Is Laparoscopy-assisted Radical Gastrectomy Safe in Patients with Child-Pugh Class A Cirrhosis?

PURPOSE: We investigated early postoperative morbidity and mortality in patients with liver cirrhosis who had undergone radical gastrectomy for gastric cancer. MATERIALS AND METHODS: We retrospectively reviewed the medical records of 41 patients who underwent radical gastrectomy at the Chonnam National University Hwasun Hospital (Hwasun-gun, Korea) between August 2004 and June 2009. There were few patients with Child-Pugh class B or C; therefore, we restricted patient selection to those with Child-Pugh class A. RESULTS: Postoperative complications were observed in 22 (53.7%) patients. The most common complications were ascites (46.3%), postoperative hemorrhage (22.0%) and wound infection (12.2%). Intra-abdominal abscess developed in one (2.4%) patient who had undergone open gastrectomy. Massive ascites occurred in 4 (9.8%) patients. Of the patients who underwent open gastrectomy, nine (21.9%) patients required blood transfusions as a result of postoperative hemorrhage. However, most of these patients had advanced gastric cancer. In contrast, most patients who underwent laparoscopic gastrectomy had early stage gastric cancer, and when the confounding effect from the different stages between the two groups was corrected statistically, no statistically significant difference was found. There was also no significant difference between open and laparoscopic gastrectomy in the occurrence rate of other postoperative complications such as ascites, wound infection, and intra-abdominal abscess. No postoperative mortality occurred. CONCLUSIONS: Laparoscopic gastrectomy is a feasible surgical procedure for patients with moderate hepatic dysfunction.

Clinical Outcome Related to Diagnosis of Saddle Pulmonary Embolism using Computed Tomographic Angiography in an Emergency Department

PURPOSE: Saddle embolism (SE) is defined as a thromboembolus located at the bifurcation of the main pulmonary artery. The aim of this study was to determine the prognostic significance of SE as diagnosed by computed tomographic (CT) angiography in patients with submassive pulmonary embolism (PE). METHODS: Between July 2006 and June 2010, 223 consecutive patients diagnosed with submassive PE using contrast enhanced CT angiography in an emergency department were assessed. One experienced radiologist evaluated the CT results, searching for any presence of SE. The clinical information including echocardiographic findings and outcomes for all patients was reviewed. The presence of SE was determined in order to assess its predictive power for major adverse events (MAE) within 1 month (shock, intubation, mortality, thrombolysis and thrombectomy). RESULTS: Sixteen out of 223 patients (7.2%) were found to have a SE. Overall mortality at 1 month was 13.5% with no difference between SE and non-SE patients (12.6% vs. 25.0%, p=0.16). SE patients had a significantly higher rate of MAE (27.5% vs. 62.5%, p=0.01). The presence of SE and the observation of a D-shaped left ventricle by echocardiography were associated with an odds ratio of the occurrence of MAE of 3.75 (95% Confidence Interval: 1.22-11.31, p=0.02), 2.94 (95% Confidence Interval: 1.39-6.22, p<0.01). CONCLUSION: SE, as diagnosed by CT angiography, was associated with submassive PE related shock, intubation, mortality, thrombolysis and thrombectomy within 1 month of observation.

Result of Stent Insertion into Iliac Arterial System: Based on Transatlantic Inter-Society Consensus (TASC) Morphologic Stratification

PURPOSE: The recommended treatments for iliac arterial occlusive disease are an endovascular procedure in TASC type A patients, but surgery in TASC type D patients. However, in TASC type B and C patients, more evidence is required to make any firm recommendations about the best treatments. This study aimed to evaluate the best treatments for patients classified using the TASC morphological stratification. METHOD: A retrospective review of the patients who had undergone stent insertion into iliac arterial occlusive lesions, between 1995 and 2004, at the Chonnam National University Hospital, was performed. All patients were also classified using the TASC morphologic stratification. The TASC type was determined from the initial peripheral angiography findings. Also, the stenosis-free patency was used as an objective end point to evaluate the hemodynamic outcome of stent insertion. RESULT: A total of 86 patients were included in the study. The number of patients classified as TASC types A, B, C and D were 1 25, 17, and 43, respectively. Stent insertion was successfully performed in all patients. The mean follow up period was 26 months. The 1-year stenosis-free patency rates were 94.4, 74.0, and 19.1% in TASC type B, C, and D, respectively. The 5-year patency rates were 50.4, 18.5, and 6.0% in TASC type B, C, and D, respectively. CONCLUSION: The TASC morphological stratification was a useful prognostic factor in relation to the short and long-term iliac stent patency. For TASC types B and C, more evidence and experience of endovascular therapy are needed to confirm the best treatment. For TASC type D, surgical treatment is strongly recommended.