Usefulness of Nasogastric Decompression Following Elective Gastric Cancer Surgery: A Randomized Prospective Study

PURPOSE: Traditionally, nasogastric decompression has been a routine procedure following major abdominal surgery or gastrointestinal surgery. This prospective, randomized controlled trial was performed in order to evaluate the usefulness of nasogastric decompression following elective gastric cancer surgery. METHODS: This study was carried out prospectively. A total of 95 patients were randomly divided into two groups, group I (45 patients with nasogatric tube) and group II (50 patients without nasogastric tube). Patients receiving emergency surgery due to gastric outlet obstruction were excluded from this study. The data was analysed by chi-square test, T-test and Mann-Whitney U test with the level of significance set at P<0.05. RESULTS: No significant differences were found between the two groups in regards to nausea, vomting, distension, anastomotic leak or wound dehiscence. However, longer hospital stay, delayed passage of flatus, delayed initiation of ambulation, delayed start of feeding and sore throat occurred more often in group I patients than in group II patients. CONCLUSION: The result showed that the routine prophylactic use of nasogastric decompression following gastric cancer surgery is an unnecessary procedure and does not offer any considerable advantage.

Prognostic factors in the Surgical Treatment of Hilar Cholangiocarcinoma / 한국간담췌외과학회지

BACKGROUND: Although much progress has been made in the management of hilar cholangiocarcinoma, long-term survival for most patients remains poor. The reasons of poor prognosis are due to mainly the difficulty of curative resection of the tumor, frequent postoperative recurrence and also the concomitant cholangitis, hyperbilirubinemia and impaired hepatic function resulted from progressive bile duct obstruction. In spite of many obstacles to surgical treatment for hilar cholangiocarcinoma, recent reports support that the surgical resection is the only promising way of treatment for better long-term survival. But there are still many problems and risks of high morbidity and mortality associated with the operation. AIMS: The appropriate selection of the patient for operation and the operation method by careful evaluation of the clinical status of the patient and the disease is very important for both improving the long-term survival and decreasing the postoperative complication. METHODS: This study was investigated to evaluate the prognostic factors in the surgical treatment of hilar cholagiocarcinoma which influence the postoperative morbidity and survival rate. RESULTS: 1) The postoperative complications were developed in 4 cases(11%) and 1 case of them was dead due to acute respiratory distress syndrome. The postoperative recurrence was observed in 6 cases(25%) and the recurred sites were local recurrences in 5 cases and bone metastasis in 1 case. Ten patients(41.7%) were dead and the causes of deaths were recurrence in 5 cases. Postoperative mean survival time was 16.46 months and 3, 7, 12 month cumulative survival rates were 84%, 67%, 51% respectively. 2) The clinicopathological factors including clinical findings, laboratory results and microscopic findings were not related significantly to the postoperative prognosis. 3) The mean survival time was 5.54 months in bile duct resection group and 26.2 months in bile duct resection with hepatic resection group. Ten month cumulative survival rate was 40% in bile duct resection group and 92.8% in bile duct resection with hepatc resection group, which means that the extent of resection is significantly related to survival rate(p=0.012). CONCLUSION: Clinicopathological factors were not associated with the postoperative prognosis and the difference of operation type(extent of resection) was significantly related to the postoperative survival rate in the surgical treatment of hilar cholangiocarcinoma. The result suggests that more wide surgical resection including hepatic resection increases the possibility of curative resection and improve the long-term survival of the patient.

Sarcomatoid Carcinoma of the Duodenum: A case report

A sarcomatoid carcinoma of the gastrointestinal tract is a very rare tumor. Only limited cases have been reported in the literature. The tumor is more malignant than the usual adenocarcinoma of the gastrointestinal tract. Typically, when discovered, a sarcomatoid carcinoma of the small intestine is already in a late stage of disease with a rapidly progressive course. The survival rate is markedly lower than for adenocarcinomas. Here, we report the case of a 63-year-old male patient who was referred from the Gastroenterology Department of Chonnam University Hospital. He had been suffering from a sudden onset of painless jaundice, and from weight loss for one month. The operation at our hospital was performed under a diagnosis of periampullary cancer. Whipple's operation was carried out on Dec. 14, 1998. Pathology confirmed the diagnosis of a sarcomatoid carcinoma of the duodenum. This article presents that case of a sarcomatoid carcinoma of the duodenum with a brief review of the literature.

Bilateral Brachial Plexus Palsy after a Radical Subtotal Gastrectomy for Early Gastric Cancer: A case report

If pressure injuries to neuromuscular, vascular, and tissue structures are to be avoided, care in the positioning patients on the operating table and in preparing for anesthesia is always important. Avoiding excessive traction of upper and lower extremities adjacent to major nerves will also limit dangerous neurologic sequelae. Here, we report the case of a 44-year-old male patient who underwent a radical subtotal gastrectomy. He suffered postoperative weakness in both arms. This article presents that case of bilateral brachial plexus palsy after a radical subtotal gastrectomym as wekk as a review of the literature.