Risk factors for peritoneal dissemination of gastric cancer.

AIM: Tumor dissemination, lymphnode involvement and surgical resection technique are the most important factors affecting patient prognosis with gastric cancer. Peritoneal dissemination adversely affects the survival rate in patients. Microscopic peritoneal dissemination can be detected with peritoneal lavage cytological examination. Peroperatively detected microscopic peritoneal dissemination changes the treatment plan for patients and can be useful when selecting patients who should undergo adjuvant chemotherapy. METHODS: At the Trakya Universtity Faculty of Medicine, General Surgery Department, a 41-year-old patient who was macroscopic peritoneal dissemination during the dates January-December 2011 was included in the study. Perioperative peritoneal lavage was performed and cytological examination of peritoneal aspirate carried out. Using tumor markers the relationship between lymph node metastasis, prognostic type, tumor location and perineural invasion was investigated on the serum and peritoneal fluid. RESULTS: Forty-one patients were operated on; 10 of them (24.4%) had positive malignant cytology and 31 (75.7%) had negative cytology. Just 1 (7.2%) patient was found to have positive cytology out of 13 (31.7%) that did not have serous invasion. Of the 28 (68.3%) patients with serous invasion, 9 patients (32.1%) were found to have positive cytology. No significant pattern was detected in the carcino-embryionic antigen, cancer antigen 19-9 and AFP levels in both the positive and negative cytology serum and peritoneal lavage fluid. Of the 41 patients operated on 5 (12.2%) were found to have cardia dissemination and 13 (31.7%) were found to have dissemination located at the corpus. Peritoneal dissemination was found to be significantly high in gastric cancer located in the cardia and corpus. Fourteen (34.1%) of the patients had stage I and stage II cancer and 27 (65.9%) of patient's had cancer in stages III and IV. Just 1 (7.1%) patient with stage I or II cancer was found to have positive malignant cytology, however 9 (33.3%) patient's of stage III and IV gastric cancer patients were tested positively for malignant cytology. CONCLUSION: A positive relationship was detected in the positive peritoneal cell malignancy with cancer stage, age, invasion depth and tumor location in patients.

Comparison between electronic method and conventional method recording and follow-up of general surgery ward-round notes taken.

AIM: Patient anamneses and ward-rounds notes taken are two key elements which have been and will be used to ensure accurate and reliable sustainability at surgery services. In this study, we aimed to find a new method which is capable of better addressing the needs in this process, simplifying it and also saving time. We also targeted to compare this new method used by us with the method, also known as conventional method, having been used for years. METHODS: Thirty patients were included in the study. The prehospitalization anamneses of the patients were taken using the two methods and the durations were recorded separately for the two methods. Thereafter, the patients were visited by two methods in the morning on each day of their stay. The durations were recorded daily and separately for the two methods. The durations were statistically evaluated separately for the anamneses and ward-round notes taken. RESULTS: Evaluations showed that the method using hand terminal (1.2250 minutes) is more advantageous in terms of duration in recording ward-round scores than the conventional method (1.3853 minutes). It was founded that in regard to the duration, the average duration of manual anamnesis taking (16.3350 minutes) is higher than that of taking anamnesis by means of hand terminal (15.4733 minutes). Furthermore, it was also seen that the use of this new technique eliminated the problems previously experienced in data transfer, access to historical data etc. CONCLUSION: In conclusion, this method that is tested by use of hand terminal is more advantageous than the conventional method in terms of time saving and accurate data transfer. It is our opinion that it will provide advantages in many more aspects if it is worked on.

Single-port laparoscopic cholecystectomy versus the classical four port laparoscopic cholecystectomy: a randomized prospective clinical trial.

AIM: The objectives of this prospective study were to compare the advantages of single-port laparoscopic cholecystectomy (SPLC) versus the classical four-port laparoscopic cholecystectomy (CLC) and to discuss these advantages in the light of current literature. METHODS: Forty eligible patients were randomized to receive SPLC (Group A, N.=20) and CLC (Group B, N.=20), and investigated with regard to age, sex, BMI (body mass index), ASA (American Society of Anesthesiologists) score, type of surgery, operative time, per-operative complication, indication for conversion to open surgery, indication for additional trocar placement in SPLC technique, post-operative pain score, additional narcotic analgesic requirement, nausea and vomiting, post-operative complication and length of hospital stay. Visual analogue scale (VAS) was used for pain scoring in all cases. RESULTS: No significant difference was found among patients in Group A and Group B in terms of age, sex, weight/BMI, ASA score, VAS scores, additional analgesic requirement and length of hospital stay (P>0.05). On the other hand, mean operative time in Group A was significantly (P<0.005) greater than that in Group B. Mean operative time in Group A was observed to be reduced after the first 10 operations. Conversion to open surgery was not required in any of the patients; however, additional trocar placement was required in two patients in Group A due to body habitus and adhesions, and operations were completed laparoscopically. CONCLUSION: We conclude that SPLC is equally effective as CLC. Patient comfort is increased and pain is decreased as the surgeon gets experienced with the technique.