Surgical Outcomes of Laparoscopic-assisted Distal Gastrectomy Versus Totally Laparoscopic Distal Gastrectomy Billroth I for Gastric Cancer.

OBJECTIVE: The present study aimed to compare intraoperative and postoperative outcomes of laparoscopic-assisted distal gastrectomy versus totally laparoscopic distal gastrectomy (TLDG) Billroth I (BI) for gastric cancer and to assess the impact of the initial introduction phase of TLDG BI anastomosis. PATIENTS AND METHODS: The study analyzed the prospectively collected data of patients who underwent laparoscopic distal gastrectomy BI from 2014 to 2021 at Seoul National University Hospital. RESULTS: Among 1116 patients, laparoscopic-assisted distal gastrectomy BI was performed in 566 patients and TLDG BI was performed in 550 patients. The total laparoscopic arm had a faster mean operative time (190 vs 208 min; P < 0.001) and a shorter postoperative hospital stay (7.4 vs 7.9 d; P < 0.001). Local complications were higher in the total laparoscopic group (17.6% vs 9.9%; P = 0.008) during the early introduction phase. CONCLUSION: The total laparoscopic approach for BI reconstruction is safe and effective with faster operative time, shorter hospital stays, and less wound infection, but it may be associated with an increase in postoperative surgical complications and hospital stay in the early introduction phase.

Surgery for Locally Advanced GIT Cancers Has Potentially Good Postoperative Outcomes in a Tertiary Hospital.

BACKGROUND: Adhesions and infiltration into adjacent tissues are present in about 12% of gastrointestinal (GIT) cancers. These adhesions have high potential risk of malignancy. Free resection margin is a predictor of good survival in such patients. This study aims at evaluating the post-operative outcomes after multi-visceral resection of locally advanced gastrointestinal cancers. PATIENTS AND METHODS: Ninety patients who underwent extended and multi-visceral resection for GIT cancers invading or adhering to adjacent organs have been included. RESULTS: For gastric cancer, distal gastrectomy was performed for 12% of the cases and total gastrectomy in 20%. For recto-sigmoid cancer, anterior resection was performed in 18% and abdomino-perineal resection in 7%. Partial colectomy was performed for colonic cancer in 43% of the cases. One organ was excised with GIT tumor in 60 cases (67%). The other 30 cases (33%) required excision of more than one organ. Pathological invasion of adjacent organs was confirmed in 42% of cases. Free margins were obtained in 87% of patients. Morbidity rate was 51%. The most frequent complications were wound infection (17%), anastomotic leak (10%), and chest infection (10%). In this study, 19% required surgical re-intervention. Positive margin and positive lymph nodes (LNs) as well as mucoid adenocarcinoma were associated with a higher recurrence rate. CONCLUSION: Achieving free resection margins could be a safe and feasible procedure and may offer good prognosis when followed by adjuvant therapy for patients with locally advanced GIT cancer if patients were precisely selected to have procedure done in a high volume center.

Impact of reconstruction methods and pathological factors on survival after pancreaticoduodenectomy.

BACKGROUND: Surgery remains the mainstay of therapy for pancreatic head (PH) and periampullary carcinoma (PC) and provides the only chance of cure. Improvements of surgical technique, increased surgical experience and advances in anesthesia, intensive care and parenteral nutrition have substantially decreased surgical complications and increased survival. We evaluate the effects of reconstruction type, complications and pathological factors on survival and quality of life. MATERIALS AND METHODS: This is a prospective study to evaluate the impact of various reconstruction methods of the pancreatic remnant after pancreaticoduodenectomy and the pathological characteristics of PC patients over 3.5 years. Patient characteristics and descriptive analysis in the three variable methods either with or without stent were compared with Chi-square test. Multivariate analysis was performed with the logistic regression analysis test and multinomial logistic regression analysis test. Survival rate was analyzed by use Kaplan-Meier test. RESULTS: Forty-one consecutive patients with PC were enrolled. There were 23 men (56.1%) and 18 women (43.9%), with a median age of 56 years (16 to 70 years). There were 24 cases of PH cancer, eight cases of PC, four cases of distal CBD cancer and five cases of duodenal carcinoma. Nine patients underwent duct-to-mucosa pancreatico jejunostomy (PJ), 17 patients underwent telescoping pancreatico jejunostomy (PJ) and 15 patients pancreaticogastrostomy (PG). The pancreatic duct was stented in 30 patients while in 11 patients, the duct was not stented. The PJ duct-to-mucosa caused significantly less leakage, but longer operative and reconstructive times. Telescoping PJ was associated with the shortest hospital stay. There were 5 postoperative mortalities, while postoperative morbidities included pancreatic fistula-6 patients, delayed gastric emptying in-11, GI fistula-3, wound infection-12, burst abdomen-6 and pulmonary infection-2. Factors that predisposed to development of pancreatic leakage included male gender, preoperative albumin < 30g/dl, pre-operative hemoglobin < 10g/dl and non PJ-duct to mucosa type of reconstruction. The ampullary cancers presented at an earlier stage and had a better prognosis than pancreatic cancer and cholangiocarcinoma. Early stage (I and II), negative surgical margin, well and moderate differentiation and absence of lymph node involvement significantly predicted for longer survival. CONCLUSIONS: PJ duct-to-mucosa anastomosis was safe, caused least pancreatic leakage and least blood loss compared with the other methods of reconstruction and was associated with early return back to home and prolonged disease free and overall survival.

Breast cancer: surgery at the South egypt cancer institute.

Breast cancer is the most frequent malignant tumor in women worldwide. In Egypt, it is the most common cancer among women, representing 18.9% of total cancer cases (35.1% in women and 2.2% in men) among the Egypt National Cancer Institute's (NCI) series of 10,556 patients during the year 2001, with an age-adjusted rate of 49.6 per 100,000 people. In this study, the data of all breast cancer patients presented to the surgical department of the South Egypt cancer Institute (SECI) hospital during the period from Janurary 2001 to December 2008 were reviewed .We report the progress of the availability of breast cancer management and evaluation of the quality of care delivered to breast cancer patients. The total number of patients with a breast lump presented to the SECI during the study period was 1,463 patients (32 males and 1431 females); 616 patients from the total number were admitted at the surgical department .There was a decline in advanced cases. Since 2001, facilities for all lines of comprehensive management have been made accessible for all patients. We found that better management could lead to earlier presentation, and better overall outcome in breast cancer patients.The incidence is steadily increasing with a tendency for breast cancer to occur in younger age groups and with advanced stages.

Simultaneous treatment of unresectable hepatocelluar carcinoma and hepatic artery aneurysm, case report.

INTRODUCTION: Hepatic artery aneurysm is uncommon with an estimated incidence of less than 0.25%. Because most patients are asymptomatic, the diagnosis is usually made as an incidental finding on imaging studies performed for other reasons. Because of their propensity to rupture with potential catastrophic intraperitoneal hemorrhage, early diagnosis is important. Herein, relatively asymptomatic aneurysm of the common hepatic artery mostly of atherosclerotic etiology is presented. The importance of imaging findings in the diagnosis of this condition is discussed and relevant literature is reviewed (1, 2). Hepatocellular carcinoma (HCC) ranks among the most common malignancies worldwide, and the prognosis for patients with HCC is typically poor. Chemoembolization has become the mainstay of treatment for patients with unresectable HCC. Transcatheter arterial chemoembolization is intended to deliver a highly concentrated dose of chemotherapy to tumor cells, prolong the contact time between the chemotherapeutic agents and the cancer cells, and minimize systemic toxicity. Ideally, achieving these goals will result in a tumor shrinkage, symptomatic relief, improved quality of life, and increased patient survival (3). METHODS: We will present a case of male patient, 72 years old, who was referred for transcatheter arterial chemoembolization for unresectable hepatocelluar carcinoma. RESULTS: Helical CT scan showed right lobe mass infiltrating the peritoneum with enhancement in the early arterial phase together with hepatic artery aneurysm that was successfully treated at the same time using emulsion of N-butyl cyanoacylate and lipodol with a concentration of 1:1. CONCLUSION: Hepatic artery aneurysms are uncommon lesions that have varied clinical presentations. Early diagnosis is essential because the natural tendency of the lesion is to rupture into peritoneal cavity or surrounding organs. Chemoembolization has become the mainstay of treatment for patients with unresectable HCC. Our case is notable, because atherosclerotic aneurysms of the hepatic artery are extremely rare with very few cases reported so far and to diagnose a hepatic artery aneurysm and to treat it in one setting with chemoembolization of unresectable HCC without rupture of the aneurysm is also unusual.

Pancreatic endocrine neoplasm can mimic serous cystadenoma.

A 57-yr-old female patient was referred to our hospital with a cystic lesion of the head of the pancreas that had been noted on abdominal computed tomography (CT). Endoscopic ultrasonography (EUS) showed a 3.0 cm rounded mass in the head of the pancreas. EUS images showed that the tumor had a solid component consisting of multiple microcysts separated by septae and a cystic component consisting of a macrocystic lesion. Thus, the tumor was suspected of being a serous cystadenoma (SCA). However, the histopathological diagnosis based on endoscopic ultrasound- guided fine-needle-aspiration biopsy (EUS-FNAB) was that of a pancreatic endocrine neoplasm (PEN). Surgical resection was performed. Despite having very similar macroscopic findings to SCA, microscopic examination revealed that the patient's tumor was definitely a PEN. This case suggests that it is very difficult to distinguish PENs from SCAs based solely on imaging methods. EUS-FNAB is essential for determining the appropriate therapeutic strategy, as it provides the histopathological diagnosis.