RESUMO
BACKGROUND: Lymph node metastasis is one of the most important prognostic factors in gastric cancer survival. Sentinel lymph node (SLN) mapping and biopsy may reduce the extension of lymph node dissection by determination of lymph node involvement. The current study prospectively evaluates the feasibility and reliability of SLN biopsy in gastric cancer. METHODS: A total of 30 patients with gastric cancer with a preoperative imaging stage of T1-T2 or T3, N0 and M0 were enrolled in the study. Furthermore, 2-16 h prior to each operation, (99m) Tc-sulphur colloid solution (0.5 mL, 2 mCi/mL) was endoscopically injected into the submucosal layer around the primary lesion. Lymph nodes were examined using a hand-held gamma probe. Subsequently, a total or subtotal gastrectomy and D2 lymphadenectomy was performed in each patient. RESULTS: The success rate of SLN biopsy was 100%. Sensitivity, specificity, positive predictive value and negative predictive value were 91.7%, 100%, 100% and 75%, respectively. Both of the two false-negative cases were in the T3 group. In cases of T2 tumours, the sensitivity was 100%. DISCUSSION: SLN biopsy using a gamma probe in early stage gastric cancer seems to be a safe, feasible and accurate procedure with high sensitivity in predicting regional lymph node involvement.
Assuntos
Adenocarcinoma/secundário , Linfonodos/patologia , Traçadores Radioativos , Biópsia de Linfonodo Sentinela , Neoplasias Gástricas/patologia , Adenocarcinoma/cirurgia , Adulto , Idoso , Idoso de 80 Anos ou mais , Intervalo Livre de Doença , Estudos de Viabilidade , Feminino , Gastrectomia/métodos , Humanos , Linfonodos/cirurgia , Metástase Linfática , Masculino , Pessoa de Meia-Idade , Invasividade Neoplásica/patologia , Estadiamento de Neoplasias , Valor Preditivo dos Testes , Cuidados Pré-Operatórios/métodos , Prognóstico , Estudos Prospectivos , Medição de Risco , Sensibilidade e Especificidade , Neoplasias Gástricas/cirurgia , Taxa de Sobrevida , Resultado do TratamentoRESUMO
PURPOSE: Lateral internal sphincterotomy has been the gold standard treatment for chronic anal fissure, but it still carries the risk of permanent damage of the anal sphincter, which has led to the implementation of alternative treatment like botulinum toxin injection. The aim of this randomized prospective controlled trial was to compare the efficacy and morbidity of botulinum toxin injection and lateral internal sphincterotomy in the treatment of chronic anal fissure. METHODS: Fifty consecutive adults with chronic anal fissure were randomly treated with either lateral internal sphincterotomy or botulinum toxin (BT) injection with 50 U BT into the internal sphincter. The complications, healing and recurrence rate, and incontinence score were assessed 2, 3, 6, 12 months after the procedure. RESULTS: Inspection at the 2-month visit revealed complete healing of the fissure in 11 (44 %) of the patients in the BT group and 22 (88 %) of the patients in the lateral internal sphincterotomy (LIS) group (p = 0.001). At the 3-month visit, there was no significant difference between the two groups in healing. The overall recurrence rate after 6 months in the BT group was higher than in the LIS group (p < 0.05). In the 3-month follow-up, the LIS group had a higher rate of anal incontinence compared to the BT group (p < 0.05). The final percentage of incontinence was 4 % in the LIS group (p > 0.05). CONCLUSIONS: The treatment of chronic anal fissure must be individualized depending on the different clinical profiles of patients. Botulinum toxin injection has a higher recurrence rate than LIS, and LIS provides rapid and permanent recovery. However, LIS carries a higher risk of anal incontinence in patients.
