Laparoscopy versus open surgery for advanced and resectable gastric cancer: a meta-analysis.

BACKGROUND: There are few studies in the literature comparing laparoscopic versus open Gastrectomy, predominantly for advanced gastric cancer (AGC). Most of the available studies and meta-analysis compare both approaches in the early gastric cancer. The meta-analysis, here presented, compares the clinical outcomes between these two procedures for AGC. OBJECTIVES: To evaluate the current status of both partial and total laparoscopic gastrectomy (LG), with regard to its short and long-term outcomes by comparing it to conventional open gastrectomy (OG) for AGC. DATA SOURCES AND REVIEW METHODS: original articles published in English language from January 1991 to October 2009 were searched in the Medline, Embase, Current Contents, Science Citation Index databases and Cochrane Controlled Trials Register. All articles comparing LG and OG for AGC were included, and those comparing outcomes only for early gastric cancer (EGC) were excluded. Clinical appraisal and data extraction were conducted independently by 3 reviewers. Statistical analysis was carried out following the DerSimonian-Laird random effects model. RESULTS: out of 2,344 studies, 7 studies were selected. One prospective randomized controlled trial, one comparative prospective study and five comparative retrospective studies were analyzed. These studies include a total of 452 patients with gastric cancer, 174 patients in the LG and 278 in the OG. The analyzed result variables were operative time, operative blood loss, hospital postoperative stay, number of dissected lymph nodes and cancer-related mortality risk. Compared to OG, LG was a longer procedure: weighted mean difference (WMD) 44 minutes; 95% confidence interval (CI) 20 to 69; I-squared = 91.6%, but was associated with a lower blood loss (WMD -122 cc; 95% CI -208 to -37; I-squared = 90.8%); this was more significant for hospital operative stay (WMD -6.2 days; 95% CI -9.4 to -2.8; I-squared = 67.8%). Moreover there were no significant differences between the two groups concerning the number of dissected lymph nodes (WMD -1.57; 95% CI -3.41 to 0.26; I-squared = 8.3) and no significant differences for cancer-related mortality risk (adjusted for 60 months of follow-up) although there was a tendency toward a protective effect for LG (Odds Ratio 0.53; 95% CI 0.23 to 1.22; I-squared 41%). CONCLUSION: Laparoscopic total and partial gastrectomy for AGC is associated with a longer operative time but lower blood loss and shorter postoperative hospital stay. Moreover there were similar outcomes between both approaches in terms of number of dissected lymph nodes and long-term follow-up (survival).

[Influence of surgeon specialization upon the results of colon cancer surgery. Usefulness of propensity scores]. / Influencia de la especialización del cirujano en los resultados tras cirugía por cáncer de colon. Utilidad de los índices de propensión (propensity scores).

INTRODUCTION: surgeon influence on colorectal cancer surgery outcomes has been repeatedly studied in the scientific literature, but conclusions have been contradictory. Here we study whether surgeon specialization is a determinant factor for outcome in these patients. The importance of propensity scores (PS) in surgical research is also studied. PATIENTS AND METHODS: a retrospective study was performed and medical records were reviewed for 236 patients who were intervened for colon cancer in Castellon General Hospital (Spain). Cases were divided into two groups (specialist and non-specialist surgeons), and both 5-year surveillance and disease free survival were compared. Comparisons were first made with no adjustments, and then subsequently using PS analysis. RESULTS: the initial (non-adjusted) analysis was clearly favourable for the specialist surgeon group (5-year surveillance, 64.3 vs. 79.3%, p = 0.028). After adjusting for PS no statistical significance was obtained. CONCLUSIONS: surgeon specialization had no significant impact on patient outcome after colon cancer surgery. Propensity score analysis is an important tool in the analysis of surgical non-randomized studies, particularly when events under scrutiny are rare.

Quiste mesentérico. Experiencia en 4 casos / Mesenteric cyst. Our experience in 4 cases

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Laparoscopic colectomy for primary colonic lymphoma.

Primary colorectal lymphoma is an infrequent disease of unknown origin and with a growing incidence. Differentiation be-tween primary lymphoma and secondary colorectal involvement is of great therapeutic and prognostic importance. The diagnosis must always be based on histological findings. Different forms of presentation have been described, though all are nonspecific. While full agreement on the best management approach for colorectal lymphoma is lacking, surgical resection is usually the treatment of choice. The role of chemotherapy has not been defined. This study reports on a case of primary lymphoma in the cecum, with clinical manifestations in the form of meteorism and early satiety. The diagnosis was established by colonoscopy and biopsy. The absence of lymph-node involvement, tumor size, existing cardiopulmonary risk factors, and the fact that a full resection of the malignancy proved possible, with tumor-free resection margins, led us to exclude adjuvant chemotherapy. After one year of follow-up the patient remains disease-free.

Tratamiento del linfoma primario de colon mediante colectomía laparoscópica / Laparoscopic colectomy for primary colonic lymphoma

El linfoma primario colorrectal es una enfermedad muy infrecuente,de causa desconocida y con una incidencia en aumento.Diferenciar entre el linfoma primario y la afectación colorrectal secundariaen el linfoma sistémico es de elevada importancia terapéuticay pronóstica. El diagnóstico ha de ser siempre histológico.Se han descrito diferentes formas de presentación, pero todasellas inespecíficas. No existe un total acuerdo sobre cuál es el mejortratamiento del linfoma colorrectal. La resección quirúrgicasuele ser el procedimiento de elección, sin haberse definido el papelde la quimioterapia. Presentamos un caso de linfoma primariolocalizado en el ciego, cuyas manifestaciones clínicas fueron meteorismoy saciedad precoz, siendo diagnosticado mediante colonoscopiay biopsia. La resección asistida por laparoscopia fue eltratamiento de elección. La no afectación ganglionar, tamaño tumoral,resección completa con márgenes libres, así como los factoresde riesgo cardiopulmonares del paciente, llevaron a desestimarla quimioterapia adyuvante. Tras un año de seguimiento elpaciente se encuentra libre de enfermedad

Primary colorectal lymphoma is an infrequent disease of unknownorigin and with a growing incidence. Differentiation betweenprimary lymphoma and secondary colorectal involvement isof great therapeutic and prognostic importance. The diagnosismust always be based on histological findings. Different forms ofpresentation have been described, though all are nonspecific.While full agreement on the best management approach for colorectallymphoma is lacking, surgical resection is usually the treatmentof choice. The role of chemotherapy has not been defined.This study reports on a case of primary lymphoma in the cecum,with clinical manifestations in the form of meteorism and earlysatiety. The diagnosis was established by colonoscopy and biopsy.The absence of lymph-node involvement, tumor size, existing cardiopulmonaryrisk factors, and the fact that a full resection of themalignancy proved possible, with tumor-free resection margins,led us to exclude adjuvant chemotherapy. After one year of follow-up the patient remains disease-free