ABSTRACT
BACKGROUND: Although the decreased incidence of gastric cancer, nevertheless many surgical questions are topical, especially the entity of resection and the extent of lymph node dissection. METHODS: We analyzed retrospectively 38 patients operated for gastric adenocarcinoma in our Surgical Division from January 1997 to December 2001. We excluded cancers of cardia and gastroesophageal junction. We evaluated gastric site, macroscopic and microscopic aspect, TNM staging and grading of gastric cancer (UICC 1997), surgical treatment, postoperative complications and survival, in order to identify the rationale surgical approach to gastric cancer in a suburban hospital. RESULTS: Most of patients affected by gastric cancer were older than 60 years (28/38=73.68%). The cancer was prevalently localized in the antral-pyloric region (21/38=55.27%), in the ulcerated form (27/38=71.05%) and differentiated as intestinal subtype (21/38=55.27%). Regarding the UICC staging we found an almost unvarying distribution, but most of cancers were at stage IV (12/38=31.58%). In 71.05% of cases (27/38) a radical operation was feasible. The most performed operation was a total gastrectomy (19/27=70.37%). We performed a D1 dissection in 85.18% of radical operations (23/27). In the resective surgery we reconstructed the intestinal continuity by a mechanical circular stapler Roux en Y anastomosis. CONCLUSIONS: When possible we perform a total gastrectomy. D1 is our standard lymph node dissection, awaiting a defined D2 role in gastric cancer surgery. In the resective surgery we reconstruct the intestinal continuity by a mechanical circular stapler Roux en Y anastomosis. Morbidity was 10.5% (4/38) and mortality was 7.89% (3/38). Old age and pre-existing pathologies have an important role on surgical outcome. Prognosis of advanced gastric cancer is poor, despite a resective surgical treatment. We emphasize the importance of prevention and early diagnosis as fundamental steps of the oncological gastric surgery.
ABSTRACT
Se proponen algunas modificaciones a la técnica operatoria de la Duodeno-Céfalo-Pancreatectomía en la fase de anastomosis Pancreática-gástrica término lateral con drenaje Naso-Pancreático. La técnica fue aplicada en 12 pacientes con cáncer de cabeza de páncreas o de la Ampolla de Vater, encontrando reducción del riesgo de complicaciones postoperatorias comunes en las técnicas tradicionales. La técnica comenzó a utilizarse en 1993 y la serie incluye los casos tratados hasta mayo de 1995, encontrándose los 12 pacientes vivos y sin síntomas de enfermedad, cumpliendo con la quimioterapia indicada.
Subject(s)
Humans , Male , Female , Middle Aged , Surgical Procedures, Operative , Pancreaticoduodenectomy , Anastomosis, Surgical , Pancreatic Neoplasms/surgery , Postoperative Complications , Ampulla of Vater/surgery , Follow-Up StudiesABSTRACT
Se proponen algunas modificaciones a la técnica operatoria de la Duodeno-Céfalo-Pancreatectomía en la fase de anastomosis Pancreática-gástrica término lateral con drenaje Naso-Pancreático. La técnica fue aplicada en 12 pacientes con cáncer de cabeza de páncreas o de la Ampolla de Vater, encontrando reducción del riesgo de complicaciones postoperatorias comunes en las técnicas tradicionales. La técnica comenzó a utilizarse en 1993 y la serie incluye los casos tratados hasta mayo de 1995, encontrándose los 12 pacientes vivos y sin síntomas de enfermedad, cumpliendo con la quimioterapia indicada. (AU)
Subject(s)
Humans , Male , Female , Middle Aged , Aged , Pancreaticoduodenectomy/methods , Anastomosis, Surgical , Surgical Procedures, Operative/methods , Pancreatic Neoplasms/surgery , Postoperative Complications , Ampulla of Vater/surgery , Follow-Up StudiesABSTRACT
We present a case report about a patient affected by an "insular" thyroid carcinoma, a poorly differentiated carcinoma, situated morphologically and biologically in an intermediate position between the well-differentiated (papillary and follicular) and the totally undifferentiated thyroid tumors. We believe that its separation from other types of thyroid cancer will lead to a more accurate estimate of its prognosis and a more aggressive therapeutic approach.
