1,721,088 research outputs found
Preoperative treatment and surgery in gastric cancer: friends or foes?
No full textUntil 2006, most reports of preoperative (neoadjuvant) treatments for gastric carcinoma were inconclusive and produced confusing results due to inhomogeneous treatment regimens, selection of patients, and response assessment. Since publication of the results from the MAGIC trial, substantial scientific evidence has suggested the benefits of perioperative (preoperative and postoperative) chemotherapy to locally advanced gastric cancer. To date, this phase III trial, coupled with preliminary data from other published reports on neoadjuvant chemotherapy and radiotherapy, supports the theoretical advantages of preoperative treatment for gastric carcinoma, thus introducing the concept of delayed surgery. Neoadjuvant treatment of resectable, locally advanced tumours might improve patients' outcomes and postpone the need for curative resection, but it also exposes patients to the risk of tumour progression
Assessing safety and feasibility of minimally invasive surgical approaches for advanced gastric cancer
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Perioperative chemotherapy for gastric cancer: how should we measure the efficacy?
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Risk factors for esophago-jejunal anastomosis leakage after total gastrectomy for cancer. A multicenter retrospective study of the Italian research group for gastric cancer
Full text linkBackground: Many Eastern reports attempted to identify predictive variables for esophago-jejunal anastomosis leakage (EJAL) after total gastrectomy for cancer. There are no definitive answers about reliable risk factors for EJAL. This retrospective study shows the largest Western series focused on this topic.Methods: This is a multicenter retrospective study analyzing patients' datasets collected by 18 Italian referral Centres of the Italian Research Group for Gastric Cancer (GIRCG) from 2000 to 2018. The inclusion criteria were pathological diagnosis of gastric and esophageal (Siewert III) carcinoma requiring total gastrectomy. The primary end point of risk analysis was the occurrence of EJAL; secondary end points were post-operative (30-day) morbidity and mortality, length of stay (LoS), and survival.Results: Data of 1750 patients submitted to total gastrectomy were collected. EJAL developed in 116 (6.6%) patients and represented the 26.3% of all the 441 observed post-operative surgical complications. EJAL diagnosis was followed by a reoperation in 39 (33.6%) patients and by an endoscopic/radiological procedure in 30 cases (25.9%). In 47 patients (40.5%) EJAL was managed with conservative approach. Post-operative LoS and mortality were significantly higher after EJAL occurrence (27 days versus 12 days and 8.6% versus 1.6%, respectively). At risk analysis, comorbidities (particularly, if respiratory), minimally invasive surgery, extended lymphadenectomy, and anastomotic technique resulted significant predictive factors for EJAL. EJAL did not significantly affect survival.Conclusions: These results were consistent with Asian experiences: the frequency of EJAL and its higher rate observed in patients with comorbidities or after minimally invasive approach were confirmed. (C) 2020 Elsevier Ltd, BASO similar to The Association for Cancer Surgery, and the European Society of Surgical Oncology. All rights reserved
Metastatic lymph node ratio: a new staging system for gastric cancer
No full textThis study was designed to analyze the prognostic significance of the staging system based on the ratio of metastatic lymph nodes (TRM) compared with the TNM staging system in patients with gastric cancer
Self-Retaining Retractor Widox® for Thyroid Surgeries: Technical Note
No full textDuring a thyroidectomy, perfect exposure of the vascular nerve structures, parathyroid gland, trachea, larynx, esophagus, and lymphnodes is crucial to facilitate the surgeon in the meticulous dissection. WIDOX® (MOSS Spa, Lesa, Italy) is an atraumatic self-retaining thyroidectomy retractor specifically designed for thyroid surgeries with an octagonal shape and six retractors (Fig. 1). It is a sterile, single-use device which keeps the surgical wound and the neck muscles retracted allowing the proper exposure of the operatory field. The device substitutes the manual retractors held by the surgeon's assistants. In our institute, we started using the self-retaining retractor WIDOX® from May 2015 for a total of 50 patients. From our preliminary experience, the self-retaining retractor WIDOX® is simple and practical and can be adapted to each patient. The use of energy-based devices and the neuromonitoring is not prevented by the presence of this retractor
Gastric Leaks after Sleeve Gastrectomy: Focus on Pathogenetic Factors
No full textAs reported by The International Federation for the Surgery of Obesity (IFSO) worldwide survey on bariatric surgery, sleeve gastrectomy has become the second most performed bariatric/metabolic procedure in the world just after gastric bypass. If we consider complications, despite a recent systematic review and meta-analysis that reported a substantial decrease in sleeve gastrectomy complication rates, leaks after sleeve gastrectomy still rate between 0 and 18%. Unlike the leaks of other types of gastrointestinal surgery, leaks after sleeve gastrectomy are challenging in diagnosis and treatment and can lead to sepsis, multiple organ failure, and even death. A standardized algorithm of diagnosis and management is still lacking. Current classification of gastric leaks is based on the time of onset and clinico-pathological aspects. Nonetheless, none of the largest series in literature report the pathogenesis of gastric leaks. Given this paucity of evidence-based data and the lack of defined guidelines, we try to examine and consider the pathogenetic factors of gastric leak to implement better treatments and predict outcomes
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