[The current and future use of robot-assisted surgery for gastro-oesophageal cancer]. / Nutidige og fremtidige aspekter ved robotkirurgi inden for øsofagus-ventrikel-cancer.

Minimally invasive oesophagectomy and gastrectomy are increasingly used procedures due to the known advantages, e.g. shorter hospital stay, less post-operative pain and quicker recovery. The technical disadvantages of laparoscopy and thoracoscopy are, however, limited degrees of freedom and ergonomic discomfort for the surgeons, but these drawbacks are expected to be reduced by robot-assisted surgery with its seven degrees of freedom, 3D vision, tremor filtering and improved ergonomics. The purpose of the review is to describe the current and future use of robot-assisted surgery for gastro-oesophageal cancer.

[Long-term survival after curative resection for oesophageal and cardia cancer]. / Sygdomsfri langtidsoverlevelse efter makroradikal operation for cancer oesophagi/cardiae.

INTRODUCTION: We present the long-term survival after curative resection for cancer at the gastro-oesophageal junction. MATERIAL AND METHODS: From 1992 through 2003, 147 patients with cancer at the gastro-oesophageal junction underwent curative resection. Preoperative evaluation included a computed tomography (CT) scan of the thorax and abdomen, gastroscopy, endoscopic ultrasonography and ultrasonography of the neck. RESULTS: Explorative laparotomy was performed in 466 patients, and 147 underwent curative resection, while 319 had advanced disease. No patients received adjuvant chemo-radiotherapy. Adenocarcinoma was found in 93% of the patients and squamous cell carcinoma in 7%. Cardia resection was performed in 78%, while 22% underwent gastrectomy. R0 resection was performed in 95% of the operations. Anastomotic dehiscence was seen in 4%. The perioperative mortality after curative resection was 3% and the 180-day-mortality was 5%. The observed five-year survival rate after curative operation was 29% and the estimated five-year survival was 24%. The five-year survival rates according to tumour stage (T1-4) were 85%, 40%, 23% and 25%, respectively. After stratification according to lymph node metastases (-/+metastases) and age below/above 70 years, five-year survival rates were 41%/ 19% and 32%/17%, respectively. Cox regression analysis showed that no metastases (N0) and age below 70 years were independent predictors of survival. CONCLUSION: The overall and stage-dependent survival after five years, perioperative mortality and complications are acceptable and comparative to those reported by foreign centres.

[Postoperative peritoneal adhesions]. / Postoperative peritoneale adhaerencer.

Postoperative adhesions occur after most surgical intraabdominal procedures, and small bowel obstruction is a common complication. Research has focused on the pathophysiology of adhesion formation and on the development of prophylactic barriers and drugs. The present paper provides a resume of existing research into peritoneal adhesion prophylaxis and pathophysiology. In conclusion, using minimal invasive technique is important to prevent adhesions. Adhesion studies should offer precise description of the adhesions and video documentation.

[Is screening of wireless capsule endoscopies by non-physicians feasible?]. / Er screening af kapselendoskopiske undersøgelser udført af ikkelaegeligt personale anvendelig?

INTRODUCTION: Reading a wireless capsule endoscopy (WCE) may be time-consuming. In order to reduce the time needed by a physician to view a WCE, we investigated if other medical professions could preview the video and detect bowel pathology in advance. MATERIALS AND METHODS: A specialist in gastroenterology and two laboratory technicians independently viewed 34 consecutive WCEs and noted all findings. Thereafter, two specialists reviewed the findings made by the technicians independently in order to make a diagnosis. The results were compared with the diagnosis made by the first specialist, who viewed the entire WCE himself. RESULTS: The reviewing specialists were able to make a correct diagnosis based on the technicians' findings in 97% and 85% of the patients, respectively. CONCLUSION: The study indicates that it is safe and timesaving to use other medical professions than physicians to preview WCEs.

Endobiliary brush biopsy: Intra- and interobserver variation in cytological evaluation of brushings from bile duct strictures.

OBJECTIVE: Obtaining cytological specimens by wire-guided endobiliary brushing at the time of endoscopic retrograde cholangiopancreatography (ERCP) is a convenient way to reach a diagnosis. Sensitivity for malignant disease is generally around 50% and specificity around 100%. The present study was designed to assess the reproducibility of the cytological examination. MATERIAL AND METHODS: Samples were obtained from 55 consecutive patients with biliary duct strictures that eventually turned out to be caused by malignant disease in 41 patients (73%). The cytology specimens were evaluated twice in different random order with an interval of at least 4 months by two pathologists blinded to the final diagnoses. Suitability for diagnosis (suitable, suboptimal or unsuitable) and cytologic diagnosis (benign, atypical, suspicious for malignancy and malignant cells) were registered. Kappa analysis was applied. RESULTS: Regarding suitability for diagnosis, the two observers reproduced their findings in 84% (kappa 0.76) and 87% (0.59) (p>0.05), while the interobserver variations on the two occasions were 76% and 78% (kappa 0.49 and 0.58, respectively) (p>0.05). Five percent of samples were rated as inadequate for diagnosis in at least one reading; 18% were suboptimal and 62-82% were suitable. The observers reproduced their cytological diagnosis in 77% and 71% (weighted kappa 0.83 and 0.75) (p>0.05), and agreed on the cytological diagnosis in 65% and 73% (weighted kappa 0.65 and 0.75) (p>0.05). CONCLUSIONS: The intra- and interobserver agreement in cytological evaluation of endobiliary brushings from bile duct strictures is generally good. The rates of inadequate and suboptimal samples can probably be reduced by modifications of the brush design.