scholarly journals Laparoscopic Partial Gastrectomy for Large Gastric GISTs

2021 ◽  
Author(s):  
Amr Abouzid ◽  
Ahmed Setit ◽  
Adel Fathi ◽  
Mosab Shetiwy
Keyword(s):  
Laparoscopic Resection ◽  
Partial Gastrectomy ◽  
Surgical Oncology ◽  
Tumor Location ◽  
Mesenchymal Tumors ◽  
Gastric Gists ◽  
Estimated Blood Loss ◽  
The Mean ◽  
Greater Curvature ◽  
Oncology Unit

Abstract Background: Gastrointestinal stromal tumors (GISTs) are considered the most common mesenchymal tumors in the gastrointestinal tract and the stomach is the most frequently site affected (50–60%). The safety and feasibility of laparoscopic surgery for gastric GISTs of sizes larger than 5 cm remains unclear. It depends on the surgical skills, tumor location and the learning curve of the surgeons. Methods: Between December 2013 and January 2021, thirty patients diagnosed with gastric GISTs underwent laparoscopic partial gastrectomy. This is a retrospective study done in surgical oncology unit, Oncology Center, Mansoura University, Egypt. Results: The most common tumor location was in the greater curvature in (46.7%). The mean tumor size was 7.2 cm (the largest was 13 cm). All of the patients underwent laparoscopic partial gastrectomy. Splenectomy was done for one patient only. The mean operative time was 152.67 minutes and the estimated blood loss (EBL) was 139.33 ml. The mean hospital stay was 3.53 days. The mean follows up period was 32.4 months. Conclusion: Laparoscopic resection for gastric GISTs has become a feasible method. Patients with large tumors have the same favorable outcomes as small tumors. Large-sized GISTs may receive neoadjuvant therapy to downstage the disease and make it amenable for laparoscopic resection.

Various fashions of laparoscopic resection for gastrointestinal stromal tumors in esophagogastric junction.

2017 ◽  
Vol 35 (15_suppl) ◽  
pp. e22512-e22512
Author(s):  
Wenjun Xiong ◽  
Wei Wang ◽  
Jin Wan
Keyword(s):  
Laparoscopic Surgery ◽  
Gastrointestinal Stromal Tumors ◽  
Esophagogastric Junction ◽  
Laparoscopic Resection ◽  
Stomach Wall ◽  
Linear Stapler ◽  
Stromal Tumors ◽  
Estimated Blood Loss ◽  
Laparoscopic Proximal Gastrectomy ◽  
The Mean

e22512 Background: Laparoscopic surgery for small (<5 cm) gastric gastrointestinal stromal tumors (GIST) is now widely performed. However, laparoscopic resection of GIST in esophagogastric junction is technically difficult. Herein, we introduce various fashion of laparoscopic resection for small GIST in esophagogastric junction. Methods: Retrospective review of 40 consecutive patients with small GIST in esophagogastric junction who underwent attempted laparoscopic surgery. GIST in esophagogastric junction was defined as that the distance of the upper border of GIST from esophagogastric line was less than 2 cm. Three fashions of laparoscopic resection were performed: fashion A, laparoscopic wedge resection using linear stapler; fashion B, laparoscopic complete resection by opening the stomach wall and the stomach wall incision was closed with suture; fashion C, laparoscopic proximal gastrectomy with pyloroplasty. The data of clinicopathologic characteristics, operative course and short-term outcomes were analyzed. Results: All procedures were finished successfully and no operative relatively complication was recorded. Tumor in 24/40 (60%) patients was located in greater curvature. 70.1% (17/24) of them received fashion A and others (7/24) underwent fashion B. Tumor in 16/40 (40%) patients was located in lesser curvature. 18.8% (3/16) of them underwent fashion C and others (13/16) underwent fashion B. The mean operative time was 97.4±21.3 min and the mean estimated blood loss was 20.5±10.4 ml. The mean first time of flatus was 39.2±10.0 hours and the time of fluid intake was 40.1±11.7 hours. The mean hospital stay was 4.2±1.3 days. The mean diameter of tumor was 2.7±1.0 cm. Conclusions: Laparoscopic surgery for small GIST in esophagogastric junction is safe and feasible. The selection of various laparoscopic resection fashions was according to the tumor location.

Safety and oncologic outcomes of robotic-assisted esophagogastrectomy.

2012 ◽  
Vol 30 (4_suppl) ◽  
pp. 93-93
Author(s):  
Sebastian G. De La Fuente ◽  
Jill M. Weber ◽  
Sarah E. Hoffe ◽  
Ravi Shridhar ◽  
Khaldoun Almhanna ◽  
...  
Keyword(s):  
Esophageal Cancer ◽  
Postoperative Complications ◽  
Operating Time ◽  
Surgical Oncology ◽  
Oncologic Outcomes ◽  
Tumor Type ◽  
Robotic Assisted ◽  
Icu Stay ◽  
Estimated Blood Loss ◽  
The Mean

93 Background: The introduction of robotic systems to surgical oncology has allowed improved visualization with more precise manipulation of tissues. In esophageal cancer patients, this is crucial since most patients undergo neoadjuvant therapy (NT) prior to surgical resection. We report our initial experience in patients undergoing robotic-assisted Ivor-Lewis esophagogastrectomy (RAIL) for oncologic purposes at a large-referral center. Methods: A retrospective review of all consecutive patients undergoing RAIL from 2010-2011 was performed. Basic demographics such as age, gender, and body mass index (BMI) were recorded. Oncologic outcomes include tumor type, location, NT, post-operative tumor margins, and nodal harvest. Immediate 30-day postoperative complications were also recorded. Results: We identified 50 patients who under went RAIL with median age of 66 (42-82 years). The mean BMI was 28.6 ± 0.7, 67% of patients received NT and 54% had an ASA classification of 3. The mean and median number of lymph nodes retrieved during surgery was 20 ± 1.4 and 18.5 (8-63) respectively. R0 resections were achieved in all patients. The mean estimated blood loss was 146 ± 15 ml and there were no conversions to an open procedure. Postoperative complications occurred in 13 (26 %) of patients. Complications included atrial fibrillation 5 (10%), pneumonia 5 (10%), anastamotic leak 1 (2%), conduit staple line leak 1(2%), and chylous thorax 2 (4%). There were no wound infections documented. The median ICU stay and length of hospitalization (LOH) were 2 and 9 days respectively. Total mean operating time calculated from time of skin incision to wound closure was 453 ± 13 minutes. The mean operative time significantly decreased over time (first 23 cases 479 min vs. second 23 cases 428 min, p<0.05). Similarly the frequency of complications decreased significantly after 28 cases: 10 (35%) vs. 3 (13%) p=0.04. There were no in hospital mortalities. Conclusions: We demonstrated that RAIL for esophageal cancer can be performed safely with acceptable oncologic outcomes. RAIL may be associated with fewer complications after a learning curve, and shorter ICU stay and LOH.

scholarly journals Modified π-shaped Esophagojejunostomy in Totally Laparoscopic Total Gastrectomy: a Report of 40 Consecutive Cases From a Single Center

2021 ◽  
Author(s):  
Jiadi Xing ◽  
Kai Xu ◽  
Maoxing Liu ◽  
Pin Gao ◽  
Fei Tan ◽  
...  
Keyword(s):  
Blood Loss ◽  
Total Gastrectomy ◽  
Surgical Outcomes ◽  
Operative Time ◽  
Tumor Location ◽  
Laparoscopic Total Gastrectomy ◽  
Estimated Blood Loss ◽  
The Mean ◽  
Totally Laparoscopic Total Gastrectomy ◽  
Totally Laparoscopic

Abstract Background: Intracorporeal esophagojejunostomy remains a challenging technique in totally laparoscopic total gastrectomy (TLTG) without established standard anastomosis method. π-shaped esophagojejunostomy in TLTG was reported to be safe and feasible. Therefore, this study aimed to depict our modified π-shaped esophagojejunostomy in TLTG and evaluate its short-term surgical outcomes.Methods: From April 2018 to October 2019, 40 patients with gastric cancer who underwent TLTG by the same surgeon with modified π-shaped esophagojejunostomy were enrolled. Clinicopathologic data including age, gender, body mass index, American Society of Anesthesiologists score, tumor size, tumor location, depth of tumor invasion, number of harvested lymph nodes, nodal metastasis and TNM stage, operative time, estimated blood loss, time to resume diet, postoperative hospital stays, complication, and mortality were collected and retrospectively analyzed.Results: The mean operative time and estimated blood loss were 264.6 ± 56.9 min and 68.5 ± 53.3 mL, respectively. Postoperative flatus occurred at 4.6 ± 1.7 days. The mean time to resume diet was 7.4 ± 1.7 days postoperatively. One patient was diagnosed with anastomotic leakage and managed with conservative therapy. Pleural effusion, occurring in 4 (10%) patients, was the most common complication. One patient experienced intra-abdominal bleeding requiring reoperation. Other complications were atrial fibrillation and wound infection. No mortality occurred during the 6-month follow-up.Conclusions: Modified π-shaped esophagojejunostomy is a safe and feasible method for intracorporeal anastomosis in TLTG, which showed favorable surgical outcomes.

scholarly journals Post mastectomy pain control using bupivacaine installation via wound drains

2019 ◽  
Vol 6 (6) ◽  
pp. 1851
Author(s):  
Mahmoud A. Alhussini ◽  
Ahmed T. Awad ◽  
Akram M. Girgis ◽  
Tarek A. El Fayomi ◽  
H. M. Agameya
Keyword(s):  
Radical Mastectomy ◽  
Visual Analogue Score ◽  
Surgical Oncology ◽  
Easy Method ◽  
Mean Values ◽  
Blinded Study ◽  
Group A ◽  
The Mean ◽  
Group B ◽  
Oncology Unit

Background: This study is a controlled prospective randomized blinded study. Our aim was to evaluate the effect of wound installation with bupivacanie through surgical drains to control postoperative pain and decrease the use of systemic analgesics after mastectomy.Methods: This study was conducted on 168 female patients candidates for modified radical mastectomy admitted to the Surgical Oncology Unit, Faculty of Medicine, University of Alexandria. Patients were randomly divided into two equal groups. Group A Bupivacaine was installed through axillary and chest wall drains by the end of surgery. While, group B was installed by equal amount of normal saline as placebo. We assessed the visual analogue score (VAS), need and timing for systemic analgesics during the first 24 hours.Results: The mean values for VAS were always lower in group A. This was reflected on the timing and need for additional analgesia.Conclusions: We concluded from this study that using bupivacaine instillation through surgical drains is an effective and easy method to control post mastectomy pain and enhance patients' recovery in the first 24 hours postoperative.

scholarly journals Laparoscopic Partial Gastrectomy for Large Gastric GISTs

2021 ◽  
Author(s):  
Amr Abouzid ◽  
Ahmed Setit ◽  
Adel Fathi ◽  
Mosab Shetiwy
Keyword(s):  
Partial Gastrectomy ◽  
Gastric Gists

scholarly journals Is There Pathological Uniformity between the Periphery and Center of a Gastrointestinal Stromal Tumor?

2021 ◽  
Vol 10 (4) ◽  
pp. 687
Author(s):  
Seong Ji Choi ◽  
Kwan Hong Lee ◽  
Chan Kyoo Yoo ◽  
Jai Hoon Yoon ◽  
Ki Seok Jang ◽  
...  
Keyword(s):  
Risk Stratification ◽  
Mitotic Index ◽  
High Power ◽  
Malignant Potential ◽  
Mitotic Count ◽  
Pathological Diagnosis ◽  
High Power Field ◽  
Gastric Gists ◽  
Significant Difference ◽  
The Mean

Background: Gastrointestinal stromal tumors (GISTs) are mesenchymal tumors and have some malignant potential. Mitotic count is important for predicting the malignant potential of GISTs. Proper treatment of GISTs requires accurate pathological diagnosis. In general, endoscopic ultrasound-guided fine-needle aspiration and deep biopsy are used for pathological diagnosis of GIST before making decisions about surgery. This study sought to evaluate the pathological uniformity of gastric GISTs for mitotic index of the center and periphery of the GIST. Methods: We retrospectively reviewed the data of 37 gastric GIST patients who underwent wedge resection at Hanyang University Hospital. We used Armed Forces Institute of Pathology criteria to classify gastric GISTs. To determine the pathological uniformity of gastric GISTs, we compared GIST risk stratification between the center and periphery of GISTs. Results: The mean size of GISTs was 3.56 ± 2.10 cm. Three lesions were located in the antrum, 11 in the fundus, 9 in the cardia, and 14 in the body. The mean age of patients was 58.65 ± 9.44 years; 18 patients were male and 19 were female. Thirty-five patients (94.6%) showed the same level of risk stratification between the center and periphery of gastric GISTs, while two patients (5.4%) presented different levels of risk between the two sites. No significant difference in mitotic count was observed between the two sites (kappa value = 0.863; p = 0.001). Conclusions: Mitotic index category (either more than five mitoses per high-power field or five or fewer mitoses per high-power field) of GISTs showed good concurrence between the center and periphery.

scholarly journals Radical prostatectomy outcomes in renal transplant recipients: a retrospective case series of Thai patients

BMC Urology ◽  
2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Kun Sirisopana ◽  
Pocharapong Jenjitranant ◽  
Premsant Sangkum ◽  
Kittinut Kijvikai ◽  
Suthep Pacharatakul ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Radical Prostatectomy ◽  
Renal Transplant ◽  
Operative Time ◽  
Case Series ◽  
Urinary Continence ◽  
Renal Transplant Recipients ◽  
Transplant Recipients ◽  
Estimated Blood Loss ◽  
The Mean

Abstract Background The incidence of prostate cancer in renal transplant recipients (RTR) is similar to the general population. Radical prostatectomy (RP) is the standard of care in the management of clinically localized cancer, but is considered complicated due to the presence of adhesions, and the location of transplanted ureter/kidney. To date, a few case series or studies on RP in RTR have been published, especially in Asian patients. This study aimed to evaluate the efficacy and safety and report the experience with RP on RTR. Methods We retrospectively reviewed data of 1270 patients who underwent RP from January 2008 to March 2020, of which 5 patients were RTR. All available baseline characteristics, perioperative and postoperative data (operative time, estimated blood loss (EBL), complications, length of hospital stay, complication), pathological stage, Gleason score, surgical margin status, and pre/postoperative creatinine were reviewed. Results Of the 5 RTR who underwent RPs (1 open radical prostatectomy (ORP), 1 laparoscopic radical prostatectomy (LRP), 2 robotic-assisted laparoscopic radical prostatectomies (RALRP), and 1 Retzius-sparing RALRP (RS-RALRP)) prostatectomy, the mean age (± SD) was 70 (± 5.62) years. In LRP and RALRP cases, the standard ports were moved slightly medially to prevent graft injury. The mean operative time ranged from 190 to 365 min. The longest operative time and highest EBL (630 ml) was the ORP case due to severe adhesion in Retzius space. For LRP and RALRP cases, the operative times seemed comparable and had EBL of ≤ 300 ml. All RPs were successful without any major intra-operative complication. There was no significant change in graft function. The restorations of urinary continence were within 1 month in RS-RALRP, approximately 6 months in RALRP, and about 1 year in ORP and LRP. Three patients with positive surgical margins had prostate-specific antigen (PSA) persistence at the first follow-up and 1 had later PSA recurrence. Two patients with negative margins were free from biochemical recurrence at 47 and 3 months after their RP. Conclusions Our series suggested that all RP techniques are safe and feasible mode of treatment for localized prostate cancer in RTR.

scholarly journals Gastric Schwannoma: A Rare but Important Differential Diagnosis of a Gastric Submucosal Mass

2012 ◽  
Vol 2012 ◽  
pp. 1-5 ◽  
Author(s):  
William Yoon ◽  
Kari Paulson ◽  
Paul Mazzara ◽  
Sweety Nagori ◽  
Mohammed Barawi ◽  
...  
Keyword(s):  
Differential Diagnosis ◽  
Surgical Resection ◽  
Treatment Options ◽  
Partial Gastrectomy ◽  
Preoperative Imaging ◽  
Mesenchymal Tumors ◽  
Gastric Schwannoma ◽  
Gastric Mass ◽  
Submucosal Mass ◽  
Slow Growing

Schwannomas are generally slow growing asymptomatic neoplasms that rarely occur in the GI tract. However, if found, the most common site is the stomach. Gastrointestinal stromal tumors (GISTs) are the most common mesenchymal tumors of the gastrointestinal tract, and 60–70% of them occur in the stomach. Owing to their typical presentation as submucosal neoplasms, gastric schwannomas and GISTs appear grossly similar. Accordingly, the differential diagnosis for a gastric submucosal mass should include gastric schwannomas. Furthermore, GI schwannomas are benign neoplasms with excellent prognosis after surgical resection, whereas 10–30% of GISTs have malignant behavior. Hence, it is important to distinguish gastric schwannomas from GISTs to make an accurate diagnosis to optimally guide treatment options. Nevertheless, owing to the paucity of gastric schwannomas, the index of suspicion for this diagnosis is low. We report a rare case of gastric schwannoma in 53-year-old woman who underwent laparoscopic partial gastrectomy under the suspicion of a GIST preoperatively but confirmed to have a gastric schwannoma postoperatively. This case underscores the importance of including gastric schwannomas in the differential diagnosis when preoperative imaging studies reveal a submucosal, exophytic gastric mass. For a gastric schwannoma, complete margin negative surgical resection is the curative treatment of choice.

Management of intended durotomy in minimally invasive intradural spine surgery

2014 ◽  
Vol 21 (2) ◽  
pp. 279-285 ◽  
Author(s):  
Lee A. Tan ◽  
Ippei Takagi ◽  
David Straus ◽  
John E. O'Toole
Keyword(s):  
Blood Loss ◽  
Minimally Invasive ◽  
Length Of Hospital Stay ◽  
Bed Rest ◽  
Tubular Retractor ◽  
Specific Patient ◽  
Dural Closure ◽  
Estimated Blood Loss ◽  
The Mean ◽  
Operative Notes

Object Minimally invasive surgery (MIS) has been increasingly used for the treatment of various intradural spinal pathologies in recent years. Although MIS techniques allow for successful treatment of intradural pathology, primary dural closure in MIS can be technically challenging due to a limited surgical corridor through the tubular retractor system. The authors describe their experience with 23 consecutive patients from a single institution who underwent MIS for intradural pathologies, along with a review of pertinent literature. Methods A retrospective review of a prospectively collected surgical database was performed to identify patients who underwent MIS for intradural spinal pathologies between November 2006 and July 2013. Patient demographics, preoperative records, operative notes, and postoperative records were reviewed. Primary outcomes include operative duration, estimated blood loss, length of bed rest, length of hospital stay, and postoperative complications, which were recorded prospectively. Results Twenty-three patients who had undergone MIS for intradural spinal pathologies during the study period were identified. Fifteen patients (65.2%) were female and 8 (34.8%) were male. The mean age at surgery was 54.4 years (range 30–74 years). Surgical pathologies included neoplastic (17 patients), congenital (3 patients), vascular (2 patients), and degenerative (1 patient). The most common spinal region treated was lumbar (11 patients), followed by thoracic (9 patients), cervical (2 patients), and sacral (1 patient). The mean operative time was 161.1 minutes, and the mean estimated blood loss was 107.2 ml. All patients were allowed full activity less than 24 hours after surgery. The median length of stay was 78.2 hours. Primary sutured dural closure was achieved using specialized MIS instruments with adjuvant fibrin sealant in all cases. The rate of postoperative headache, nausea, vomiting, and diplopia was 0%. No case of cutaneous CSF fistula or symptomatic pseudomeningocele was identified at follow-up, and no patient required revision surgery. Conclusions Primary dural closure with early mobilization is an effective strategy with excellent clinical outcomes in the use of MIS techniques for intradural spinal pathology. Prolonged bed rest after successful primary dural closure appears unnecessary, and the need for watertight dural closure should not prevent the use of MIS techniques in this specific patient population.

scholarly journals One hundred consecutive endoscopic repairs of sagittal craniosynostosis: an evolution in care

2017 ◽  
Vol 20 (5) ◽  
pp. 410-418 ◽  
Author(s):  
Dennis C. Nguyen ◽  
Scott J. Farber ◽  
Gary B. Skolnick ◽  
Sybill D. Naidoo ◽  
Matthew D. Smyth ◽  
...  
Keyword(s):  
Blood Loss ◽  
Patient Care ◽  
Length Of Hospital Stay ◽  
Successful Outcome ◽  
Emissary Vein ◽  
Sagittal Craniosynostosis ◽  
Care Protocol ◽  
Estimated Blood Loss ◽  
Helmet Therapy ◽  
The Mean

OBJECTIVEEndoscope-assisted repair of sagittal craniosynostosis was adopted at St. Louis Children’s Hospital in 2006. This study examines the first 100 cases and reviews the outcomes and evolution of patient care protocols at our institution.METHODSThe authors performed a retrospective chart review of the first 100 consecutive endoscopic repairs of sagittal craniosynostosis between 2006 and 2014. The data associated with length of hospital stay, blood loss, transfusion rates, operative times, cephalic indices (CIs), complications, and cranial remolding orthosis were reviewed. Measurements were taken from available preoperative and 1-year postoperative 3D reconstructed CT scans.RESULTSThe patients’ mean age at surgery was 3.3 ± 1.1 months. Of the 100 patients, 30 were female and 70 were male. The following perioperative data were noted. The mean operative time (± SD) was 77.1 ± 22.2 minutes, the mean estimated blood loss was 34.0 ± 34.8 ml, and the mean length of stay was 1.1 ± 0.4 days; 9% of patients required transfusions; and the mean pre- and postoperative CI values were 69.1 ± 3.8 and 77.7 ± 4.2, respectively. Conversion to open technique was required in 1 case due to presence of a large emissary vein that was difficult to control endoscopically. The mean duration of helmet therapy was 8.0 ± 2.9 months. Parietal osteotomies were eventually excluded from the procedure.CONCLUSIONSThe clinical outcomes and improvements in CI seen in our population are similar to those seen at other high-volume centers. Since the inception of endoscope-assisted repair at our institution, the patient care protocol has undergone several significant changes. We have been able to remove less cranium using our “narrow-vertex” suturectomy technique without affecting patient safety or outcome. Patient compliance with helmet therapy and collaborative care with the orthotists remain the most essential aspects of a successful outcome.

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