Prognostic factors in gastric carcinoma after R0 resection with DH lymph node dissection. Tunisian experience

Curative resection with adequate lymph node dissection is the treatment of choice for gastric cancer. To determine the prognostic factors after R0 resection with DII lymph node dissection. We retrospectively assessed 126 patients who underwent R0 resection with DII lymph node dissection for gastric cancer [excluding the upper third of the stomach] in a single institution between 1991 and 2006 with median follow-up of 38.5 months [6 - 219]. Prognostic factors were assessed by Cox proportional hazard model. There were 45 women and 81 men. The median age was 60 years [21 - 87]. Four patients died [3.2%]. Postoperative hospital morbidity was 16.7%. The pathologic review of the slides revealed that 50% of the tumors were stage T3 [63 cases]. The median number of lymph node removed was 11 [8-40], 50% were involved. Five and 10 years survival rates were respectively 56.9% and 40.2%. In multivariable analysis, depth of wall invasion, lymph node involvement and more than 15 retrieved lymph nodes were found to be independent prognosis factors. After R0 resection with DII lymphadenectomy, depth of wall invasion, lymph node involvement and more than 15 retrieved lymph nodes were independent predictive factors for survival

[Peripancreatic sporadic gastrinoma]

The peri-pancreatic sporadic gastrinoma represents a paradigm of digestive endocrinology. It was originally an abnormal secretion of gastrin fits the syndrome Zollinger-Ellison. The objective of our work is to clarify the diagnostic strategy and therapeutic conduct of gastrinoma. We report the case of a patient aged 42 years, hospitalized for bleeding duodenal ulcer, revealed a Zollinger-Ellison syndrome. The objective of our work is to clarify the diagnosis strategy and therapeutic conduct of gastrinoma. We report the case of a patient aged 42 years, hospitalized for bleeding duodenal ulcer, revealed a Zollinger-Ellison syndrome. The different explorations have shown that it was a primitive peripancreatique sporadic gastrinoma. In surgery, we discover a retropancreatique tumor associated to a stenosis post-bulbar ulcer. It was conducted a enucleation of the tumor with vagotomie troncular and normalization of the values of gastrinemie. The sporadic gastrinoma is rare, its emphasis in increasingly being facilitated by the technology of modern medical imaging. Treatment of pancreatic gastrinoma is multidisciplinary. Surgery is the only cure for this disease

[Early gastric adenocarcinoma]

the purpose of this study was to determine the epidemiological and clinical behaviour of the superficial adenocarcinoma of the stomach, to clarify its pathological characteristics, therapeutic as well as his its prognosis. Over a period of 14 years [1990-2004], 16 patients were operated for a superficial gastric adenocarcinoma among 155 gastric cancers treated during the same period in the service of general surgery [A] La Rabta. The superficial gastric adenocarcinoma represented 10.3% of our series. The mean age was 59 years. It was about 8 men and 8 women. Two patients was followed for a chronic stomach ulcer, a patient is followed for Biermer anaemia and another one for Menetrier disease. Among these cancers, 12 were intra mucosal and 4 invaded the submucousa. Lymph node involvement was present only in one case. The cancer was located in the antrium in 8 cases and was multifocal in 3 cases. One patient died in postoperative case because of a medical cause. The 5-year-overall survival was 65.6%. The recurrence had interested only one patient. the superficial gastric adenocarcinoma is rare. The follow up of precancerous states allows its diagnosis. The treatment is based on the gastric resection associated to the DI-type lymph node clearance. The multifocal character imposes a surveillance of the remaining gastric stump

[Laparoscopic appendicectomy versus conventional appendicectomy prelliminary results of a retrospective comparative study]

The value of laparoscopic surgery in appendicitis is not established. Studies suffer from many controversies. The aim of this study is to compare the safety and benefits of laparoscopic versus open appendectomy in patients with clinically non complicated acute appendicitis. One hundred thirty nine patients wore analyzed retrospectively following either laparoscopic or open appendectomy. We excluded peritonitis, appendicular abscesses and patients with history of digestive surgery. The main outcome measures wore operative duration, postoperative complications and length of hospital stay. There was no mortality. The overall complication rate was similar in both groups [13,9%versus 7,4%in the laparoscopic and open groups respectively p=0,22]. Operating duration was significantly longer in the laparoscopic group [62 minutes versus 40 minutes p=0,001] while there was no difference in length of stay. Laparoscopic appendectomy did not offer a significant advantage over open appendectomy in acute non complicated appendicitis. The choice of the procedure should be based on surgeon or patient preferences

[Gastric adenocarcinoma with lymphoid stroma: about nine cases]

The purpose of this work is to study the pathological features and the outcome of lymphoid stroma gastric carcinoma and its relation with Epstein-Bar Virus [EBV] and the importance of the EBV serology in detection of early reccurence. Between January 1990 and december 2004, 155 patients underwent gastric resection for gastric carcinoma. Nine of them had lymphoid stroma gastric carcinoma. Over all survival as well as disease free survival were determined. Detection of reccurence was based on clinical exam and on findings yielded by endoscopy, radiological exams and EBV serology. A comparison of survival rate of patients beteween current gastric carcinoma and those with lymphoid stroma gatsric carcinoma was done using the Log Rank test. the patients [7 men and 2 women] had a mean age of 61 years [41 to 82]. The tumor was in the antrum in 4 cases, in the body of the stomach in 3 cases and in the cardia in 2 cases. The mean tumor size was 8 cm with deep invasion of the stomach wall in 5 cases and ganglion invasion in 6 cases out of 9. EBV was detected in all patients by in situ hybridation. Post operative morbidity and mortality were nil. Global survival and disease free survival were, respectively, 53.3% and 65.6% in lymphoid stroma gatsric carcinoma, and 43.4% and 63.5% for current gatsric carcinoma. Three patients died of a reccurent disease after 6, 30 and 33 months. The remaing 6 patients didn't have signs of reccurence. lymphoid stroma gastric carcinoma is a bulky, local disease. In our patients, it was always associated with EBV. Over all survival was better than survival of current gastric carcinoma, although there was no significance. EBV serology can be an effective screening procedure of reccurence

Traitement medico-laparoscopique du kyste hydatique du foie mythe ou realite! Resultats preliminaires. a propos de 27 cas

The laparoscopic treatment of hydatic cyst of the liver is at present condified. These last years, several progresses were obtained in the laparoscopic approach of hydatic cyst by avoiding the risk of preoperative hydatic peritoneal scattering. The aim of this study is to evaluate the effect of albendazole given before a laparoscopic management of the hydatic cyst of the liver

Tumeur papillaire solide et kystique du pancreas

solid cystic papillary tumors of the pancreas are rare. This tumors were seen in young women. They have distinct clinic pathologic characteristics. Their prognosis is excellent because of their low grad of malignancy. The tumor was encapsulated and have favorable prognosis after complete surgical resection. We report one case of solid cystic papillary tumor of the pancreas occuring in female patient who are 20 years old. This observation have been a pre operative morphologic and ultrastructural study [CT, Ctscan, EE, IRM and immunohisto-chemistry study] who permetted to elaborate diagnosis