Current management of gastric cancer.

Gastric cancer is a disease with high incidence and mortality in our population. The prognosis of patients with this disease is closely related to the neoplasm stage at diagnosis, including the following characteristics of the tumor: extension into the gastric wall thickness, spread to locoregional lymph nodes and the ability to generate distant metastases, as described by the TNM classification. For localized tumors characterized only by invasion of mucosa or submucosa at diagnosis, survival at 5 years is between 70 and 95% with exclusive surgical management; however, when extension into the gastric wall is higher and/or there is locoregional nodal involvement, survival decreases to 20-30% at 5 years. Currently, at high-volume centers, the extent of gastrectomy is individualized based on several parameters, which in an increasing number of cases allows a total gastrectomy with D2 lymphadenectomy and preservation of the spleen and pancreas. This improved procedure increases the chance of R0 surgery and improves the relationship between resected and affected lymph nodes, resulting in a decreased risk of the long-term locoregional recurrence. To improve these results, different therapeutic strategies combining chemotherapy or chemoradiotherapy with surgery have been tested. Previously, the Intergroup 0116 clinical trial, published in 2001, which changed clinical practice in the United States, showed that adjuvant chemoradiotherapy improved survival (from 26 to 37 months overall survival) of these patients. In Europe, perioperative chemotherapy has been considered the standard treatment, since the publication of two randomized phase III trials showed an increase at 5 years survival in the group treated with chemotherapy.

Situación actual en el tratamiento del cáncer gástrico / Current management of gastric cancer

El cáncer gástrico es un tumor de alta incidencia y mortalidad en nuestro medio, y su pronóstico está íntimamente relacionado con la situación neoplásica al diagnóstico, que incluye su extensión en el grosor de la pared gástrica, sobre los ganglios linfáticos locorregionales y su capacidad de generar metástasis a distancia, extensión basada en la clasificación TNM. En aquellos tumores localizados al diagnóstico, caracterizados por la invasión únicamente de mucosa-submucosa, la supervivencia a 5 años se establece entre el 70 y el 95% con manejo quirúrgico exclusivo, sin embargo, cuando la extensión en la pared es mayor y/o existe afectación ganglionar locorregional, la supervivencia disminuye al 20-30% a 5 años. Actualmente en centros con alto volumen de pacientes, la extensión de la gastrectomía se individualiza en función de varios parámetros, optándose, en cada vez más casos, por la realización de una gastrectomía total con linfadenectomía D2 y preservación esplenopancreática, pues esta aumenta las posibilidades de conseguir una cirugía R0 y mejora la relación entre ganglios resecados y ganglios afectados, lo que se traduce en una disminución del riesgo de recidiva locorregional a largo plazo. Con el objetivo de mejorar estos resultados, se han ensayado distintas estrategias terapéuticas de quimioterapia o quimiorradioterapia asociadas a la cirugía. Entre todas ellas destaca el ensayo 0116 del intergroup, publicado en el 2001, que cambió la práctica clínica asistencial en Estados Unidos, ya que demostró que un tratamiento de quimiorradioterapia tras la cirugía mejoraba la supervivencia (de 26 a 37 meses de mediana) de estos pacientes. En Europa es la quimioterapia perioperatoria el tratamiento estándar habitual, desde que se publicaron dos estudios aleatorizados fase III que demostraron un aumento en la supervivencia a 5 años en el grupo tratado con quimioterapia(AU)

Gastric cancer is a disease with high incidence and mortality in our population. The prognosis of patients with this disease is closely related to the neoplasm stage at diagnosis, including the following characteristics of the tumor: extension into the gastric wall thickness, spread to locoregional lymph nodes and the ability to generate distant metastases, as described by the TNM classification. For localized tumors characterized only by invasion of mucosa or submucosa at diagnosis, survival at 5 years is between 70 and 95% with exclusive surgical management; however, when extension into the gastric wall is higher and/or there is locoregional nodal involvement, survival decreases to 20-30% at 5 years. Currently, at high-volume centers, the extent of gastrectomy is individualized based on several parameters, which in an increasing number of cases allows a total gastrectomy with D2 lymphadenectomy and preservation of the spleen and pancreas. This improved procedure increases the chance of R0 surgery and improves the relationship between resected and affected lymph nodes, resulting in a decreased risk of the long- term locoregional recurrence. To improve these results, different therapeutic strategies combining chemotherapy or chemoradiotherapy with surgery have been tested. Previously, the Intergroup 0116 clinical trial, published in 2001, which changed clinical practice in the United States, showed that adjuvant chemoradiotherapy improved survival (from 26 to 37 months overall survival) of these patients. In Europe, perioperative chemotherapy has been considered the standard treatment, since the publication of two randomized phase III trials showed an increase at 5 years survival in the group treated with chemotherapy(AU)

Rationale for gastrectomy with D2 lymphadenectomy in the treatment of gastric cancer.

BACKGROUND: In the surgical management of gastric cancer, D2 lymphadenectomy aims to reduce the incidence of locoregional relapse, and to increase patient survival. METHODS: A prospective study was made of 126 consecutive patients operated upon for gastric cancer, with gastrectomy and D2 lymphadenectomy. Hospital morbidity and mortality, relapses, and patient survival after 5 years were studied. RESULTS: The overall hospital mortality rate was 1.6%, with a mortality of 2.1% in the patients submitted to total gastrectomy. The overall morbidity rate was 29.4%. Dehiscence of the esophagojejunal anastomosis was recorded in 1.6%. The median follow-up was 73.6 months. Relapses were observed in 37% of the patients (76% in the first 2 years). Overall actuarial survival after 5 years was 52.3%, and 5-year survival in the patients with R0 resection with positive N2 lymph nodes according to the Japanese classification was 26.5%. CONCLUSION: Our results show that D2 lymphadenectomy can be performed with low morbidity-mortality, and a 5-year survival of more than 50%. The procedure offers benefit in terms of survival for a certain percentage of patients with positive level N2 lymph nodes.

[Morbidity and mortality in gastrectomy with D2 lymphadenectomy in a specialised unit]. / Morbilidad y mortalidad de la gastrectomía con linfadenectomía D2 en una unidad especializada.

INTRODUCTION: The combination of gastrectomy and D2 lymphadenectomy is still not a widely accepted therapeutic option by Western surgeons, due to its high post-operative morbidity and mortality. OBJECTIVE: To evaluate the morbidity and mortality in a series of patients with gastric cancer treated by gastrectomy and D2 lymphadenectomy, and compare these results with those published by centres with notable experience. PATIENTS AND METHOD: A descriptive and prospective study on a series of 126 consecutive patients with gastric cancer treated by gastrectomy and D2 lymphadenectomy. All complications were recorded, grouped into abdominal and non-abdominal, as well as surgical re-interventions. RESULTS: Total gastrectomy was performed on 95 (75.4%) of the 126 patients. It was combined with splenectomy in 22 cases (17.5%) and left pancreatectomy in 9 (7.1%). The stages, according to the AJCC, were: stage 0: 4.8%, IA: 17.5%, IB: 22.2%, II: 10.3%, IIIA: 16.7%, IIIB: 9.5%, and stage IV: 19%. Of these patients 52.4% were overweight and more than 60% had an ASA risk assessment of III or IV. Fifty complications arose in 37 (29%) of the 26 patients, which required 12 surgical re-interventions (all in total gastrectomy cases). Four anastomosis dehiscence were diagnosed and 4 intra-abdominal abscesses with no evidence of anastomosis dehiscence which were resolved with drainage. Two (1.6%) of the 126 patients died, both after total gastrectomy and with no evidence of intra-abdominal complications. CONCLUSIONS: Patients with gastric cancer, even with associated risk factors, can be treated by gastrectomy and D2 lymphadenectomy with similar morbidity and mortality rates to those centres with more experience, due to a great extent to sub-specialising in this surgery.

Morbilidad y mortalidad de la gastrectomía con linfadenectomía D2 en una unidad especializada / Morbidity and mortality in gastrectomy with D2 lymphadenectomy in a specialised unit

Introducción. La asociación de gastrectomía y linfadenectomía D2 no es todavía una opción terapéutica ampliamente aceptada por los cirujanos occidentales debido a que la morbilidad y la mortalidad postoperatorias son elevadas. Objetivo. Evaluar la morbilidad y la mortalidad en una serie de pacientes con cáncer gástrico tratados con gastrectomía y linfadenectomía D2, y comparar estos resultados con los publicados por centros con experiencia relevante. Pacientes y método. Estudio descriptivo y prospectivo de una serie de 126 pacientes consecutivos con cáncer gástrico tratados con gastrectomía y linfadenectomía D2. Se registraron todas las complicaciones, agrupadas en abdominales y no abdominales, así como las reintervenciones quirúrgicas. Resultados. Se realizó gastrectomía total en 95 (75,4%) de los 126 pacientes. Se asoció esplenectomía en 22 (17,5%) casos y pancreatectomía izquierda en 9 (7,1%). Los estadios, según la AJCC, fueron: estadio 0, el 4,8%; IA, el 17,5%; IB, el 22,2%; II, el 10,3%; IIIA, el 16,7%; IIIB, el 9,5%, y IV, el 19%. El 52,4% de los pacientes tenían sobrepeso y más del 60%, una valoración del riesgo ASA III o IV. Se produjeron 50 complicaciones en 37 (29%) de los 126 pacientes, que precisaron 12 reintervenciones quirúrgicas (todas en casos de gastrectomía total). Se diagnosticaron 4 dehiscencias de anastomosis y 4 abscesos intraabdominales sin evidencia de dehiscencia anastomótica que se solucionaron con drenaje. De los 126 pacientes, 2 (1,6%) fallecieron, ambos tras una gastrectomía total y sin evidencia de complicaciones intraabdominales. Conclusiones. A los pacientes con cáncer gástrico, incluso con factores de riesgo asociados, se puede tratarlos con gastrectomía y linfadenectomía D2, con cifras de morbilidad y mortalidad semejantes a las de los centros de mayor experiencia, en gran parte debido a la subespecialización en esta cirugía (AU)

Introduction. The combination of gastrectomy and D2 lymphadenectomy is still not a widely accepted therapeutic option by Western surgeons, due to its high post-operative morbidity and mortality. Objective. To evaluate the morbidity and mortality in a series of patients with gastric cancer treated by gastrectomy and D2 lymphadenectomy, and compare these results with those published by centres with notable experience. Patients and method. A descriptive and prospective study on a series of 126 consecutive patients with gastric cancer treated by gastrectomy and D2 lymphadenectomy. All complications were recorded, grouped into abdominal and non-abdominal, as well as surgical re-interventions. Results. Total gastrectomy was performed on 95 (75.4%) of the 126 patients. It was combined with splenectomy in 22 cases (17.5%) and left pancreatectomy in 9 (7.1%). The stages, according to the AJCC, were: stage 0: 4.8%, IA: 17.5%, IB: 22.2%, II: 10.3%, IIIA: 16.7%, IIIB: 9.5%, and stage IV: 19%. Of these patients 52.4% were overweight and more than 60% had an ASA risk assessment of III or IV. Fifty complications arose in 37 (29%) of the 26 patients, which required 12 surgical re-interventions (all in total gastrectomy cases). Four anastomosis dehiscence were diagnosed and 4 intra-abdominal abscesses with no evidence of anastomosis dehiscence which were resolved with drainage. Two (1.6%) of the 126 patients died, both after total gastrectomy and with no evidence of intra-abdominal complications. Conclusions. Patients with gastric cancer, even with associated risk factors, can be treated by gastrectomy and D2 lymphadenectomy with similar morbidity and mortality rates to those centres with more experience, due to a great extent to sub-specialising in this surgery (AU)

[Multifocal basaloid squamous carcinoma of the esophagus]. / Carcinoma basaloide escamoso multifocal de esófago.

Basaloid-squamous carcinoma is a poorly-differentiated variety of squamous cell carcinoma. The most common location is the upper aerodigestive tract and the incidence of this entity in the esophagus is low. Despite advances in knowledge of the biology of these tumors, their recent description and their low frequency has hampered consensus on the therapeutic approach. We present a case of basaloid-squamous cell of the esophagus a 54 year-old man who underwent an esophagectomy with lymphadenectomy and has been followed-up for 5 years with no evidence of disease recurrence. We also provide a literature review of this entity.

Carcinoma basaloide escamoso multifocal de esófago / Multifocal basaloid squamous carcinoma of the esophagus

El carcinoma basaloide escamoso es una variedad pobremente diferenciada del carcinoma escamoso. Se localiza predominantemente en el tracto aerodigestivo superior, y es poco frecuente en el esófago. Si bien ha habido avances en los últimos años en la comprensión de la biología de estos tumores, su descripción reciente y su escasa frecuencia justifican que aún no haya una conducta terapéutica consensuada en el cáncer basaloide escamoso de esófago. Presentamos un caso de cáncer basaloide escamoso multifocal de esófago en un varón de 54 años, al que se realizó una esofagectomía con linfadenectomía y que tras un seguimiento de más de 5 años no hay evidencias de recurrencia de la enfermedad. Se realiza una revisión de la bibliografía sobre el tema

Basaloid-squamous carcinoma is a poorly-differentiated variety of squamous cell carcinoma. The most common location is the upper aerodigestive tract and the incidence of this entity in the esophagus is low. Despite advances in knowledge of the biology of these tumors, their recent description and their low frequency has hampered consensus on the therapeutic approach. We present a case of basaloid-squamous cell of the esophagus a 54 year-old man who underwent an esophagectomy with lymphadenectomy and has been followed-up for 5 years with no evidence of disease recurrence. We also provide a literature review of this entity

Resultados de la fundoplicatura laparoscópica en la enfermedad por reflujo gastroesofágico con síntomas atípicos / Results of laparoscopic fundoplication in gastroesophageal reflux disease with atypical manifestations

Introducción. La enfermedad por reflujo gastroesofágico (ERGE) se presenta clínicamente con síntomas típicos (pirosis y regurgitaciones) y atípicos (tos, asma, dolor torácico no cardíaco). La fundoplicatura laparoscópica (FPL) se realiza desde hace más de 10 años para el tratamiento de esta enfermedad con resultados similares o mejores que con cirugía abierta. El objetivo de este trabajo es evaluar los resultados clínicos y funcionales de la FPL en la ERGE con síntomas atípicos. Pacientes y método. De 158 pacientes consecutivos con ERGE que fueron sometidos a FPL tipo Nissen (enero de 1999 a marzo de 2006), se identificó a 27 pacientes con síntomas atípicos. A todos se les realizó manometría y pH-metría preoperatoria y al 78% de ellos, en el postoperatorio (sexto mes). Se analizaron los datos de la historia clínica y se realizó una encuesta clínica telefónica. Resultados. No hubo mortalidad ni conversiones. La mediana del seguimiento fue de 21 meses. Todos los síntomas atípicos (tos, dolor torácico, asma, afonía y carraspera) disminuyeron significativamente (p < 0,05). La persistencia de síntomas en 5 pacientes no se relacionó, salvo en 1 de ellos, con reflujo ácido patológico. Respondieron a la encuesta telefónica un 89% de los pacientes, y el 79% no tenía síntomas. La mediana de satisfacción de los pacientes por la cirugía fue de 9 en una escala del 0 al 10. Conclusiones. La FPL en la ERGE con síntomas atípicos es un procedimiento seguro y tiene buenos resultados (clínica y funcionalmente) en grupos especializados; se obtiene, además, una alta aceptación por parte de los pacientes (AU)

Introduction. Gastroesophageal reflux disease (GERD) may present with typical (heartburn and regurgitation) and atypical symptoms (cough, asthma, non-cardiac chest pain). Laparoscopic fundoplication has been performed for approximately 10 years, with results similar to or better than those obtained with open antireflux procedures. The aim of this study was to evaluate the clinical and functional results of laparoscopic fundoplication in patients with GERD and atypical symptoms. Patients and method. There were 158 consecutive patients with GERD who underwent a 360° laparoscopic fundoplication (January 1999 to March 2006) and 27 patients had atypical symptoms. All patients underwent preoperative manometry and 24 hour pH-metry and 78% underwent the same tests postoperatively (at 6 months). Data from hospital records were analyzed and a clinical telephone survey was conducted. Results. There was no mortality and no conversions were required. The median length of follow-up was 21 months. All atypical symptoms (cough, chest pain, asthma, dysphonia and hoarseness) were significantly reduced (p < 0.05). There was no relationship between symptom persistence in five patients and pathologic acid reflux, except in one patient. Eighty-nine percent of the patients responded to the telephone survey; of these, 79% had no symptoms. The median satisfaction score was 9 (from 0 to 10). Conclusions. Laparoscopic fundoplication for GERD with atypical symptoms is a safe procedure with good results (clinical and functional) in trained groups patients. Moreover a high satisfaction rate is obtained (AU)

Intra-abdominal follicular dendritic cell sarcoma.

Follicular dendritic cell (FDC) sarcoma is a very rare condition. We report here an intra-abdominal FDC sarcoma occurring as a mass, dependent on the celiac and left gastric lymph chains, that was completely excised. Eighteen months after surgery a recurrence at the liver pedicle was detected by a CT-scan and fully resected; in order to prevent another disease relapse postoperative radiotherapy was given.

Esophageal squamous cell carcinoma after liver transplantation.

The occurrence of an oesophageal squamous cell carcinoma following liver transplantation is very infrequent. Such an event has been related to a history of alcohol-induced cirrhosis, as in other squamous cell tumours of the oropharynx. We report the case of a 64-year-old male patient diagnosed as having oesophageal squamous cell carcinoma six years after having had a liver transplant due to alcohol-induced cirrhosis. The tumour was treated surgically and consisted of an Ivor-Lewis oesophagectomy. The patient is disease-free 17 months after surgery. A review of the cases reported in the literature indicated treatment with chemotherapy and radiation therapy, and with excision in some cases. Generally, despite aggressive treatment the prognosis is poor.

Esophageal squamous cell carcinoma after liver transplantation

The occurrence of an oesophageal squamous cell carcinoma following liver transplantation is very infrequent. Such an event has been related to a history of alcohol-induced cirrhosis, as in other squamous cell tumours of the oropharynx. We report the case of a 64-year-old male patient diagnosed as having oesophageal squamous cell carcinoma six years after having had a liver transplant due to alcohol-induced cirrhosis. The tumour was treated surgically and consisted of an Ivor-Lewis oesophagectomy. The patient is disease-free 17 months after surgery. A review of the cases reported in the literature indicated treatment with chemotherapy and radiation therapy, and with excision in some cases. Generally, despite aggressive treatment the prognosis is poor

Nutrición enteral con yeyunostomía con catéter de aguja en la anastomosis esofágica. Complicaciones de la técnica / Enteral nutrition with needle catheter jejunostomy in esophageal anastomosis. Complications of the technique

Objetivo. El objetivo de este trabajo ha sido evaluar la presencia de complicaciones asociadas al empleo de la yeyunostomía quirúrgica con catéter y la tolerancia de la nutrición enteral. Pacientes y método. Estudio retrospectivo de 58 pacientes consecutivos a los que se les practicó cirugía resectiva esofágica o gástrica con anastomosis esofágica y se les realizó una yeyunostomía con catéter de aguja. Las variables estudiadas han sido: el inicio de la nutrición enteral, la duración de la perfusión, las complicaciones asociadas con el uso de la yeyunostomía y la tolerancia de la nutrición enteral. Resultados. La mortalidad de la serie ha sido del 1,7%. La infusión de nutrición enteral se inició en una media de 4,84 ± 5,01 días y duró una media de 7,9 ± 7,5 días. En 1 paciente no pudo utilizarse la yeyunostomía por obstrucción del catéter; en otros 2 pacientes se objetivó cierta resistencia a la perfusión de la nutrición pero pudieron ser alimentados a través de la sonda. Un paciente tuvo que ser reintervenido por presentar una peritonitis por extravasación de la nutrición enteral dentro de la cavidad peritoneal. Dos pacientes presentaron dificultad para la retirada del catéter, y 1 de ellos precisó la exploración de la herida cutánea bajo anestesia local. La tasa global de complicaciones en relación con la yeyunostomía fue del 10,3%. La tolerancia de la nutrición enteral fue correcta en 41 casos, se disminuyó el ritmo de la infusión en 6 casos y se suspendió por intolerancia en 10. Conclusiones. La yeyunostomía con catéter de aguja es una buena opción en los pacientes con anastomosis esofágicas debido a la baja morbilidad asociada con su empleo y la buena tolerancia de la nutrición enteral (AU)

Objective. The aim of this study was to evaluate the presence of complications associated with the use of surgical needle catheter jejunostomy and tolerance to enteral nutrition. Patients and method. We performed a retrospective study of 58 consecutive patients, who underwent esophageal or gastric resection with esophageal anastomosis and needle catheter jejunostomy. The variables studied were initiation of enteral nutrition, duration of perfusion, complications associated with the use of jejunostomy, and tolerance to enteral nutrition. Results. Mortality in the series was 1.7%. Infusion of enteral nutrition was started at mean of 4.84 ± 5.01 days and lasted for a mean of 7.9 ± 7.5 days. In one patient the jejunostomy could not be used due to catheter obstruction and in another 2 patients some resistance to perfusion of nutrition was observed but these patients could be fed through the tube. One patient had to undergo reintervention due to peritonitis caused by extravasation of the enteral nutrition within the peritoneal cavity. Catheter withdrawal was difficult in 2 patients; of these, 1 patient required investigation of the skin wound under local anesthetic. The overall rate of jejunostomy-related complications was 10.3%. Tolerance of enteral nutrition was acceptable in 41 patients, the infusion rate was reduced in 6 patients and infusion was discontinued due to intolerance in 10. Conclusions. Because needle catheter jejunostomy produces low morbidity and good tolerance to enteral nutrition, it is a valid alternative in patients with esophageal anastomosis (AU)

Calidad de vida tras funduplicatura por vía laparoscópica en el tratamiento del reflujo gastroesofágico / Quality of life after laparoscopic fundoplication for gastroesophageal reflux disease

Objetivo. Evaluar nuestros resultados en grado de satisfacción y calidad de vida de los pacientes intervenidos de reflujo gastroesofágico por vía laparoscópica. Pacientes y método. Estudio transversal en 49 pacientes consecutivos intervenidos de reflujo gastroesofágico por laparoscopia. Todos están intervenidos desde hace más de 6 meses y corresponden a casos del mismo cirujano. Se ha estudiado la morbilidad quirúrgica, el grado de satisfacción y la calidad de vida; para esta última, se remitió por correo, a todos los pacientes, los cuestionarios de calidad de vida SF-36 y GIQLI. Resultados. La edad media de los pacientes era de 40,5 años (rango, 23-71), 9 eran mujeres y 40, varones. A todos los pacientes se les practicó el cierre de ambas ramas del pilar diafragmático y funduplicatura floppy de 360°. No hubo ninguna reconversión. La tasa de complicaciones fue del 8,2% (un síndrome febril no filiado, una retención urinaria aguda, una hemorragia autolimitada y una hernia incisional en un orificio de un trocar). Respondieron a la encuesta 43 pacientes (87,7%). El grado de satisfacción fue de 8,7 (sobre 10), el 89,5% volvería a aceptar la intervención y el 94,6% la recomendaría a un familiar. Las puntuaciones obtenidas en el cuestionario SF-36 fueron similares a los valores poblacionales, salvo en la función física y en el dominio de dolor corporal, donde hubo diferencias significativas. La puntuación global media del cuestionario GIQLI fue de 110,8, similar a la de otros estudios publicados. Conclusiones. Aunque es un estudio de corte transversal, estos resultados preliminares indican un alto grado de satisfacción que se refleja en los estudios de calidad de vida (AU)

Objective. To evaluate our results in terms of satisfaction and quality of life in patients who underwent laparoscopic 360° fundoplication for gastroesophageal reflux disease. Patients and method. We performed a cross-sec-tional study of 49 consecutive patients who underwent laparoscopic 360° fundoplication for gastroesophageal reflux disease. All patients had been operated on more than 6 months previously by the same surgeon. Postoperative morbidity was recorded. Patients were sent the SF-36 and GIQLI quality of life questionnaires and were also asked about their degree of satisfaction with the surgery. Results. The mean age was 40.5 years (range, 2371). There were nine women and 40 men. All patients underwent a floppy 360° fundoplication and crural closure. There were no conversions. The complication rate was 8.2% (one case each of fever of unknown origin, acute urinary retention, self-limiting bleeding and hernia from a port). Forty-three patients completed the questionnaires (87.7%). Satisfaction with surgery was 8.7 points (out of 10), 89.5% would undergo surgery again and 94.6% would recommend it to a relative. The results of the SF-36 questionnaire were similar to population-based reference values except in the domains of physical functioning and bodily pain where statistically significant differences were found. The mean global GIQLI score was 110.8, which was similar to other studies published in the medical literature. Conclusions. Although this is a cross-sectional study, these preliminary results indicate a high degree of satisfaction with laparoscopic fundoplication, which was reflected in the results of the quality of life questionnaires (AU)

[Quality of life after laparoscopic fundoplication for gastroesophageal reflux disease]. / Calidad de vida tras funduplicatura por vía laparoscópica en el tratamiento del reflujo gastroesofágico.

OBJECTIVE: To evaluate our results in terms of satisfaction and quality of life in patients who underwent laparoscopic 360 degrees fundoplication for gastroesophageal reflux disease. PATIENTS AND METHOD: We performed a cross-sectional study of 49 consecutive patients who underwent laparoscopic 360 degrees fundoplication for gastroesophageal reflux disease. All patients had been operated on more than 6 months previously by the same surgeon. Postoperative morbidity was recorded. Patients were sent the SF-36 and GIQLI quality of life questionnaires and were also asked about their degree of satisfaction with the surgery. RESULTS: The mean age was 40.5 years (range, 23-71). There were nine women and 40 men. All patients underwent a floppy 360 degrees fundoplication and crural closure. There were no conversions. The complication rate was 8.2% (one case each of fever of unknown origin, acute urinary retention, self-limiting bleeding and hernia from a port). Forty-three patients completed the questionnaires (87.7%). Satisfaction with surgery was 8.7 points (out of 10), 89.5% would undergo surgery again and 94.6% would recommend it to a relative. The results of the SF-36 questionnaire were similar to population-based reference values except in the domains of physical functioning and bodily pain where statistically significant differences were found. The mean global GIQLI score was 110.8, which was similar to other studies published in the medical literature. CONCLUSIONS: Although this is a cross-sectional study, these preliminary results indicate a high degree of satisfaction with laparoscopic fundoplication, which was reflected in the results of the quality of life questionnaires.

[Enteral nutrition with needle catheter jejunostomy in esophageal anastomosis. Complications of the technique]. / Nutrición enteral con yeyunostomía con catéter de aguja en la anastomosis esofágica. Complicaciones de la técnica.

OBJECTIVE: The aim of this study was to evaluate the presence of complications associated with the use of surgical needle catheter jejunostomy and tolerance to enteral nutrition. PATIENTS AND METHOD: We performed a retrospective study of 58 consecutive patients, who underwent esophageal or gastric resection with esophageal anastomosis and needle catheter jejunostomy. The variables studied were initiation of enteral nutrition, duration of perfusion, complications associated with the use of jejunostomy, and tolerance to enteral nutrition. RESULTS: Mortality in the series was 1.7%. Infusion of enteral nutrition was started at mean of 4.84+/-5.01 days and lasted for a mean of 7.9+/-7.5 days. In one patient the jejunostomy could not be used due to catheter obstruction and in another 2 patients some resistance to perfusion of nutrition was observed but these patients could be fed through the tube. One patient had to undergo reintervention due to peritonitis caused by extravasation of the enteral nutrition within the peritoneal cavity. Catheter withdrawal was difficult in 2 patients; of these, 1 patient required investigation of the skin wound under local anesthetic. The overall rate of jejunostomy-related complications was 10.3%. Tolerance of enteral nutrition was acceptable in 41 patients, the infusion rate was reduced in 6 patients and infusion was discontinued due to intolerance in 10. CONCLUSIONS: Because needle catheter jejunostomy produces low morbidity and good tolerance to enteral nutrition, it is a valid alternative in patients with esophageal anastomosis.

Rotura pancreática aislada diagnosticada por TC en un traumatismo cerrado / Isolated blunt pancreatic rupture diagnosed by computerized axial tomography

La tomografía computarizada (TC) es el método de elección en el diagnóstico por la imagen de los pacientes hemodinámicamente estables con traumatismo abdominal cerrado. A diferencia de otras lesiones, la rotura pancreática puede ser difícil de diagnosticar mediante TC. Hasta en el 40 por ciento de los pacientes con lesión pancreática comprobada quirúrgicamente, la TC realizada puede ser normal. Presentamos un caso de rotura pancreática con sección del conducto principal que fue diagnosticada por TC. Se describe el papel de diferentes pruebas de laboratorio y de las técnicas de diagnóstico por la imagen en el planteamiento terapéutico del paciente con una lesión pancreática secundaria a un traumatismo abdominal cerrado (AU)

Nonobstructive dysphagia and recovery of motor disorder after antireflux surgery.

BACKGROUND: Changes in motor disorder after Nissen 360 degrees surgery were studied based on clinical signs of preoperative nonobstructive dysphagia. MATERIALS AND METHODS: Forty-seven patients undergoing Nissen 360 degrees fundoplication for gastroesophageal reflux were studied with pH recording and esophageal manometry before and 1 year after fundoplication. Amplitude of contraction of the distal third of the esophagus (ACDTE) and the presence of primary propulsive waves were studied. RESULTS: Fourteen patients had clinical signs of preoperative dysphagia. Of these, 50% had an ACDTE lower than 30 mm Hg, and 71.4% nonpropulsive waves (P <0.05). Forty-three percent and 30%, respectively, of patients with dysphagia recovered ACDTE and the presence of primary propulsive waves 1 year after the procedure, as compared with 66.6% (P <0.05) and 81.8% (P <0.01%) of patients without dysphagia. CONCLUSIONS: A correlation was found between preoperative dysphagia and esophageal motility disorders (P <0.05). One year after fundoplication, recovery was significantly higher in patients without preoperative dysphagia.

Cáncer de muñón gástrico. Réplica de los autores / Gastric stump cancer. Reply

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