Showing papers in "Digestive Surgery in 2013"
TL;DR: Scientific evidence is scarce for some aspects of ACD treatment, leading to treatment being guided by the surgeon's personal preference, and this guideline of the diagnostics and treatment ofACD can be used as a reference for clinicians who treat patients with ACD.
Abstract: Background: The incidence of acute left-sided colonic diverticulitis (ACD) is increasing in the Western world. To improve the quality of patient care, a guideline
250 citations
TL;DR: Diverticulectomy with myotomy has become the mainstream treatment option for Zenker's diverticulum (ZD), and in certain selected patients, endoscopic diverticulotomy may offer some advantages over open surgery, such as less trauma and a lower complication rate.
Abstract: Background: Different surgical techniques have been indicated for the management of Zenker's diverticulum (ZD), including diverticulectomy, diverticulopexy, and d
134 citations
TL;DR: Early oral feeding is safe and effective in patients undergoing elective colorectal surgery and there were no significant differences in the risk of anastomotic dehiscence, pneumonia, wound infection, rate of nasogastric tube reinsertion, vomiting, or mortality.
Abstract: Background: The safety and effectiveness of early oral feeding after colorectal surgery has not been determined. We performed a meta-analysis to evaluate surgical
130 citations
TL;DR: Results from detailed molecular and/or pathological GC studies, although promising, still have limited clinical utility in predicting survival and stratifying GC patients for appropriate treatment.
Abstract: The development of gastric adenocarcinoma is a complex multistep process involving multiple genetic alterations. Based on pathology, four different macroscopic types and at least two major histological types, intestinal and diffuse, have been described. Most gastric cancer (GC) show genetic instability, either microsatellite instability or chromosomal instability, which is considered an early event in gastric carcinogenesis. Molecular studies of alterations of single genes have provided evidence that intestinal and diffuse type GC evolve via different genetic pathways. Recent results from high-throughput whole-genome expression or copy number studies have demonstrated extensive genetic diversity between cases and within individual GC. Sets of commonly up- or downregulated microRNAs have been identified in GC and might be useful in the near future to identify pathways of GC progression. Results from detailed molecular and/or pathological GC studies, although promising, still have limited clinical utility in predicting survival and stratifying GC patients for appropriate treatment.
81 citations
TL;DR: The majority of patients with hepatic metastases should be considered for resectional surgery, if all disease can be resected, as this offers the only opportunity for prolonged survival.
Abstract: Half of all patients with colorectal cancer develop metastatic disease. The liver is the principal site for metastases, and surgical resection is the only modality that offers the potential for long-term cure. Appropriate patient selection for surgery and improvements in perioperative care have resulted in low morbidity and mortality rates, resulting in this being the therapy of choice for suitable patients. Modern management of colorectal liver metastases is multimodal incorporating open and laparoscopic surgery, ablative therapies such as radiofrequency ablation or microwave ablation and (neo)adjuvant chemotherapy. The majority of patients with hepatic metastases should be considered for resectional surgery, if all disease can be resected, as this offers the only opportunity for prolonged survival.
61 citations
TL;DR: There was no survival difference between open and laparoscopic CME colonic resections, and the present OS improved from a previous OS from 2000, while the surgical approach was not a significant predictor for any of the survival parameters.
Abstract: Background: Complete mesocolic excision (CME) and a high (apical) vascular tie may improve oncologic outcome after surgery for colon cancer. Our primary aim was t
60 citations
TL;DR: A brief yet updated overview of the current understanding of CRC as a genetic and molecular disease with potential for clinical pathways of prevention, improved prediction and better prognosis in the future is given.
Abstract: Colorectal cancer (CRC) is, for sporadic forms, most strongly related to lifestyle factors. The epidemic of obesity and physical inactivity has great impact on disease patterns. Likewise, an altered metabolism has consequences at the cellular and molecular level with implications for cancer initiation and growth. Understanding the genetic hallmarks of cancers has improved over the years and now also includes cancer metabolic reprogramming. The initiation of cancer through genetic instability, including chromosomal instability, microsatellite instability and epigenetic silencing through the CpG island methylator phenotype follows pathways with distinct clinical, pathological, and genetic characteristics. These can potentially be used for molecular classification and comprehensive tumor profiling for improved diagnostics, prognosis and treatment in CRC. For one, epidermal growth factor receptor-directed treatment now considerably prolongs survival in metastatic disease, but defining the true responders from non-responders has emerged as complex. Further, the use of both non-steroidal anti-inflammatory drugs including cyclooxygenase-2 inhibitors is associated with a decreased incidence of adenoma and reduced mortality rate of CRC. This review gives a brief yet updated overview of the current understanding of CRC as a genetic and molecular disease with potential for clinical pathways of prevention, improved prediction and better prognosis in the future.
58 citations
TL;DR: Despite the wide variety of prognostic factors reported in the literature, this study was only able to identify a preoperative CEA ≥200 ng/ml and the presence of tumour within 1 mm of the resection margin as being of value in predicting survival.
Abstract: Introduction: A variety of factors have been identified in the literature which influence survival following resection of colorectal liver metastases (CRLM). Much
56 citations
TL;DR: The use of PMA for abdominal wall closure is associated with significantly lower incidence of IH compared to PS, and a trend was observed for chronic pain in favor of the PS group.
Abstract: Background: Incisional hernia (IH) remains one of the most frequent postoperative complications after abdominal surgery As a consequence, primary mesh augmentation (PMA), a technique to strengthen the abdominal wall, has been gaining popularity This meta-analysis was conducted to evaluate the prophylactic effect of PMA on the incidence of IH compared to primary suture (PS) Methods: A meta-analysis was conducted according to the PRISMA guidelines Randomized controlled trials (RCTs) comparing PMA and PS for closing the abdominal wall after surgery were included Results: Out of 576 papers, 5 RCTs were selected comprising 346 patients IH occurred significantly less in the PMA group (RR 025, 95% CI 012-052, I20%; p < 0001) No difference could be observed with regard to wound infection (RR 086, 95% CI 039-191, I2 0%; p = 071) or seroma (RR 122, 95% CI 064-233, I2 0%; p = 055) A trend was observed for chronic pain in favor of the PS group (RR 595, 95% CI 074-4803, I20%; p = 009) Conclusion: The use of PMA for abdominal wall closure is associated with significantly lower incidence of IH compared to PS
55 citations
TL;DR: Asian findings could be relevant and generalizable to other regions when D2 surgery is performed by experienced surgeons, and promising efficacy has been demonstrated in several phase II studies with the safe use of D2 or more extended surgery following neoadjuvant chemotherapy.
Abstract: This review presents the current status of adjuvant and neoadjuvant treatment options for primary resectable gastric cancer in the East, with updated data from recent studies. Marked disparities between the East and the West in standard surgical procedures (D2 vs. D1/0 lymphadenectomy) and their outcomes result in significant geographical variation in preferred adjuvant treatments. Currently, oral fluoropyrimidine-based postoperative adjuvant chemotherapy, 1 year of S-1 chemotherapy, or capecitabine plus oxaliplatin for 6 months are the standards of care after curative resection with D2 lymphadenectomy for stage II/III gastric cancer in the East, though there is still some room for improvement. The role of postoperative adjuvant chemoradiotherapy (CRT) following curative D2 gastrectomy has long been debated in the East. However, the first prospective randomized controlled trial comparing CRT with chemotherapy alone failed to demonstrate a survival benefit, thus further studies are required. Chemotherapy has been pursued as a neoadjuvant approach in East Asia because of a rare locoregional recurrence after curative D2 gastrectomy. Locally advanced, marginally resectable gastric cancer with poor prognosis, such as large type 3 or 4 tumors, para-aortic and/or bulky nodal disease, and serosa-positive gastric cancer, is the main target of neoadjuvant chemotherapy. Promising efficacy has been demonstrated in several phase II studies with the safe use of D2 or more extended surgery following neoadjuvant chemotherapy. Although the results of ongoing phase III trials are awaited, Asian findings could be relevant and generalizable to other regions when D2 surgery is performed by experienced surgeons.
50 citations
TL;DR: Current literature has no adequate evidence to prove that PG is superior to PJ for patients undergoing PD in terms of postoperative complications, and a standardized classification of pancreatic fistula and other intra-abdominal complications may enable an objective, valid comparison between PG and PJ.
Abstract: Background and Objectives: The method of pancreatic reconstruction after pancreaticoduodenectomy (PD) is closely associated with postoperative morbidity, mortality, and patient's quality of life. The objective of this study is to evaluate which anastomosis approach - pancreaticogastrostomy (PG) or pancreaticojejunostomy (PJ) is a better option of choice in terms of postoperative complications. Methods: Articles comparing PG and PJ that were published by July 2011 were retrieved and subjected to a systematic review and meta-analysis. Results: Four randomized controlled trials (RCTs) and 22 observational clinical studies (OCSs) were included. RCTs showed that the PG group had significantly lower incidence rates of postoperative intra-abdominal fluid collection (p = 0.003, relative risk (RR) 0.50, 95% CI 0.31-0.79) and multiple intra-abdominal complications (p = 0.0007, RR 0.26, 95% CI 0.12-0.56) than the PJ group. OCSs demonstrated significant differences between PG and PJ in terms of frequencies of postoperative biliary fistula, intra-abdominal fluid collection, pancreatic fistula, morbidity, and mortality. The overall analysis revealed significant differences in frequencies of intra-luminal hemorrhage (p = 0.03, OR 2.82, 95% CI 1.08-7.33) and grade B/C pancreatic fistula (p = 0.002, OR 0.42, 95% CI 0.24-0.73) between the two groups. Conclusions: Current literature has no adequate evidence to prove that PG is superior to PJ for patients undergoing PD in terms of postoperative complications. A standardized classification of pancreatic fistula and other intra-abdominal complications may enable an objective, valid comparison between PG and PJ.
TL;DR: Patients with nondilated intrahepatic bile ducts who underwent a PTBD procedure for the treatment of bile leakage between January 2000 and August 2012 were retrospectively assessed and PTBD was an effective treatment with low complication rates.
Abstract: Objective and Background: Bile leakage is a serious postoperative complication and percutaneous transhepatic biliary drainage (PTBD) may be an option when endoscopic treatment is not feasible. In this retrospective study, we established technical and clinical success rates as well as the complication rates of PTBD in a large group of patients with postoperative bile leakage. Methods: Data on all patients with nondilated intrahepatic bile ducts who underwent a PTBD procedure for the treatment of bile leakage between January 2000 and August 2012 were retrospectively assessed. Data included type of surgery, site of bile leak, previous attempts of bile leak repair, interval between surgery and PTBD placement. Outcome measures were the technical and clinical success rates, the procedure-related complications, and mortality rate. Results: A total of 63 patients were identified; PTBD placement was technically successful in 90.5% (57/63) after one to three attempts. The clinical success rate was 69.8% (44/63). Four major complications were documented (4/63; 6.3%): liver laceration, pneumothorax, pleural empyema, and prolonged hemobilia. One minor complication involved pain. Conclusions: PTBD is an effective treatment with low complication rates for the management of postsurgical bile leaks in patients with nondilated bile ducts.
TL;DR: The ADC values predicted the prognosis of patients with advanced esophageal squamous cell carcinoma as well as the treatment response.
Abstract: Background: The aim of this study was to investigate the utility of the apparent diffusion coefficient (ADC) value in diffusion-weighted magnetic resonance imagin
TL;DR: For early-stage gastric cancer such as cT1N0, for which a better prognosis can be potentially achieved through conventional surgical approaches, the establishment of individualized, minimally invasive treatments that may retain the patients' quality of life should be the next surgical challenge.
Abstract: Clinical application of sentinel node (SN) mapping in patients with early gastric cancer has been a controversial issue for years. However, a recent meta-analysis and a prospective multicenter trial of SN mapping for early gastric cancer have shown acceptable SN detection rates and accuracy of determination of lymph node status. A dual-tracer method that utilizes radioactive colloids and blue dyes is currently considered the most reliable method for the stable detection of SNs in patients with early gastric cancer. However, new technologies such as indocyanine green infrared or fluorescence imaging might revolutionize the SN mapping procedures in gastric cancer. For early-stage gastric cancer such as cT1N0, for which a better prognosis can be potentially achieved through conventional surgical approaches, the establishment of individualized, minimally invasive treatments that may retain the patients' quality of life should be the next surgical challenge. Although there are many unresolved technical issues, laparoscopic SN biopsy with laparoscopic minimized gastrectomy or endoscopic mucosal resection/endoscopic submucosal dissection could be a promising strategy to achieve this goal.
TL;DR: The present results indicate that the implementation of ERAS programs in pancreatic, hepatic, esophageal and gastric surgery patients contributes to a reduction in complications, length of hospital stay and costs without an increase in mortality or readmission rates.
Abstract: Over the last 20 years, a new concept of perioperative patient care based on a construct of evidence-based interventions referred to as 'enhanced recovery after surgery' (ERAS) has been developed. The main pillars of ERAS programs include optimal postoperative pain management and early enteral feeding and mobilization after surgery. Several studies, mostly based on experiences with patients undergoing colonic resection, suggest that ERAS implementation is feasible and safe. However, there are very few well-designed studies that have evaluated the usefulness of ERAS programs after major upper abdominal surgery. The present review focuses on the discussion of the most relevant and recently published data on the application of ERAS programs in pancreatic, hepatic, esophageal and gastric surgery. A total of 23 articles have been reviewed by the authors. The high frequency and the potentially hazardous nature of some postoperative complications associated with major upper abdominal surgery and the lack of well-designed randomized controlled trials are limiting factors for the application of ERAS. However, the present results indicate that the implementation of ERAS programs in pancreatic, hepatic, esophageal and gastric surgery patients contributes to a reduction in complications, length of hospital stay and costs without an increase in mortality or readmission rates.
TL;DR: This review presents a state-of-the art overview of endoscopic and surgical treatment options for patients with painful chronic pancreatitis, and elaborate on the timing of surgery.
Abstract: Chronic pancreatitis is an inflammatory disease of the pancreas with abdominal pain as the most prominent symptom. Adequate treatment of patients with chronic pancreatitis remains a major challenge, mainly because of the lack of evidence-based treatment protocols. The primary goal of treatment is to achieve long-term pain relief, control of the complications associated with the disease, and to restore the quality of life. Currently, a conservative step-up approach is often used for the treatment of pain; progression to severe and intractable pain is considered necessary before invasive treatment is considered. Recent studies, however, suggest that surgical intervention should not be considered only as last-resort treatment, since it can mitigate disease progression, achieve excellent pain control, and preserve pancreatic function. In this review, we present a state-of-the art overview of endoscopic and surgical treatment options for patients with painful chronic pancreatitis, and elaborate on the timing of surgery.
TL;DR: There might be potential benefit in reducing POPF thanks to the use of pancreatic duct stents due to a significant difference on overall POPF rate, as well as postoperative morbidity and hospital stay.
Abstract: Background and Objective: Several studies suggested that pancreatic stents had some benefit during pancreatoduodenectomy (PD), but others disagree. Whether pancreatic duct stents could prevent postoperative pancreatic fistula (POPF) is still under controversy. Methods: Randomized controlled trials published before November 2012 were all aggregated, focusing on the evaluation of pancreatic duct stents during PD. Trial data was reviewed and extracted independently by two reviewers. The quality of the including studies was assessed by the Cochrane handbook 5.1.0. Results: Seven studies were included, with a total of 793 patients. The results showed that compared with nonstents, stents during PD was associated with a significant difference on overall POPF rate (OR = 0.65, 95% CI 0.45-0.95, p = 0.02), POPF grades B and C (OR = 0.45, 95% CI 0.27-0.76, p = 0.003), and hospital stay (MD = -4.28, 95% CI -6.81, -1.75, p = 0.0009). Subgroup analyses showed that the external stent had a significant difference in the incidence of overall POPF (OR = 0.46, 95% CI 0.29-0.73, p = 0.0009), POPF grades B and C (OR = 0.49, 95% CI 0.30-0.79, p = 0.003), postoperative morbidity (OR = 0.63, 95% CI 0.42-0.96, p = 0.03), as well as hospital stay. Conclusions: Based upon this meta-analysis, there might be potential benefit in reducing POPF thanks to the use of pancreatic duct stents.
TL;DR: Evidence for LDG for advanced gastric cancer is still insufficient and the issue of lack of generalization still remains, even after ongoing multicenter randomized controlled trials have revealed clinical evidence.
Abstract: Laparoscopic gastrectomy for gastric cancer is rapidly becoming popular because of the technical developments and the accumulated data of laparoscopic surgery in gastric cancer patients. The aim of this review is to present the current body of evidence and to highlight controversial issues of laparoscopic gastrectomy for gastric cancer. Laparoscopic distal gastrectomy (LDG) provides better or comparable outcomes compared to conventional open distal gastrectomy (ODG) in terms of short-term results. The long-term survival of LDG is expected to be comparable to that of ODG in early-stage gastric cancer, and an ongoing Korean multicenter randomized controlled trial (KLASS-01) will provide more clear evidence. Laparoscopic total gastrectomy is still selectively performed compared to LDG, and there is still debate on the safety of the laparoscopic esophagojejunostomy technique. Laparoscopic pylorus-preserving gastrectomy seems to be preferred for early gastric cancer in the middle third of the stomach in terms of functional advantages and comparable oncologic outcome. Evidence for LDG for advanced gastric cancer is still insufficient and the issue of lack of generalization still remains, even after ongoing multicenter randomized controlled trials have revealed clinical evidence. Laparoscopic sentinel node navigation surgery is still experimental and the surgical procedure has yet to be standardized. Robotic gastrectomy is feasible for early gastric cancer in terms of similar outcome, but is much more expensive in comparison to laparoscopic surgery. Its benefit over the conventional laparoscopic gastrectomy has not yet been proven.
TL;DR: The possibility of an HC of the Pancreas should be considered in the differential diagnosis of an uncommon pathological mass of the pancreas and treatment seems to be related to the association with other neoplasms, tumor extension at the time of diagnosis and the possibility to perform a radical resection.
Abstract: Background: Hepatoid carcinomas (HCs) are extrahepatic neoplasms exhibiting features of hepatocellular tumors in terms of morphology and immunohistochemistry. They have been described in several organs, most notably in the stomach and ovary. They can present in pure forms or in association with other morphological aspects, such as endocrine tumors or ductal adenocarcinomas. The aim of this review is to describe aspects of hepatoid adenocarcinoma of the pancreas with regard to epidemiology, diagnosis, and treatment. Methods: The PubMed database was searched for publications addressing hepatoid adenocarcinoma of the pancreas. We have searched for articles including the following keywords: ‘pancreatic hepatoid carcinoma', ‘ectopic liver cancer' and ‘rare pancreas neoplasm' published to date. As references, we used case reports and review articles. Results: Pancreatic forms of HCs are extremely uncommon: only 22 cases have been reported. Conclusions: The possibility of an HC of the pancreas should be considered in the differential diagnosis of an uncommon pathological mass of the pancreas. Treatment seems to be related to the association with other neoplasms, tumor extension at the time of diagnosis and the possibility to perform a radical resection. The common embryologic origin of the pancreas and liver, together with peculiar environmental factors, may explain the development of pancreatic HCs.
TL;DR: The current body of evidence and follow-up practices after curative resection of gastric cancer is reviewed and the prognostic effect of early detection seems doubtful.
Abstract: There is currently no consensus on the best strategy for the follow-up of patients who have undergone surgical treatment with curative intent for gastric cancer. The wide variation in recommendations for surveillance among international experts and hospital schedules clearly reflects a lack of an established body of evidence on this subject. Consequently, most of the international guidelines aimed at early detection of disease recurrence gloss over details concerning the mode, duration, and intensity of surveillance since they cannot be based on an acceptable grade of recommendation. Very few report anything other than the detection of recurrences or death as the primary endpoints, and, given the poor survival of patients with recurrent gastric cancer, the prognostic effect of early detection seems doubtful. In recent years, an increasing focus on evidence-based medicine, which has coincided with a growing concern about costs and efficiency in medicine, has caused a reevaluation of most surveillance practices. In this paper, we review and discuss the current body of evidence and follow-up practices after curative resection of gastric cancer.
TL;DR: A D2 dissection without routine splenectomy and pancreatic tail resection in experienced hands should be considered standard of care for advanced resectable gastric cancer, both in Asian and in Western patients.
Abstract: The extent of surgery for gastric cancer has been debated since Billroth performed his first gastrectomy in 1881 This review gives an overview of the available literature on the extent of gastrectomy and lymphadenectomy for advanced resectable gastric cancer Subtotal gastrectomy is associated with lower morbidity and mortality compared with total gastrectomy, without compromising long-term survival However, a positive resection margin decreases the chance of curation Frozen section examination may prevent this For poorly differentiated singlet ring cell tumors, there may be an argument to perform a total gastrectomy in all cases In 1981, the Japanese Research Society for the Study of Gastric Cancer provided guidelines for the standardization of surgical treatment and pathological evaluation of gastric cancer Since then, D2 lymph node dissections have become the standard of care in Japan Because of the superior stage-specific survival rates in Japan, a D2 dissection was evaluated in several Western randomized controlled trials, but no survival benefit was found for a D2 over a D1 dissection This might be explained by the increased mortality in the D2 dissection groups which might be the result of a standard pancreaticosplenectomy and low experience with D2 dissections Adding the removal of the para-aortic nodes to a D2 dissection does not further improve survival The removal of lymph node stations 10 and 11 by splenectomy showed an increased morbidity, no survival benefit, and a very poor prognosis if lymph nodes were affected Therefore, pancreaticosplenectomy should only be performed in cases of tumor invasion into these organs A D2 dissection without routine splenectomy and pancreatic tail resection in experienced hands should be considered standard of care for advanced resectable gastric cancer, both in Asian and in Western patients Centralization and auditing may further improve outcomes after gastrectomy
TL;DR: Using the laparoscope combined with the soft choledochoscope for gallbladders-preserving cholecystolithotomy can remove stones, preserve gallbladder function, and effectively avoid the various complications of choleCystectomy.
Abstract: Background: Cholecystolithiasis is a common disease Cholecystectomy is the main treatment method but is associated with various complications in some patients This study explores a novel, minimally invasive surgery for the removal of calculi and the preservation of the gallbladder using a laparoscope combined with the soft choledochoscope Method: A retrospective analysis was conducted between January 2010 and December 2012 in 65 patients with cholecystolithiasis who underwent the minimally invasive surgery for calculi removal and gallbladder preservation Results: In 61 cases of gallstone removal, the gallbladder was preserved perfectly with no complications The other 4 cases were switched to laparoscopic cholecystectomy because of tiny stones blocking the cystic duct or submucosal stones The success rate was 938% Follow-up included both clinical assessment and ultrasound examination every 6 months after the operation The patients with preoperative symptoms were symptom-free, and gallbladder function was well preserved The overall stone recurrence rate was 492% at a mean follow-up of 26 months (range 6-40) Conclusions: Using the laparoscope combined with the soft choledochoscope for gallbladder-preserving cholecystolithotomy can remove stones, preserve gallbladder function, and effectively avoid the various complications of cholecystectomy In our follow-up, gallbladder function was not affected and the stone recurrence rate was quite low
TL;DR: An updated overview of the current controversies and a state-of-the-art perspective on the qualitative and quantitative aspects of using lymph nodes as a prognostic marker in colon cancer are provided.
Abstract: For patients undergoing curative resections for colon cancer, the nodal status represents the strongest prognostic factor, yet at the same time the most disputed issue as well. Consequently, the quali
TL;DR: The most useful nomenclature for the arterial system of the large intestine for colorectal surgeons is established and the frequency of important arterial variations is reviewed.
Abstract: Introduction: Databases of information on surgical treatment for colorectal cancer have been created in various countries and data have started to be released. Th
TL;DR: It seems justified to exclude gallbladder specimens from histopathological examination based on the absence of macroscopic abnormalities, saving medical costs and maintaining patient safety, according to a retrospective study conducted in a large community hospital in the Netherlands.
Abstract: Background/Aims: Gallbladder specimens are routinely sent for histopathological examination after cholecystectomy in order to rule out the presence of gallbladder
TL;DR: Gallbladder cancer has a high frequency of K-ras codon 12 mutation with poorer outcomes in resected stage II and III disease, and k-ras mutational analysis has important prognostic implications that need to be investigated further.
Abstract: Background: Point mutation of K-ras is associated with carcinogenesis and overall survival in various cancers. We investigated the mutational spectrum of K-ras codon 12 in resected normal and gallbladder cancer tissue samples in a Northern Indian population and correlated it with different clinicopathological parameters. Patients and Methods: Gallbladder tissues from normal (n = 24) and cancer patients (n = 39) were analyzed for K-ras codon 12 mutation by restriction fragment length polymorphism. Statistical analysis was carried out using the χ2 test or Fisher's exact test. Survival was estimated using the Kaplan-Meier method, and the difference between survival curves was analyzed by the log-rank test. Results: The frequency of K-ras mutation was significantly higher (p = 0.001) in gallbladder cancer tissue samples (16/39) compared to normal samples (1/24). Patients with K-ras mutation had a significantly decreased overall survival (p = 0.003), particularly for stage II (p = 0.021) and III (p = 0.009) cancers. No significant correlation was observed with any of the other clinicopathological factors studied. Conclusions: Gallbladder cancer has a high frequency of K-ras codon 12 mutation with poorer outcomes in resected stage II and III disease. K-ras mutational analysis has important prognostic implications that need to be investigated further.
TL;DR: Elective resection of the sigmoid for persisting or recurring symptoms after an episode of diverticulitis improves general QoL and discomfort caused by abdominal pain, abnormal defecation and fatigue in the vast majority of patients.
Abstract: Background: Although the risks of elective resection for diverticular disease are well studied, studies on subjective improvement are scarce. This study aims to i
TL;DR: Those at highest risk for conversion are elderly male patients with prior abdominal surgery who present emergently with laboratory evidence of biliary inflammation.
Abstract: Background/Purpose: Laparoscopic cholecystectomy (LC) is the standard treatment for symptomatic benign gallbladder disease. The identification of factors that reliably predict the need to convert LC to open cholecystectomy (OC) would help with patient education and counseling. Methods: Between January 2000 and December 2009, 4,698 patients underwent cholecystectomy. LC was attempted in 4,434 patients (94.4%) and OC from the start was performed in 264 patients (5.6%). The causes for conversion were evaluated. The change in conversion rate between 2000 and 2004 and between 2005 and 2009 was analyzed. Factors predictive of conversion were identified by univariate and multivariate analysis. Results: Conversion to OC from an initial LC approach was required in 234 patients (5.3%). The main cause for conversion was dense adhesions (54.7%). Independent risk factors in multivariate analysis were male gender (p 9 × 103/μl, and urgently indicated cholecystectomy (p Conclusions: Those at highest risk for conversion are elderly male patients with prior abdominal surgery who present emergently with laboratory evidence of biliary inflammation.
TL;DR: The method may be suitable to predict male EF following rectal resection following surgery for rectal cancer because of the degree of agreement between electromyography-based and cystomanometry-based IONM.
Abstract: Background: The objective was to investigate whether two-dimensional intraoperative neuromonitoring (IONM) of pelvic autonomic nerves has the potential to predict
TL;DR: For the next more accurate staging, it is suggested the collaboration between Eastern and Western high-volume centers in gastric cancer because the inconsistency of surgical approaches, especially with respect to nodal resection, remains a barrier to mutual understanding.
Abstract: There are two major stage classification systems for gastric cancer: the tumor-node-metastasis (TNM) stages by the International Union against Cancer (UICC) and the Japanese Classification of Gastric Carcinoma by the Japanese Gastric Cancer Association (JGCA). Preoperative stage classification using either of these systems is essential for deciding on the treatment strategy in the era of various multimodal therapeutic options. Evolution of multidetector computerized tomography with isotropic volumetric imaging and various 3D images has increased the accuracy of T and N staging in patients with gastric cancer, although detection of peritoneal deposits and nodal metastasis in the absence of lymphadenopathy remain problematic with the imaging tools currently available. The TNM and JGCA classifications have undergone revisions independent of each other, and the discrepancies were not helpful when international comparisons and cooperation were needed. More recently, the JGCA and TNM classifications were merged to have identical T and N categories, in addition to the more straightforward M categories that indicate the presence of distant metastasis. The result of these efforts is that researchers in Japan and the rest of the world are now looking at a similar disease when they discuss cancer that belongs to the same stage. A nomogram that incorporates other established prognostic determinants in addition to the TNM component may be a future direction for a more sophisticated means of predicting outcome. The increasing incidence of junctional (esophagogastric junction) cancer in the Far East has spurred researchers from this region to adequately stage the disease and to consider suitable treatment modalities for this disease entity, whereas Western researchers are more inclined to treat this disease as esophageal cancer. This could be an area for future international debate. For the next more accurate staging, we suggest the collaboration between Eastern and Western high-volume centers in gastric cancer because the inconsistency of surgical approaches, especially with respect to nodal resection, remains a barrier to mutual understanding.