Asunto(s)
Endosonografía , Gastrectomía , Gastroenterostomía , Laparoscopía , Humanos , Gastrectomía/métodos , Gastrectomía/efectos adversos , Gastroenterostomía/métodos , Gastroenterostomía/efectos adversos , Endosonografía/métodos , Laparoscopía/métodos , Ultrasonografía Intervencional , Femenino , Obstrucción de la Salida Gástrica/etiología , Obstrucción de la Salida Gástrica/cirugía , Persona de Mediana Edad , AdultoRESUMEN
Among all patients with gastric cancer, 40% admit to the hospitals due to cancer-related complications. The most common complications of gastric cancer are bleeding (22-80%), malignant gastric outlet obstruction (26-60%), and perforation (less than 5%). The main treatment methods for gastric cancer complicated by bleeding are various forms of endoscopic hemostasis, transarterial embolization and external beam radiotherapy. Surgical treatment is possible in case of ineffective management. However, surgical algorithm is not standardized. Malignant gastric outlet stenosis requires decompression: endoscopic stenting, palliative gastroenterostomy. Surgical treatment is also possible (gastrectomy, proximal or distal resection of the stomach). The main problem for patients with complicated gastric cancer is the lack of standardized algorithms and abundance of potential surgical techniques. The aim of our review is to systematize available data on the treatment of complicated gastric cancer and to standardize existing methods.
Asunto(s)
Obstrucción de la Salida Gástrica , Estenosis Pilórica , Neoplasias Gástricas , Humanos , Neoplasias Gástricas/cirugía , Gastroenterostomía/efectos adversos , Obstrucción de la Salida Gástrica/complicaciones , Obstrucción de la Salida Gástrica/cirugía , Estenosis Pilórica/cirugía , Constricción Patológica/cirugía , Stents/efectos adversos , Cuidados Paliativos/métodosRESUMEN
Gastric outlet obstruction (GOO) poses a common and challenging clinical scenario, characterized by mechanical blockage in the pylorus, distal stomach, or duodenum, resulting in symptoms such as nausea, vomiting, abdominal pain, and early satiety. Its diverse etiology encompasses both benign and malignant disorders. The spectrum of current treatment modalities extends from conservative approaches to more invasive interventions, incorporating procedures like surgical gastroenterostomy (SGE), self-expandable metallic stents (SEMSs) placement, and the advanced technique of endoscopic ultrasound-guided gastroenterostomy (EUS-GE). While surgery is favored for longer life expectancy, stents are preferred in malignant gastric outlet stenosis. The novel EUS-GE technique, employing a lumen-apposing self-expandable metal stent (LAMS), combines the immediate efficacy of stents with the enduring benefits of gastroenterostomy. Despite its promising outcomes, EUS-GE is a technically demanding procedure requiring specialized expertise and facilities.
Asunto(s)
Obstrucción de la Salida Gástrica , Gastroenterostomía , Humanos , Gastroenterostomía/efectos adversos , Gastroenterostomía/métodos , Endosonografía/efectos adversos , Endosonografía/métodos , Obstrucción de la Salida Gástrica/diagnóstico por imagen , Obstrucción de la Salida Gástrica/etiología , Obstrucción de la Salida Gástrica/cirugía , Píloro/cirugía , Stents/efectos adversos , Constricción Patológica/complicaciones , Constricción Patológica/cirugíaRESUMEN
BACKGROUND: Abdominal surgical infectious complications (ASIC) after gastrectomy for gastric cancer impair patients' survival and quality of life. JCOG0912 was conducted to compare laparoscopy-assisted distal gastrectomy with open distal gastrectomy for clinical stage IA or IB gastric cancer. The present study aimed to identify risk factors for ASIC using prospectively collected data. METHODS: We performed a post-hoc analysis of the risk factors for ASIC using the dataset from JCOG0912. All complications were evaluated according to the Clavien-Dindo classification (CD). ASIC was defined as CD grade I or higher anastomotic leakage, pancreatic fistula, abdominal abscess, and wound infection. Analyses were performed using the logistic regression model for univariable and multivariable analyses. RESULTS: A total of 910 patients were included (median age, 63 years; male sex, 61 %). Among them, ASIC occurred in 5.8 % of patients. In the univariable analysis, male sex (odds ratio [OR] 2.855, P = 0.003), diabetes (OR 2.565, P = 0.029), and Roux-en-Y (R-Y) reconstruction (vs. Billroth â , OR 2.707, P = 0.002) were significant risk factors for ASIC. In the multivariable analysis, male sex (OR 2.364, P = 0.028) and R-Y reconstruction (vs. Billroth â , OR 2.310, P = 0.015) were independent risk factors for ASIC. CONCLUSIONS: Male sex and R-Y reconstruction were risk factors for ASIC after distal gastrectomy. Therefore, when performing surgery on male patients or when R-Y reconstruction is selected after gastrectomy for gastric cancer, surgeons should pay special attention to prevent ASIC.
Asunto(s)
Laparoscopía , Neoplasias Gástricas , Humanos , Masculino , Persona de Mediana Edad , Neoplasias Gástricas/cirugía , Neoplasias Gástricas/complicaciones , Calidad de Vida , Gastroenterostomía/efectos adversos , Factores de Riesgo , Laparoscopía/efectos adversos , Gastrectomía/efectos adversos , Complicaciones Posoperatorias/etiología , Resultado del TratamientoRESUMEN
An 84-year-old man with gastric cancer, cT2N0M0, cStage â underwent laparoscopic distal gastrectomy, D1+dissection, and Roux-en-Y reconstruction. We started enteral nutrition on the second postoperative day, but milky drainage appeared from the drain on the fifth postoperative day. The triglyceride in the ascites was markedly elevated, and it was diagnosed as a lymphorrhea. Neither conservative treatment nor lymphangiography were successful. We decided to perform surgical intervention because the lymphorrhea did not improve for about 1 month after gastrectomy. At laparotomy, we detected the lymphatic ducts using enteral nutrition of fat formulas during surgery and successfully closed the lymphatic ducts by suturing and ligation on the 38th postoperative day. Prolonged lymphorrhea causes extreme deterioration of the patient's general condition. Prolonged total parenteral nutrition also increases the risk of infection. It is important to perform surgical treatment for intractable lymphorrhea that does not improve with conservative treatment without hesitation.
Asunto(s)
Laparoscopía , Enfermedades Linfáticas , Neoplasias Gástricas , Masculino , Humanos , Anciano de 80 o más Años , Gastroenterostomía/efectos adversos , Laparoscopía/efectos adversos , Gastrectomía/efectos adversos , Anastomosis en-Y de Roux/efectos adversos , Neoplasias Gástricas/cirugía , Neoplasias Gástricas/complicacionesRESUMEN
Objective: To compare the clinical efficacy and quality of life between uncut Roux-en-Y and Billroth II with Braun anastomosis in laparoscopic distal gastrectomy for gastric cancer patients. Methods: A retrospective cohort study was performed. Inclusion criteria: (1) 18 to 75 years old; (2) gastric cancer proved by preoperative gastroscopy, CT and pathological results and tumor was suitable for D2 radical distal gastrectomy; (3) postoperative pathological diagnosis stage was T1-4aN0-3M0 (according to the AJCC-7th TNM tumor stage), and the margin was negative; (4) Eastern Cooperative Oncology Group (ECOG) physical status score <2 points, and American Association of Anesthesiologists (ASA) grade 1 to 3; (5) no mental illness; (6) able to answer questionnaires independently; (7) patients agreed to undergo laparoscopic distal gastrectomy and signed an informed consent. Exclusion criteria: (1) patients with severe chronic diseases and American Association of Anesthesiologists (ASA) grade >3; (2) patients with other malignant tumors; (3) patients suffered from serious mental diseases; (4) patients received neoadjuvant chemotherapy or immunotherapy. According to the above criteria, clinical data of 200 patients who underwent laparoscopic distal gastrectomy at the Department of General Surgery of the First Affiliated Hospital of Army Medical University from January 2016 to December 2019 were collected. Of the 200 patients, 108 underwent uncut Roux-en-Y anastomosis and 92 underwent Billroth II with Braun anastomosis. The general data, intraoperative and postoperative conditions, complications, and endoscopic evaluation 1 year after the surgery were compared. Besides, the quality of life of two groups was also compared using the Chinese version of the European Organization For Research and Treatment of Cancer (EORTC) quality of life questionnaire-Core 30 (QLQ-C30) and quality of life questionnaire-stomach 22 (QLQ-STO22). Results: There were no significant differences in baseline data between the two groups (all P>0.05). All the 200 patients successfully underwent laparoscopic distal gastrectomy without intraoperative complications, conversion to open surgery or perioperative death. There were no significant differences between two groups in operative time, intraoperative blood loss, postoperative complications, time to flatus, time to removal of gastric tube, time to liquid diet, time to removal of drainage tube or length of postoperative hospital stay (all P>0.05). Endoscopic evaluation was conducted 1 year after surgery. Compared to Billroth II with Braun group, the uncut Roux-en-Y group had a significantly lower incidences of gastric stasis [19.8% (17/86) vs. 37.0% (27/73), χ(2)=11.199, P=0.024], gastritis [11.6% (10/86) vs. 34.2% (25/73), χ(2)=20.892, P<0.001] and bile reflux [1.2% (1/86) vs. 28.8% (21/73), χ(2)=25.237, P<0.001], and the differences were statistically significant. The EORTC questionnaire was performed 1 year after surgery, there were no significant differences in the scores of QLQ-C30 scale between the two groups (all P>0.05), while the scores of QLQ-STO22 showed that, compared to the Billroth II with Braun group, the uncut Roux-en-Y group had a lower pain score (median: 8.3 vs. 16.7, Z=-2.342, P=0.019) and reflux score (median: 0 vs 5.6, Z=-2.284, P=0.022), and the differences were statistically significant (all P<0.05), indicating milder symptoms. Conclusion: The uncut Roux-en-Y anastomosis is safe and reliable in laparoscopic distal gastrectomy, which can reduce the incidences of gastric stasis, gastritis and bile reflux, and improve the quality of life of patients after surgery.
Asunto(s)
Adolescente , Adulto , Anciano , Humanos , Persona de Mediana Edad , Adulto Joven , Anastomosis en-Y de Roux/efectos adversos , Anastomosis Quirúrgica/efectos adversos , Gastrectomía/métodos , Gastroenterostomía/efectos adversos , Laparoscopía/métodos , Complicaciones Posoperatorias/epidemiología , Calidad de Vida , Estudios Retrospectivos , Neoplasias Gástricas/patología , Resultado del TratamientoRESUMEN
Apresenta-se o caso de um homem, 57 anos, submetido a uma antrectomia com reconstrução a Billroth II devido a uma úlcera péptica sangrante, que evoluiu no quarto dia de pós-operatório com intuscepção anterógrada jejuno-jejunal, causando síndrome da alça aferente.
Its reported a case of a 57-year-old male, who underwent an antrectomy with Billroth II reconstruction because of an bleeding peptic ulcer, that evolved in the fourth day postoperatively with a anterograde jejunojejunal intussusception causing afferent loop syndrome.
Asunto(s)
Humanos , Masculino , Persona de Mediana Edad , Gastroenterostomía , Gastroenterostomía/efectos adversos , Síndrome del Asa Aferente , Gastrectomía , IntususcepciónRESUMEN
PURPOSE: To assess the clinical manifestations and multidetector-row computed tomography (MDCT) findings of afferent loop syndrome (ALS) and to determine the role of MDCT on treatment decisions. MATERIALS AND METHODS: From January 2004 to December 2008, 1,100 patients had undergone gastroenterostomy reconstruction in our institution. Of these, 22 (2%) patients were diagnosed as ALS after surgery that included Roux-en-Y gastroenterotomy (n=9), Billroth-II gastrojejunostomy (n=7), and Whipple's operation (n=6). Clinical manifestations and MDCT features of these patients were recorded and statistically analyzed. The presumed etiologies of obstruction shown on the MDCT were correlated with clinical information and confirmed by surgery or endoscopic biopsy. RESULTS: The most common clinical symptom was acute abdominal pain, presenting in 18 patients (82%). We found that a fluid-filled C-shaped afferent loop in combination with valvulae conniventes projecting into the lumen was the most common MDCT features of ALS. Malignant causes of ALS, such as local recurrence and carcinomatosis, are the most common etiologies of obstruction. These etiologies and associated complications can be predicted 100% by MDCT. CONCLUSION: Our results suggest that MDCT is a reliable modality for assessing the etiologies of ALS and guiding treatment decisions.
Asunto(s)
Adulto , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Masculino , Persona de Mediana Edad , Síndrome del Asa Aferente/diagnóstico por imagen , Gastroenterostomía/efectos adversos , Estudios Retrospectivos , Tomografía Computarizada por Rayos X/métodosRESUMEN
Adult intussusception represents 5% of all cases of intussusception and accounts for only 1-5% intestinal obstructions. Intussusception is a rare complication after gastric surgery with an incidence estimated at 0.1%. Early diagnosis of the acute onset intussusception is critical because mortality rates increase abruptly with delay in surgical treatment. We present here a case of jejunogastric intussusception diagnosed by gastroscopy in a patient with a history of distal gastrectomy due to early gastric cancer who had experienced hematemesis.
Asunto(s)
Anciano , Humanos , Masculino , Gastroenterostomía/efectos adversos , Gastroscopía , Hematemesis/complicaciones , Intususcepción/complicaciones , Enfermedades del Yeyuno/complicaciones , Tomografía Computarizada por Rayos XRESUMEN
En una serie de 122 casos operados de cácner gástrico avanzado, en el período 1975-1985, se utilizó cirugía paliativa en algunos de ellos, analizando el uso de la yeyunostomía contemporánea asociada a la misma como método válido para permitir la curación de las complicaciones presentadas en el postoperatorio inmediato (AU)
Asunto(s)
Humanos , Neoplasias Gástricas/cirugía , Cuidados Paliativos , Gastroenterostomía , Gastroenterostomía/efectos adversos , Fístula/etiologíaRESUMEN
En una serie de 122 casos operados de cácner gástrico avanzado, en el período 1975-1985, se utilizó cirugía paliativa en algunos de ellos, analizando el uso de la yeyunostomía contemporánea asociada a la misma como método válido para permitir la curación de las complicaciones presentadas en el postoperatorio inmediato
Asunto(s)
Humanos , Cuidados Paliativos , Neoplasias Gástricas/cirugía , Fístula/etiología , Gastroenterostomía , Gastroenterostomía/efectos adversosRESUMEN
Los autores presentan 23 casos (1,6%) de pacientes portadores de un síndrome de gastritis alcalina reoperados en el Hospital Nacional de Gastroenterología "Dr Bonorino Udaondo", en el período comprendido entre enero de 1960 y diciembre de 1985, sobre un total de 1.400 intervenciones quirúrgicas practicadas para tratar la enfermedad ulcerosa gastroduodenal; 19 de los 23 casos presentaban un síndrome de gastritis alcalina bien definido, mientras que el resto (4 casos) un síndrome mixto por el agregado o participación de otros síndromes. La operación primaria consistió en una resección gástrica tipo Bilroth II en 22 casos y el restante era portador de una vagotomía con gastroenteroanastomosis. En todos ellos se estudiaron los aspectos clínicos, radiológicos, de laboratorio, endoscópicos e histopatológicos, test de Kay y Hollander. Las intervenciones quirúrgicas correctoras fueron: Soupault-Bucaille con asa isoperistáltica (7 casos); con asa anisoperistáltica tipo Poth (1 caso); reoperaciones con la técnica de Y de Roux (14 casos); desgastroenterostomía, cierre de la brecha gástrica y yeyunal y piloroplastia (1 caso). Se completó con vagotomía. Un 50% de los casos tienen 5-8 años de operados; otros fueron reexaminados a los 10 y 15 años, hallándose asintomáticos (AU)
Asunto(s)
Adulto , Persona de Mediana Edad , Anciano , Humanos , Masculino , Femenino , Úlcera Péptica/cirugía , Gastrectomía/efectos adversos , Gastroenterostomía/efectos adversos , Gastritis/etiología , Reflujo Biliar/etiología , Reoperación , Gastritis/cirugía , Gastritis/patología , Estudios de SeguimientoRESUMEN
Los autores presentan 23 casos (1,6%) de pacientes portadores de un síndrome de gastritis alcalina reoperados en el Hospital Nacional de Gastroenterología "Dr Bonorino Udaondo", en el período comprendido entre enero de 1960 y diciembre de 1985, sobre un total de 1.400 intervenciones quirúrgicas practicadas para tratar la enfermedad ulcerosa gastroduodenal; 19 de los 23 casos presentaban un síndrome de gastritis alcalina bien definido, mientras que el resto (4 casos) un síndrome mixto por el agregado o participación de otros síndromes. La operación primaria consistió en una resección gástrica tipo Bilroth II en 22 casos y el restante era portador de una vagotomía con gastroenteroanastomosis. En todos ellos se estudiaron los aspectos clínicos, radiológicos, de laboratorio, endoscópicos e histopatológicos, test de Kay y Hollander. Las intervenciones quirúrgicas correctoras fueron: Soupault-Bucaille con asa isoperistáltica (7 casos); con asa anisoperistáltica tipo Poth (1 caso); reoperaciones con la técnica de Y de Roux (14 casos); desgastroenterostomía, cierre de la brecha gástrica y yeyunal y piloroplastia (1 caso). Se completó con vagotomía. Un 50% de los casos tienen 5-8 años de operados; otros fueron reexaminados a los 10 y 15 años, hallándose asintomáticos