Laparoscopic gastrectomy for gastric adenocarcinoma. Long-term results.

BACKGROUND: The objective of our paper is to report on the long-term results of patients with gastric cancer treated by mini-invasive surgery with "intention-to-treat" laparoscopy. PATIENTS AND METHODS: Between June 1993 and January 2006, 130 patients comprising 94 men and 36 women with gastric adenocarcinoma were prospectively selected by two surgical teams in three hospitals based on a prior agreement (CHU Charleroi, Belgium, Centre Hospitalier de Luxembourg and Zumárraga Hospital, Spain). Patients with adenocarcinoma of the cardia were excluded. Mean age of patients was 68 years (range, 37-85 years). RESULTS: Post-operative mortality within 60 days of operation was 6 patients; 109 patients were therefore properly followed up for an average of 49 months (range, 2-153 months).Average survival time for 10 non-resected patients was 4.5 months. Average survival rate for all 14 palliatively resected patients was 6.9 months. Actuarial 5-year survival rate for R0-type surgery was 35%. Global actuarial 5-year survival rate after resective surgery was 31%. CONCLUSIONS: Laparoscopic gastrectomy with any kind of lymphadenectomy is a major but safe operation with acceptable mortality and morbility rates in patients with advanced gastric cancer, usually in poor general condition. Laparoscopic gastrectomy for locally advanced cancers is equivalent to laparotomy as far as long-term oncological results are concerned.

MRI and endoscopic ultrasonography in the staging of gastric cancer.

OBJECTIVE: to determine the diagnostic precision of endoscopic ultrasounds (EUS) and magnetic resonance imaging (MRI) in the preoperative staging of gastric cancer. METHODS: a prospective, blind study was carried out in 17 patients diagnosed with gastric cancer (GC) using endoscopic biopsy from November 2002 to June 2003. Patients underwent preoperative MRI and EUS. The reference test used was pathology, and laparotomy for non-resectable cases. RESULTS: MRI (53%) was better than EUS in the assessment of gastric wall infiltration (35%). MRI (50%) was also superior to EUS (42%) for N staging. After pooling stages T1-T2 and T3-T4 together, results improved for both MRI (67 and 87.5%, respectively) and EUS (67 and 62.5%, respectively) (p < 0.05). N staging--lymph node invasion--results were correct in 50% for MRI as compared to EUS (42%). In classifying positive and negative lymph nodes EUS was superior to MRI (73 versus 54%). CONCLUSIONS: MRI was the best method in the assessment of gastric wall infiltration. EUS was superior to MRI for T1 staging, and in the assessment of lymph node infiltration.

The value of colonoscopy to assess rectal bleeding in patients referred from Primary Care Units.

OBJECTIVES: Rectal bleeding is very common in the general population. It is produced mainly because of benign disease originating in the anus and the rectum. Our aim was to evaluate the need for colonoscopy in patients presenting with rectal bleeding. PATIENTS AND METHODS: Patients referred from Primary Care Units and complaining of rectal bleeding were included prospectively in a three-month study. All patients underwent a careful medical history along with physical examination, laboratory tests, and colonoscopy. RESULTS: 126 patients with a mean age of 49.2 years (range: 19-80) were studied. Rectal digital examination was abnormal in 75 cases (59.5%). Severe disease was encountered in 22 patients (neoplasm, angiodysplasia, and inflammatory bowel disease); 10 patients had polyps, 6 had colorectal cancer, and 6 had inflammatory bowel disease. Out of 63 patients younger than 50 years, 5 had severe disease, all of them in the form of inflammatory bowel disease. CONCLUSIONS: A neoplasm of the rectum and colon in patients younger than 50 years is a rare event. A colonoscopy must be performed in this group of patients to rule out inflammatory bowel disease.

Preoperative platelet count in pancreas cancer: a prognostic factor?

AIM: To determine whether preoperative platelet count influenced the prognosis for surgical treatment of pancreas cancer. METHODS: Retrospective study of 144 patients operated on for pancreatic cancer: 49 with adenocarcinoma, operable with curative intent (group A), 86 in whom palliative resection or bypass was done (group B), and 9 in whom exploratory laparotomy was done. Preoperative platelet count was done for all patients. Groups A and B were divided into 2 subgroups (> 200,000 platelets/mm3 and < 200,000 platelets/mm3), and an additional subgroup was established for patients with > 300,000 platelets/mm3. Survival was analyzed in the resulting subgroups. RESULTS: Among patients who underwent curative resection, statistical analysis revealed significantly better survival (p < 0.05) in patients with a platelet count > 200,000 platelets/mm3 and a very significant difference (p < 0.01) in the 300,000 platelets/mm3 subgroup. No differences were found in the subgroups of patients who underwent palliative surgery. CONCLUSION: Preoperative platelet count may represent a prognostic factor in patients with pancreatic cancer operated on with curative intent. Our findings justify the need for clinical trials of antiangiogenic therapy.

Colonic volvulus.

OBJECTIVE: To review the incidence of volvulations in our workplace, to study the procedures employed in its treatment, and to discuss our results during the last 20 years. MATERIAL AND METHODS: A series of colonic volvulus treated between 1978 and 1998 at one hospital is presented. RESULTS: We reviewed 41 cases. Volvulus locations are: sigmoid colon: 21, caecum: 17, transverse colon: 2, and splenic flexure: 1. Mortality rates according to the type of volvulus and type of operative procedure is analyzed. Four cases of volvulus recurrence (9%). CONCLUSIONS: Treatment guidelines for the approach to colonic volvulus are presented.

[Prognostic significance of delayed cutaneous reactivity in 5-year survival in colorectal cancer: a prospective study]. / El valor pronóstico de la reactividad cutánea retardada en la supervivencia a 5 años en el cáncer colorrectal: un estudio prospectivo.

A series of 84 patients operated on for colorrectal cancer-Duke's stages A:6, B:22, C:51 and D:5- are studied prospectively and with a 5 year follow-up. All of them were treated in the same hospital and with identical criteria during a period of time of two years. Immunoglobulins (A, G, M) and skin reactivity measured through a multiantigen device were determined preoperatively and at 48 hours and 30 days after operation. Data analysis was done once real survival at 5 years was known. Immunoglobulins changes showed no significance in relation to survival in this series. Preoperative skin reactivity values measured in mms demonstrated prognostic significance for patients in stage C when considering survivors -p < 0.05- and decreased -p < 0.01- at five years. Numerical values of skin reactivity done with a delayed hypersensitivity multiantigen compound may represent and additional prognostic factor to be considered in advanced colorrectal cancer patients.

Cystic neoplasms of the pancreas: a series.

MATERIAL AND METHODS: a series of 23 cases with cystic pancreatic neoplasms studied and treated between December 1977 and December 2001 out of 297 cases of pancreatic neoplasms is presented. RESULTS: 16/23 were true pancreatic cystic neoplasms: 9 microcystic adenomas and 6 mucinous cystoadenoma type. There were also 2 hydatid cysts, 1 lymphangioma, 2 cases of tuberculosis involving de pancreas, 1 lymphoma and 1 papillary cystic tumor type. CONCLUSIONS: true cystic tumors of the pancreas accounts for 5,8% of the neoplasms studied in our hospital.