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.

Three ports laparoscopic resection for colorectal cancer: a step on refining of reduced port surgery.

Background. Reduced port surgery (RPS) is becoming increasingly popular for some surgeries. However, the application of RPS to the field of colectomy is still underdeveloped. Patients and Methods. In this series, we evaluated the outcome of laparoscopic colorectal resection using 3 ports technique (10 mm umbilical port plus another two ports of either 5 or 10 mm) for twenty-four cases of colorectal cancer as a step for refining of RPS. Results. The mean estimated blood loss was 70 mL (40-90 mL). No major intraoperative complications have been encountered. The mean time for passing flatus after surgery was 36 hours (12-48 hrs). The mean time for oral fluid intake was 36 hours and for semisolid food was 48 hours. The mean hospital stay was 5 days (4-7 days). The perioperative period passed without events. All cases had free surgical margins. The mean number of retrieved lymph nodes was 14 lymph nodes (5-23). Conclusion. Three ports laparoscopy assisted colorectal surgeries looks to be safe, effective and has cosmetic advantages. The procedure could maintain the oncologic principles of cancer surgery. It's a step on the way of refining of reduced port surgery.

Activation of nuclear factor kappa B and induction of migration inhibitory factor in tumors by surgical stress of laparotomy versus carbon dioxide pneumoperitoneum: an animal experiment.

BACKGROUND: Surgical trauma may be associated with enhanced tumor growth and establishment. The authors studied the effect of carbon dioxide (CO(2)) pneumoperitoneum versus laparotomy on tumor necrosis factor-alpha (TNFalpha), migration inhibitory factor (MIF) expression, and nuclear factor kappa B (NFkappaB) activity in human gastric cancer. METHODS: Nude mice were inoculated intraperitoneally with human gastric cancer cells (MKN45). Then laparotomy, CO(2) pneumoperitoneum, and anesthesia alone were performed randomly. Tumor growth and associated TNFalpha and MIF expression and NFkappaB activity were determined. RESULTS: Total tumor weight, especially at the anterior abdominal wall, was higher after laparotomy than after CO(2) pneumoperitoneum (p < 0.05). The mRNA expression of TNFalpha was higher 24 and 48 h after laparotomy than after CO(2) pneumoperitoneum (p < 0.05 and p < 0.01, respectively). At all the examined time points, MIF mRNA expression also was higher after laparotomy than after CO(2) pneumoperitoneum (p < 0.05 until 1 week or p < 0.01 at 2 weeks). The NFkappaB protein was more activated after laparotomy than after CO(2) pneumoperitoneum 6 h subsequent to surgical procedures. CONCLUSION: After CO(2) pneumoperitoneum, tumors have less TNFalpha and MIF expression and less NFkappaB activity than after laparotomy. This may be associated with less tumor growth, supporting minimal invasive techniques in gastrointestinal oncologic surgery.