Initial results of robot-assisted Ivor-Lewis oesophagectomy with intrathoracic hand-sewn anastomosis in the prone position.

BACKGROUND: There is scanty experience concerning robot-assisted Ivor-Lewis oesophagectomy, so every new experience is helpful. METHODS: We describe the techniques and short-term results of Ivor-Lewis oesophagectomy using a laparoscopic approach and robot-assisted thoracoscopy, and an observational study of prospective surveillance of the first 14 patients treated for oesophageal cancer. A gastric tube was created laparoscopically. Oesophagectomy was performed through a robot-assisted thoracoscopy followed by hand-sewn intrathoracic anastomosis. RESULTS: There were no conversion cases. Mortality was zero. Six patients had a major complication. There were no cases of respiratory complication or recurrent laryngeal nerve palsy. Three patients had a radiological fistula (21.4%), successfully treated by endoscopic stenting, and one (7.1%) had an anastomosis leak needing reoperation. There were two cases of chylothorax (14.3%). CONCLUSIONS: Our initial results suggest that the reported technique is safe and satisfies the oncological principles. It provides the advantages of minimally invasive surgery by overcoming some limitations of conventional thoracoscopy.

[Rectal hemorrhage as the first manifestation of prostatic carcinoma]. / Rectorragia como primera manifestación de un carcinoma prostático.

OBJECTIVES: An uncommon case of prostatic carcinoma presenting as rectal hemorrhage is described. The diagnostic and therapeutic aspects are discussed and the importance of distinguishing this condition from rectal carcinoma is underscored. METHODS/RESULTS: The clinical features of a patient with invasive prostatic carcinoma presenting as rectal hemorrhage are described. CONCLUSIONS: Rectal involvement by invasive prostatic carcinoma should be suspected in patients consulting for a rectal pathology, particularly if the patient has a previous history of prostatism or carcinoma of the prostate. The incidence of rectal involvement by prostatic carcinoma has been reported to range from 1 to 11%.

[Wilms' tumor in Cantabria. Review of our cases (1974-1990)]. / Tumor de Wilms en Cantabria. Revisión de nuestra casuística (1974-1990).

We reviewed the records of patients with genitourinary tumors that had been diagnosed and treated at the Section of Pediatric Surgery of Marqués de Valdecilla Hospital from 1974 to 1990. There were 14 such tumors. Of these, 12 (85.7%) were Wilm's tumor. This tumor type is the subject of the present study. Regarding its clinical features, 33.3% of the cases consulted for hematuria and an abdominal mass was the most common finding in the course of the disease (83%). We underscore the usefulness of CT and ultrasound in making the diagnosis. In the cases where these noninvasive imaging techniques were used, their efficacy rate was 100%. Together with IVP, these constitute the fundamental diagnostic tools. With regard to treatment, radical nephrectomy was performed in all cases and combined with radio and chemotherapy according to protocol. Pathological examination confirmed the diagnosis of Wilms' tumor in all the cases. Following the NWTS classification, there were 2 stage I,5 stage II, 2 stage III and 3 stage IV. Apart from tumor stage, the histological features significantly influenced the diagnosis. The survival rates for those with favourable or unfavourable histologic features were 70% and 36%, respectively.