Outcome of surgical management of adenocarcinoma of esophagogastric junction

Adenocarcinoma of the esophagogastric junction [AEG] is a challenging disease for the surgeon. Because of its borderline location, the choice of surgical strategy is controversial. Efforts are currently directed to select patients who may benefit from extensive resection. Therefore, we carried out this prospective study to evaluate the outcome of surgical treatment based on Siewert's classification. From January 2004 to December 2006, 36 patients with AEG underwent resection. The choice of surgical approach was based on the location of the tumor center. The treatment of choice was esophagectomy and proximal gastrectomy for type I tumors and extended gastrectomy and distal esophagectomy for type II and III tumors. The outcome of surgery and prognostic factors were analyzed. Fourteen out of the 36 AEG cases [39%] were diagnosed as having type I tumors, twelve [33%] had type II and 10 [28%] had type Ill AEG tumors. Esophagectomy with proximal gastreetomy was carried out in all patients with type I tumors. Eleven patients with type I tumors underwent transhiatal resection while 3 patients underwent transthoracic resection. All type III tumor patients underwent transabdominal resection by total gastrectomy with transhiatal resection of the distal esophagus. The extent of surgery for type II tumors was the same as type III however, ten patients had a transabdominal resection, while one patient had a thoracotomy and another patient underwent transhiatal esophagectomy. The overall 2-year survival rate was 33.3%. Survival rate was significantly associated with pT stage, pathological node-positive category and tumor stage. Postoperative 30-day mortality and morbidity rates were 30.5%, 36.1%; respectively. Siewert's classification provides a useful tool for selecting the surgical approach but should be tailored to individual patients to achieve R0 resection. Survival is still largely stage dependent and earlier diagnosis holds the key to improve prognosis

problem of mandibular resection in intraoral tumours

A total of 50 patients with intra-oral carcinomas were examined and treated at the N.C.I. during the period 1979 - 1980. All these cases were treated surgically by traditional Commando's operation. The mandibular bone, its covering periosteum and neurovascular bundle were examined separatly. The study showed that 56% of the cases, under went bone resection without actual malignant invasion i.e the bone could be spared. This work stresses the fact that conservative mandibular resection can be done safely so long as there is normal tissue clearance even a few milimeters between tumour, bone and a negative X-ray results preopratively. This gives the patients a good functional and cosmetic results

comparative study of ileal loop conduit and rectosigmoid bladder as methods of urine diversion after radical cystectomy for bilharzial cancer bladder

A prospective study including 177 patients with T[2] and T[3] bilharzial cancer bladder for whom radical cystectomy was done, followed by rectal bladder for 115 patients and ileal loop conduit for 62 patients. Per-operative blood loss averaged 1500 cc in rectal bladder and 1800 c.c. in ileal loop conduit. Post-operative morbidity and mortality were higher after ileal loop conduit than after a rectal bladder diversion. The renal function studies showed no superiority of one method over the other. But evaluation of the bladder substitute showed that the rectal bladder was mere suitable for our patients as it acted as a reservoir which can hold up to 700 c.c. of urine with a frequency of evacuation every 4-6 hours and diurnal and nocturnal continence in 24% of cases, diurnal continence in 66%, and incontinence in the remaining. 10% of cases