Prevention of delayed gastric emptying after right colectomy with extended lymphadenectomy: A randomized controlled trial.

BACKGROUND: Delayed gastric emptying sometimes occurs after right colectomy with extended lymphadenectomy. The aim of this randomized controlled trial is to evaluate the effect on delayed gastric emptying after performing a fixation of the stomach to the retrogastric tissue to return the stomach to a physiological position after right colectomy with lymphadenectomy, including gastrocolic lymph nodes dissection for proximal transverse colon cancer. METHODS: From January 2015 to December 2020, patients undergoing right colectomy with extensive lymphadenectomy for proximal transverse colon cancer were randomly assigned to either the gastropexy group or the conventional group. In the gastropexy group, the posterior wall of the stomach, at the level of the antrum, was sutured to the retrogastric tissue to prevent the abnormal shape that the gastric antrum acquires together with the duodeno-pancreatic complex, the shape that leads to an obstruction of the antrum region and to the delay in emptying the gastric contents. RESULTS: Mean age, sex, comorbidities, and right colectomy procedures were similar in the 2 groups. Delayed gastric emptying developed in twelve patients in the conventional group (38.7%) versus 4 patients (12.1%) in the gastropexy group (P = .014). The total number of complications was higher in the conventional group (14 complications) than in the gastropexy group (7 complications). According to univariate analysis, gastropexy significantly lowered the risk of delayed gastric emptying (P = .014). Overall morbidity was 9.7% in the conventional group versus none in the gastropexy group. Postoperative hospitalization was longer in the conventional group (7.61 ±â€…3.26 days) than in the gastropexy group (6.24 ±â€…1.3 days; P = .006). CONCLUSION: Gastropexy decreases the occurrence of delayed gastric emptying after right colectomy with extended lymphadenectomy for proximal transverse colon cancer.

NET G3 vs NEC: p53 and Rb1 Immunolabeling in High-grade Gastrointestinal Neuroendocrine Neoplasms - Is It Enough for the Differential Diagnosis?

BACKGROUND AND AIMS: High-grade gastrointestinal neuroendocrine neoplasms (GI-NENs) are divided into well-differentiated G3 neuroendocrine tumors (NETs G3) and neuroendocrine carcinomas (NECs), having identical cut-offs of proliferation, but different biomolecular origins. This translates in distinct treatment choices. Our aim was to establish if p53/Rb1 immunohistochemical status in GI-NENs with Ki67 index >20% can predict the histopathological diagnosis. METHODS: p53/Rb1 immunolabelling was performed on 42 cases of high-grade GI-NENs, diagnosed as NET G3, NEC and mixed neuroendocrine-non-neuroendocrine neoplasms (MiNEN) with NEC component. Immunolabeled slides were digitally scanned, with automatic quantification of p53 and Rb1, blind to the diagnosis. RESULTS: The p53 positive percentage was stratified; two cut-offs were selected, naming the intervals as N (null, <1%), T (tumor, 1%-20%) and C (carcinoma, >20%). The Rb1 expression loss in >90% of neoplastic cells was considered mutational. NETs G3 mainly showed the T status (14/16, 87.5%), followed by N (1/16, 6.25%) and C (1/16, 6.25%); NECs and NEC components in MiNENs predominantly expressed the C status (19/26, 73.08%), followed by N (5/26, 19.23%) and T (2/26, 7.69%) (p<0.001, χ 2 =27.017). NET G3s showed positive expression for Rb1; 73.08% of NECs expressed negative Rb1 (p<0.001, χ 2 =21.351). NECs and NEC components in MiNENs showed Rb1 mutational status in 13 C cases (13/19, 68.42%), 4 N cases (4/5, 80%) and in both the T cases (p=0.002, χ 2 =11.187). CONCLUSIONS: Our results highlight the correlations between the p53/Rb1 immunostainings and the histopathological diagnosis of high-grade GI-NENs. NECs and NEC components in MiNENs showed a p53 mutational status (0% or 21-100%) and predominantly negative Rb1 expression. NETs G3 showed a p53 wild-type status (1-20%) and retained Rb1 expression. These findings suggest that the differential diagnosis of high-grade GI-NENs may benefit from p53/Rb1 immunohistochemical tests in everyday practice.

Diffuse large B cell lymphoma CD5-positive arising in an immune deficiency and immune dysregulation setting: A case report and brief review of the literature.

RATIONALE: In the era of antiretroviral therapy, lymphoma is the primary cause of cancer-related death among human immunodeficiency virus (HIV)-infected people and the most prevalent and aggressive non-Hodgkin lymphoma is diffuse large B cell lymphoma, which usually has an aggressive clinical course. CD5-positive diffuse large B cell lymphoma (DLBCL) is an insufficiently studied, relatively new entity, which accounts for 5% to 10% of the DLBCL population. The current study presents the clinicopathological features, diagnostic approach, and clinical outcomes of this HIV-related lymphoma and highlights the importance of the early diagnosis of CD5-positive DLBCL. PATIENT CONCERNS: We present a case of a 30-year-old male patient, with a medical history of HIV-positive serology and antiviral treatment, presenting with diffuse abdominal pain and symptoms related to obstruction or perforation, followed by exploratory laparotomy and surgical resection of the small intestine with other areas of involvement. The surgical specimen was morphologically evaluated and immunohistochemical stained. DIAGNOSES AND INTERVENTIONS: Histopathologic examination revealed a diffuse neoplastic proliferation of large B lymphocytes within the small intestine, lacking features of other defined types of large B cell lymphoma. The diagnosis of CD5-positive DLBCL subtype was made after immunostaining with twelve monoclonal antibodies (CD3, CD5, CD10, CD20, CD23, CD30, CD68, Cyclin D1, MUM1, Bcl2, Bcl6, and Ki-67). The expression profile of immunohistochemical markers (CD10, Bcl6, and MUM1) established the cell of origin of this case of DLBCL by using the Hans algorithm. LESSONS: The current report highlights the importance of early diagnosis of CD5-positive DLBCL because of its poor prognosis and calls attention to the critical importance to identify immunodeficiencies because doing so affects the types of treatments available. Although cell-of-origin is useful for predicting outcomes, the germinal center B cell like and activated-B cell like subtypes remain heterogeneous, with better, and worse prognostic subsets within each group.

Residual Gallbladder and Cystic Duct Stump Stone after Cholecystectomy: Laparoscopic Management.

Background: Cholecystectomy is the standard treatment for symptomatic gallstones, and the persistence of symptoms after surgery defines postcholecystectomy syndrome. Biliary causes of postcholecystectomy syndrome include subtotal cholecystectomy and remnant cystic duct stump stone; causes that are encountered with a low frequency, but which require diagnosis and provocative treatment. Laparoscopic management of such cases is recommended, but requires well-trained teams in laparoscopic surgery. Methods: This study is a retrospective analysis of patients who required surgical treatment for residual gallbladder and cystic duct stump stone after a cholecystectomy, hospitalized in the Surgery Department of Constanta County Hospital, who required completion of resection and were operated laparoscopically. Results: Between January 2010 and March 2020, 14 patients were hospitalized with residual gallbladder and cystic duct stump stone that required surgery. All patients underwent laparoscopic surgery. Symptomatology was dominated by recurrent biliary colic (50%). The period between the primary surgery and the surgery to complete the resection varied between 2-22 years. There were 4 cases of subtotal cholecystectomies, and 10 cases of remnant cystic duct stump stones. Intraoperative complications were encountered in only one case (7.14%), the number of days of hospitalization was on average 3 days. No patient showed any symptoms at 6-month postoperative follow-up. Conclusions: Postcholecystectomy syndrome is difficult to diagnose, symptomatic patients with remnant cystic duct stump stone/ subtotal cholecystectomy requiring surgery are difficult to manage. Laparoscopic surgery is preferred for the benefits that laparoscopic surgery brings, but requires an experienced surgeon in advanced laparoscopic techniques.

Ventralex® ST Patch for Laparoscopic Repair of Ventral Hernias.

INTRODUCTION: The surgical approach for treating ventral hernia is still under debate, as well as the optimal devices to be used for such treatment. For small size defects, the tendency is to use the open approach, due to the lower cost/efficiency ratio. However, for medium-size defects, even though costlier, laparoscopy provides better results. The present study analyzes the results of a simple and effective laparoscopic technique for mesh repairing of small and medium size ventral defects using Ventralex® ST patch. METHOD: Between January 1, 2015 and January 31, 2020, 93 patients with ventral primary nonobstructive abdominal wall defects (up to 3 cm) treated laparoscopically using the intraperitoneal onlay mesh repair technique with Ventralex® patch (22 patients) and Ventralex® ST patch (71 patients). Results were prospectively analyzed based on postoperative complications, postoperative pain, recurrent hernia, and quality of life. RESULTS: The technique was used in 60 patients with umbilical hernia (64.5%), 18 patients with juxta-umbilical hernia (19.3%), and 15 patients with epigastric hernia (16.1%). Out of these, 22 patients had nonreducible (nonobstructive) hernia. The median operating time was 55 minutes (range 40-80 min). Minor complications were recorded in 15 cases (16.1%). The mean hospitalization time was 1.24 days (range 1-2). After a median follow-up of 39 months (range 20-81), the recurrence rate was 11.1% and nil (p = 0.010), and other complaints were recorded in 11.1% and 3.3% of patients (p = 0.293), for Ventralex® patch and Ventralex® ST patch, respectively. CONCLUSIONS: In conclusion, the use of Ventralex® ST patch for laparoscopic intraperitoneal onlay mesh repair of small and medium size ventral hernia is simpler and more cost-effective than standard laparoscopic patches, with superior results when compared to Ventralex® patch.