Clinical significance of lymphadenectomy in patients with gastric cancer.

Approximately thirty percent of patients with gastric cancer undergo an avoidable lymph node dissection with a higher rate of postoperative complication. Comparing the D1 and D2 dissections, it was found that there is a significant difference in morbidity, favoured D1 dissection without any difference in overall survival. Subgroup analysis of patients with T3 tumor shows a survival difference favoring D2 lymphadenectomy, and there is a better gastric cancer-related death and non-statistically significant improvement of survival for node-positive disease in patients with D2 dissection. However, the extended lymphadenectomy could improve stage-specific survival owing to the stage migration phenomenon. The deployment of centralization and application of national guidelines could improve the surgical outcomes. The Japanese and European guidelines enclose the D2 lymphadenectomy as the gold standard in R0 resection. In the individualized, stage-adapted gastric cancer surgery the Maruyama computer program (MCP) can estimate lymph node involvement preoperatively with high accuracy and in addition the Maruyama Index less than 5 has a better impact on survival, than D-level guided surgery. For these reasons, the preoperative application of MCP is recommended routinely, with an aim to perform "low Maruyama Index surgery". The sentinel lymph node biopsy (SNB) may decrease the number of redundant lymphadenectomy intraoperatively with a high detection rate (93.7%) and an accuracy of 92%. More accurate stage-adapted surgery could be performed using the MCP and SNB in parallel fashion in gastric cancer.

[Prospective comparative study of sentinel lymph node mapping in gastric cancer -- submucosal versus subserosal marking method]. / Gyomortumorok orszemnyirokcsomó-jelölésének prospektív, összehasonlító vizsgálata -- submucosus kontra subserosus jelölés.

BACKGROUND: Forty percent of patients with gastric cancer undergo unnecessary extended lymph node dissection which may result in higher rate of morbidity and mortality. Successful sentinel lymph node (SLN) mapping may help to reduce the number of extended lymphadenectomy. Various marking methods are in use to detect the sentinel lymph node in gastric cancer. METHODS: Forty consecutive patients underwent open gastric resection with blue dye mapping and modified D2 lymph node dissection. Sixteen patients (group A) were marked submucosally with endoscopy and 24 patients (group B) were labelled by the surgeon subserosally. The staining method and the lymphadenectomy were supervised by the same surgeon. RESULTS: A total of 795 lymph nodes were removed and examined. The mean number of blue nodes was 4.1 per patient in group A and 4.8 in group B. The false negative rate was 0% in group A and 7.7% in group B. The sensitivity and specificity of SLN mapping was 100% in the submucosal group. The specificity of subserosal marking method was 100%, while the seínsitivity was 92.3%. Submucosal and subserosal marking methods were proven to be equivalent in detection rate, sensitivity and specificity based on 90% confidence interval of the ratio of indicators. CONCLUSIONS: Our results suggest that sentinel lymph node mapping with blue dye alone represents a safety procedure and seems to be adaptable with high sensitivity and specificity, especially in cases of T1 and T2 tumors.

Value of sentinel lymph node mapping using a blue dye-only method in gastric cancer: a single-center experience from North-East Hungary.

BACKGROUND: Forty percent of patients with gastric cancer have unnecessarily extended lymph node dissections with higher rates of morbidity and mortality than those in non-extended procedures. Successful sentinel lymph node (SLN) mapping may help to reduce the number of extended lymphadenectomies. METHODS: SLN mapping was investigated by a blue dye-only method in patients with gastric cancer. The first cohort of patients (n = 16) were marked submucosally by an endoscopist and in the second cohort of patients (n = 23) a subserosal injection was performed by the surgeon. RESULTS: Thirty-nine patients, all Caucasians, underwent gastric resection or total gastrectomy with SLN biopsy using patent blue-dye mapping and modified D2 lymphadenectomy. The mapping procedure and the lymphadenectomy were supervised by the same surgeon. A total of 770 lymph nodes were removed and examined. The mean number of blue nodes was 4.3 per patient. In 22/23 cases at least one SLN showed tumor involvement. The sensitivity of SLN mapping was 95.7%, the false-negative rate was 4.3%, and the specificity was 100%. The negative predictive value was 93.8% and the positive predictive value was 100%. In cases of T1 and T2 tumors the sensitivity was 100%. We found the two marking methods (submucosal vs. subserosal) to be equivalent and there was no side-effect of the blue-dye mapping. CONCLUSIONS: Our results suggest that SLN mapping with blue dye alone represents a safe procedure that seems to be adaptable for non-obese patients undergoing open surgery for gastric cancer in the Eastern European region. The procedure has high sensitivity and specificity, especially in cases of T1 and T2 tumors.

Videothoracoscopic treatment of a rare complication of nasojejunal tube insertion.

OBJECTIVE: Intubation of the tracheobronchial tree is the most common type of malposition during the placement of narrow-bore enternal tubes. CASE REPORT: In addition to other treatment components in a 65-year-old female, nasojejunal feeding was started to treat her for severe acute pancreatitis. After the placement of the narrow-bore feeding tube, she developed dyspnea and huskiness. On auscultation and X-ray investigation, the right pneumothorax was detected and the tube was found in the chest cavity. The diagnosis was confirmed by bronchoscopy. Videothoracoscopic resection and closure of the lacerated lung, using a tube thoracostomy, were performed. The patient recovered after postoperative conservative treatment for her pancreatitis. CONCLUSION: Pneumothorax and laceration of the lung-caused by the malposition of narrow-bore enternal tube-can be successfully treated by applying videothoracoscopy.

[Wireless capsule endoscopy and its role in gastroenterology: our results and a review of the literature]. / Kapszulás endoszkópia helye a gasztroenterológiai diagnosztikában: irodalmi attekintés saját eredményeink tükrében.

INTRODUCTION: Since its recent introduction, capsule endoscopy has revolutionized the diagnostics of diseases of the small bowel. The number of studies on the use of this method is constantly increasing. Along with this, our knowledge about the usability and diagnostic power of capsule endoscopy is growing and the indications for this technique are getting progressively more accurate. AIMS: To study the usability of capsule endoscopy in suspected Crohn's disease, in gastrointestinal bleeding of small bowel origin, and in undetermined abdominal complains. METHOD: Capsule endoscopy was performed in 20, previously examined, carefully selected patients. RESULTS: Positive findings were recorded in all patients with gastrointestinal bleeding and in 3/4 of patients with suspected Crohn's disease. However, in patients with indeterminate abdominal complains, the capsule endoscopy proved to be inefficient. CONCLUSION: In the study below, based on their own experience, the authors try to provide an overall picture of capsule endoscopy by reviewing contemporary medical literature. The usability of the capsule endoscopy in suspected Crohn's disease and gastrointestinal bleeding of small bowel origin is suggested by the results of the study.