Prophylactic Drain Versus No Drain in Curative Gastric Cancer Surgery-A Randomized Controlled Trial.

BACKGROUND: The adoption of enhanced recovery after surgery protocols has questioned the placement of prophylactic drain after curative gastrectomy. A 2015 Cochrane meta-analysis did not find convincing evidence of routine drain placement in gastrectomy, but the quality of evidence was questioned. The present study compared short-term outcomes of prophylactic drain placement versus no drain in gastrectomy. METHODOLOGY: The study is a prospective, non-inferiority, and randomized controlled trial. Histologically proven adenocarcinoma of the stomach undergoing curative gastrectomy with D2 lymphadenectomy was included in the study. Randomization was done intra-operatively. The primary outcome was a postoperative hospital stay. Secondary outcomes included the return of bowel function, achieving adequate enteral feeding, re-surgery, morbidity, and mortality. RESULTS: One hundred fifty-seven patients were registered, of which 108 patients underwent curative surgery, and were randomized to 54 patients in each group. The median age was 55 years (range: 23-78) and 58.5 years (range: 35-80) in the drain and no drain group. No significant difference was noticed in primary or secondary outcomes in both groups. CONCLUSION: Avoid placing a prophylactic drain is not inferior to drain placement following gastrectomy with D2 lymphadenectomy for stomach adenocarcinoma. So, routine prophylactic drain placement can be avoided.

Minimally invasive esophagectomy: Preservation of arch of Azygos vein in prone position.

Minimally invasive esophagectomy (MIE) for oesophageal cancer has gained wide popularity in recent years due to its improved morbidity and mortality outcomes. We describe our modified technique of MIE in prone position with preservation of the arch of azygos vein. In our experience with 14 patients, the mean operative duration was 378 min (standard deviation [SD] 378 ± 59 min) and the mean blood loss was 390 ml (SD 390 ± 142 ml). The mean lymph node count was 28 (range 17-54). The Visick score was I in 12 (85.7%) patients and II in 2 (14.3%) patients at follow-up. The preservation of azygos vein arch is a technically feasible procedure and may be associated with a better quality of life outcome.

Laparoscopic resection for low rectal cancer in a patient with horseshoe kidney - Technical considerations to prevent iatrogenic injuries.

Horseshoe kidney (HSK) is a rare congenital malformation of the kidneys and is commonly associated with other anomalies of the renovascular and ureteropelvic systems. These anomalies present a surgical challenge, especially for surgeries involving the retroperitoneum. We present the case of a 56-year-old male patient with biopsy-proven rectal cancer who had completed neoadjuvant chemoradiation and was planned for curative resection. Contrast-enhanced computed tomography (CECT) of the abdomen and pelvis revealed the presence of an HSK. Reconstructed three-dimensional (3D) images of the renal vasculature revealed the presence of an accessory renal artery originating directly from the aorta and supplying the isthmus of the HSK without any other venous or ureteral anomalies. Laparoscopic abdominoperineal resection with total mesorectal excision was done without any untoward complications. The presence of HSK per se is not a contraindication for laparoscopic operations involving the retroperitoneum. Pre-operative 3D CECT helps to identify the presence of anatomical variations and guides surgical resection.