Laparoscopic Completion Total Gastrectomy for Remnant Gastric Cancer Compared to Laparoscopic Total Gastrectomy in Short- and Medium-Term Results.

Introduction: The incidence of remnant gastric cancer is increasing in recent years. The advantages of minimally invasive surgery for gastric cancer are well established. However, laparoscopic completion total gastrectomy for remnant gastric cancer harbors difficulties due to adhesions, changed configuration of the anatomical organs, and changes on the lymphatic flow. We aim to investigate the feasibility, safety, and the short-term outcomes of laparoscopic completion total gastrectomy compared to laparoscopic total gastrectomy. Materials and Methods: All patients who underwent total gastrectomy from January 2018 to December 2021 at Shamir Medical Center were included in the study. Patients were divided into two groups-completion gastrectomy and total gastrectomy. The groups were compared for demographics, operative, and clinical outcomes. Results: Overall, 22 patients were included in the study. Eight were completion gastrectomy following subtotal gastrectomy for malignancy and 14 were primary total gastrectomy. All operations were performed by minimal invasive surgery technique. Average age was 64 years, with no differences in gender. Two major intraoperative complications were noted in completion group (25% versus 0%, P = .12). Both length of surgery (3:03 versus 3:40, P = .049) and length of stay (7 days versus 9 days, P = .5) were shorter in completion group. There were fewer postoperative complications (12.5% versus 28.5%, P = .61). Average number of harvested lymph nodes was significantly lower in completion group (10 versus 33, P = .002). Conclusion: Laparoscopic completion total gastrectomy for remnant gastric cancer is safe and feasible having comparable oncological surrogate's parameters and recurrence profile. Clinical Registration Number: 0015-22-ASF.

Endoscopic dacryocystorhinostomy among the old and oldest-old populations - A case control study.

OBJECTIVE: Despite increased risks of nasolacrimal duct obstruction (NLDO) with age, and the continuous growth of the old population proportion, data on endoscopic dacryocystorhinostomy (eDCR) among the old is lacking. This study aims to evaluate long-term eDCR efficacy and safety in the old and oldest-old population. METHODS: A retrospective case-control study of patients aged 80 ≤ (oldest-old) and 65-79 (old) compared with younger controls who underwent eDCR, between 2002 and 2017. Pre-, intra- and postoperative factors were collected using an integrated hospital-community system. Success rates were analyzed and measured at the first visit following surgery (immediate success), and after five years. Demographics, comorbidities, complications rates, and outcomes were compared between the groups. RESULTS: The study groups included 52 oldest-old patients (mean age 83.4 ± 3.6), 127 old patients (72.3 ± 4.14) and 142 control patients (57.8 ± 18.0). The immediate and success rates were 94.2%, 93.7% and 90.8% and five-year success rates were 80.0%, 76.6% and 80% among oldest-old, old and controls, respectively. No significant differences in success rates were found, even despite higher comorbidity rates among the study's group (96 and 92.8% vs. 63.2%, among oldest-old, old and controls respectively, p <0.001). Intra- and postoperative complications rates were low in all groups. CONCLUSIONS: Among older population, including oldest-old and old, eDCR safety and long-term outcomes are comparable with younger patients, suggesting that eDCR should be offered to NLDO patients, regardless of age.

Five- and 10-Year Outcomes for Primary Endoscopic Dacryocystorhinostomy: Failure Rate and Risk Factors.

INTRODUCTION: Endoscopic dacryocystorhinostomy (eDCR) is the preferred approach for nasolacrimal duct obstruction, yet quality data on long-term outcomes is lacking. STUDY DESIGN: A retrospective study in a single, academic institution. OBJECTIVE: To assess the 5- and 10-year success rates of eDCR, and its associated risks. PATIENTS AND METHODS: All eDCRs conducted at Kaplan Medical Center between the years 2002-2017 were included. For long-term follow-up analysis, two subgroups with a minimum of documented 5- and 10-year follow-up after surgery were defined. Surgical success was defined by both anatomical (observed patent lacrimal flow) and functional (symptomatic relief) success. Data was collected from the hospital's electronic medical records and was completed by phone interviews. Pre-, intra-, and postoperative variables were collected and stratified by multivariate analysis. RESULTS: After exclusions, 321, 168, and 65 patients were included for immediate, 5- and 10-year outcome analysis, respectively. Overall success rates were 92.5%, 86.3%, and 80%, respectively. The anatomical success rates were 93.8%, 89.9%, and 86.1%, respectively. Multivariate analysis revealed that older age (P < .001, P = .001) previous smoking (P = .043, P = .037), and postoperative complains of epiphora (even when a successful irrigation was observed, P < .001, P = .01) were all associated with eDCR failure 5 and 10 years following surgery. Male gender was also associated with eDCR failure (5 years, P = .045; 10 years, P = .063). CONCLUSIONS: Despite decreased rates over time, eDCR is beneficial for the majority of patients also at 10 years following surgery. Older age, smoking, postoperative epiphora, and male gender are related to long-term failure and should be discussed with the patients before surgery. LEVEL OF EVIDENCE: 3b Laryngoscope, 131:10-16, 2021.