Search PubMed⌕ Search

SEARCH · Search PubMed

Results for “Gastrectomy”

Search indexed PubMed citations on genomics, clinical trials, systematic reviews and public health. Explore titles, authors and supplied subject terms, then open the PubMed record.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 937 records · Page 52Linked to original sources
PubMed2002

The influence of hospital and surgeon volume on in-hospital mortality for colectomy, gastrectomy, and lung lobectomy in patients with cancer.

BACKGROUND: This study explores the volume-mortality relationship for 3 groups of cancer procedures to determine whether higher-volume hospitals, higher-volume surgeons, or both are associated with lower in-hospital mortality. METHODS: New York's Statewide Planning and Research Cooperative System was used to identify more than 32,000 hospital inpatients with a cancer diagnosis who underwent colectomy, lobectomy of the lung, or gastrectomy between January 1, 1994, and December 31, 1997. The association of in-hospital mortality rates with provider (hospital and surgeon) volume was examined after adjusting for differences in age, demographics, organ metastasis, socioeconomic status, and comorbidities. RESULTS: For hospital volume for gastrectomy, the highest-volume quartile had an absolute risk-adjusted mortality rate that was 7.1% lower (P <.0001) than the lowest-volume quartile, although the overall mortality rate for the procedure was only 6.2%. For surgeon volume for colectomy, the highest- and lowest- volume quartiles differed by 1.9% (P <.0001), although the procedure mortality rate was only 3.5%. For hospital volume for lung lobectomy, the absolute difference in mortality was 1.7%. Patients undergoing operations performed by high-volume surgeons in high-volume hospitals usually had significantly lower risk-adjusted mortality rates than did patients who had low-volume surgeons or who were in low-volume hospitals, or both. CONCLUSIONS: For all 3 procedure groups, the risk-adjusted in-hospital mortality is significantly lower when the procedures are performed by high-volume providers.

Colectomy↗
PubMed2002

Functional characteristics of the pylorus in patients undergoing pylorus--preserving gastrectomy for early gastric cancer.

BACKGROUND: This study investigates the functional characteristics of the pylorus in patients undergoing pylorus-preserving gastrectomy (PPG) for early gastric cancer. METHODS: In study 1, postprandial symptoms and gastric emptying were compared between 2 groups of 12 patients with early gastric cancer more than 1 year after either PPG (PPG group) or distal gastrectomy (DG) (DG group). Gastric emptying was evaluated with the dual isotope technique for liquids and solids separately. In study 2, pyloric motility was evaluated with a sleeve/sidehole manometric assembly in 7 patients undergoing PPG, which was compared with that in the preoperative patients. RESULTS: In study 1, the overall modified Visick score of postprandial symptoms and the Sigstad dumping score were significantly lower in the PPG group compared with the DG group (P <.05). Early accelerated gastric emptying was observed in both groups for liquids, but only in the DG group for solids. In study 2, isolated pyloric pressure waves induced by intraduodenal lipid infusion and phase III-like activity induced by intravenous erythromycin infusion were preserved after PPG. CONCLUSIONS: The quantitative analysis of postoperative symptoms revealed that PPG patients were associated with better clinical conditions than DG patients. The clinical benefits of PPG are considered to be based on the function of the preserved pylorus.

Adult↗
PubMed2003

Editorial comment: feasibility of central gastrectomy for gastric cancer.

BACKGROUND: Central gastrectomy (CG) for gastric cancer was developed to preserve pyloric function and maintain a large gastric volume. Whether this procedure is feasible for limited cases of gastric cancer is unclear. METHODS: On the basis of Union Internationale Contre le Cancer TNM classification, pathologic characteristics, perioperative parameters, and long-term results, we analyzed 100 patients who underwent CG. RESULTS: Pathologic findings included T1 (tumor depth, mucosal or submucosal) in 82 patients and T2 (muscularis propria or subserosal) in 18 patients. Mean number of dissected lymph nodes was 17.3, and pathologic N1 (node metastasis, 6 or less) was found in 14 patients. There were no operative deaths, but 5 patients had postoperative complications: anastomotic leakage in 1, severe gastric stasis in 2, ischemic gastric ulcer in 1, and intra-abdominal bleeding in 1. No patient had a cancer recurrence in a mean follow-up of 49 months. New early gastric cancer was detected in 3 patients during follow-up endoscopic examination. The 5-year cumulative survival was 0.97. One year after CG, 63 patients had early satiety after food intake. Mean ratio of 1-year postoperative/preoperative body weight was 95%. CONCLUSIONS: Central gastrectomy with sufficient node dissection resulted in good long-term survival and minimal postoperative weight loss. CG is a safe and useful procedure for selected patients with gastric cancer, although close follow-up for recurrence and a more precise analysis on physiologic states is needed.

Blood Loss, Surgical↗
PubMed1999

Improved physical condition by limiting lymphadenectomy around the coeliac artery after distal gastrectomy for gastric cancer.

OBJECTIVE: To find out whether a less extensive lymphadenectomy could relieve the postoperative symptoms associated with D2 resection of gastric cancer. DESIGN: Retrospective study. SETTING: Teaching hospital, Japan. SUBJECTS: 142 patients who had dissection along the left gastric and common hepatic arteries and dissection of the perigastric nodes during curative distal gastrectomy without splenectomy or pancreatectomy between 1990 and 1994. 79 who had no dissection around the coeliac artery were compared with 63 who had. INTERVENTIONS: Questionnaires sent out in February 1996. MAIN OUTCOME MEASURES: Short term and long term morbidity. RESULTS: The patients who had had coeliac dissection were significantly more likely to prefer digestible and light food (p = 0.006); and were significantly more likely to complain of diarrhoea (p = 0.001), abdominal pain (p = 0.02), and late dumping (p = 0.03) than those who did not. Patients who had had coeliac dissection tended to eat more digestible foods in smaller volumes/meal during the early postoperative years, and had more abdominal pain, fullness, and oesophageal reflux during the later years. CONCLUSION: Limiting coeliac dissection during curative distal gastrectomy can improve the patients' physical condition postoperatively.

Celiac Artery↗
PubMed1994

Laparoscopic and minilaparotomy Billroth I gastrectomy for gastric ulcer using an abdominal wall-lifting method.

Laparoscopic distal gastrectomy is still technically difficult because of the lack of appropriate techniques, the expensive laparoscopic instruments, and the use of numerous disposable stapling devices. In an attempt to solve these problems, we have designed a method of laparoscopic and minilaparotomy Billroth I gastrectomy using an abdominal wall-lifting method.

Abdominal Muscles↗
PubMed1995

Laparoscopic minilaparotomy Billroth I gastrectomy with extraperigastric lymphadenectomy for early gastric cancer using an abdominal wall-lifting method.

Laparoscopic gastrectomy with extraperigastric lymphadenectomy for early gastric cancer has never been performed because of technical difficulties attributable to the lack of appropriate techniques, the high cost of laparoscopic instruments, and the need for numerous disposable stapling devices. In order to solve these problems, we have designed a method of laparoscopic minilaparotomy using an abdominal wall-lifting method, and a patient with early gastric cancer (depth of submucosa) underwent by this laparoscopic minilaparotomy distal gastrectomy with extraperigastric lymphadenectomy. During his postoperative recovery, the patient requested no narcotic analgesic, and was discharged on postoperative day 14.

Abdominal Muscles↗
PubMed2001

Comparison of patient-controlled epidural analgesia with and without night-time infusion following gastrectomy.

To assess the analgesic efficacy and side effects of a supplemental night-time infusion in patient-controlled epidural analgesia (PCEA) after gastrectomy, we carried out a randomized, double-blind study. The number of requests were lower (P<0.005) in the PCEA plus night-time infusion group than in the PCEA alone group during the postoperative nights. Patients who had a PCEA plus night-time continuous infusion, slept with fewer interruptions than those who had only the PCEA. VAS pain scores on coughing were significantly lower (P<0.05) in the PCEA plus infusion group than in the PCEA alone group during the night following postoperative day 1. In conclusion, a night-time infusion in PCEA following gastrectomy decreases the incidence of postoperative pain, provides a better sleep pattern, and reduces the degree of the pain associated with coughing during the night.

Analgesia, Epidural↗
PubMed1998

Dietary fructooligosaccharides prevent osteopenia after gastrectomy in rats.

Postgastrectomy osteopenia is observed generally in humans. Fructooligosaccharides increase the absorption of calcium from the large intestine of healthy rats. Thus, we have examined whether they stimulate calcium absorption and prevent osteopenia in rats following total gastrectomy. Rats were subjected to either a sham surgical operation or Billoth II gastrectomy. Seven rats from each surgical treatment group were fed a control diet, and another seven rats of each treatment group were fed a diet containing fructooligosaccharides (75 g/kg diet) for 4 wk. For 5 d each week, feces were collected, and the calcium and phosphorus contents were measured for calculation of the absorption of these minerals. At the end of the experiment, the rats were killed and bones were collected. The net calcium absorption, calcium content and bone mineral density of the femur and tibia in gastrectomized rats fed the control diet were significantly less than those in sham-operated rats fed control diet. The net calcium absorption in rats fed the fructooligosaccharides diet was greater than that in rats fed control diet. Moreover, dietary fructooligosaccharides prevented the decrease in the calcium content and bone mineral density in gastrectomized rats. Dietary fructooligosaccharides enhanced calcium absorption and prevented the changes indicative of postgastrectomy osteopenia such as decreases in bone calcium content and bone mineral density in gastrectomized rats.

Absorption↗
PubMed1995

Ventilatory responses to inspiratory resistive loading before and after gastrectomy during isoflurane anesthesia.

We tested the hypothesis that steady-state responses to inspiratory-flow-resistive loading would be preserved immediately after upper abdominal surgery in anesthetized patients. Twenty patients were studied immediately before and after gastrectomy under 1 minimum alveolar anesthetic concentration (MAC) of isoflurane anesthesia. Ventilation, airway occlusion pressure, and Paco2 were measured before and during inspiratory-flow-resistive breathing lasting from 6 to 7 min. Ten of 20 subjects were tested with resistance of 51.8 cm H2O.L-1.s-1 (Load 1) and the remaining 10 subjects were tested with resistance of 83.3 cm H2O.L-1.s-1 (Load 2). Ventilatory variables obtained immediately before and after surgery were compared in each group. Baseline ventilation increased postoperatively with greater frequency of breathing and comparable tidal volume (VT). Immediately after the application of resistive load, minute ventilation (VI) significantly decreased both pre- and postoperatively, due primarily to the decrease of VT. During sustained loading, VI gradually increased and reached steady state in 2-3 min. After 5 min of loading, Paco2 returned to the control level with Load 1 whereas with Load 2, it was higher than the control value. The magnitude and time course of reduced ventilation in response to resistive load were identical between pre- and postoperative conditions. We conclude that the ability of maintaining ventilation to imposed inspiratory-flow-resistive loading is well preserved during 1 MAC of isoflurane anesthesia before and after gastrectomy.

Adult↗
PubMed1997

The effects of atrial natriuretic peptide infusion on hemodynamic, renal, and hormonal responses during gastrectomy.

UNLABELLED: Atrial natriuretic peptide (ANP) antagonizes the reninangiotensin-aldosterone, adrenocorticotropic hormone-cortisol, vasopressin, and endothelin systems. Surgical injury stimulates these systems and causes vasoconstriction and antidiuresis. We assessed the hemodynamic, renal, and endocrine effects of continuous intravenous infusion of ANP in patients anesthetized with sevoflurane undergoing gastrectomy. ANP (0.1 microgram.kg-1.min-1; ANP group, n = 9) or saline (control group, n = 9) was infused continuously for 3 h from the start of the operation. The ANP group showed much higher urinary volume and sodium, potassium, and chloride excretion than the control group, although the former had lower arterial blood pressure. ANP infusion slightly inhibited aldosterone secretion and initially tended to inhibit renin secretion stimulated by surgery, but it did not affect surgery-induced increases in the plasma concentrations of vasopressin, adrenocorticotropic hormone, cortisol, or endothelin. Two patients in the ANP group experienced excessive hypotension, one experienced bradycardia, and two experienced mild hypoxemia, which required treatment but were resolved easily. These findings suggest that ANP infusion may be used with caution for controlling renal function and arterial blood pressure during surgery. IMPLICATIONS: Continuous intravenous infusion of atrial natriuretic peptide, 0.1 microgram.kg-1.min-1, during gastrectomy was associated with higher water and sodium excretion and lower arterial blood pressure. It tended to inhibit the renin-angiotensin-aldosterone system compared with saline infusion, which suggests that atrial natriuretic peptide may be useful for intraoperative circulation control.

Adrenocorticotropic Hormone↗
PubMed2000

Preemptive analgesia by intravenous low-dose ketamine and epidural morphine in gastrectomy: a randomized double-blind study.

BACKGROUND: Morphine and ketamine may prevent central sensitization during surgery and result in preemptive analgesia. The reliability of preemptive analgesia, however, is controversial. METHODS: Gastrectomy patients were given preemptive analgesia consisting of epidural morphine, intravenous low-dose ketamine, and combinations of these in a randomized, double-blind manner. Postsurgical pain intensity was rated by a visual analog scale, a categoric pain evaluation, and cumulative morphine consumption. RESULTS: Preemptive analgesia by epidural morphine and by intravenous low-dose ketamine were significantly effective but not definitive. With epidural morphine, a significant reduction in visual analog scale scores at rest was observed at 24 and 48 h, and morphine consumption was significantly lower at 6 and 12 h, compared with control values. With intravenous ketamine, visual analog scale scores at rest and morphine consumption were significantly lower at 6, 12, 24, and 48 h than those in control subjects. The combination of epidural morphine and intravenous ketamine provided definitive preemptive analgesia: Visual analog scale scores at rest and morphine consumption were significantly the lowest at 6, 12, 24, and 48 h, and the visual analog scale score during movement and the categoric pain score also were significantly the lowest among the groups. CONCLUSION: The results suggest that for definitive preemptive analgesia, blockade of opioid and N-methyl-d-aspartate receptors is necessary for upper abdominal surgery such as gastrectomy; singly, either treatment provided significant, but not definitive, postsurgical pain relief. Epidural morphine may affect the spinal cord segmentally, whereas intravenous ketamine may block brain stem sensitization via the vagus nerve during upper abdominal surgery.

Aged↗
PubMed1975

Nutritional consequences of total gastrectomy.

Nutritional status was investigated in 10 patients who had previously undergone total gastrectomy without evidence of malignancy. The ability of these patients to ingest and absorb adequate amounts of nutrients was examined. Metabolic balance studies were also performed to discover how effectively these patients could accumulate and use the absorbed nutrients. In the controlled hospital situation, the amount of food ingested was greater than the amount required for maintenance of Ideal Body Weight. Although mild malabsorption of fat and nitrogen was documented, weight gain and positive nitrogen balance occurred. In direct contrast, food intake significantly decreased when the patients returned to their home environment. While severe malabsorption may contribute to malnutrition in the individual patient, the most common mechanism responsible for postoperative malnutrition was inadequate intake. In the occasional patient with severe malabsorption, the universal demonstration of jejunal anaerobic bacterial overgrowth offers important therapeutic implications. The relative importance of pancreatico-biliary insufficiency in promoting malabsorption remains to be determined. Construction of a Hunt-Lawrence jejunal pouch was not found to favorably affect caloric intake, weight gain, degree of malabsorption, or dumping symptoms. Although some degree of malnutrition does result from total gastric resection, in most cases it is mild and potentially correctable. Avoidance of indicated total gastrectomy due to fears of progressive postoperative malnutrition is unwarranted.

Adult↗
PubMed1985

Vagotomy plus Bilroth II gastrectomy for the prevention of recurrent alcohol-induced pancreatitis.

Three retrospective reviews documenting a lessened frequency of acute recurrent alcohol-induced pancreatitis following vagotomy, with or without gastrectomy or gastroenterostomy, prompted a prospective evaluation of truncal vagotomy with Bilroth II gastrectomy as a means of preventing such exacerbations. Randomization between operation and encouragement to abstain from alcohol in patients with a history of more than one, but less than ten, acute bouts of alcohol-induced pancreatitis was set by odd-even digits in the hospital number. Of 176 patients admitted with acute alcoholic pancreatitis during 23 months of study, 49 were excluded because of too few or too many prior attacks. Another 61 refused to enter the study. At least one (average 1.9) recurrence requiring hospitalization was noted in 49, or 80%, of these patients on follow-up for 2 to 26 months (average 14 months). Of the 66 who consented to participate, 33 were randomized not to undergo operation and had almost identical recurrence statistics (i.e., an average of 1.7 recurrences in 24, or 73%). By contrast, only two of 31, or six per cent, allocated to operation have experienced a recurrence (p less than 0.001). Two who had been randomized were excluded because of persisting active pancreatitis.

Acute Disease↗
PubMed1986

Healing of esophagojejunal anastomoses after experimental total gastrectomy. A comparative study using manually sutured or stapled anastomoses.

In construction of the eosphagojejunostomy after total gastrectomy, the EEA stapled (US Surgical Corporation, Norwalk, CT) and the two-layer interrupted 3-0 Dexon anastomoses are compared concerning the radiological appearance, breaking strength, circulation, and collagen concentration. Thirty female pigs were used. After total gastrectomy and Roux-en-Y preparation, the pigs were randomized to achieve sutured or stapled anastomoses. 141Ce-labeled microspheres were used for measurements of anastomotic blood flow. After the pigs were killed, the breaking strength of the anastomosis was recorded, the collagen content determined, and an anastomotic index calculated comparing two perpendicular diameters in the anastomosis and 5 cm above. Breaking strength, leakage frequency, and anastomotic index were the same in the two groups. One week after surgery, there was a significant increase in anastomotic circulation (p less than 0.05) in both the sutured and the stapled anastomoses compared to controls. Collagen increased equally with time in the two groups (p less than 0.01). The stapled esophagojejunostomy was faster to perform (20 min) than the sutured (28 min) (p less than 0.05).

Animals↗
PubMed1989

Total versus subtotal gastrectomy for adenocarcinoma of the gastric antrum. A French prospective controlled study.

In a multicentric trial the postoperative mortality and the 5-year survival of elective total gastrectomy (TG) was compared with subtotal gastrectomy (SG) for adenocarcinoma of the antrum operated on with intent of cure. Two hundred and one patients were included in the study; 32 were excluded after pathologic examination (linitis plastica, superficial cancer, lymphoma). One hundred sixty-nine patients remained for analysis, with 93 undergoing TG and 76 undergoing SG. Elective TG did not increase postoperative mortality (1.3%) compared with SG (3.2%). There was no difference in the 5-year survival rate (48%). Analysis of survival showed no difference in the two techniques when related to nodal involvement and serosal extension. It is concluded that both TG and SG can be performed safely in patients with adenocarcinoma of the antrum; however TG did not increase the survival rate.

Adenocarcinoma↗
PubMed1995

Jejunal pouch reconstruction after total gastrectomy for cancer. A randomized controlled trial.

OBJECTIVE: The authors determined the optimum reconstruction procedure after total gastrectomy in terms of the quality of life of the patients. SUMMARY BACKGROUND DATA: Gastric replacement with various enteric reservoirs has been used to improve the postprandial symptoms and nutrition of patients after total gastrectomy. However, the effect of each is uncertain because no prospective randomized studies have been conducted. METHODS: A randomized controlled trial was conducted to compare the usefulness of the three reconstruction procedures of simple Roux-en-Y (RY; N = 10), pouch and Roux-en-Y (PR; N = 10), and pouch and interposition (PI; N = 10). In each subject, the postprandial symptoms, food intake in a single meal, body weight, serum nutritional parameters, and emptying time of the gastric substitute were evaluated. RESULTS: The PR group showed significantly greater food intake in a single meal than the RY and PI groups, and greater weight recovery than the PI group. A gastric emptying test also revealed satisfactory retention capacity and emptying time of the gastric substitute in the PR group. CONCLUSIONS: Pouch and Roux-en-Y reconstruction is the most useful of the three procedures for improving the postoperative quality of life. In patients with pouch and interposition reconstruction, the clinical assessment was quite poor, even though it is a physiologic route.

Adult↗
PubMed1997

Ileocolon interposition as a substitute stomach after total or proximal gastrectomy.

OBJECTIVE: The authors evaluated ileocolon interposition as a substitute stomach after total gastrectomy (TG) or proximal gastrectomy (PG). SUMMARY BACKGROUND DATA: Although the jejunum frequently is used for reconstruction to create a substitute stomach after TG or PG, there are few reports on ileocolon interposition. METHODS: The authors performed ileocolon interposition in 47 patients who underwent TG (N = 18) or PG (N = 29) for malignant gastric lesion and evaluated the function of this structure as a substitute stomach using esophagoscopy, manometry, pH-metry, emptying time, oral glucose tolerance test (OGTT), and postoperative body weight changes. RESULTS: No patient reported any reflux symptoms or showed endoscopic findings of reflux esophagitis. These results were well supported by manometry and acid loading pH-metry. Emptying time and OGTT showed good capacity as a reservoir of food, and the postoperative body weight averaged more than 90% of preoperative weight. Clinically, no significant difference between these two groups was recognized during long-term follow-up for up to 12 years after operation. There were no cases of direct operative death, and the 5- and 10-year survival rates were 64.7% and 40.2%, respectively. CONCLUSIONS: Ileocolon interposition after TG or PG has the advantages of preventing postoperative reflux esophagitis and of providing functional replacement of the stomach as a reservoir for ingested food.

Adult↗
PubMed2002

Ileocecal valve as substitute for the missing pyloric sphincter after partial distal gastrectomy.

OBJECTIVES: Accelerated gastric emptying (including dumping syndrome) occurs frequently after gastric resections, largely resulting from rapid entry of meal contents into the small intestine. The authors hypothesized that an ileocecal segment used as an interpositional graft placed between the remaining part of the stomach and the small intestine would slow down food transit and thus replace pyloric function. METHODS: Thirty Göttingen minipigs were randomized into three groups. Group 1: partial gastrectomy and Roux-en-Y reconstruction; Group 2: partial gastrectomy and ileocecal interpositional graft; and Group 3: sham laparotomy. Gastric emptying in the nonsedated animals was quantified using radioscintigraphy at 3 and 6 months postoperatively. The animals ingested 300 grams of soft food containing 99mTc labeled resin- pellets using a technique previously described. Data were analyzed using ANOVA. RESULTS: Three months postoperatively, the ileocecal group had a significantly prolonged gastric emptying time compared with the Roux-en-Y group, but gastric emptying time was also significantly faster compared to the control group (sham laparotomy). After 6 months no significant difference was seen between the ileocecal group and the controls, while emptying rates were still significantly faster in the Roux-en-Y group. CONCLUSIONS: Reconstruction of the gastric reservoir with an ileocecal segment largely restores gastric emptying patterns of food in minipigs. Six months postoperatively, gastric emptying time is similar to that of controls, and significantly slower when compared with the group with Roux-en-Y reconstruction. These results suggest that the ileocecal interposition graft could offer specific advantages over current reconstruction procedures.

Anastomosis, Roux-en-Y↗