Vascular endostapler as aid to hepatic vein control during hepatic resections.

Significant hemorrhage during hepatic resections for malignancies can result in increased mortality due to liver failure or acute blood loss. Massive hemorrhage is often related to loss of control or injury to the hepatic veins or inferior vena cava. Prevention or reduction of intraoperative blood loss, through improved surgical techniques and increased operator experience, can significantly reduce postoperative morbidity and mortality. Although the use of continuous or intermittent clamping of the portal triad structures (Pringle maneuver) has reduced the incidence of bleeding during hepatic transections, the hepatic vein ligation step of liver resections continues to be a possible source of major blood loss. Because of its safety, rapidity, and ease of application, the EndoGIA 30V vascular stapler is presented as an efficient means for controlling and dividing the major hepatic veins. In skilled hands, this stapling device can contribute to a reduction in incidence and risk of major intraoperative bleeding during hepatectomy. The critical factor to ensuring postoperative morbidity reduction, however, is the surgeon's experience in major hepatic resection procedures.

Modality of failure following resection of stage I and stage II non-small cell lung cancer.

The pattern and sites of recurrence were studied in 270 patients with resected Stage I (NO) or Stage II (Nl) non-small cell lung cancer (NSCLC). Survival, incidence, and type of intrathoracic locoregional recurrence versus distant extra-thoracic recurrence after surgical excision were analyzed. Prognostic parameters, such as postsurgical stage, histologic type, degree of cellular differentiation, and surgical approach, were examined to discern their influence on tumor recurrence. The total incidence of recurrence in patients with stage I and II tumors was high, with a radical surgical approach often resulting ineffective, because of incomplete locoregional neoplastic extirpation due to micrometastases. Lymph node metastases worsened prognosis, with Nl tumors demonstrating a significantly higher recurrence rate at 5 years (63%) than NO neoplasms (48%) (p < 0.01). Stage I tumors showed an elevated incidence of local recurrence (45%), with tumor T-factor making a significant contribution in such cases. N1-factor combined with an elevated T-factor (Stage II Subclass pT2Nl neoplasms) promoted a higher incidence of distant rather than local recurrence. A shorter disease-free interval was observed in patients with N tumors as opposed to NO neoplasms. Histologic type did not play a statistically significant role (p = ns) in the total incidence of recurrence. A similar total incidence of recurrence was observed in Stage I and II tumors treated by lobectomy (51%) or pneumonectomy (56%), with locoregional recurrence appearing more frequently after lobectomy.