Mediastinal and abdominal node dissection for carcinoma of thoracic and abdominal esophagus

To evaluate the safety and complications of mediastinal and abdominal dissection in association with subtotal and total esophagectomy for carcinoma of thoracic and abdominal esophagus. 29 patients having curable carcinoma of the esophagus underwent mediastinal and abdominal node dissection. Subtotal esophagectomy was performed in 16 patients while total esophagectomy was performed in 13 patients. Pathological staging was: stage I 0%, stage IIA 24%, stage IIB 62% and stage III 13%. Positive mediastinal and celiac lymph nodes was found in 38% with a mean number of 6 [range1 -12]. The mean number of dissected lymph nodes was 14 [range 8 - 34]. Chest infection occurred in 27%. Early surgical complications were intrathoracic anastomotic leakage 6%, cervical leakage 10%, anastomotic bleeding in one patient and recurrent laryngeal nerve palsy in two patients. Postoperative mortality was 10%. Four patients had locoregional recurrence. Three-year survival rate were 21% for stage IIA and ranged from 11- 0% for stage IIB and III. The technique of mediastinal and abdominal dissection can be performed with subtotal and total esophagectomy with low rate of complications. This leads to more accurate staging, but it is unclear from this small study whether it has an impact on the survival or not

Ileocecal bladder VS. neoileal bladder [Studer's Bladder] after radical cystectomy in bladder cancer patients: a comparative study

This study was performed on 60 patients with invasive bladder cancer divided into 2 groups: Group A comprised 29 patients who underwent radical cystectomy and reconstructed with neoileal bladder and group B included 31 patients who were reconstructed by ileocecal bladder substitutions after radical cy stectomy. Postoperative complications occurred in 24.1% in group A including 2 mortalities. In group B, the complication rate was 25.8%, also with 2 mortalities. Day continence was achieved in 92% and 89% in group A and B, respectively. The mean post voiding residual urine was more in group A than group B, being 90 +/- 72 cc; while it was 12 + orournal 20 cc in group B. Acidosis and hyponatremia were evident in group A. The pelvicalyceal systems were preserved in 85% of patients of group A compared with 93% in group B. The mean renal cortical thickness was less in group A than in group B. Although the cystometric capacity was more and the basal pressure was less in the neoileal bladder, this was not reflected on the degree of diurnal and nocturnal continence or back pressure on the renal units compared with the ileocecal bladder. Continence in both pouches was comparable. Moreover, the renal units were preserved better in the ileocecal bladder than in the neoileal bladder. Also, the residual urine was much more in the neoileal bladder with its potential complications of infection and stone formation. In addition, acidosis was more evident in the neoileal bladder