A Prospective Study Comparing of Laparoscopy-assisted vs Conventional Open Gastrectomy for Gastric Cancer

PURPOSE: The technique of laparoscopic gastrectomy has developed for early gastric cancer, but a few reports have studied the objective advantages of laparoscopic techniques in a prospective manner. The purpose of this study is to compare laparoscopy-assisted gastrectomy (LG) with conventional open gastrectomy (OG) by the operative outcomes, the recovery of bowel function, and the complications in a prospective nonrandomized manner. METHODS: We studied 73 patients with gastric cancer who were diagnosed as stage I (IA, IB) preoperatively between July 2003 and September 2004. 38 patients underwent LG and 35 patients underwent OG. All patients underwent radical lymphadenectomy (D2), and were treated by a single surgeon. RESULTS: Patients of the two groups were comparable by age, sex, BMI (Body mass index), preoperative stages and mean number of retrived lymph nodes. The mean operative time was shorter in the OG group (P=0.012), and the mean amount of blood loss was significantly less in the LG group than in the OG group (P=0.002). The patients in the LG group recovered bowel function significantly earlier than those in the OG group (P=0.01), thus, the mean hospital stay was significantly shorter in the LG group (P=0.007). The postoperative pain was significantly lower in the LG group (P<0.001). The postoperative complications were 4 cases in the LG group and 6 cases in the OG group, and there were no conversions and no mortalities. CONCLUSION: LG, when compared with OG, has several advantages, including less blood loss, rapid return of gastrointestinal function, less pain, and shorter hospital stay with compromising the cure rate. In addition, for evaluation of the validity of laparoscopic surgery in gastric cancer, a large scaled randomized prospective multicenter study is required.

A Case of Wandering Spleen in a Patient Who Presented at the ED with Mild Abdominal Pain in the Left Upper Quadrant

A wandering spleen is a rare entity characterized by incomplete fixation of the spleen by lienorenal and gastrosplenic ligaments. The spleen can migrate to the lower abdomen or pelvis and the condition can be congenital or acquired. We report a case of torsion of a wandering spleen in a patient presenting with progressing mild left upper quadrant pain.

Hepatocellular Carcinoma with Biliary Tumor Thrombi

Hepatocellular carcinoma (HCC) with obstructive jaundice that is caused by bile duct tumor thrombi (BDT) is a rare finding and the appropriate treatment has not yet been detrmined. Some authors have reported that hepatic resection and the removal of the BDT without extrahepatic bile duct resection were sufficient procedures. On the other hand, other authors have reported that it was reasonable to resect the extrahepatic bile duct with the primary lesion. The 55-year-old man was admitted with obstructive jaundice and he was without any other symptoms. Preoperative ERCP (Endoscopic retrograde cholangiopancreatography) and CT (Computed tomography) showed the BDT extending from the main mass in the left lobe to the common hepatic duct. An ENBD (endoscopic naso-biliary drainage catheter) was placed to decrease the serum total bilirubin concentration (17.5 mg/dl on admission). The serum total bilirubin concentration was 4.7 mg/dl one day before the operation. The ICG-R15 was 36% one week before the operation. The serum AFP (alpha-fetoprotein) concentration was 4872 ng/ml. The serum ALP (alkaline phosphatase) and GGT (gamma-glutamyl transferase) concentrations were elevated. The serum albumin concentration and prothrombin time were normal. Left lobectomy, extrahepatic bile duct resection and Roux-en-Y hepaticojejunostomy were performed with stenting each bile duct orifice. Histologically, the BDT had partially invaded the confluence of the bile duct. At present, the patient is doing well without any recurrence of tumor. Many reports have insisted the BDT rarely invades the confluence portion of bile duct. Therefore BDT extraction without extrahepatic bile duct resection is a sufficient procedure for HCC with the BDT. However, this strategy was inadequate for our case.

The Novel Approach of Multiple Colon Cancer Liver Metastases Treatment

Multiple bilobar liver metastases (MBLM) are the main cause of low resectability in the colon cancer liver metastases. The authors experienced one case of initially non-resectable colon cancer liver metastases. He was curatively and safely treated with a two-stage hepatectomy using the new method of future remnant liver volume growing. A 54-year-old man was referred to our department with the sigmoid colon cancer combined with MBLM, which were checked in two small metastatic lesions in the left lobe and five large sized lesions in the right lobe in the computed tomogram (CT). At first, a laparoscopy-assisted anterior resection was performed. We performed the 1st stage hepatectomy 3 weeks after the colon resection. Intra-operative Ultrasonogram (US) found 9 small superficial metastatic lesions in the left lobe. All that lesions were completely removed by non-anatomical wedge resection. An occlusion balloon catheter was placed in the right portal vein through a small branch of the inferior mesenteric vein at that time. The future remnant liver volume was sufficiently increased 3 weeks after the 1st hepatectomy. A right hepatectomy was safely performed 22 days after the 1st hepatectomy. The patient had received a regional chemotherapy (interleukin2 based immuno-chemotherapy through hepatic artery) for 6 months, then has been receiving a systemic chemotherapy (biweekly Oxaliplatin, leucovorin, plus 5-fluorouracil) without any recurrence evidence.

Focal Nodular Hyperplasia of the Liver

Focal nodular hyperplasia (FNH) is a benign hepatic tumor that likely represents a local hyperplastic response of hepatocytes to a congenital vascular anomaly. The histological feature of focal nodular hyperplasia is dominated by a progressive fibrotic process. Focal lesions of the liver represent a significant diagnostic problem for various imaging modalities. Because of that, in some cases, the distinction between focal nodular hyperplasia and other primary hepatic neoplasms is not possible. In the present report, we describe focal nodular hyperplasia observed in three patients with and without chronic liver disease. These patients were disclosed by various imaging procedures. Under the clinical impression of a hepatocellular carcinoma, operations were performed. The results were consistent with the typical observation in focal nodular hyperplasia. We report three cases of focal nodular hyperplasia of the liver mimicking hepatocellular carcinomas in patients with and without chronic liver disease.

Giant Colonic Diverticulum

While diverticulosis of the colon is a relatively common disease, a solitary giant colonic diverticulum is rare. Although there exist some theories about the formation of the giant colonic diverticulum, none is really conclusive. The preoperative diagnosis of giant colonic diverticulum is made radiographically with findings of a large, smoothly marginated, round homogeneous radiolucency in the abdomen that is in close apposition to the colon on barium enema examination. Early surgical treatment is necessary since the complication rate is high. One case of giant colonic diverticulum is presented, the clinical, radiologic and pathologic findings are discussed, and the etiology and differential diagnosis, reviewe.

Management of Acute Laryngeal Trauma Patients / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Laryngeal trauma is an uncommon but potentially catastrophic injury. The purpose of this study was to analyze the association between injury mechanism and the degree of injury, and to assess the outcome after the treatment. MATERIALS AND METHOD: A 10-year retrospective study of 21 patients with acute laryngeal trauma seen from 1988 to 1997 at Wonju Christian Hospital is presented. All patients are classified by injury mechanism (penetrating vs blunt) and degree of injury (Group I through V). These patients have been studied with attention to clinical manifestation, injury mechanism, degree of injury and outcome after the treatment. RESULTS: The main presenting symptoms and signs were dyspnea, hoarseness, tenderness and subcutaneous emphysema. Eleven cases were categorized as penetrating injury and the other ten cases as blunt injury. Sites of laryngeal injury included thyroid cartilage fracture, soft tissue laceration, cricoid cartilage fracture, pyriform sinus perforation and vocal folds injury. All patients were decannulated. Sixteen patients made a full return to normal voice, four were assessed fair but one was graded as poor. CONCLUSION: Conservative treatment of group II injuries was effective. In this cases, the greater the actual trauma, the poorer the results. Also, blunt trauma proved more serious than penetrating trauma and early surgical intervention was associated with better outcome. Authors suggest esophagoscopy to be performed at the time of operation.