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PubMedDate not supplied

Preoperative irradiation of primarily non-resectable adenocarcinoma of the rectum and rectosigmoid.

In a series of 328 patients with adenocarcinoma of the rectum and rectosigmoid, 39 had a tumour which was considered locally non-resectable (19 patients) or borderline resectable (20 patients). Twenty-eight of these patients received radiation therapy with a daily target dose of 2 Gy up to a total of 46 Gy. If the tumour was still considered non-resectable 3 weeks later, radiation therapy was usually continued up to a total dose of 64 Gy together with 5-fluorouracil. Fifteen patients with a non-resectable tumour received radiation therapy up to a total dose of either 46 Gy (7 patients) or 64 Gy (8 patients). Only two patients underwent resection. Of the 20 patients with a tumour that was considered borderline resectable, 13 received 46 Gy. Nine patients in this group were radically resected. Totally 11 tumours were resected, constituting 39 per cent of the patients who were treated up to 46 Gy or more. Truly locally inoperable tumours in this series were thus rarely converted to extirpative tumours by means of radiation therapy. Most patients with a tumour considered borderline resectable seemed to benefit from the treatment. In addition, the palliative effect of radiation therapy was excellent.

Adenocarcinoma↗
PubMed1986

Medulloblastoma in childhood: results of radical resection and low-dose neuraxis radiation therapy.

This review concerns 22 children who were treated from 1980 through 1983 for medulloblastoma in the posterior fossa. Treatment included attempts at radical resection of the tumor and postoperative craniospinal radiation therapy, with 5000 to 5500 rads directed to the posterior fossa and 2500 rads to the remaining craniospinal axis. This lower radiation dose to the neuraxis was used to avoid late adverse effects upon the growing central nervous system of the children. Gross confirmation of total resection was obtained in 13 patients (the "total resection group"); however, nine patients had a subtotal resection leaving a small portion of the tumor extending into the cerebellar peduncles or the cerebellopontine angle, or else encasing the posterior inferior cerebellar artery (the "subtotal resection group"). Six patients in the total resection group demonstrated tumor extension into the cerebellar peduncles, which was removed by means of a surgical carbon dioxide laser without neurological sequelae. Biopsy of the arachnoid membrane from the cisterna magna and cytological examination of the cerebrospinal fluid (CSF) prior to manipulation of the tumor were carried out in 12 patients. All but one showed dissemination of medulloblastoma cells. Myelography and CSF cytological study were undertaken 2 months after radiation therapy in 12 patients and were positive in two. There were no case mortalities in the total resection group during the 24- to 67-month follow-up period, whereas the 1-year survival rate in the "subtotal resection group" was only 44.4%. This study suggests that medulloblastoma can be controlled with a low radiation dose to the neuraxis, should a grossly confirmed total resection be achieved at craniotomy.

Adolescent↗
PubMed2000

Intraoperative hippocampal electrocorticography to predict the extent of hippocampal resection in temporal lobe epilepsy surgery.

OBJECT: Among the variety of surgical procedures that are performed for the treatment of medically refractory mesial temporal lobe epilepsy (TLE), no consensus exists as to how much of the hippocampus should be removed. Whether all patients require a maximal hippocampal resection has not yet been determined. METHODS: At the University of Washington, all TLE operations are performed in a tailored fashion, guided by electrocorticography (ECoG). The amount of hippocampal resection is determined intraoperatively by the extent of interictal epileptiform abnormalities on ECoG recorded from that structure, resulting in a hippocampal resection that is individualized for each patient. Using this approach, the authors prospectively observed 140 consecutive patients who underwent surgery for mesial TLE with pathological diagnoses of either mesial temporal sclerosis with neuronal loss (MTS group) or mild gliosis without neuronal loss (non-MTS group) to determine whether the extent of hippocampal resection correlates with outcome when a tailored approach is used. Additionally, the authors analyzed whether the presence of residual interictal epileptiform activity on ECoG following mesial temporal resection predicts poorer seizure control. With at least 18 months of clinical follow up, 67% of the 140 patients were seizure free or had only a single postoperative seizure. There was no correlation between the size of the hippocampal resection and seizure control in the group as a whole or when stratified by pathological subtype. Using an intraoperatively tailored strategy, individuals with a larger hippocampal resection (> 2.5 cm) were not more likely to have seizure-free outcomes than patients with smaller resections (p = 0.9). Additionally, both MTS and non-MTS patients, in whom postoperative ECoG detected residual epileptiform hippocampal (but not cortical or parahippocampal) interictal activity following surgical resection, had significantly worse seizure outcomes (p = 0.01 in the MTS group; p = 0.002 in the non-MTS group). CONCLUSIONS: Intraoperative hippocampal ECoG can predict how much hippocampus should be removed to maximize seizure-free outcome, allowing for sparing of possibly functionally important hippocampus.

Adolescent↗
PubMed2001

Bowel resection in children.

BACKGROUND: In developed countries, most bowel resections in children are for congenital anomalies and massive resection and short bowel syndrome are frequent problems. OBJECTIVE: To review indications, morbidity and mortality of bowel resection in children in a developing country. DESIGN: A retrospective study. SETTING: Ahmadu Bello University Teaching Hospital Zaria, Nigeria. SUBJECTS: Forty six children aged < or = 12 years who had bowel resection in a period of five years. RESULTS: The commonest indication was typhoid perforation 25 (54%), 21 (84%) of them aged > 5 years. Intussusception was the indication in eight (17%), six less than one year. Bowel resection was performed for congenital anomalies in nine (18%) patients, seven of them < 1 month (abdominal wall defect in four, intestinal atresia in two, strangulating inguinal hernia in one, strangulating band in one, Meckel's diverticulitis, one). Resection for trauma and neoplastic conditions were few (2.4% each). Twelve patients (26%) developed 17 complications including would infection in seven (15%) anastomotic dehiscence, five (11%), abdominal wound dehiscence, three (14%), intra-abdominal abscess and stitch sinus, one (2%) each respectively. Most of the complications followed right hemicolectomy for intussusception and resection for typhoid perforation. Massive bowel resection was necessary in only one patient. There were nine deaths (20%). The mortality was highest in neonates and infants (38%). CONCLUSION: The indications for bowel resection in this environment differ from that in developed countries. Most of the indications (74%) are preventable by improvements in sanitation and early presentation and treatment. The morbidity and mortality are highest in neonates and infants and meticulous attention to technical details may minimise them.

Child↗
PubMed1997

Color flow sonography in evaluating the resectability of periampullary and pancreatic tumors.

Over the past several years, we have developed a technique to assess the resectability of periampullary and pancreatic tumors using color flow sonography. This is a feasibility study to determine if sonography with color flow imaging can play a role in evaluating patients with periampullary and pancreatic tumors. This study comprises a retrospective analysis of 51 patients referred for color flow sonographic evaluation of resectability of periampullary and pancreatic neoplasm. Scanning was performed with state-of-the-art color flow sonographic systems. Vessels that were touched or occluded by tumor were categorized according to a Pancreatic Color Doppler Score. Other factors affecting resectability (metastasis, enlarged nodes) were recorded. Sonographic findings were correlated with surgical resectability and pathologic findings regarding tumor margins. The color flow study was complete technically (all index vessels visualized) in 49 of 51 patients (96%). In all, 643 of 647 vessels (99.4%) were imaged. Forty-five patients had sufficient surgical, pathologic, or clinical proof to be included in the resectability analysis. All 18 patients with circumferential tumor or vascular occlusion (Pancreatic Color Doppler Score 4 and 5) were found to have unresectable disease. All 10 patients in whom tumor did not touch (Pancreatic Color Doppler Score 0) had negative margins. All 30 patients considered to have unresectable tumors sonographically could not be resected. Patients in this category had one or more of the following: positive pathologic margins, positive nodes, liver metastasis, or not clinically resectable. Six of 15 considered resectable sonographically (40%) were unresectable for cure. Surgeons believed that color flow sonography influenced management in 10 of 45 patients (22% overall). Color flow sonography, a painless, noninvasive, and relatively inexpensive examination, may be an effective screening tool to evaluate periampullary and pancreatic neoplasms for resectability. Our data show that color flow sonography can correctly predict unresectability of periampullary and pancreatic neoplasms. Any future evaluation of imaging and management of periampullary and pancreatic tumors should include color flow sonography.

Adenocarcinoma↗
PubMed1999

[Surgical treatment of lung cancer with combined resection of the aorta or superior vena cava].

Until December 1997, 699 cases of lung cancer were resected in our institute. Four cases of invasion into the aorta and seven cases of invasion into the superior vena cava were also operated and each vessels were reconstructed. Two pneumonectomies and nine lobectomies were performed. Four cases of squamous cell carcinoma, three of adenocarcinoma, three of large cell carcinoma and one of adenosquamous carcinoma were found on pathological examination. Four cases of N0, four of N2 and two of N3 were also detected on pathological lymph node evaluation. One case was stage IV with metastasis of ipsilateral axillar lymph nodes and the others were stage IIIB. With respect to pathological curability, absolutely noncurative operation was performed in all cases involving the aorta and absolutely noncurative in four and relatively curative three in cases involving the superior vena cava. During resection and reconstruction of the aorta, three cases received temporary blood supplying bypass and one case was underwent temporary clamping. Two cases developed bilateral lower extremity paralysis. During resection and reconstruction of the superior vena cava, one case underwent intraluminal temporary blood supplying bypass, two received sideclamping and four were reconstructed with double artificial grafts for bilateral innominate veins. Two cases who underwent resection of the aorta died within one year and one is alive after nine months of operation. Five cases who underwent resection of the superior vena cava died due to cancer. One case of N0 and relatively curative is alive in free of recurrence after seven years and six months of operation and another case who had brain metastasis resected is alive after two years and two months of pulmonary operation. Careful selection should be made for resection of the aorta because the prognosis is usually poor. In the resection of the superior vena cava, good prognosis is expected in some cases (N0, relatively curative) and quality of life is expected to improve with the prevention of the superior vena cava syndrome. Aggressive resection should be considered for lung cancer invasion into the superior vena cava.

Adult↗
PubMedDate not supplied

Surgical resection of hepatocellular carcinoma in elderly cirrhotic patients.

BACKGROUND/AIMS: Both cirrhosis and old age have been reported to be risk factors for hepatic resection. This study evaluated the clinical results of hepatic resection in elderly hepatocellular carcinoma (HCC) patients with cirrhosis. METHODOLOGY: During a 5-year period, 248 patients with HCC underwent curative hepatic resection. Among them, 24 elderly patients (age: > or = 70 years) with cirrhosis (Group I), 24 patients (age: > or = 70 years) without cirrhosis (Group II), and 98 patients (age: < 70 years) with cirrhosis (Group III) were selected for the study. The clinical and pathologic parameters, including pre-operative demographic features, surgical factors, pathological factors, DNA flow-cytometric analysis of the resected specimen, and post-resection prognosis were compared among the three groups. RESULTS: Group I patients had a significantly higher incidence of small-size tumors, hepatitis C infection, concomitant esophageal varices, and minor resection with a shorter surgical margin in the resected specimen. The surgical morbidity and mortality of Group I was similar to that of Group II and III patients. However, the disease-free survival rate was significantly lower in the Group I patients than in Group II (p = 0.02) and Group III patients (p = 0.04). CONCLUSIONS: Our findings indicate that although hepatic resection can be done safely in elderly cirrhotic HCC patients, the prognosis for these patients was less favorable even when curative resection was performed.

Adult↗
PubMed1999

[Laparoscopic bowel resection for early colon cancer].

Following the successful introduction of laparoscopic cholecystectomy, many reports confirming the feasibility of using laparoscopy for bowel resection and predicting that it would be advantageous in terms of its minimal invasiveness have been published. In the context of cancer treatment, however, the feasibility of lymphadenectomy, the risk of recurrence, and survival have emerged as major concerns. Even though mucosal cancer (Tis) can be treated by endoscopic resection (ER), when this is not possible open surgery (OS) must be performed. In patients with T1 cancer, tumors showing slight submucosal layer invasion (sm 1) can be treated in the same way as Tis (in cancer) cancers. But 5% to 10% of patients with T1 cancer have massive submucosal layer invasion (sm 2-3) with paracolic lymph node metastasis. At least partial bowel resection with paracolic lymphadenectomy is considered necessary for T1 (sm 2-3) cancers in principle. In summary, laparoscopic local excision of Tis cancers that are endoscopically unresectable and laparoscopically assisted partial resection with paracolic lymphadenectomy for T1 cancers have become accepted because local excision and partial resection with paracolic lymphnedectomy are fairly simple to perform laparoscopically. Therefore as a strategy for the treatment of early colorectal cancer (CRC), minimally invasive laparoscopic bowel resection (LBR) has been positioned between endoscopic resection (ER) and open surgery (OS). While the difficulty of performing radical lymphadenectomy is considered one of the greatest obstacles to the introduction of laparoscopic bowel resection (LBR) for the treatment of advanced colorectal cancer (CRC), early colon cancer is a good indication for laparoscopic bowel resection.

Colonic Neoplasms↗
PubMedDate not supplied

Early and long-term prognostic factors after liver resection for HCC.

The Authors discuss the principal early and long term predictive factors after liver resection in patients with hepatocellular carcinoma (HCC). The Authors report (131 cases) early mortality as 7.6%, entirely confined in the group, numerically prevalent and affected by cirrhosis. None of the 50 patients with chronic hepatitis (29 cases) or normal liver (21 cases) died after hepatic resection. Mortality is higher in Child B patients (20.7%) and in cases in which a massive haemotransfusion was given (p < 0.05), apart from the width of resection and from the number of hepatic resections. None of 41 cirrhotic Child A patients undergoing a limited hepatic resection (< or = 1 segment) died during the perioperative period. In the group of patients which survived to the resection, global survival at 5 years was 45%. The most important prognostic factor is local recurrence while cirrhosis and the degree of liver failure are not statistically significant. No feature can identify a subgroup of patients with a higher risk of recurrence, which is observed in 52% of patients with a follow up observation after more than 1 year. Among the 29 patients alive after more than 4 years from liver resection, only 11 didn't have local recurrence. The others were treated with iterative hepatic resections or with radiological techniques. In conclusion, the present experience suggests that, in selected cases, hepatic resection could be a low risk therapy (in cirrhotic patients as well). The long term results could improve with an aggressive attitude towards recurrence.

Adult↗
PubMedDate not supplied

[Current indications for sublobar resection in non-small-cell bronchogenic carcinoma].

Over the past 30 years, there has been considerable controversy regarding the role of segmental and wedge resections in the management of stage I (T1-T2N0M0) non-small-cell lung cancer. Recently, a prospective randomized trial (Lung Cancer Study Group, 1995) revealed unfavorable results after limited resection, which, in early stage lung cancer, remains a reasonable option for patients with compromised pulmonary reserve, especially those in whom a previous contralateral resection has been performed. The following report describes the role of limited resection in the management of patients with T1-T2N0 non-small-cell lung cancer and presents a retrospective review of our series of 125 limited resections out of 1356 resections performed for lung cancer. In particular, long term survival and the frequency of local/regional recurrence were noted in 92 cases operated on with a curative intent. 26.6% vs 12.5% local/regional recurrence rates were observed among patients undergoing limited resections for T2 and T1 lung cancer, respectively. The five year survival in the limited resection group was 13.5% for T1 and 60% for T2 vs 51% and 72% in the standard procedure group, respectively. The lobectomy results were superior to those of sublobar resection. The latter should be reserved for patients in poor general condition contraindicating a standard lobectomy.

Adult↗
PubMedDate not supplied

Carcinoembryonic antigen for the detection of recurrent disease following curative resection of colorectal cancer.

BACKGROUND: During recent years a discussion about cost-effectiveness and importance of follow-up determination of carcinoembryonic antigen (CEA) after curative resection of large bowel cancer has developed. PATIENTS AND METHODS: Between 1990 and 1998 follow-up CEA levels of 1,321 patients after curative colorectal cancer resection were prospectively collected in cooperation with family physicians, CEA determinations were made with different assays by various laboratories. The reported findings were adjusted for the different methods used. RESULTS: 306 patients developed recurrent disease following curative cancer resection (23.2% of all patients). Regarding the role of follow-up CEA determination, they were divided into: I. no preoperative CEA determination/insufficient follow-up (N = 47); II. no elevation of CEA with primary cancer, a) elevation with recurrent disease (N = 62), b) no elevation at any time point (N = 53), c) role of CEA not completely elucidated (N = 41); III. elevated CEA levels with primary cancer, a) no increase with recurrent disease (N = 21), b) increase with other symptoms of recurrent disease (N = 45), c) increased levels as early symptom of recurrent disease (N = 37). 30 patients (9.8% of all patients with recurrent disease; 2.3% of all patients) with increased CEA levels at the time of recurrent disease underwent surgical resection with curative intention (R0 resection). CONCLUSIONS: Our findings indicate that up to 47% of the patients with recurrent disease and 11% of all patients (N = 144, groups IIa + IIIb + IIIc) could benefit from routine follow-up CEA determinations after curative colorectal cancer resection. Nonetheless, only 2.3% of all patients with elevated CEA levels underwent R0 resection of recurrent disease. Despite these detection and R0 resectability rates, CEA plays a crucial role in the early detection of recurrent disease and remains an important part of routine patient care after curative resection of colorectal cancer.

Biomarkers, Tumor↗
PubMedDate not supplied

Favorable quality of life after repeat hepatic resection for recurrent hepatocellular carcinoma.

BACKGROUND/AIMS: The appropriate choice of treatment for recurrent hepatocellular carcinoma after hepatic resection remains controversial. The aim of this study is to clarify prognostic factors and quality of life in patients with tumor recurrence after hepatic resection for hepatocellular carcinoma. METHODOLOGY: We retrospectively analyzed 188 patients with hepatocellular carcinoma who underwent curative hepatic resection between 1988 and 1997. Statistical analysis was performed to identify prognostic factors involved after recurrence. Furthermore, quality of life after treatment for recurrence was compared between patients with repeat hepatic resection or hepatic arterial infusion chemotherapy. RESULTS: In 123 patients with recurrence, unfavorable predictors after recurrence are pTNM Stage III/IV at initial surgery, receiving chemotherapy before initial surgery and presence of extrahepatic recurrence. In contrast, favorable predictors are 3 years or more of disease-free interval and repeat hepatic resection. The incidence of deteriorated performance status in the repeat hepatic resection group was lower than in the hepatic arterial infusion chemotherapy group because of better psychological function in patients undergoing repeat hepatic resection. CONCLUSIONS: Repeat hepatic resection provides a good prognosis and a favorable quality of life in patients with recurrence after hepatic resection for hepatocellular carcinoma.

Adult↗
PubMed2002

[Partial liver resections: mortality, morbidity and risk factors for postoperative complications in 133 patients/137 operations; Utrecht University Medical Center 1991/2000].

OBJECTIVE: Evaluation of the results of partial liver resections for both benign and malignant abnormalities and the identification of risk factors for the development of complications. DESIGN: Descriptive, retrospective. METHOD: All consecutive partial liver resections performed between January 1991 and October 2000 at the University Medical Centre Utrecht, the Netherlands, were reviewed for preoperative, peroperative and postoperative parameters. Risk factors were determined by means of a univariate analysis and a multiple logistic regression analysis. The 5-year survival rates were calculated using the Kaplan-Meier method. RESULTS: A total of 133 patients (71 men and 62 women; median age: 58 years (range: 17-79)) underwent 137 hepatic resections for benign (n = 29) and malignant (n = 108) liver abnormalities. In total, 74 procedures (54%) were considered to be major hepatic resections and blood transfusion was required in 97 patients (71%). A total of 43 complications was observed in 32 patients (32/137; 23%). Eight patients died as a result of postoperative complications (8/137; 5.8%). Independent risk factors associated with the development of major complications were a major resection (OR: 3.6) and more than 2 peroperative units of packed cells (OR: 5.0). The principal indication for liver resection were colorectal metastases (n = 69). The 5-year survival rate after liver resection for colorectal metastases was 38% (95% CI: range 21-54) with a 5-year disease-free survival rate of 25% (range 10-41). The postoperative mortality in this group was 2.9%. CONCLUSION: After partial liver resection for benign and malignant lesions the mortality was 5.8% and the morbidity 23%. The risk of postoperative morbidity was related to the number of peroperative units of packed cells and the extent of the resection.

Adolescent↗
PubMed2002

[Significance of resecting the head of the pancreas for the treatment of gallbladder cancer from the perspective of surgical results and mode of lymph node metastasis].

The significance of resecting the head of the pancreas was clinicopathologically investigated, predominantly by examining the mode of lymph node metastasis, in patients with gallbladder cancer. Of 60 patients who underwent resection of gallbladder cancer, 24 patients (40.0%) had lymph node metastasis. The breakdown of lymph node metastases was as follows: 12b (24.0%), 16 (21.7%), 13 (17.1%), 8 (12.2%), 12c (12.0%), 12p (8.0%), and 6 (6.3%). Of 45 patients with advanced gallbladder cancer, 14 patients survived more than 5 years after surgery. In the absence of lymph node metastasis, there were some long-term survivors following D0 dissection, gallbladder resection, or liver bed resection. However, all five long-term survivors with lymph node metastasis underwent S4aS5 resection combined with pylorus preserving pancreatoduodenectomy (PPPD) and D3 dissection. Seven patients had number 13 lymph node metastasis, and only two n2 patients who underwent S4aS5 resection combined with PPPD and D3 dissection, survived more than 5 years. There were no long-term survivors with n3 lymph node metastasis. Of the 50 patients who underwent curative resection, 13 patients experienced recurrence: in the liver in six patients, in the peritoneum in four patients, in the lymph nodes in four patients, in the bone in two patients, in the lung in one patient, and local in one patient (including duplicate cases). Of the four patients with lymph node recurrence, two demonstrated number 12 and/or number 13 lymph node metastasis at the time of surgery and underwent bile duct-conserving D2 dissection, although cancer recurred in the head of the pancreas, probably due to recurrence in number 13 lymph node. Extensive resection including resection of the head of the pancreas was therefore effective in patients with up to n2 lymph node metastasis as long as the cancer could be completely sected.

Adult↗
PubMedDate not supplied

[Surgical resection of hepatic hilar tumors].

Hepatic hilar cancer has an extremely poor prognosis and resection for cure is a realistic possibility in only 15-20% of patients. Tumours confined strictly to the biliary confluence can often be excised locally without resorting to hepatic resection (Bismuth's type I, II). Tumours extending beyond the second order bifurcation (Bismuth's type III) require hepatic resection. In the period 1996-1998 ten patients with hilar cancer (adenocarcinoma) underwent curative resection at our Institution. There were 9 men and 1 women with a mean age of 61.7 years (range 49-76 yrs). One neoplastic lesion was Bismuth's type I, five type II, four type III. The mean preoperative bilirubin level was 20 mg% and the mean duration of jaundice was 4 weeks. Four patients had skeletonization resection of the tumour and extrahepatic bile ducts, clearing all lymphocellular and other tissue from the hepatic pedicle and coeliac axis. Bilioenteric continuity was reestablished by a Roux-en-Y jejunal loop with separate biliary duct anastomoses. Six patients required also hepatic resection to adequately remove the tumour (1 right hepatectomy, 2 right lobectomy, 2 left hepatectomy, 1 segmentectomy III). Three patients had liver metastases. One patient had involvement of the left arterial and portal branch. The postoperative staging was 2 stage II, 1 stage III, 7 stage IV. In 5 patients hepatic lymph nodes (N1) were involved. In no patient the tumour was found at the margin of resection. The median estimated blood loss for hepatic resection was 1,000 ml and for skeletonization 500 ml. Intraoperative mortality was 0%. Operative mortality was 20%. Three patients had a complicated postoperative course (1 cerebral TIA, 1 multiorgan failure, 1 ictus cerebri). All patients died. The mean postoperative survival was 7.4 months. Four patients (N1+) died of local tumour recurrence at 8, 11, 6, and 8 months. In our experience resective procedures can achieve a longer survival and a better quality of life. The operative mortality may be kept to a minimum by adequate selection of patients and technical expertise.

Aged↗
PubMed2002

[Effect of extending the resection on postoperative complications of total gastrectomies: experience with 161 operations].

Authors operated on 416 patients for gastric cancer between 1st of June 1991 and 31st of May 2001. Among them 305 lesions were resectable. So the resection rate was 73.3 per cent. Gastrectomy was performed in 161 patients (52.8 per cent of resections). Total gastrectomy with omentectomy was performed in 44 patients. In 96 patients splenectomy, in 19 patients splenectomy with the resection of the left side of the pancreas, in 33 patients distal esophageal resection and in 8 patients other organ resection was performed with total gastrectomy. Standard, two field lymphadenectomy has been performed only in the past few years. Uneventful recovery followed in 100 cases (62 per cent), 61 patients (38 per cent) suffered complications in the postoperative period. The most frequent surgical complication was anastomotic leak, which was observed in 8 patients (5 per cent). Septic complications, intraluminal bleeding, postoperative pancreatitis, intraabdominal bleeding, pancreatic fistula and small bowel obstruction were the most frequent surgical complications. Most general complications occurred in the cardiorespiratory system. In 9 patients reoperation was necessary. Eight patients (5 per cent) died in the postoperative period. In patients with extended gastrectomy significantly more complications occurred--compared with gastrectomy + omentectomy only. This could also be observed in patients with only splenectomy. If more organs were removed or resected with total gastrectomy and splenectomy, the complication rate increased only if pancreatic resection was performed. Mortality rate increased in these patients as well. The esophageal or other neighbouring organ (colon, small-bowel, liver, diaphragm etc.) resection had no influence on the postoperative morbidity or mortality. Extended operations should be performed, as the risk is acceptable, if there is hope for tumour clearance.

Female↗
PubMedDate not supplied

Laparoscopic bowel resection: a comparison of three ultrasonically activated devices.

BACKGROUND AND OBJECTIVES: To compare resection time and collateral thermal damage of 3 currently available ultrasonically activated devices in laparoscopic small bowel surgery. METHODS: AutoSonix, SonoSurg, and UltraCision were compared in laparoscopic small bowel mesentery resection in a porcine model. A resection was defined as 12 endarcade arteries supplying the intended bowel segment. Vssels were divided 1 cm off the bowel wall. AutoSonix, SonoSurg, and UltraCision were comparable for blade length and type, cutting mechanism, handle ergonomics, and vibration amplitude, but not well matched for vibration frequency (55.5;23.5;55.5 kHz), working shaft diameter (5;11;10 mm) and length (29;33;34 cm), respectively. A sample size of 114 was calculated to detect a 25% difference with 90% power at a 5% significance level. Resections were allocated to devices by block randomization. Analysis of variance and pairwise Scheffe tests were used for multiple comparisons, and a Kaplan-Meier plot was drawn to confirm differences in resection time with each device. A pathologist blind to the devices evaluated bowel wall biopsies for thermal damage. RESULTS: Procedures as allocated comprised 114 resections (38 with each device). UltraCision median resection time of 5160 (range 2340-7860) seconds was significantly longer (P=0.0001). The difference in resection time between AutoSonix (median 3420, range 1860-8760 s) and SonoSurg (median 3660, range 1800-6900 s) did not reach statistical significance. A microscopy revealed no thermal damage. CONCLUSIONS: Laparoscopic resection time for porcine bowel mesentery was shorter with AutoSonix or SonoSurg than with UltraCision, and no thermal damage to the bowel wall was found.

Animals↗
PubMedDate not supplied

Hepatic resection for hepatocellular carcinoma in severely cirrhotic livers.

BACKGROUND/AIMS: Liver resection for hepatocellular carcinoma is typically avoided in patients with severe cirrhosis, as this may predispose patients to pronounced surgical risks and worse long-term outcomes. This study examined our results of hepatectomy for hepatocellular carcinoma in patients with different degrees of impaired liver function. METHODOLOGY: A retrospective comparison of background characteristics and operative results in patients with resected hepatocellular carcinoma was performed, with patients classified as having either severely impaired liver function (High Group, preoperative indocyanine green 15-minute retention rate > or = 30%; n = 22) or normal liver function (Low Group, indocyanine green 15-minute retention rate < or = 10%; n = 37). RESULTS: The preoperative liver function of those in the High Group was significantly worse than those in the Low Group. Despite similar tumor diameters between groups, the amount of liver resected in the High Group was significantly smaller than in the Low Group, primarily because of more limited resections with narrow margins in the former. However, patients in the High Group had similar recurrence and survival rates when compared to those in the Low Group whose resections included wide surgical margins. In analyzing those that did or did not undergo transcatheter arterial chemoembolization prior to resection, a better disease-free and actuarial survival rate was observed in the High Group with preoperative transcatheter arterial chemoembolization compared to those without transcatheter arterial chemoembolization or those in the Low Group with transcatheter arterial chemoembolization. CONCLUSIONS: For patients with limited liver function reserve, such as those in the High Group, resection of hepatocellular carcinoma with preservation of liver parenchyma may take priority over a wide resection margin. In addition, we suggest the use of preoperative transcatheter arterial chemoembolization in selected patients with severe cirrhosis undergoing resection of hepatocellular carcinoma.

Aged↗