These guidelines were developed jointly by the American Society of Health-System Pharmacists (ASHP), the Infectious Diseases Society of America (IDSA), the Surgical Infection Society (SIS), and the Society for Healthcare Epidemiology of America (SHEA). This work represents an update to the

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Clinical practice guidelines for antimicrobial prophylaxis in surgery

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Clinical practice guidelines for antimicrobial prophylaxis in surgery.

Surgical site infection: Incidence and impact on hospital utilization and treatment costs

The recommended treatment of distal gastric cancer consists of a radical resection of the distal 4/5 of the stomach with a free margin of 5 to 6 cm.1–3 The extent of the associated lymph node dissection is still debated. Japanese authors suggest an extended dissection with the routine involvement of D1 and D2 lymph nodes, while an even wider (D3 and D4) dissection is advocated in cases of suspected invasion of more distant lymph nodes.4–8 Western authors often prefer a limited dissection (D1) because of the higher operative mortality and morbidity rates associated with extended lymphadenectomy (D2),9–13 even when distal pancreatectomy is avoided, as well as the lack of a significantly improved long-term survival data.14–18

In the past decade, laparoscopic techniques have gained wide clinical acceptance in surgical practice. This approach offers important advantages when compared with open surgery: reduced intraoperative blood loss, reduced postoperative pain and accelerated recovery, earlier return to normal bowel function with earlier resumption of oral intake, early discharge from hospital, and lower financial costs.19–22

The same advantages have been reported after laparoscopic subtotal or total gastrectomy for benign tumors as well as early gastric cancers.23–31 However, laparoscopically assisted subtotal gastrectomy for distal gastric cancer can only be justified and widely accepted as a safer alternative to open surgery if equal long-term results are obtained. This would suggest an equivalent radical oncologic resection.

The purpose of our study was to compare early and 5-year results of subtotal gastrectomy performed for distal gastric cancer using both a laparoscopic and an open approach, therefore defining the role of laparoscopic surgery in the treatment of this disease.

Laparoscopic versus open subtotal gastrectomy for distal gastric cancer: five-year results of a randomized prospective trial

Objective The aim of this study was to evaluate the safety of this trial with respect to morbidity and mortality. Summary background data Laparoscopic-assisted distal gastrectomy (LADG) is rapidly gaining popularity. However, there is limited evidence regarding its oncologic safety. We therefore conducted a phase III multicenter, prospective, randomized study comparing LADG with open gastrectomy (ODG). Methods Patient eligibility criteria were pathologically-proven adenocarcinoma, 20 to 80 years of age, preoperative stage I, no history of other cancer, chemotherapy, or radiotherapy. The primary end point was to determine whether there is a difference in overall survival between 2 groups. The morbidity and mortality were compared to evaluate the safety of this trial. The time was decided on the hypothesis that the morbidity of this trial was not significantly different from that of previous reports on open gastric cancer surgeries (17%-20%). This study is registered at ClinicalTrials.gov and carries the following ID number: NCT00452751. Results A total of 342 patients were randomized (LADG, 179 patients; ODG, 161 patients) between January 1, 2006 and July 19, 2007. There were no significant differences between the 2 groups in age, gender, and comorbidities. The postoperative complication rates of the LADG and ODG groups were 10.5% (17/179) and 14.7% (24/163), respectively (P = 0.137). Reoperations were required in 3 cases each group. The postoperative mortality was 1.1% (2/179) and 0% (0/163) in the LADG and ODG groups (P = 0.497), respectively. Conclusion There was no significance difference in the morbidity and mortality between the 2 groups. Therefore, we conclude that this trial is safe and is thus ongoing.

Morbidity and mortality of laparoscopic gastrectomy versus open gastrectomy for gastric cancer: an interim report--a phase III multicenter, prospective, randomized Trial (KLASS Trial).

Laparoscopic distal partial gastrectomy is still technically difficult under conditions of a pneumoperitoneum because of the lack of appropriate techniques and laparoscopic instruments. We describe here a technique of laparoscopy-assisted Billroth I gastrectomy under an abdominal wall-elevating method.

Laparoscopy-assisted Billroth I gastrectomy.

Purpose
To assess the risk factors of surgical site infection (SSI) in gastrointestinal surgery.

Risk Factors Associated with Surgical Site Infection in Upper and Lower Gastrointestinal Surgery

Prevention of recurrence of esophageal varices after endoscopic injection sclerotherapy with ethanolamine oleate.

Endoscopic injection sclerotherapy for 1,000 patients with esophageal varices: A nine‐year prospective study

Epstein-Barr virus (EBV) is associated with certain types of gastric carcinoma. We report a case of EBV-positive undifferentiated carcinoma of the stomach in a 59-year-old woman with a well-demarcated ulcerating tumor in the gastric body. Examination of the resected stomach revealed that the tumor was undifferentiated carcinoma with lymphoid stroma, or lymphoepithelioma-like carcinoma. Tumor cells were positive for EBV by in situ hybridization. Gastroenterologists must keep in mind that localized ulcerating tumors of the stomach histologically seen as undifferentiated carcinnoma with lymphoid stroma are linked to EBV infection.

Yasunori Iso

Papers

Laparoscopy-assisted Billroth I gastrectomy.

Risk Factors Associated with Surgical Site Infection in Upper and Lower Gastrointestinal Surgery

Prevention of recurrence of esophageal varices after endoscopic injection sclerotherapy with ethanolamine oleate.

Endoscopic injection sclerotherapy for 1,000 patients with esophageal varices: A nine‐year prospective study

Epstein-Barr virus-associated gastric carcinoma