1,720,969 research outputs found
Laparoscopic excision for ectopic peritoneal paragonimiasis mimicking a gastric duplication cyst: A case report
Full text linkIntroduction: Paragonimiasis, lung fluke disease caused by infection with Paragonimus species, is a food-borne parasitic zoonosis. The overriding symptoms of Paragonimus westermani infection include chronic cough, shortness of breath, and pleuritic pain. Extrapulmonary paragonimiasis caused by aberrant parasitic migration is known to occur in a variety of sites such as the brain, abdominal wall, and intraperitoneal cavity. Ectopic paragonimiasis is an uncommon disease that presents with a few clinical manifestations, which makes it difficult to diagnose and treat. Case presentation: A 47-year-old man with an unremarkable medical and surgical history presented with a peritoneal lesion that was discovered incidentally on abdominal computed tomography during routine health screening. The patient did not exhibit any associated symptoms such as abdominal pain. The radiologic diagnosis was a gastric duplication cyst and we performed laparoscopic excision of the peritoneal mass. Histopathological examination revealed paragonimiasis, and the result of the skin test for paragonimiasis was positive. The patient was treated with praziquantel. Clinical discussion: The diagnosis of ectopic peritoneal paragonimiasis remains challenging due to inexperience, misdiagnosis, and its rarity. Clinicians should bear in mind that an intra-abdominal mass may be related to a parasitic infection. The detection of the ova of Paragonimus parasites in sputum and biopsy specimens may be difficult due to an insufficient amount. Conclusion: Clinicians need to thoroughly take the patient's history and clinically suspect parasitic infections. Laparoscopic resection of this rare mass is safe, feasible, and allows for rapid recovery
Spontaneous rupture of immature gastric teratoma with hemoperitoneum in a newborn with 3-year follow-up
Full text linkAmong the subtypes of germ cell tumors, teratomas are the most frequent in the pediatric population and commonly occur in the sacrococcygeal region and the gonads. Less than 1% of all teratoma are found in abdominal organs including the stomach, liver, and kidney. Gastric teratomas are very rare tumors predominantly found in infants. Moreover, an immature gastric teratoma is exceptionally rare. Here, we present a case of immature gastric teratoma with spontaneous rupture in a newborn who was preoperatively diagnosed with neuroblastoma. On the first day after birth, the neonate presented with progressive abdominal distension accompanying respiratory distress. A firm mass was detected during a physical examination of the abdomen. An emergency exploratory laparotomy revealed hemoperitoneum resulting from a rupture of the tumor located in the posterior wall of the gastric antrum. Complete resection of the tumor and gastroduodenostomy were performed. The pathology evaluation revealed a grade 3 immature gastric teratoma with no malignant components. The patient was treated with adjuvant chemotherapy to prevent recurrence, since the tumor was ruptured in the abdominal cavity and the level of alpha-fetoprotein was decreased but still remained high above the normal range after surgery. In conclusion, physicians should be aware of the existence of gastric teratoma as the differential diagnosis of a huge abdominal mass in infants, especially neonates. Complete surgical removal of the tumor and long-term follow-up has been adopted as the standard management for immature gastric teratoma, although there has been controversy with adjuvant chemotherapy
Comparison of surgical outcomes between integrated robotic and conventional laparoscopic surgery for distal gastrectomy: a propensity score matching analysis
Full text linkThis study was aimed to compare the surgical outcomes between conventional laparoscopic distal gastrectomy (CLDG) and integrated robotic distal gastrectomy (IRDG) which used both Single-Site platform and fluorescence image-guided surgery technique simultaneously. Retrospective data of 56 patients who underwent IRDG and 152 patients who underwent CLDG were analyzed. Propensity score matching analysis was performed to control selection bias using age, sex, American Society of Anesthesiologists score, and body mass index. Fifty-one patients were selected for each group. Surgical success was defined as the absence of open conversion, readmission, major complications, positive resection margin, and inadequate lymph node retrieval (<16). Patients characteristics and surgical outcomes of IRDG group were comparable to those of CLDG group, except longer operation time (159.5 vs. 131.7 min; P < 0.001), less blood loss (30.7 vs. 73.3 mL; P = 0.004), higher number of retrieved lymph nodes (LNs) (50.4 vs. 41.9 LNs; P = 0.025), and lower readmission rate (2.0 vs. 15.7%; P = 0.031). Surgical success rate was higher in IRDG group compared to CLDG group (98.0 vs. 82.4%; P = 0.008). In conclusion, this study found that IRDG provides the benefits of higher number of retrieved LNs, less blood loss, and lower readmission rate compared with CLDG in patients with early gastric cancer
Omentum preservation as an oncologically comparable and surgically superior alternative to total omentectomy during radical gastrectomy for T3–T4 gastric cancer
No full textBackground: Total omentectomy has conventionally been performed and has been regarded as standard procedure in radical gastrectomy for cancer. However, omentum preservation is the preferred procedure during minimally invasive surgery, without sufficient evidence of oncological safety, especially for T3–T4 gastric cancer. Method: A total of 3,510 patients who underwent radical gastrectomy for T3–T4 gastric cancer between January 2003 and December 2015 were reviewed, retrospectively. After propensity score matching, 225 patients in the omentum preservation group were compared with 225 patients in the total omentectomy group. The primary outcome was 5-year overall survival. Results: The omentum preservation group showed significantly shorter operation time (P = .001) and less blood loss (P = .004) than the total omentectomy group. Shorter operation time was also observed with both open and minimally invasive approaches (P < .001 and P = .007, respectively). The 5-year overall survival rates were 75.4% for the omentum preservation group and 72.6% for the total omentectomy group (log-rank P = .06; hazard ratio 0.7 [95% confidence interval, 0.48–1.01]). The 5-year relapse-free survival was higher in the omentum preservation group (73.8%) than in the total omentectomy group (66.1%), without statistical significance (log-rank P = .09; hazard ratio 0.74 [95% confidence interval, 0.52–1.06]). Conclusion: Regardless of the surgical approach, omentum preservation provided comparable oncologic outcomes with better surgical outcomes, suggesting that this could be an acceptable alternative to total omentectomy for T3–T4 gastric cancer. These findings warrant further investigation in randomized clinical trials
Reduced-port totally robotic distal subtotal gastrectomy for gastric cancer: 100 consecutive cases in comparison with conventional robotic and laparoscopic distal subtotal gastrectomy
Full text linkBy overcoming technical difficulties with limited access faced when performing reduced-port surgery for gastric cancer, reduced-port totally robotic gastrectomy (RPRDG) could be a safe alternative to conventional minimally invasive gastrectomy. An initial 100 consecutive cases of RPRDG for gastric cancer were performed from February 2016 to September 2018. Short-term outcomes for RPRDG with those for 261 conventional laparoscopic (CLDG) and for 241 robotic procedures (CRDG) over the same period were compared. Learning curve analysis for RPRDG was conducted to determine whether this procedure could be readily performed despite fewer access. During the first 100 cases of RPRDG, no surgeries were converted to open or laparoscopic surgery, and no additional ports were required. RPRDG showed longer operation time than CLDG (188.4 min vs. 166.2 min, p < 0.001) and similar operation time with CRDG (183.1 min, p = 0.315). The blood loss was 35.4 ml for RPRDG, 85.2 ml for CLDG (p < 0.001), and 41.2 ml for CRDG (p = 0.33). The numbers of retrieved lymph nodes were 50.5 for RPRDG, 43.9 for CLDG (p = 0.003), and 55.0 for CRDG (p = 0.055). Postoperative maximum C-reactive protein levels were 96.8 mg/L for RPRDG, 87.8 mg/L for CLDG (p = 0.454), and 81.9 mg/L for CRDG (p = 0.027). Learning curve analysis indicated that the overall operation time of RPRDG stabilized at 180 min after 21 cases. The incidence of major postoperative complications did not differ among groups. RPRDG for gastric cancer is a feasible and safe alternative to conventional minimally invasive surgery. Notwithstanding, this procedure failed to reduce postoperative inflammatory responses
ASO Author Reflections: Prediction of Survival Outcomes Based on Preoperative Clinical Parameters in Gastric Cancer
No full textPrediction of Survival Outcomes Based on Preoperative Clinical Parameters in Gastric Cancer
No full textBackground: Few current preoperative risk assessment tools provide essential, optimized treatment for gastric cancer. The purpose of this study was to develop and validate a nomogram that uses preoperative data to predict survival and risk assessments. Methods: A survival prediction model was constructed using data from a developmental cohort of 1251 patients with stage I to III gastric cancer who underwent curative resection between January 2005 and December 2008 at Ajou University Hospital, Korea. The model was internally validated for discrimination and calibrated using bootstrap resampling. To externally validate the model, data from a validation cohort of 2012 patients with stage I to III gastric cancer who underwent surgery at multiple centers in Korea between January 2001 and June 2006 were analyzed. Analyses included the model’s discrimination index (C-index), calibration plots, and decision curve that predict overall survival. Results: Eight independent predictors, including age, sex, clinical tumor size, macroscopic features, body mass index, histology, clinical stages, and tumor location, were considered for developing the nomogram. The discrimination index was 0.816 (adjusted C-index) in the developmental cohort and 0.781 (adjusted C-index) in the external validation cohort. Additionally, in both the developmental and validation datasets, age and tumor size were significantly correlated with each other and were independent indicators for survival (P < 0.05). Conclusions: We developed a new nomogram by using the most common and significant preoperative parameters that can help to identify high-risk patients before treatment and help clinicians to make appropriate decisions for patients with stage I to III gastric cancer
Long-term Comparison of Robotic and Laparoscopic Gastrectomy for Gastric Cancer: A Propensity Score-weighted Analysis of 2084 Consecutive Patients
No full textOBJECTIVE: To compare long-term outcomes between robotic and LG approaches using propensity score weighting based on a generalized boosted method to control for selection bias. SUMMARY OF BACKGROUND DATA: Minimally invasive surgical approaches for GC are increasing, yet limited evidence exists for long-term outcomes of robotic gastrectomy (RG). METHODS: Patients (n = 2084) with GC stages I-III who underwent LG or RG between 2009 and 2017 were analyzed. Generalized boosted method was used to estimate a propensity score derived from all available preoperative characteristics. Long-term outcomes were compared using the adjusted Kaplan-Meier method and the weighted Cox proportional hazards regression model. RESULTS: After propensity score weighting, the population was balanced. Patients who underwent RG showed reduced blood loss (16 mL less, P = 0.025), sufficient lymph node harvest from the initial period, and no changes in surgical outcomes over time. With 52-month median follow-up, no difference was noted in 5-year overall survival in unweighted [91.5% in LG vs 94% in RG; hazard ratio (HR), 0.71; 95% confidence interval (CI), 0.46-1.1; P = 0.126] and weighted populations (94.2% in LG vs 93.2% in RG; HR, 0.88; 95% CI, 0.52-1.48; P = 0.636). There were no differences in 5-year recurrence-free survival (RFS), with unweighted 5-year RFS of 95.4% for LG and 95.2% for RG (HR, 0.95; 95% CI, 0.55-1.64; P = 0.845) and weighted 5-year RFS of 96.3% for LG and 95.3% for RG (HR, 1.24; 95% CI, 0.66-2.33; P = 0.498). CONCLUSIONS: After balancing covariates, RG demonstrated reliable surgical outcomes from the beginning. Long-term survival after RG and LG for GC was similar
Laparoscopic Gastrectomy Using Instruments with a Minimal Diameter for Early Gastric Cancer: A Feasible Alternative to Conventional Laparoscopic Gastrectomy for Experienced Surgeons
No full textBACKGROUND: The application of laparoscopic surgery using instruments that are 3 mm or less in diameter for patients with early gastric cancer (EGC) has not yet been established. We aimed to evaluate the feasibility and safety of laparoscopic gastrectomy using instruments with minimal diameter. METHODS: We retrospectively analyzed 41 patients who underwent laparoscopic subtotal gastrectomy with D1-positive lymph node dissection for EGC. Among them, 17 patients underwent laparoscopic gastrectomy using instruments with a minimal diameter (experimental group), while 24 patients underwent conventional laparoscopic gastrectomy (control group). In the experimental group, we used two 3-mm trocars, one 5-mm trocar, and the GelPOINT((R)) Advanced Access Platform. We compared operative outcomes between the two groups and assessed the learning curve of laparoscopic gastrectomy using instruments with minimal diameter. RESULTS: The operative outcomes were similar between the two groups. The preoperative-to-postoperative day 2 ratio of neutrophil count in the experimental group was significantly lower than in the control group (2.07 versus 2.65; P = .038). Morbidity was not observed in the experimental group and 3 patients experienced complications in the control group, although it was not significantly different (P = .252). The operation time according to the accumulation of cases was stable without any significant change in the experimental group. CONCLUSIONS: Laparoscopic gastrectomy using instruments with minimal diameter is technically feasible and safe for EGC and could also be a good alternative to conventional laparoscopic gastrectomy to minimize the impact of surgical invasiveness when performed by experienced surgeons
Feasibility of Linear-Shaped Gastroduodenostomy during the Performance of Totally Robotic Distal Gastrectomy
Full text linkPURPOSE: Although linear-shaped gastroduodenostomy (LSGD) was reported to be a feasible and reliable method of Billroth I anastomosis in patients undergoing totally laparoscopic distal gastrectomy (TLDG), the feasibility of LSGD for patients undergoing totally robotic distal gastrectomy (TRDG) has not been determined. This study compared the feasibility of LSGD in patients undergoing TRDG and TLDG. Materials and Methods All c: onsecutive patients who underwent LSGD after distal gastrectomy for gastric cancer between January 2009 and December 2017 were analyzed retrospectively. Propensity score matching (PSM) analysis was performed to reduce the selection bias between TRDG and TLDG. Short-term outcomes, functional outcomes, learning curve, and risk factors for postoperative complications were analyzed.
RESULTS: This analysis included 414 patients, of whom 275 underwent laparoscopy and 139 underwent robotic surgery. PSM analysis showed that operation time was significantly longer (163.5 vs. 132.1 minutes, P<0.001) and postoperative hospital stay significantly shorter (6.2 vs. 7.5 days, P<0.003) in patients who underwent TRDG than in patients who underwent TLDG. Operation time was the independent risk factor for LSGD after intracorporeal gastroduodenostomy. Cumulative sum analysis showed no definitive turning point in the TRDG learning curve. Long-term endoscopic findings revealed similar results in the two groups, but bile reflux at 5 years showed significantly better improvement in the TLDG group than in the TRDG group (P=0.016).
CONCLUSIONS: LSGD is feasible in TRDG, with short-term and long-term outcomes comparable to that in TLDG. LSGD may be a good option for intracorporeal Billroth I anastomosis in patients undergoing TRDG
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