Three-year survival and distribution of lymph node metastases in gastric cancer following neoadjuvant chemotherapy: results from a European randomized clinical trial.

BACKGROUND: Adequate lymphadenectomy is an important step in gastrectomy for cancer, with a modified D2 lymphadenectomy being recommended for advanced gastric cancers. When assessing a novel technique for the treatment of gastric cancer, lymphadenectomy should be non-inferior. The aim of this study was to assess completeness of lymphadenectomy and distribution patterns between open total gastrectomy (OTG) and minimally invasive total gastrectomy (MITG) in the era of peri-operative chemotherapy. METHODS: This is a retrospective analysis of the STOMACH trial, a randomized clinical trial in thirteen hospitals in Europe. Patients were randomized between OTG and MITG for advanced gastric cancer after neoadjuvant chemotherapy. Three-year survival, number of resected lymph nodes, completeness of lymphadenectomy, and distribution patterns were examined. RESULTS: A total of 96 patients were included in this trial and randomized between OTG (49 patients) and MITG (47 patients). No difference in 3-year survival was observed, this was 57.1% in OTG group versus 46.8% in MITG group (P = 0.186). The mean number of examined lymph nodes per patient was 44.3 ± 16.7 in the OTG group and 40.7 ± 16.3 in the MITG group (P = 0.209). D2 lymphadenectomy of 71.4% in the OTG group and 74.5% in the MITG group was performed according to the surgeons; according to the pathologist compliance to D2 lymphadenectomy was 30% in the OTG group and 36% in the MITG group. Tier 2 lymph node metastases (stations 7-12) were observed in 19.6% in the OTG group versus 43.5% in the MITG group (P = 0.024). CONCLUSION: No difference in 3-year survival was observed between open and minimally invasive gastrectomy. No differences were observed for lymph node yield and type of lymphadenectomy. Adherence to D2 lymphadenectomy reported by the pathologist was markedly low.

Health related quality of life following open versus minimally invasive total gastrectomy for cancer: Results from a randomized clinical trial.

INTRODUCTION: Minimally invasive techniques show improved short-term and comparable long-term outcomes compared to open techniques in the treatment of gastric cancer and improved survival has been seen with the implementation of multimodality treatment. Therefore, focus of research has shifted towards optimizing treatment regimens and improving quality of life. MATERIALS AND METHODS: A randomized trial was performed in thirteen hospitals in Europe. Patients were randomized between open total gastrectomy (OTG) or minimally invasive total gastrectomy (MITG) after neoadjuvant chemotherapy. This study investigated patient reported outcome measures (PROMs) on health-related quality of life (HRQoL) following OTG or MITG, using the Euro-Qol-5D (EQ-5D) and the European Organization for Research and Treatment of Cancer (EORTC) questionnaires, modules C30 and STO22. Due to multiple testing a p-value < 0.001 was deemed statistically significant. RESULTS: Between January 2015 and June 2018, 96 patients were included in this trial. Forty-nine patients were randomized to OTG and 47 to MITG. A response compliance of 80% was achieved for all PROMs. The EQ5D overall health score one year after surgery was 85 (60-90) in the open group and 68 (50-83.8) in the minimally invasive group (P = 0.049). The median EORTC-QLQ-C30 overall health score one year postoperatively was 83,3 (66,7-83,3) in the open group and 58,3 (35,4-66,7) in the minimally invasive group (P = 0.002). This was not statistically significant. CONCLUSION: No differences were observed between open total gastrectomy and minimally invasive total gastrectomy regarding HRQoL data, collected using the EQ-5D, EORTC QLQ-C30 and EORTC-QLQ-STO22 questionnaires.

Open versus minimally invasive total gastrectomy after neoadjuvant chemotherapy: results of a European randomized trial.

BACKGROUND: Surgical resection with adequate lymphadenectomy is regarded the only curative option for gastric cancer. Regarding minimally invasive techniques, mainly Asian studies showed comparable oncological and short-term postoperative outcomes. The incidence of gastric cancer is lower in the Western population and patients often present with more advanced stages of disease. Therefore, the reproducibility of these Asian results in the Western population remains to be investigated. METHODS: A randomized trial was performed in thirteen hospitals in Europe. Patients with an indication for total gastrectomy who received neoadjuvant chemotherapy were eligible for inclusion and randomized between open total gastrectomy (OTG) or minimally invasive total gastrectomy (MITG). Primary outcome was oncological safety, measured as the number of resected lymph nodes and radicality. Secondary outcomes were postoperative complications, recovery and 1-year survival. RESULTS: Between January 2015 and June 2018, 96 patients were included in this trial. Forty-nine patients were randomized to OTG and 47 to MITG. The mean number of resected lymph nodes was 43.4 ± 17.3 in OTG and 41.7 ± 16.1 in MITG (p = 0.612). Forty-eight patients in the OTG group had a R0 resection and 44 patients in the MITG group (p = 0.617). One-year survival was 90.4% in OTG and 85.5% in MITG (p = 0.701). No significant differences were found regarding postoperative complications and recovery. CONCLUSION: These findings provide evidence that MITG after neoadjuvant therapy is not inferior regarding oncological quality of resection in comparison to OTG in Western patients with resectable gastric cancer. In addition, no differences in postoperative complications and recovery were seen.

Hemoperitoneo espontáneo relacionado con desgarro de bridas omentales durante la gestación / Spontaneous hemoperitoneum related to tearing of omental flanges

El hemoperitoneo espontáneo idiopático relacionado con intervenciones quirúrgicas previas y durante la gestación es una situación excepcional pudiendo ser letal para madre y feto. A pesar de los avances médicos, la mortalidad por bajo nivel de sospecha sigue manteniéndose alta. Presentamos el caso de una mujer de 36 años en la semana 30 de gestación, sin antecedentes patológicos o traumáticos salvo cesárea previa tres años antes, que acude con inestabilidad hemodinámica y dolor abdominal severo. Se realiza laparotomía de urgencia evidenciando abundante hemoperitoneo sin punto de sangrado excepto un coágulo centinela en epiplón mayor y superficie anterior uterina (AU)

The spontaneous idiopathic hemoperitoneum related to prior surgical procedures and during pregnancy it’s an exceptional situation, lethal to both mother and fetus. Despite medical advances, mortality due to low level of suspicious remains high. We report the case of a 36 year-old woman at 30 weeks gestation with no history of disease or trauma except a previous cesarean three years ago, who presents with hypovolemia signs and severe abdominal pain. Is performed an emergency laparotomy showing hemoperitoneum without bleeding point except a sentinel clot in the omentum and the anterior surface of the uterus (AU)

Úlcera gástrica penetrante en el hígado / Gastric ulcer penetrating the liver

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[Role of laparoscopic surgery in the treatment of achalasia: an analysis of 50 cases]. / Papel del tratamiento quirúrgico por vía laparoscópica de la achalasia de cardias: análisis de 50 casos.

UNLABELLED: Achalasia is an uncommon oesophageal motor disorder, with a controversial therapeutic management. AIM: The aim of our study was to analyse our experience in the management of achalasia, assessing the impact of minimally invasive surgery, its complications and its outcomes in the short and medium term. METHODS: A retrospective and descriptive study was designed, including all patients operated on between 1999 and 2010 with the diagnosis of achalasia. Previous diagnostic tests, duration of symptoms, previous non-surgical treatment, surgical approach, associated antireflux intervention, surgical time and perioperative complications were analysed. RESULTS: A total of 50 patients, 24 males and 26 females, with a mean age of 47 years underwent laparoscopic surgery. The mean duration of the disease was 2 years. Eleven (22%) patients had received endoscopic treatment (1-4 sessions) prior to the surgery, with 100% of symptomatic recurrence. The surgery was accompanied by a Dor fundoplication in 48 patients, and Toupet fundoplication in the remaining two. The mean surgical time was 123 minutes. There were 9 intraoperative complications (5 gastric mucosal perforations, 2 bleeding, 1 liver injury and 1 aspiration); 4 postoperative complications (3 scapular pain and 1 sub-phrenic collection) were reported. The long-term subjective symptomatic response was excellent/good in 84% of patients, intermediate in 12% and a poor response in 4%. The mean follow-up was 28 months. CONCLUSIONS: Heller cardiomyotomy should be the treatment of choice in selected Achalasia patients, because of its short and long term outcomes, and its low morbidity.

Adrenalectomía laparoscópica: presentación de 43 casos / Laparoscopic adrenalectomy: Presentation of 43 cases

Introducción El propósito del estudio es exponer y analizar nuestra experiencia en adrenalectomía laparoscópica (AL).Material y métodos Estudio descriptivo y retrospectivo sobre AL realizada en nuestro centro desde enero de 2000 hasta diciembre de 2008.ResultadosSe realizaron un total de 43 AL a 41 pacientes mediante abordaje transperitoneal lateral. La mediana de edad de los pacientes intervenidos se situó en 53 años. La principal indicación en frecuencia de nuestra serie fue el hiperaldosteronismo (19), seguido de incidentalomas (8), feocromocitomas (6), síndrome de Cushing (6), lesiones metastásicas (3) y carcinoma suprarrenal primario (1). La media de estancia hospitalaria poscirugía fue de 3 días y la media del tamaño de las masas fue de 30mm (rango: 4–155mm). No hubo mortalidad en nuestra serie. La necesidad de conversión se redujo a un caso; en ningún caso fue necesario reintervenir a un paciente. ConclusionesLa AL es una técnica segura y eficaz en el tratamiento de tumores suprarrenales que puede realizarse con riesgo y morbilidad mínima (AU)

Introduction The aim of the study was to present and analyse our experience in laparoscopic adrenalectomy (LA).Materials and methods Descriptive and retrospective study including LA performed over 8 years, between 2000 and 2008 in our hospital. Results A total of 43 LA were performed to 41 patients using a transperitoneal lateral approach. Indications for adrenalectomy included hyperaldosteronism (19), non-functioning adenoma (8), phaeochromocytoma (6), Cushing's syndrome (6), metastasis (3) and adrenal primary tumour (1). Median postoperative hospital stay was 3 days and the median size of the masses was 30mm (range: 4–155mm) Complications occurred in 3 patients (2 respiratory infections, and 1 intraoperative bleeding). There was no mortality. Only one case needed conversion to open adrenalectomy; no patients required reintervention. Conclusion Laparoscopic adrenalectomy is a safe and effective method in the treatment of adrenal masses and it can be performed with minimal risk and morbidity (AU)

[Laparoscopic adrenalectomy: presentation of 43 cases]. / Adrenalectomía laparoscópica: presentación de 43 casos.

INTRODUCTION: The aim of the study was to present and analyse our experience in laparoscopic adrenalectomy (LA). MATERIALS AND METHODS: Descriptive and retrospective study including LA performed over 8 years, between 2000 and 2008 in our hospital. RESULTS: A total of 43 LA were performed to 41 patients using a transperitoneal lateral approach. Indications for adrenalectomy included hyperaldosteronism (19), non-functioning adenoma (8), phaeochromocytoma (6), Cushing's syndrome (6), metastasis (3) and adrenal primary tumour (1). Median postoperative hospital stay was 3 days and the median size of the masses was 30mm (range: 4-155mm) Complications occurred in 3 patients (2 respiratory infections, and 1 intraoperative bleeding). There was no mortality. Only one case needed conversion to open adrenalectomy; no patients required reintervention. CONCLUSION: Laparoscopic adrenalectomy is a safe and effective method in the treatment of adrenal masses and it can be performed with minimal risk and morbidity.