ABSTRACT
BACKGROUND: Pancreatic fistula (PF) is one of the most serious postoperative complications of gastrectomy. Misidentification of the boundary between the pancreas and the dissected fat is a primary concern. In this study, we focused on differences in the appearance of the pancreas and the dissected fat in actual surgical images and statistically analyzed the relationship between the pancreas and the dissected fat. METHODS: We analyzed data from 109 gastric cancer patients who underwent curative gastrectomy between November 2018 and March 2023. Intraoperative images were taken from videos of lymph node dissections of Nos.6 and 8a regions, and the mean gray value of the areas was measured using ImageJ software for analysis. The visceral fat area (VFA) was evaluated by preoperative axial CT at the umbilical level using Ziostation software. RESULTS: A significant correlation was observed between the fat/pancreas gray value ratio in the No.8a lymph node region and the drain/serum amylase ratio (P < 0.001). The fat/pancreas gray value ratio in the No.6 lymph node region correlated with VFA (P < 0.001). The VFA and drain/serum amylase ratio were significantly higher in the group with intra-abdominal complications (P = 0.004). CONCLUSIONS: We revealed significant relationships between the fat/pancreas gray value ratio with drain/serum amylase and VFA. Detecting differences in gray values between the pancreas and the dissected fat may lead to a decrease in the drain/serum amylase ratio and PF.
Subject(s)
Gastrectomy , Laparoscopy , Pancreatic Fistula , Robotic Surgical Procedures , Stomach Neoplasms , Humans , Pancreatic Fistula/etiology , Pancreatic Fistula/epidemiology , Gastrectomy/methods , Gastrectomy/adverse effects , Male , Laparoscopy/methods , Laparoscopy/adverse effects , Female , Robotic Surgical Procedures/methods , Robotic Surgical Procedures/adverse effects , Middle Aged , Aged , Risk Assessment/methods , Stomach Neoplasms/surgery , Stomach Neoplasms/pathology , Lymph Node Excision/methods , Lymph Node Excision/adverse effects , Postoperative Complications/epidemiology , Postoperative Complications/diagnostic imaging , Postoperative Complications/etiology , Intra-Abdominal Fat/diagnostic imaging , Pancreas/diagnostic imaging , Pancreas/surgery , Pancreas/pathology , Retrospective Studies , AdultABSTRACT
A 79-year-old woman was diagnosed with cT2N0M0, cStage â sigmoid colon cancer. Preoperative staging computed tomography(CT)incidentally revealed severe stenosis of the celiac and superior mesenteric arteries. A collateral blood channel communicating between the inferior mesenteric artery and the celiac artery region was well developed. Therefore, a sigmoidectomy with D1 lymph node dissection was performed to preserve this collateral blood channel as a surgery for sigmoid colon cancer. There are few reports on surgical procedures for patients with simultaneous stenosis of multiple major abdominal arteries. In addition, there are no consensus about the optimal surgical procedure and extent of lymph node dissection for colorectal cancer with well-developed collateral vessels that should be preserved. Preoperative three-dimensional CT angiography(3D-CTA)and intraoperative blood-flow assessment using Indocyanine Green help risk management of multi- organ ischemia due to misidentification and injury of collateral arteries. It is important to keep oncological validity as well as risk management. We report a case of sigmoid colon cancer with asymptomatic stenosis of the celiac and superior mesenteric arteries.
Subject(s)
Gastrointestinal Diseases , Sigmoid Neoplasms , Female , Humans , Aged , Sigmoid Neoplasms/surgery , Sigmoid Neoplasms/pathology , Mesenteric Artery, Superior/diagnostic imaging , Mesenteric Artery, Superior/surgery , Celiac Artery/diagnostic imaging , Celiac Artery/surgery , Constriction, Pathologic/surgery , Colon, Sigmoid/blood supply , Colon, Sigmoid/pathology , Colon, Sigmoid/surgeryABSTRACT
BACKGROUND: Duodenal neuroendocrine tumors (NET) are rare, and few reports have demonstrated the effectiveness of chemotherapy for duodenal NET, with not many other treatment options available. Here, we present a case of unresectable duodenal NET G2 that was effectively treated with streptozocin (STZ) monotherapy. We also perform a literature review. CASE SUMMARY: A 57-year-old man presented with multiple lymph node metastasis, liver metastasis, and bone metastasis that occurred after the primary resection of the duodenal NET G2. His long-term survival was obtained; the duration of stable disease exceeded 1 year and 6 months following STZ monotherapy. In addition, his CA 19-9 levels, which previously were increasing, normalized following treatment. CONCLUSION: To our knowledge, no study has reported the effectiveness of STZ monotherapy for duodenal NET. Our findings demonstrate that for unresectable duodenal NETs, STZ should be first administered as a high volume/single dose to stabilize the disease. However, if the disease progresses, a combination therapy may be effective in obtaining a long-term prognosis of the patient. Furthermore, CA19-9 levels may be an effective factor for determining the therapeutic effect of STZ in NET with other metastases.
