Surgical Outcomes of Laparoscopic Resection for Subepithelial Lesions on the Gastric Fundus Performed in the Supine or Lateral Decubitus Position.

BACKGROUND: Laparoscopic resection of gastric subepithelial lesions (SELs) located on the posterior wall of the gastric fundus is technically difficult and time-consuming. To facilitate access, we propose performing the laparoscopic procedure with patients in a right lateral decubitus position, rather than the standard supine position. The aim of our study was to compare operative and clinical outcomes for laparoscopic SEL resection performed in either the right lateral decubitus or the traditional supine position. METHODS: The analysis was based on the data of 62 patients who underwent laparoscopic resection of SELs of the gastric fundus at Chonnam National University Hospital: 30 patients in the supine position (SUP) group and 32 in the right lateral decubitus position (RLD) group. All surgeries were performed by a single surgeon. Between-group comparisons were evaluated by Student's t, chi-squared, or Fisher's least squared tests, as appropriate for the data set. RESULTS: Compared with the SUP group, the RLD had shorter operative time (103 minutes versus 52 minutes, P < .001), less intraoperative blood loss (71 mL versus 31 mL, P < .001), and lower C-reactive protein levels on postoperative days 1 and 2 (P < .005). Time to first flatus and length of hospital stay were comparable between groups. CONCLUSION: Laparoscopic gastric wedge resection for SELs on the gastric fundus in the right lateral decubitus position is feasible and safe, and provides operative advantages over the supine position.

Clinicopathological features of female gastric carcinoma patients with curative resection: comparison with male patients.

Little is known about the clinicopathological features of female gastric carcinoma (FGC) patients. We compared the clinicopathologic features and outcomes of FGC patients with curative resection with those of male gastric carcinoma (MGC) patients. We reviewed the hospital records of 940 FGC patients between 1986 and 2005 at Chonnam National University Hospital. Multivariate analysis showed that presence of serosal invasion, lymph node metastasis, and operative type were significant prognostic factors for survival of FGC patients with curative resection. Furthermore, the overall 5-year survival rate of FGC patients with curative resection (53.4%) was higher than that of MGC patients (47.6%, p<0.05). In advanced cases, no significant difference was observed in the overall 5-year survival rate between the FGC and MGC patients (41.6% vs 37.4%, p>0.05). Therefore, serosal invasion, lymph node metastasis, and type of operation were statistically significant parameters associated with survival. Early detection is more important for improving the prognosis of female patients with gastric cancer than for male patients.

Preoperative predictors of malignant gastric submucosal tumor.

PURPOSE: The preoperative prediction of malignant potential in patients with gastric submucosal tumors (SMTs) plays an important role in decisions regarding their surgical management. METHODS: We evaluated the predictors of malignant gastric SMTs in 314 patients with gastric SMTs who underwent surgery in Chonnam National University Hospital. RESULTS: The malignant SMTs were significantly associated with age (odds ratio [OR], 1.067; 95% confidence interval [CI], 1.042 to 1.091; P < 0.0001), presence of central ulceration (OR, 2.690; 95% CI, 1.224 to 5.909; P = 0.014), and tumor size (OR, 1.791; 95% CI, 1.483 to 2.164; P < 0.0001). Receiver operating characteristic curve analysis showed that tumor size was a good predictor of malignant potential. The most relevant predictor of malignant gastric SMT was tumor size with cut-offs of 4.05 and 6.40 cm. CONCLUSION: Our findings indicated that age, central ulceration, and tumor size were significant preoperative predictors of malignant SMTs. We suggest that 4 cm be selected as a threshold value for malignant gastric SMTs. In patients with a gastric SMT larger than 4 cm with ulceration, wide resection of the full thickness of the gastric wall or gastrectomy with adequate margins should be performed because of its malignant potential.

Clinical features and surgical outcome of solid pseudopapillary tumor of the pancreas: 30 consecutive clinical cases.

BACKGROUND/AIM: This study examined the clinical characteristics and surgical outcomes of solid pseudopapillary tumors of the pancreas (SPT). METHODOLOGY: Cases of SPT encountered in our hospital between January 1994 and December 2009 were reviewed retrospectively. The clinicopathological factors in the benign and malignant cases were compared to determine what features of the tumor could suggest malignant potential. RESULTS: Thirty patients with SPT were identified: 26 females and 4 males with a average age of 30.5 years (range 9-66). The median size of the tumors was 6.2cm (range 1.25 to 15.0). Tumors were located in the head (50%), neck (3.3%), body (16.7%) and tail (30%) of the pancreas. Surgical procedures included a local tumor resection (10 cases) or radical resection, such as a pancreaticoduodenectomy (6 cases), central pancreatectomy (1 case) or distal pancreatectomy (13 cases). There was no recurrence after the surgical resection. All patients were alive at a median follow-up of 58 months (range 6 to 187). Among the clinico-pathological factors, the presence of calcification was associated with the malignant potential (OR=16.000, 95% CI=1.451-176.451, p=0.024). CONCLUSIONS: SPT is a less aggressive pancreatic neoplasm that differs from other pancreatic cancers. The prognosis is favorable after a surgical resection. The presence of calcification is a predictive factor for a malignant SPT.

Acute Blindness of Right Eye after Cervical Spine Surgery in the Prone Position: A case report / 대한마취과학회지

We observed a patient who had central retinal artery occlusion with severely reduced visual acuity and characteristic retinal changes after cervical spine surgery under general anesthesia. In acute stage, visual acuity was slightly improved. But over course of several months, there was no improvement in visual acuity and central scotoma was remained. There were no evidences of hypotension or anemia during operation. The only presumptive cause was direct external ocular compression by horseshoe headrest. It is necessary to pay attention to eyes when prone positioning in the patients of cervical spine surgery.

Anesthetic Management of Congenital Tracheal Stenosis with Hypercarbia / 대한마취과학회지

Congenital tracheal stenosis is a rare life-threatening obstruction in infancy and childhood. Symptoms are ranged from recurrent stridor and wheezing to severe respiratory compromise and hypercarbia. If the patient with tracheal stenosis, who has hypercarbia, is hyperventilated to maintain normocarbia, air is trapped in the lung and the risk of pulmonary barotrauma is increased. Cardiopulmonary-bypass is recommended for this patient to have corrective surgery. Permissive hypercapnia is proposed for the mechanical ventilation of patients with severe tracheal stenosis before cardiopulmonary-bypass.