RESUMEN
INTRODUCTION: Combined pancreaticoduodenectomy and esophagectomy poses a challenge for reconstruction. CASE REPORT: We report a case of a combined pancreaticoduodenectomy and esophagectomy for synchronous pancreatic and esophageal cancer, with reconstruction using a supercharged jejunal interposition. DISCUSSION: The supercharged jejunal anastomosis is a versatile option for foregut reconstruction.
Asunto(s)
Carcinoma de Células en Anillo de Sello/cirugía , Neoplasias Esofágicas/cirugía , Esofagectomía , Neoplasias Primarias Múltiples/cirugía , Neoplasias Pancreáticas/cirugía , Pancreaticoduodenectomía , Anciano , Carcinoma de Células en Anillo de Sello/patología , Neoplasias Esofágicas/patología , Humanos , Masculino , Neoplasias Primarias Múltiples/patología , Neoplasias Pancreáticas/patologíaRESUMEN
PURPOSE: Patients receiving cancer-related thoracotomy are highly symptomatic in the first weeks after surgery. This study examined whether at-home symptom monitoring plus feedback to clinicians about severe symptoms contributes to more effective postoperative symptom control. PATIENTS AND METHODS: We enrolled 100 patients receiving thoracotomy for lung cancer or lung metastasis in a two-arm randomized controlled trial; 79 patients completed the study. After hospital discharge, patients rated symptoms twice weekly for 4 weeks via automated telephone calls. For intervention group patients, an e-mail alert was forwarded to the patient's clinical team for response if any of a subset of symptoms (pain, disturbed sleep, distress, shortness of breath, or constipation) reached a predetermined severity threshold. No alerts were generated for controls. Group differences in symptom threshold events were examined by generalized estimating equation modeling. RESULTS: The intervention group experienced greater reduction in symptom threshold events than did controls (19% v 8%, respectively) and a more rapid decline in symptom threshold events. The difference in average reduction in symptom interference between groups was -0.36 (SE, 0.078; P = .02). Clinicians responded to 84% of e-mail alerts. Both groups reported equally high satisfaction with the automated system and with postoperative symptom control. CONCLUSION: Frequent symptom monitoring with alerts to clinicians when symptoms became moderate or severe reduced symptom severity during the 4 weeks after thoracic surgery. Methods of automated symptom monitoring and triage may improve symptom control after major cancer surgery. These results should be confirmed in a larger study.