scholarly journals Modified Devine Exclusion for Unresectable Distal Gastric Cancer in Symptomatic Patients

2017 ◽  
Vol 11 (1) ◽  
pp. 9-16 ◽  
Author(s):  
María Carmen Fernández-Moreno ◽  
Roberto Martí-Obiol ◽  
Fernando López ◽  
Joaquín Ortega
Keyword(s):  
Gastric Cancer ◽  
Oral Tolerance ◽  
Outlet Obstruction ◽  
Postoperative Mortality ◽  
Palliative Surgery ◽  
Alternative Methods ◽  
Blood Transfusions ◽  
Safe Procedure ◽  
Severe Anemia ◽  
Distal Gastric Cancer

Background: In patients with outlet obstruction syndrome and/or severe anemia secondary to unresectable gastric cancer (GC), partial stomach-partitioning gastrojejunostomy, or modified Devine exclusion, is a surgical alternative. Methods: A retrospective study was conducted on patients with unresectable distal GC treated with modified Devine exclusion as palliative surgery between February 2005 and December 2015. It consisted of a series of 10 patients with outlet obstruction syndrome and/or severe anemia. The outcomes of this technique were based on oral tolerance, blood transfusions, postoperative complications, and survival. Results: Early oral tolerance and a low rate of blood transfusions were observed postoperatively. There was no postoperative mortality and a very low complication rate without anastomotic leakage. Median survival was 9 months. Conclusions: Partial stomach-partitioning gastrojejunostomy is a safe procedure for unresectable GC which can improve the quality of life of these patients.

scholarly journals Big End Double-Layer Stents for the Treatment of Gastric Outlet Obstruction Caused by Stomach Cancer

2019 ◽  
Vol 2019 ◽  
pp. 1-6
Author(s):  
Ding Shi ◽  
Dong Wu ◽  
Yongpan Liu ◽  
Feng Ji ◽  
Yinsu Bao
Keyword(s):  
Gastric Cancer ◽  
Survival Time ◽  
Stomach Cancer ◽  
Double Layer ◽  
Gastric Outlet Obstruction ◽  
Outlet Obstruction ◽  
Metal Stents ◽  
Mean Survival Time ◽  
Distal Gastric Cancer ◽  
The Mean

Objectives. This study is aimed at evaluating the efficacy and safety of the big end double-layer uncovered self-expanding metal stents (SEMS) for the treatment of gastric outlet obstruction (GOO) caused by distal stomach cancer.Methods. Seventy three patients receiving big end double-layer uncovered SEMS for the treatment of GOO caused by distal gastric cancer will be included in this multicenter prospective clinical trial. The main outcome measures included the functional outcome, the complications, the reinterventional rates, the average treatment charges, and the mean survival time. Monthly telephone calls were needed to assess the food intake until the patients died.Results. The technical and the clinical success rates were 98.6%. The stent obstruction caused by tumor ingrowth was observed in one patient (1.4%). The incidence of food impaction was 2.9% (2/70) and the reinterventional rate was 4.3% (3/70). However, stent migration and obstruction caused by overgrowth were not observed. No perforation and severe bleeding were observed. The median cost of endoscopic stenting and total hospitalization (including reinterventions) for the big end double-layer uncovered SEMS in this study was $2945 and $3408, respectively. The mean survival time was 212.5 days.Conclusions. The placement of big end double-layer uncovered SEMS is a safe and effective modality and has the potential to be one of the options for the treatment of GOO caused by the distal gastric cancer.

Distal subtotal resection and gastrectomy in the treatment of patients with gastric cancer. A critical review of meta-analyses

2020 ◽  
pp. 26-35
Author(s):  
S. Panin ◽  
M. Postolov ◽  
N. Kovalenko ◽  
A. Beburishvili ◽  
S. Tolstopyatov
Keyword(s):  
Gastric Cancer ◽  
Postoperative Mortality ◽  
Evidence Base ◽  
Subtotal Resection ◽  
Validity Assessment ◽  
Distal Gastric Cancer ◽  
Systematic Biases ◽  
Meta Analyses ◽  
Level 2 ◽  
Systematic Review Process

The purpose of the work is to study the evidence base by comparing the results of distal subtotal resection and gastrectomy with D2 lymphadenectomy in patients with distal gastric cancer. Materials and methods. Three meta-analyses were selected during the systematic review process. Their validity assessment and critical analysis were carried out using the recommendations of the Cochrane community. Results. The greatest heterogeneity was noted in calculations of the frequency of postoperative complications. This indicator ranges from 1.1 % to 22 %. Postoperative mortality ranges from 0.6 % to 2.9 %. The overall five-year survival rate after gastrectomy is 49.6 %–53.9 %, after distal subtotal resection — 55.9 %–63.9 %. A large number of systematic biases in completed meta-analyses reduces the degree of reliability of the evidence base in this matter to the level 2 of evidence. Conclusion. Further evidence-based level 1 studies are needed to compare the results of distal subtotal resection and gastrectomy in patients with distal gastric cancer.

scholarly journals Combined Aggressive Distal Gastrectomy and Double-Tract Reconstruction for Palliation of Incurable Locally Invasive Distal Gastric Cancer With Gastric Outlet Obstruction

2019 ◽  
Vol 103 (11-12) ◽  
pp. 593-599
Author(s):  
Yoshito Kiyasu
Keyword(s):  
Gastric Cancer ◽  
Gastric Outlet Obstruction ◽  
Distal Gastrectomy ◽  
Outlet Obstruction ◽  
Operation Time ◽  
Abdominal Sepsis ◽  
Peritoneal Lavage Cytology ◽  
Double Tract Reconstruction ◽  
Distal Gastric Cancer ◽  
The Mean

Objective: To evaluate combined aggressive distal gastrectomy (ADG) and double-tract (DT) reconstruction (ADGDTR) for palliative treatment of gastric cancer with gastric outlet obstruction (GOO). Summary of Background Data: An effective standard palliation procedure has not been identified for patients with incurable gastric cancer. Methods: I retrospectively evaluated patients presenting to my clinic with GOO secondary to locally invasive distal gastric cancer between March 1996 and March 2011. Following a complete workup, patients underwent ADGDTR. ADG included the gastric tumor in whole or in part. DT reconstruction consisted of gastrojejunostomy, jejunoduodenostomy, and jejunojejunostomy. Results: In the enrolled patients (n = 7; 5 male; mean age, 71 years [range, 60–83 years]), preoperative comorbidities included anemia (7), diabetes mellitus (2), hepatic cirrhosis (1), cardiac ischemia (1), and Parkinson disease (1). The lesion invaded the pancreas in all patients, and the transverse mesocolon, liver, and mesentery were each involved in 1 patient. Metastatic disease affected the lymph nodes in 5 patients, liver in 1, and peritoneal cavity in 4. Peritoneal lavage cytology was positive in 3 patients and untested in 4. The mean operation time was 207 minutes (range, 150–295 minutes), and mean blood loss was 290 g (range, 110–480 g). Six patients had no postoperative complications, but 1 died of abdominal sepsis. The mean length of hospitalization was 43 days (range, 28–73 days), and mean survival was 8.3 months (range, 2–22 months). Six patients tolerated a low-residue or regular diet postoperatively. Conclusions: ADGDTR provided effective, low-risk palliation and long-term oral ingestion in patients with incurable, locally invasive distal gastric cancer with GOO.

scholarly journals The Predictive and Prognostic Factors in Patients with Gastric Cancer Accompanied by Gastric Outlet Obstruction

2020 ◽  
Vol 2020 ◽  
pp. 1-8
Author(s):  
Hongliang Zu ◽  
Huiling Wang ◽  
Chunfeng Li ◽  
Wendian Zhu ◽  
Yingwei Xue
Keyword(s):  
Gastric Cancer ◽  
Prognostic Factors ◽  
Lymph Node ◽  
Lymph Node Metastasis ◽  
Tumor Size ◽  
Outlet Obstruction ◽  
Clinicopathological Features ◽  
Depth Of Invasion ◽  
Node Metastasis ◽  
Distal Gastric Cancer

Purpose. This study is aimed at evaluating the clinicopathological features and prognostic significance of gastric outlet obstruction (GOO) in patients with distal gastric cancer. Methods. A retrospective review of 1564 individuals with distal gastric cancer from 2002 to 2010 was performed. In total, 157 patients had GOO. The clinicopathological features of the patients with GOO were compared with those of the patients without GOO. A Kaplan-Meier survival analysis and Cox proportional hazard model were used to assess the overall survival. Results. The patients with distal gastric cancer with GOO generally presented more aggressive pathologic features, a poorer nutritional status, more duodenal infiltration, and peritoneal dissemination than those with cancer without GOO. In the univariate analysis, curability, GOO, age, prealbumin, albumin, hemoglobin (Hb), the tumor size, the macroscopic type, lymph node metastasis, and the depth of invasion had a statistically significant influence on prognosis. The multivariate analysis showed that curability, GOO, the tumor size, lymph node metastasis, and the depth of invasion were independent prognostic factors. Conclusions. Gastric cancer with GOO exhibits aggressive biological features and has poor outcomes. The multivariate analysis showed that curability, GOO, the tumor size, lymph node metastasis, and the depth of invasion were independent prognostic factors. The gastric outlet status should be considered in the selection of surgical treatment methods for patients with gastric cancer.

Phẫu thuật nội soi 3D cắt bán phần xa dạ dày trong điều trị ung thư dạ dày

2021 ◽  
Author(s):  
Hai Thanh Phan
Keyword(s):  
Gastric Cancer ◽  
Blood Loss ◽  
Operative Time ◽  
Distal Gastrectomy ◽  
Three Dimensional ◽  
Oncologic Outcome ◽  
Intraoperative Blood Loss ◽  
3D Laparoscopy ◽  
Distal Gastric Cancer ◽  
The Mean

TÓM TẮT Đặt vấn đề: Những nghiên cứu gần đây cho thấy phẫu thuật nội soi với kỹ thuật 3D (three - dimensional) đã mang lại nhiều thuận lợi trong điều trị ung thư dạ dày khi so sánh với màn hình 2D truyền thống. Vì vậy chúng tôi thực hiện nghiên cứu này với mục đích đánh giá tính an toàn, kết quả ngắn hạn và kết quả ung thư học của phẫu thuật nội soi 3D trong điều trị ung thư phần xa dạ dày. Phương pháp nghiên cứu: Thực hiện nghiên cứu tiến cứu trên 37 bệnh nhân cắt phần xa dạ dày kèm nạo vét hạch điều trị ung thư dạ dày bằng phẫu thuật nội soi kỹ thuật 3D tại Khoa Ngoại nhi - cấp cứu bụng, Bệnh viện Trung Ương Huế từ 03/2018 đến 09/2021. Kết quả: Phẫu thuật nội soi 3D được thực hiện ở tất cả 37 bệnh nhân, không có trường hợp nào chuyển mổ mở. Thời gian phẫu thuật trung bình là 69,86 ± 20,46 phút, lượng máu mất trong mổ trung bình là 171,22 ± 15,47 ml, số hạch vét được trung bình là 20,49 ± 4,11 hạch và thời gian nằm viện sau phẫu thuật trung bình là 10 ngày (6 - 26 ngày). Tỷ lệ biến chứng là 8,1 % với 1 trường hợp (2,7%) dò mỏm tá tràng, không có trường hợp nào tử vong sớm sau mổ. Tỉ lệ sống còn sau 1 năm là 87,27% và sau 3 năm là 83,31%. Kết luận: Áp dụng phẫu thuật nội soi 3D trong cắt phần xa dạ dày có thể thực hiện an toàn và khả thi. Giúp giảm đáng kể thời gian mổ, lượng máu mất trong mổ và đảm bảo được nguyên tắc an toàn về ung thư học. ABSTRACT EFFICACY USING THREE - DIMENSIONAL LAPAROSCOPY IN THE TREATMENT OF DISTAL GASTRIC CANCER Background: Recent studies have supported that three - dimensional (3D) laparoscopy has advantages in treating gastric cancer compared with conventional two - dimensional (2D) screens. This study investigated the safety, short - term efficacy, and oncological outcome of three - dimensional (3D) laparoscopic distal gastric cancer surgery. Materials and Methods: We prospectively analyzed the clinical data from 37 patients treated with 3D laparoscopic systemic lymphadenectomy for distal gastric cancer at the Hue Central Hospital from March 2018 to September 2021. The effects on operative time, intraoperative blood loss, the number of lymph nodes removed, postoperative recovery time, complications, and oncologic outcome were analyzed. Results: Three - dimensional (3D) laparoscopic distal gastrectomy was successfully carried out in 37 patients. The mean operative time was 69,86 ± 20,46 minutes, mean intraoperative blood loss was 171,22 ± 15,47 ml, the number of harvested lymph nodes was 20,49 ± 4,11, and the mean postoperative hospital stay was 10 (6 - 26 days). The incidence of postoperative complications was 8,1%, with 1 case of duodenal stump fistula. The one - year overall survival rate was 87,27%, and the three - year overall survival rate was 83,31%. Conclusions: 3D laparoscopy distal gastrectomy could be performed safely and feasibly. They reducethe operative time and intraoperative blood loss in distal gastrectomy with a good oncologic outcome. Keywords: Laparoscopic gastrectomy, D2 lymphadenectomy, 3D laparoscopy

scholarly journals ADDUCTOR POLLICIS MUSCLE THICKNESS AND PREDICTION OF POSTOPERATIVE MORTALITY IN PATIENTS WITH STOMACH CANCER

2018 ◽  
Vol 31 (1) ◽  
Author(s):  
Aline Kirjner POZIOMYCK ◽  
Oly Campos CORLETA ◽  
Leandro Totti CAVAZZOLA ◽  
Antonio Carlos WESTON ◽  
Edson Braga LAMEU ◽  
...  
Keyword(s):  
Gastric Cancer ◽  
Stomach Cancer ◽  
Nutritional Assessment ◽  
Postoperative Mortality ◽  
Muscle Thickness ◽  
Adductor Pollicis ◽  
Dominant Hand ◽  
Adductor Pollicis Muscle ◽  
Risk Of Death ◽  
Muscle Compartment

ABSTRACT Background: Malnutrition is very prevalent in patients with gastric cancer and increases the risk of morbidity and mortality. Adductor pollicis muscle thickness (APMT) appears as an important objective, quick, inexpensive and noninvasive measure to assess the muscle compartment Aim: To compare APMT and other nutritional assessment methods and to correlate these methods with postoperative mortality Methods: Forty-four patients, 29 men and 15 women, mean age of 63±10.2 and ranging from 34-83 years, who underwent nine (20.5%) partial and 34 (77.3%) total gastrectomies due to stomach cancer (stage II to IIIa) were preoperatively assessed by Patient Generated Subjective Global Assessment (PG-SGA), anthropometry and laboratorial profile Results: APMT better predicted death (p<0.001) on both, dominant and non-dominant hand, and well correlated with albumin (p=0.039) and PG-SGA (p=0.007) Conclusion: APMT clearly allowed to determine malnutrition and to predict risk of death in patients with gastric cancer.

scholarly journals Effect of hospital volume on postoperative mortality and survival after oesophageal and gastric cancer surgery in the Netherlands between 1989 and 2009

2012 ◽  
Vol 48 (7) ◽  
pp. 1004-1013 ◽  
Author(s):  
Johan L. Dikken ◽  
Anneriet E. Dassen ◽  
Valery E.P. Lemmens ◽  
Hein Putter ◽  
Pieta Krijnen ◽  
...  
Keyword(s):  
Gastric Cancer ◽  
The Netherlands ◽  
Hospital Volume ◽  
Postoperative Mortality ◽  
Cancer Surgery ◽  
Gastric Cancer Surgery

scholarly journals Is Holmium Laser Enucleation of the Prostate a Good Surgical Alternative in Benign Prostatic Hyperplasia Management? A Review Article

2020 ◽  
Vol 11 (2) ◽  
pp. 197-203 ◽  
Author(s):  
Amirreza Abedi ◽  
Mohammad Reza Razzaghi ◽  
Amirhossein Rahavian ◽  
Ebrahim Hazrati ◽  
Fereshte Aliakbari ◽  
...  
Keyword(s):  
Benign Prostatic Hyperplasia ◽  
Specific Antigen ◽  
Young Patients ◽  
Outlet Obstruction ◽  
Prostatic Hyperplasia ◽  
Holmium Laser ◽  
Safe Procedure ◽  
Open Prostatectomy ◽  
Laser Enucleation ◽  
Holmium Laser Enucleation

Several therapeutic approaches such as holmium laser enucleation of the prostate (HoLEP) have been introduced to relieve bladder outlet obstruction caused by benign prostatic hyperplasia (BPH). Compared with other techniques including the transurethral resection of the prostate (TURP) and simple open prostatectomy, HoLEP results in a shorter hospital stay and catheterization time and fewer blood loss and transfusions. HoLEP is a size-independent treatment option for BPH with average gland size from 36 g to 170 g. HoLEP is a safe procedure in patients receiving an anticoagulant and has no significant influence on the hemoglobin level. Also, HoLEP is an easy and safe technique in patients with a prior history of prostate surgery and a need for retreatment because of adenoma regrowth. The postoperative erectile dysfunction rate of patients treated with HoLEP is similar to TURP or open prostatectomy and about 77% of these patients experience loss of ejaculation. Patients with transitional zone volume less than 30 mL may suffer from persistent stress urinary incontinence following HoLEP so other surgical techniques like bipolar TURP are a good choice for these patients. In young patients, considering HoLEP with high prostate-specific antigen density and a negative standard template prostate biopsy, multiparametric MRI needs to be considered to exclude prostate cancer.

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