Initial results of robot-assisted Ivor-Lewis oesophagectomy with intrathoracic hand-sewn anastomosis in the prone position.

BACKGROUND: There is scanty experience concerning robot-assisted Ivor-Lewis oesophagectomy, so every new experience is helpful. METHODS: We describe the techniques and short-term results of Ivor-Lewis oesophagectomy using a laparoscopic approach and robot-assisted thoracoscopy, and an observational study of prospective surveillance of the first 14 patients treated for oesophageal cancer. A gastric tube was created laparoscopically. Oesophagectomy was performed through a robot-assisted thoracoscopy followed by hand-sewn intrathoracic anastomosis. RESULTS: There were no conversion cases. Mortality was zero. Six patients had a major complication. There were no cases of respiratory complication or recurrent laryngeal nerve palsy. Three patients had a radiological fistula (21.4%), successfully treated by endoscopic stenting, and one (7.1%) had an anastomosis leak needing reoperation. There were two cases of chylothorax (14.3%). CONCLUSIONS: Our initial results suggest that the reported technique is safe and satisfies the oncological principles. It provides the advantages of minimally invasive surgery by overcoming some limitations of conventional thoracoscopy.

Valor pronóstico de la citometría de flujo en el linfoma gástrico / Prognostic value of flow cytometry in surgically treated primary gastric lymphoma

Aim: to investigate whether flow cytometry could help to definethe optimal therapeutic strategy of primary gastric lymphomas.Material and method: retrospective study of 46 patients havingprimary gastric lymphoma –according to Dawson criteria– inAnn Arbor stage IE and IIE, who were surgically treated. From selectedparaffin-embedded tissue blocks of the tumor, DNA contentwas studied by flow cytometry (FC). Other pathological tumor featureswere analysed by hematoxiline-eosine and Giemsa stains aswell as immunohistochemical study; any possible influence onpostoperative survival was investigated through statistical analysis.Results: the DNA ploidy pattern was diploid in 40 cases(87%) and aneuploid (hyperdiploid) in 6 (13%). Postoperative survivalprobability (PSP) was 62.7% at 5 years. Statistical analysisshowed significant prognostic value for Ann Arbor classification–with higher PSP for stage IE (p = 0.009)– and FC parameters: diploidtumors had higher PSP than aneuploid tumors. Also tumorshaving S-phase (p = 0.044) or G2-M phase values (p = 0.023) underthe respective mean values had higher PSP. No influence onPSP was found for wall invasion, Helicobacter pylori infection,Isaacson’s histologic type or resection margin involvement. Nosignificant relationship was appreciated between Isaacson’s histologictype and DNA ploidy patterns.Conclusion: FC could be useful in assessing gastric lymphomaprognosis

Objetivo: investigar si la citometría de flujo (CF) en el linfomagástrico primario podría ayudar a definir la estrategia terapéutica.Material y método: estudio retrospectivo de 46 pacientescon linfoma gástrico primario –de acuerdo con los criterios deDawson– en estadio IE y IIE de Ann Arbor, tratados quirúrgicamente.Se analizó el contenido tumoral de ADN mediante CF, a partirde preparaciones tumorales conservadas en parafina. Además seestudiaron otras características tumorales mediante tinciones dehematoxilina-eosina, giemsa y análisis inmuno-histoquímico. Seinvestigó su posible influencia sobre la probabilidad de supervivenciapostoperatoria (PSP) mediante análisis estadístico.Resultados: el patrón de ploidía tumoral fue diploide en 40casos (87%) y aneuploide (hiperdiploide) en 6 (13%). El análisis estadísticodemostró valor pronóstico para la clasificación de AnnArbor –con superior PSP para el estadio IE (p = 0,009)–, así comopara los parámetros de CF: los tumores diploides se asociaron auna PSP superior (p = 0.009), al igual que los tumores con valoresde fase S (p = 0,044) o fase G2-M (p = 0,023) inferiores a lasrespectivas medias. No se observó influencia sobre la supervivenciade la invasión tumoral en la pared, presencia de Helicobacterpylori, tipo histológico de Isaacson o afectación del borde de resección.Tampoco se apreció relación significativa entre el tipohistológico de Isaacson y el contenido de ADN.Conclusión: la CF podría ser útil para determinar el pronósticodel linfoma gástrico

A novel mutation in the E-cadherin gene in the first family with hereditary diffuse gastric cancer reported in Spain.

AIMS: Mutations of the E-cadherin gene (CDH1) result in dominantly inherited hereditary diffuse gastric cancer (HDGC). We report a study in the first family diagnosed with HDGC in Spain, examining the presence of mutations in the CDH1 gene. METHODS: The presence of mutations was studied by direct sequencing of all CDH1 exons. Immunohistochemical analysis with specific antibodies was used to detect the expression of E-cadherin in normal and tumour tissue. RESULTS: A novel 1610delC mutation in exon 11 has been found in a Spanish family diagnosed with HDGC. This mutation generates a premature stop codon at position 1667 giving rise to a truncated protein that lacks the transmembrane and beta-catenin-binding domains. The presence of a 1610delC germline mutation was confirmed in three family members diagnosed with diffuse gastric cancer, and also in six asymptomatic members. Of note, the diffuse gastric cancer coexisted with a gastric lymphoma in the proband. Furthermore, immunohistochemical analyses of tumour tissue showed the complete absence of E-cadherin in the proband, revealing a second genetic hit at the CDH1 locus. CONCLUSIONS: We have identified a HDGC family in Spain that carries a novel germline truncating mutation in the CDH1 gene.

Do current indications for surgery of primary gastric lymphoma exist?

OBJECTIVE: To analyze the results of our series in order to assess whether surgical excision is still a valid therapeutic option in case the patient needs surgery. Secondarily, to analyze Helicobacter pylori infection rate. PATIENTS AND METHOD: A retrospective study of 69 consecutive patients having stage IE-IIE primary gastric lymphoma; of these, 65 were treated by gastrectomy between 1974 and 1999. Mean age: 62.6 years (28-85). New staining of paraffin-embedded samples from the surgical specimen were carried out (hematoxiline-eosine, Giemsa, immunohistochemistry) and reviewed. The histological classification was performed according to Isaacson's criteria. The statistical analysis was done by Chi-squared and Fisher's exact tests, as well as Kaplan-Meier and Log-Rank tests. RESULTS: Mortality was 9.2%. There were non-fatal complications in 10.8%. Helicobacter pylori was identified in 62.7%. Seven patients (11.9%) suffered a relapse. The 5-year survival probability was 87%. The statistical analysis did not show any influences of Ann Arbor stage, gastric wall invasion, Helicobacter pylori infection, histological type, or margin resection involvement on survival. CONCLUSIONS: Surgical excision provides a high rate of complete remissions and excellent long-term survival with acceptable mortality. Therefore it appears to be a valid treatment in case of emergency surgery, incidental finding, or lack of histological diagnosis.

¿Existen indicaciones actuales para la cirugía en el linfoma gástrico? / Do current indications for surgery of primary gastric lymphoma exist?

Objetivo: analizar los resultados de nuestra serie a fin de establecer si la extirpación quirúrgica continúa siendo una opción terapéutica válida para las situaciones en las que pudiera precisarse cirugía. Como objetivo secundario, analizar la prevalencia de infección por Helicobacter pylori. Pacientes y método: estudio retrospectivo de 69 pacientes consecutivos diagnosticados de linfoma gástrico primario, en estadio IE y IIE de Ann Arbor, 65 de los cuales fueron tratados mediante gastrectomía entre 1974 y 1999. Edad media: 62,6 años (28-85). En 60 casos se revisó la histología de la pieza de resección con nuevas tinciones (hematoxilina-eosina, Giemsa), y estudio inmunohistoquímico de los bloques de parafina. La clasificación histológica se realizó de acuerdo con la clasificación de Isaacson. El análisis estadístico se realizó mediante las pruebas de Chi cuadrado y prueba exacta de Fisher y Kaplan-Meier y Log-Rank para el análisis de supervivencia. Resultados: la mortalidad fue de 9,2%. Se produjeron complicaciones no mortales en 10,8%. Se identificó Helicobacter pylori en 62,7%. Se produjo recaída en 7 pacientes (11,9%). La probabilidad de supervivencia fue de 87% a 5 años. El análisis estadístico no demostró influencia del estadio de Ann Arbor, invasión en la pared gástrica, infección por Helicobacter pylori, tipo histológico, ni afectación de bordes sobre la supervivencia. Conclusiones: la extirpación quirúrgica posibilita un alto grado de remisión completa y una excelente supervivencia a largo plazo, con mortalidad aceptable, por lo que es un tratamiento válido en caso de ausencia de diagnóstico histológico, hallazgo incidental o urgencia

Objective: to analyze the results of our series in order to assess whether surgical excision is still a valid therapeutic option in case the patient needs surgery. Secondarily, to analyze Helicobacter pylori infection rate. Patients and method: a retrospective study of 69 consecutive patients having stage IE-IIE primary gastric lymphoma; of these, 65 were treated by gastrectomy between 1974 and 1999. Mean age: 62.6 years (28-85). New staining of paraffin-embedded samples from the surgical specimen were carried out (hematoxiline-eosine, Giemsa, immunohistochemistry) and reviewed. The histological classification was performed according to Isaacson’s criteria. The statistical analysis was done by Chi-squared and Fisher’s exact tests, as well as Kaplan-Meier and Log-Rank tests. Results: mortality was 9.2%. There were non-fatal complications in 10.8%. Helicobacter pylori was identified in 62.7%. Seven patients (11.9%) suffered a relapse. The 5-year survival probability was 87%. The statistical analysis did not show any influences of Ann Arbor stage, gastric wall invasion, Helicobacter pylori infection, histological type, or margin resection involvement on survival. Conclusions: surgical excision provides a high rate of complete remissions and excellent long-term survival with acceptable mortality. Therefore it appears to be a valid treatment in case of emergency surgery, incidental finding, or lack of histological diagnosis

Prognostic value of flow cytometry in surgically treated primary gastric lymphoma.

AIM: To investigate whether flow cytometry could help to define the optimal therapeutic strategy of primary gastric lymphomas. MATERIAL AND METHOD: Retrospective study of 46 patients having primary gastric lymphoma--according to Dawson criteria--in Ann Arbor stage IE and IIE, who were surgically treated. From selected paraffin-embedded tissue blocks of the tumor, DNA content was studied by flow cytometry (FC). Other pathological tumor features were analysed by hematoxiline-eosine and Giemsa stains as well as immunohistochemical study; any possible influence on postoperative survival was investigated through statistical analysis. RESULTS: The DNA ploidy pattern was diploid in 40 cases (87%) and aneuploid (hyperdiploid) in 6 (13%). Postoperative survival probability (PSP) was 62.7% at 5 years. Statistical analysis showed significant prognostic value for Ann Arbor classification--with higher PSP for stage IE (p = 0.009)--and FC parameters: diploid tumors had higher PSP than aneuploid tumors. Also tumors having S-phase (p = 0.044) or G2-M phase values (p = 0.023) under the respective mean values had higher PSP. No influence on PSP was found for wall invasion, Helicobacter pylori infection, Isaacson's histologic type or resection margin involvement. No significant relationship was appreciated between Isaacson's histologic type and DNA ploidy patterns. CONCLUSION: FC could be useful in assessing gastric lymphoma prognosis.