Extended lymph node dissection for gastric cancer: results of a prospective, multi-centre analysis of morbidity and mortality in 118 consecutive cases.

This study reports interim data on post-operative morbidity, hospital mortality and duration of hospital stay of Italian patients undergoing extended lymph-node dissection combined with a pancreas-preserving technique for gastric cancer. Of the 218 patients admitted to one of eight general and/or university hospitals in North Italy, 118 were enrolled in the trial. Eligible patients presented with proven primary adenocarcinoma of the stomach without clinical evidence of distant, peritoneal and/or liver metastasis, or metastasis in para-aortic and retropancreatic nodes at intraoperative biopsy. Patients underwent the extended procedure as described by the Japanese Research Society for the Study of Gastric Cancer, following the Maruyama pancreas-preserving technique. A strict quality control system was used to ensure the performance of a standard surgical treatment. A surgeon of the reference centre (M.D.), who stayed at the National Cancer Center Hospital in Tokyo to learn the D2 technique from a specialist Japanese surgeon, became the trial supervisor and assisted each surgeon in all the Italian participating centres. The patients were staged according both to the TNM system and to the General Rules for the Gastric Cancer Study in Surgery and Pathology. Post-operative surgical complications developed in 21 patients (17.8%). The non-surgical complication rate was 2.5%. Reoperation was necessary in six patients (5%), all of whom survived. The 30-day mortality rate for the eligible group was 2.5%. The overall hospital mortality was the same. Total gastrectomy was associated with a slightly higher operative mortality (4.5% vs 1.3%). Only one patient died from an anastomotic leak. The rate of leakages was higher after total than after distal gastrectomy (15.9 vs 5.4%); the association of splenectomy and pancreatectomy worsened the morbidity rate. D2 lymphadenectomy with pancreas-preserving technique, when performed at experienced centres, seems a feasible and safe technique for the radical treatment of gastric cancer in selected Western patients.

[Inguinal hernia: technics compared in our experience. Hernioplasties compared]. / Ernia inguinale: tecniche a confronto nella nostra esperienza. Ernioplastiche a confronto.

The authors describe their survey carried out on 875 patients operated on for inguinal hernia between 1984 and 1989. 412 of these patients were checked in the out-patients' department after a minimum 2 year period. The regular check-up parameters were assessed, paying particular attention to the problem of recurrence. This occurred in 47 patients, which is equal to 11% of the total for the Bassini and Postempski techniques, and 8.9% for the Shouldice method. On first observation, statistical data analysis carried out on the results obtained, do not show any significant differences. However, notwithstanding the fact that the authors are at the initial stages with chances of varying results, important data have emerged in favour of the canadian technique.

[Antibiotic prophylaxis with aztreonam in general surgery]. / Profilassi antibiotica con aztreonam in chirurgia generale.

Personal experience in peroperative antibiotic prophylaxis with aztreonam (Azactam) in 81 patients undergoing abdominal surgery of choice is reported. The usefulness, handiness and lack of side-effects of this parenteral drug are reiterated. The incidence of surgical wound infections was 2.5%, while that of associated infections was 6.1%. Considering these results, the use of aztreonam (Azctam) is recommended in peroperative prophylaxis as a drug of choice.