observed in 17 patients that were totally asymptomatic, allowing the initiation of multimodal treatment resulting in an important increasing of survival.
CONCLUSIONS:
18FDG-PET-CT has a very good sensitivity (89.7%) and specificity (85.7%) in detecting local and distant recurrences during post-operative follow-up. Positive 18FDG-PET/CT findings may lead to an early change in the management of these patients, directing them towards rescue surgery or chemotherapy thereby improving their overall surviva
Laparoscopic cholecystectomy for a symptomatic cholelithiasis in a patient presenting situs viscerum inversus totalis. A case report.
No full textAbstract
INTRODUCTION:
Situs Viscerum Inversus totalis (SIT) is a rare anomaly with genetic predisposition, in which organs are translated, completely or partially, on the opposite side of the body. Generally there are no organic dysfunctions. Situs Inversus can cause difficulties in the diagnostic and therapeutic management of abdominal diseases because of the mirror-like anatomy. On a clinical point of view the symptoms of cholelithiasis may be confused by the opposite position of the gall bladder
CASE PRESENTATION:
We report the case of a 48 year old female latin-american with symptomatic cholelithiasis and Situs Viscerum Inversus Totalis, treated with Laparoscopic Cholecystectomy.
CONCLUSION:
Videolaparoscopy represents the gold standard treatment in managing cholelithiasis in SIT patients. Surgical treatment can be facilitated in case of well-experienced operators, as it is well recognised a major difficulty for surgeons in managing the anatomical condition of SIT
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