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1.
BMC Gastroenterol ; 19(1): 205, 2019 Dec 02.
Artigo em Inglês | MEDLINE | ID: mdl-31791240

RESUMO

PURPOSE: To determine the indications for adjuvant chemotherapy (AC) in patients with stage IIa gastric cancer (T3N0M0 and T1N2M0) according to the 7th American Joint Committee on Cancer (AJCC). METHODS: A total of 1593 patients with T3N0M0 or T1N2M0 stage gastric cancer were identified from the Surveillance, Epidemiology, and End Results (SEER) database for the period 1988.1-2012.12. Cox multiple regression, nomogram and decision curve analyses were performed. External validation was performed using databases of the Fujian Medical University Union Hospital (FJUUH) (n = 241) and Italy IMIGASTRIC center (n = 45). RESULTS: Cox multiple regression analysis showed that the risk factors that affected OS in patients receiving AC were age > 65 years old, T1N2M0, LN dissection number ≤ 15, tumor size > 20 mm, and nonadenocarcinoma. A nomogram was constructed to predict 5-year OS, and the patients were divided into those predicted to receive a high benefit (points ≤ 188) or a low benefit from AC (points > 188) according to a recursive partitioning analysis. OS was significantly higher for the high-benefit patients in the SEER database and the FJUUH dataset than in the non-AC patients (Log-rank < 0.05), and there was no significant difference in OS between the low-benefit patients and non-AC patients in any of the three centers (Log-rank = 0.154, 0.470, and 0.434, respectively). The decision curve indicated that the best clinical effect can be obtained when the threshold probability is 0-92%. CONCLUSION: Regarding the controversy over whether T3N0M0 and T1N2M0 gastric cancer patients should be treated with AC, this study presents a predictive model that provides concise and accurate indications. These data show that high-benefit patients should receive AC.

2.
BMC Cancer ; 19(1): 1048, 2019 Nov 06.
Artigo em Inglês | MEDLINE | ID: mdl-31694573

RESUMO

BACKGROUND: Most lymph node metastasis (LNM) models for early gastric cancer (EGC) include lymphovascular invasion (LVI) as a predictor. However, LVI must be confirmed by postoperative pathology. In this study, we aimed to develop a model for predicting the risk of LNM/LVI in EGC using preoperative factors. METHODS: EGC patients who underwent radical gastrectomy at Fujian Medical University Union Hospital and Sun Yat-sen University Cancer Center (n = 1460) were selected as the training set. The risk factors of LNM/LVI were investigated. Data from the International study group on Minimally Invasive surgery for GASTRIc Cancer trial (n = 172) were selected as the validation set. RESULTS: In the training set, the incidence of LNM/LVI was 21.6%. The 5-year cancer-specific survival rates of patients with and without LNM/LVI were 92.4 and 95.0%, respectively, with significant difference (P = 0.030). Multivariable logistic regression analysis showed that the four independent risk factors for LNM/LVI were female, tumor larger than 20 mm, submucosal invasion and undifferentiated tumor histological type (all P <  0.05); the area under the curve (AUC) was 0.694 (95% confidence interval [CI]: 0.659-0.730). Patients were divided into low-risk, intermediate-risk, high-risk and extremely high-risk groups by recursive partitioning analysis; the incidences of LNM/LVI were 5.4, 12.6, 24.2 and 37.8%, respectively (P <  0.001). The AUC of the validation set was 0.796 (95%CI, 0.662-0.851) and the predictive performance of the LNM/LVI risk in the validation set was consistent with that in the training set. CONCLUSIONS: The risk of LNM/LVI in differentiated mucosal EGC is low, which indicated that endoscopic resection is a treatment option. The risk of LNM/LVI in undifferentiated mucosal EGC and submucosa EGC are high and gastrectomy with lymph node dissection is suggested.

3.
J Cancer ; 10(17): 4106-4113, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31417655

RESUMO

Purpose: To compare the clinicopathologic data and short-term surgical outcomes of laparoscopic gastrectomy (LG) for gastric cancer (GC) between the east and west. Methods: Patient demographics, surgical procedures, pathological information, and postoperative recovery were compared among gastric cancer patients who underwent LG in the clinical trial of IMIGASTRIC (NCT02325453) between 2009 and 2016. Results: More younger males, higher BMI, lower ASA score and less neoadjvant chemotherapy were evident in east patient cohort. Eastern patients had a higher proportion of proximal, differentiated and advanced gastric cancers. More total gastrectomies, larger extent of lymph node (LN) dissection, and higher number of retrieved LNs were found in the eastern patients. However, more Roux-en-Y anastomosis procedures during distal gastrectomy and intra-corporeal anastomosis were performed in the western patients. The west patients showed faster postoperative recovery than the eastern patients. The mortality rates of the western patients were comparable to those of the eastern patients. However, fewer III-IV complications were evident in the eastern centers. Multivariate analyses revealed that an elderly age, higher ASA score, and more blood loss were the significant independent risk factors of postoperative complications for eastern patients. However, for the western patients, the independent risk factors were neoadjuvant therapy, more retrieval LNs, and pT3-4 stage. Conclusions: The selections and short-term surgical outcomes of LG for GC were widely different between East and West. To obtain more objective and accurate results, these differences should be considered in future international prospective studies.

4.
J Surg Oncol ; 120(4): 685-697, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31317558

RESUMO

BACKGROUND: How to best evaluate the disease-specific survival (DSS) of gastric cancer (GC) survivors over time is unclear. METHODS: Clinicopathological data from 22 265 patients who underwent curative intend resection for GC were retrospectively analyzed. Changes in the patients' 3-year conditional disease-specific survival (CS3) were analyzed. We used time-dependent Cox regression to analyze which variables had long-term effects on DSS and devised a dynamic predictive model based on the length of survival. RESULTS: Based on 1-, 3-, and 5-year survivorships, the CS3 of the population increased gradually from 62% to 68.1%, 83.7%, and 90.6%, respectively. Subgroup analysis showed that the CS3 of patients who had poor prognostic factors initially demonstrated the greatest increase in postoperative survival time (eg, N3b: 26.6%-84.1%, Δ57.5% vs N0: 84.1%-93.3%, Δ9.2%). Time-dependent Cox regression analysis showed the following predictor variables constantly affecting DSS: age, the number of examined lymph nodes (LNs), T stage, N stage, and site (P < .05). These variables served as the basis for a dynamic prediction model. CONCLUSIONS: The influence of prognostic factors on DSS and CS3 changed dramatically over time. We developed an effective model for predicting the DSS of patients with GC based on the length of survival time.


Assuntos
Adenocarcinoma/mortalidade , Bases de Dados Factuais , Gastrectomia/mortalidade , Excisão de Linfonodo/mortalidade , Complicações Pós-Operatórias/mortalidade , Neoplasias Gástricas/mortalidade , Adenocarcinoma/patologia , Adulto , Idoso , Feminino , Humanos , Agências Internacionais , Masculino , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Valor Preditivo dos Testes , Estudos Retrospectivos , Neoplasias Gástricas/patologia , Taxa de Sobrevida
5.
Eur J Surg Oncol ; 45(10): 1934-1942, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31027946

RESUMO

BACKGROUND: Previous studies have elucidated that on average, long-term cancer survivors have better prognoses than newly diagnosed individuals. This study aimed to devise a nomogram to predict the conditional probability of cancer-specific survival (CPCS) in gastric cancer (GC) patients after D2 lymphadenectomy. METHODS: Clinicopathological data for 2,596 GC patients who underwent D2 lymphadenectomy in an Eastern institution (the training cohort) were retrospectively analysed. Cancer-specific survival (CSS) was predicted using Cox regression models. A nomogram was constructed to predict CPCS at 3 and 5 years post-gastrectomy. Two external validations were performed using a cohort of 2,198 Chinese patients and a cohort of 504 Italian patients. RESULTS: In the training cohort, the 5-year CPCS was 59.2% immediately post-gastrectomy and increased to 68.8%, 79.7%, and 88.8% at 1, 2, and 3 years post-gastrectomy, respectively. Multivariate Cox regression analyses showed that age; tumour site, size and invasion depth; numbers of examined and metastatic lymph nodes; and surgical margins were independent prognostic factors of CSS (all P < 0.05) and formed the nomogram predictor variables. Internal validation showed that the conditional nomogram exhibited good discrimination ability at 3 and 5 years post-gastrectomy (concordance index, 0.794 and 0.789, respectively). External validation showed a 3- and 5-year concordance index of 0.788 and 0.785, respectively, in the Chinese cohort, and 0.792 and 0.787, respectively, in the Italian cohort. Calibration of the nomogram predicted that survival corresponded closely with actual survival. CONCLUSIONS: we developed a robust nomogram to predict CPCS after D2 lymphadenectomy for GC based on survival duration.

6.
Surg Infect (Larchmt) ; 20(4): 271-277, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30720387

RESUMO

Background: The objective of the study was to investigate the effects of intra-abdominal infection after curative gastrectomy on the prognosis of patients. Patients and Methods: Data were collected for enrolled patients who underwent curative gastrectomy in two centers; the relationship between intra-abdominal infection and prognosis was analyzed. Results: Of the 5,721 patients in the entire group, intra-abdominal infection occurred in 202 (3.5%) patients. Co-morbidities and duration of surgical procedures ≥240 minutes represented the independent risk factors for intra-abdominal infection. The overall five-year survival of patients with and without intra-abdominal infection was 60.2% and 64.3%, respectively (p = 0.041). After propensity score matching, the five-year overall survival between the two groups was not significantly different (p = 0.909). T staging, N staging, American Society of Anesthesiologists score, and age were independent prognostic factors for the overall survival of patients who underwent curative gastrectomy. The meta-analysis of the random effects model showed that there were no significant differences in the five-year overall survival between patients with and without intra-abdominal infection. Conclusions: The development of intra-abdominal infection after curative gastrectomy is associated closely with co-morbidities and longer operation time, whereas intra-abdominal infection does not lead to reduced long-term survival of patients.


Assuntos
Gastrectomia/efeitos adversos , Infecções Intra-Abdominais/epidemiologia , Idoso , Feminino , Seguimentos , Gastrectomia/mortalidade , Humanos , Infecções Intra-Abdominais/mortalidade , Masculino , Pessoa de Meia-Idade , Prognóstico , Fatores de Risco , Análise de Sobrevida
7.
Updates Surg ; 71(4): 695-700, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-30019164

RESUMO

Robotic surgery has been proposed over the last decade as a valid option to treat gastrointestinal malignancies in a minimally invasive method, yielding encouraging results. The authors examine the outcomes of a consecutive series of patients with stromal gastrointestinal neoplasms who were operated on using a totally robotic technique. There were 36 patients in the study, with median age 70 years. Resected tumors were located in the esophagus, stomach, duodenum, small intestine and rectum. Perioperative morbidity was 8% and no mortality occurred. R0 resection was achieved in all cases. At a median follow-up of 25 months, 35 patients were disease free while there was one case of death related to metastatic disease. Robotic surgery is a valid option to resect gastrointestinal stromal tumors anywhere along the gastrointestinal tract in a minimally invasive manner.

8.
Chin J Cancer Res ; 30(5): 568-570, 2018 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-30510369

RESUMO

In recent years, some researchers have tried to find a way to improve the surgical identification of the lymphatic drainage routes and lymph node stations during radical gastrectomy, thus starting a new research frontier in this field called " navigation surgery". Among the different reported solutions, the introduction of the indocyanine green (ICG) has drawn attention for its characteristics, a fluorescence dye that can be detected in the near infrared spectral band (NIR). A fluorescence imaging technology has been integrated in the latest version of the Da Vinci robotic system and surgeons have extensively reported their experiences in colorectal and hepato-biliary surgery for tumors, vascular and lymphatic structures visualization. However, up to date, the combined use of fluorescence imaging and robotic technology has not been adequately investigated during lymphadenectomy in gastric cancer.

9.
J Gastric Cancer ; 18(3): 230-241, 2018 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-30276000

RESUMO

Purpose: Enhanced recovery after surgery (ERAS) protocols for gastric cancer patients have shown improved outcomes in Asia. However, data on gastric cancer ERAS (GC-ERAS) programs in the United States are sparse. The purpose of this study was to compare perioperative outcomes before and after implementation of an GC-ERAS protocol at a National Comprehensive Cancer Center in the United States. Materials and Methods: We reviewed medical records of patients surgically treated for gastric cancer with curative intent from January 2012 to October 2016 and compared the GC-ERAS group (November 1, 2015-October 1, 2016) with the historical control (HC) group (January 1, 2012-October 31, 2015). Propensity score matching was used to adjust for age, sex, number of comorbidities, body mass index, stage of disease, and distal versus total gastrectomy. Results: Of a total of 95 identified patients, matching analysis resulted in 20 and 40 patients in the GC-ERAS and HC groups, respectively. Lower rates of nasogastric tube (35% vs. 100%, P<0.001) and intraabdominal drain placement (25% vs. 85%, P<0.001), faster advancement of diet (P<0.001), and shorter length of hospital stay (5.5 vs. 7.8 days, P=0.01) were observed in the GC-ERAS group than in the HC group. The GC-ERAS group showed a trend toward increased use of minimally invasive surgery (P=0.06). There were similar complication and 30-day readmission rates between the two groups (P=0.57 and P=0.66, respectively). Conclusions: The implementation of a GC-ERAS protocol significantly improved perioperative outcomes in a western cancer center. This finding warrants further prospective investigation.

10.
Ann Surg Oncol ; 25(8): 2383-2390, 2018 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-29881929

RESUMO

BACKGROUND: Previous studies have developed three nomograms for the individual prediction of overall survival after gastric cancer surgery. In this study, the performance of these nomograms was evaluated and compared with that of a simplified nomogram in a multinational cohort of patients. METHODS: Clinical data from patients who underwent resection (R0) with curative intent for GC at three specialized centers (two from China and one from Italy) and data from the Surveillance, Epidemiology, and End Results database were retrospectively analyzed. RESULTS: The study analyzed 9810 patients, and the simplified nomogram was developed based on the following factors present in all models: age, sex, depth of invasion, and number of metastatic lymph nodes. In the decision curve analyses, the simplified nomogram demonstrated similar net benefit gains relative to previous models. The discriminative ability of the simplified nomogram was similar to those of the three existing nomograms, and calibration of the simplified nomogram resulted in a predicted survival similar to the actual survival. The predictive ability of the simplified nomogram was superior to that of the American Joint Committee on Cancer (AJCC) stage using Eastern and Western validation data (p < 0.01). Additionally, the simplified nomogram predicted the probabilities within each AJCC stage to illustrate the heterogeneity of risk within each stage. CONCLUSION: The novel simplified nomogram simplifies the assessment of individual survival after R0 resection for GC without sacrificing predictive ability. It also has potential for use with other databases and for clinical applications.


Assuntos
Técnicas de Apoio para a Decisão , Gastrectomia/mortalidade , Nomogramas , Sistema de Registros/estatística & dados numéricos , Neoplasias Gástricas/mortalidade , Idoso , China/epidemiologia , Feminino , Seguimentos , Humanos , Itália/epidemiologia , Masculino , Pessoa de Meia-Idade , Prognóstico , Estudos Prospectivos , Estudos Retrospectivos , Neoplasias Gástricas/epidemiologia , Neoplasias Gástricas/patologia , Neoplasias Gástricas/cirurgia , Taxa de Sobrevida
11.
World J Gastroenterol ; 23(23): 4293-4302, 2017 Jun 21.
Artigo em Inglês | MEDLINE | ID: mdl-28694670

RESUMO

AIM: To show outcomes of our series of patients that underwent a total gastrectomy with a robotic approach and highlight the technical details of a proposed solution for the reconstruction phase. METHODS: Data of gastrectomies performed from May 2014 to October 2016, were extracted and analyzed. Basic characteristics of patients, surgical and clinical outcomes were reported. The technique for reconstruction (Parisi Technique) consists on a loop of bowel shifted up antecolic to directly perform the esophago-enteric anastomosis followed by a second loop, measured up to 40 cm starting from the esojejunostomy, fixed to the biliary limb to create an enteroenteric anastomosis. The continuity between the two anastomoses is interrupted just firing a linear stapler, so obtaining the Roux-en-Y by avoiding to interrupt the mesentery. RESULTS: Fifty-five patients were considered in the present analysis. Estimated blood loss was 126.55 ± 73 mL, no conversions to open surgery occurred, R0 resections were obtained in all cases. Hospital stay was 5 (3-17) d, no anastomotic leakage occurred. Overall, a fast functional recovery was shown with a median of 3 (3-6) d in starting a solid diet. CONCLUSION: Robotic surgery and the adoption of a tailored reconstruction technique have increased the feasibility and safety of a minimally invasive approach for total gastrectomy. The present series of patients shows its implementation in a western center with satisfying short-term outcomes.


Assuntos
Anastomose em-Y de Roux/métodos , Anastomose Cirúrgica/métodos , Gastrectomia/efeitos adversos , Gastrectomia/métodos , Procedimentos Cirúrgicos Robóticos/métodos , Neoplasias Gástricas/cirurgia , Idoso , Feminino , Humanos , Laparoscopia , Tempo de Internação , Excisão de Linfonodo , Masculino , Pessoa de Meia-Idade , Duração da Cirurgia , Procedimentos Cirúrgicos Robóticos/instrumentação , Técnicas de Sutura , Resultado do Tratamento
12.
World J Gastroenterol ; 23(13): 2376-2384, 2017 Apr 07.
Artigo em Inglês | MEDLINE | ID: mdl-28428717

RESUMO

AIM: To investigate the role of minimally invasive surgery for gastric cancer and determine surgical, clinical, and oncological outcomes. METHODS: This is a propensity score-matched case-control study, comparing three treatment arms: robotic gastrectomy (RG), laparoscopic gastrectomy (LG), open gastrectomy (OG). Data collection started after sharing a specific study protocol. Data were recorded through a tailored and protected web-based system. Primary outcomes: harvested lymph nodes, estimated blood loss, hospital stay, complications rate. Among the secondary outcomes, there are: operative time, R0 resections, POD of mobilization, POD of starting liquid diet and soft solid diet. The analysis includes the evaluation of type and grade of postoperative complications. Detailed information of anastomotic leakages is also provided. RESULTS: The present analysis was carried out of 1026 gastrectomies. To guarantee homogenous distribution of cases, patients in the RG, LG and OG groups were 1:1:2 matched using a propensity score analysis with a caliper = 0.2. The successful matching resulted in a total sample of 604 patients (RG = 151; LG = 151; OG = 302). The three groups showed no differences in all baseline patients characteristics, type of surgery (P = 0.42) and stage of the disease (P = 0.16). Intraoperative blood loss was significantly lower in the LG (95.93 ± 119.22) and RG (117.91 ± 68.11) groups compared to the OG (127.26 ± 79.50, P = 0.002). The mean number of retrieved lymph nodes was similar between the RG (27.78 ± 11.45), LG (24.58 ± 13.56) and OG (25.82 ± 12.07) approach. A benefit in favor of the minimally invasive approaches was found in the length of hospital stay (P < 0.0001). A similar complications rate was found (P = 0.13). The leakage rate was not different (P = 0.78) between groups. CONCLUSION: Laparoscopic and robotic surgery can be safely performed and proposed as possible alternative to open surgery. The main highlighted benefit is a faster postoperative functional recovery.


Assuntos
Laparoscopia/estatística & dados numéricos , Complicações Pós-Operatórias/epidemiologia , Procedimentos Cirúrgicos Robóticos/estatística & dados numéricos , Neoplasias Gástricas/cirurgia , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Itália/epidemiologia , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos
13.
Eur J Cancer ; 79: 1-14, 2017 07.
Artigo em Inglês | MEDLINE | ID: mdl-28456089

RESUMO

IMPORTANCE: Hyperthermic intraperitoneal chemotherapy (HIPEC) has been used within various multimodality strategies for the prevention and treatment of gastric cancer peritoneal carcinomatosis. OBJECTIVE: To systematically evaluate the role of HIPEC in gastric cancer and clarify its effectiveness at different stages of peritoneal disease progression. DATA SOURCES: Medline and Embase databases between January 1, 1985 and June 1, 2016. STUDY SELECTION: Randomised control trials and high-quality non-randomised control trials selected on a validated tool (methodological index for non-randomised studies) comparing HIPEC and standard oncological management for the treatment of advanced stage gastric cancer with and without peritoneal carcinomatosis were considered. DATA EXTRACTION AND SYNTHESIS: A random-effects network meta-analysis. MAIN OUTCOMES AND MEASURES: The primary outcomes were overall survival and disease recurrence. Secondary outcomes were overall complications, type of complications, and sites of recurrence. RESULTS: A total of 11 RCTs and 21 non-randomised control trials (2520 patients) were included. For patients without the presence of peritoneal carcinomatosis (PC), the overall survival rates between the HIPEC and control groups at 3 or 5 years resulted in favour of the HIPEC group (risk ratio [RR] = 0.82, P = 0.01). No difference in the 3-year overall survival (RR = 0.99, P = 0.85) in but a prolonged median survival of 4 months in favour of the HIPEC group (WMD = 4.04, P < 0.001) was seen in patients with PC. HIPEC was associated with significantly higher risk of complications for both patients with PC (RR = 2.15, P < 0.01) and without (RR = 2.17, P < 0.01). This increased risk in the HIPEC group was related to systemic drugs toxicity. Anastomotic leakage rates were found to be similar between groups. CONCLUSIONS: Our study demonstrates a survival advantage of the use of HIPEC as a prophylactic strategy and suggests that patients whose disease burden is limited to positive cytology and limited nodal involvement may benefit the most from HIPEC. For patients with extensive carcinomatosis, the completeness of cytoreductive surgery is a critical prognostic factor for survival. Future RCTs should better define patient selection criteria.


Assuntos
Antineoplásicos/administração & dosagem , Carcinoma/tratamento farmacológico , Hipertermia Induzida/métodos , Neoplasias Gástricas/tratamento farmacológico , Carcinoma/mortalidade , Carcinoma/cirurgia , Ensaios Clínicos como Assunto , Progressão da Doença , Humanos , Hipertermia Induzida/efeitos adversos , Hipertermia Induzida/mortalidade , Infusões Parenterais , Recidiva Local de Neoplasia/etiologia , Recidiva Local de Neoplasia/mortalidade , Neoplasias Peritoneais/mortalidade , Neoplasias Peritoneais/prevenção & controle , Neoplasias Peritoneais/cirurgia , Complicações Pós-Operatórias/induzido quimicamente , Complicações Pós-Operatórias/mortalidade , Ensaios Clínicos Controlados Aleatórios como Assunto , Neoplasias Gástricas/mortalidade , Neoplasias Gástricas/cirurgia , Taxa de Sobrevida , Resultado do Tratamento
14.
Surg Oncol ; 26(1): 28-36, 2017 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-28317582

RESUMO

PURPOSE: Surgeons tend to view the robotic right colectomy (RRC) as an ideal beginning procedure to gain proficiency in robotic general and colorectal surgery. Nevertheless, oncological RRC, especially if performed with intracorporeal ileocolic anastomosis confectioning, cannot be considered a technically easier procedure. The aim of this study was to assess the learning curve of the RRC performed for oncological purposes and to evaluate its safety and efficacy investigating the perioperative and pathology outcomes in the different learning phases. METHODS: Data on a consecutive series of 108 patients undergoing RRC with intracorporeal anastomosis between June 2011 and September 2015 at our institution were prospectively collected to evaluate surgical and short-term oncological outcomes. CUSUM (Cumulative Sum) and Risk-Adjusted (RA) CUSUM analysis were performed in order to perform a multidimensional assessment of the learning curve for the RRC surgical procedure. Intraoperative, postoperative and pathological outcomes were compared among the learning curve phases. RESULTS: Based on the CUSUM and RA-CUSUM analyses, the learning curve for RRC could be divided into 3 different phases: phase 1, the initial learning period (1st-44th case); phase 2, the consolidation period (45th-90th case); and phase 3, the mastery period (91th-108th case). Operation time, conversion to open surgery rate and the number of harvested lymph nodes significantly improve through the three learning phases. CONCLUSIONS: The learning curve for oncological RRC with intracorporeal anastomosis is composed of 3 phases. Our data indicate that the performance of RRC is safe from an oncological point of view in all of the three phases of the learning curve. However, the technical skills necessary to significantly reduce operative time, conversion to open surgery rate and to significantly improve the number of harvested lymph nodes were achieved after 44 procedures. These data suggest that it might be prudent to start the RRC learning curve by treating only benign diseases and to reserve the performance of oncological resection to when at least the initial learning phase has been completed.


Assuntos
Colectomia/métodos , Neoplasias do Colo/cirurgia , Curva de Aprendizado , Procedimentos Cirúrgicos Robóticos/métodos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Anastomose Cirúrgica , Neoplasias do Colo/patologia , Feminino , Seguimentos , Humanos , Laparoscopia , Masculino , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Duração da Cirurgia , Prognóstico , Estudos Prospectivos , Estudos Retrospectivos , Adulto Jovem
15.
Zhonghua Wei Chang Wai Ke Za Zhi ; 20(2): 135-139, 2017 Feb 25.
Artigo em Chinês | MEDLINE | ID: mdl-28226344

RESUMO

OBJECTIVE: Postoperative complications are important outcome measurements for surgical quality and safety control. However, the complication registration has always been problematic due to the lack of definition consensus and the other practical difficulties. This narrative review summarizes the data registry system for single institutional registry, national data registry, international multi-center trial registries in the western world, aiming to share the experience of complication classification and data registration. We interviewed Dr. Koh from Royal Prince Alfred Hospital in Australia for single institutional experience, Dr. van der Wielen and Dr. Desideriofor, from two international multi-center trial(STOMACH) and registry (IMIGASTRIC) respectively, and Prof. Dr. Wijnhoven from the Dutch Upper GI Audit(DUCA). The major questions include which complications are obligated to report in the respective registry, what are the definitions of those complications, who perform the registration, and how are the complications evaluated or classified. Four telephone conferences were initiated to discuss the above-mentioned topics. The DUCA and IMGASTRIC provided the definition of the major complications. The consent definition provided by DUCA was based on the LOW classification which came out after a four-year discussion and consensus meeting among international experts in the according field. However, none of the four registries asked for an obligatory standardization of the diagnostic criteria among the participating centers or surgeons. Instead, all the registries required a detailed recording of the diagnostic strategy and classification of the complications with the Clavien-Dindo scoring system. Most data were registered by surgeons or data managers during or immediately after the hospitalization. The investigators or an independent third party conducted the auditing of the data quality. Standardization of complication diagnosis among different centers is a difficult task, consuming much effort and time. On top of that, standardization of the complication registration is of critical and practical importance. We encourage all centers to register complications with the diagnostic criteria and following intervention. Based on this, the Clavien-Dindo classification can be properly justified, which has been widely accepted by most centers and should be routinely used as the standard evaluation system for postoperative complications in gastric tumor surgery.


Assuntos
Coleta de Dados/normas , Técnicas e Procedimentos Diagnósticos/normas , Procedimentos Cirúrgicos do Sistema Digestório/efeitos adversos , Complicações Pós-Operatórias/classificação , Complicações Pós-Operatórias/epidemiologia , Sistema de Registros/normas , Medição de Risco/métodos , Medição de Risco/normas , Neoplasias Gástricas/cirurgia , Austrália/epidemiologia , Coleta de Dados/estatística & dados numéricos , Técnicas e Procedimentos Diagnósticos/estatística & dados numéricos , Procedimentos Cirúrgicos do Sistema Digestório/estatística & dados numéricos , Pesquisas sobre Serviços de Saúde , Humanos , Países Baixos/epidemiologia , Complicações Pós-Operatórias/diagnóstico , Neoplasias Gástricas/complicações
16.
Endocrine ; 55(3): 748-753, 2017 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-27259508

RESUMO

No randomized clinical trials (RCTs) have yet evaluated the bariatric surgery's efficacy and safety in patients newly diagnosed with type 2 diabetes mellitus (T2DM). The aim of this multicenter RCT is to compare bariatric surgery, particularly laparoscopic sleeve gastrectomy (LSG), with conventional medical therapy (CMT) in obese patients (body mass index between 30 and 42 kg/m2) newly diagnosed with T2DM and without any diabetes-related complications at any stage. A total of 100 eligible patients will be randomized at a 1:1 ratio to undergo one of the two planned treatments and will be followed for at least 6 years after randomization. The main objective of the ESINODOP trial is to investigate the efficacy of LSG compared with CMT alone in inducing and maintaining a remission of T2DM (defined as HbA1c levels ≤6.0 %, without active pharmacologic therapy after 1 year). The remission of T2DM will also be evaluated with the criteria provided by the American Diabetes Association (ADA), and the additional parameters such as adverse event rates, micro- and macrovascular complications, weight loss, gastrointestinal hormones, and quality of life will be compared. The study started on September 2015 and the planned recruitment period is 3 years. Patient recruitment and follow-up take place in the two diabetology and nutrition centers participating in the study, which are performed on a national basis. The ESINODOP trial is designed with the intent of comparing the efficacy of CMT alone to that of CMT in conjunction with LSG performed at the time of diabetes diagnosis in mildly obese diabetic patients. Currently, patients with these characteristics are not eligible for bariatric/metabolic surgery.


Assuntos
Diabetes Mellitus Tipo 2/cirurgia , Gastrectomia/métodos , Obesidade/cirurgia , Adulto , Idoso , Protocolos Clínicos , Gastrectomia/efeitos adversos , Humanos , Pessoa de Meia-Idade , Projetos de Pesquisa , Adulto Jovem
17.
Artigo em Inglês | MEDLINE | ID: mdl-27458487

RESUMO

INTRODUCTION: Over the years various therapeutic techniques for diverticulitis have been developed. Laparoscopic peritoneal lavage (LPL) appears to be a safe and useful treatment, and it could be an effective alternative to colonic resection in emergency surgery. AIM: This prospective observational study aims to assess the safety and benefits of laparoscopic peritoneal lavage in perforated sigmoid diverticulitis. MATERIAL AND METHODS: We surgically treated 70 patients urgently for complicated sigmoid diverticulitis. Thirty-two (45.7%) patients underwent resection of the sigmoid colon and creation of a colostomy (Hartmann technique); 21 (30%) patients underwent peritoneal laparoscopic lavage; 4 (5.7%) patients underwent colostomy by the Mikulicz technique; and the remaining 13 (18.6%) patients underwent resection of the sigmoid colon and creation of a colorectal anastomosis with a protective ileostomy. RESULTS: The 66 patients examined were divided into 3 groups: 32 patients were treated with urgent surgery according to the Hartmann procedure; 13 patients were treated with resection and colorectal anastomosis; 21 patients were treated urgently with laparoscopic peritoneal lavage. We had no intraoperative complications. The overall mortality was 4.3% (3 patients). In the LPL group the morbidity rate was 33.3%. CONCLUSIONS: Currently it cannot be said that LPL is better in terms of mortality and morbidity than colonic resection. These data may, however, be proven wrong by greater attention in the selection of patients to undergo laparoscopic peritoneal lavage.

18.
Int J Surg ; 30: 25-30, 2016 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-27102326

RESUMO

BACKGROUND: During the last decade, criteria for liver resection were extended thanks to surgical and oncological developments, thus increasing the number of surgeries for non-colorectal liver metastases. However, the real advantages of surgery in this category of patients remain debated, due to the few studies available in the literature. The present study aims to analyze liver surgery performed for metastatic disease at a single referral center, comparing outcomes of patients that underwent resections for colorectal and non-colorectal metastases. METHODS: The overall study period was January 2005-May 2015. A total of 170 patients were selected from the institutional database and then included in the analysis. Patients and tumors characteristics were reported. Overall survival and subgroup analyses based on different primary malignancies were performed. The Kaplan-Meier method was used. RESULTS: The mean age of the patients was 67.68 ± 10.98 years. Primary malignancies distribution resulted as follows: colorectal (77.1%), genitourinary (7.6%), neuroendocrine (5.3%), breast (4.7%), foregut (2.9%), melanoma (2.4%). The overall survival rates at 1, 3, 5 years, were 96.2%, 42.8% and 14.7%, respectively. The survival analysis showed a mean overall survival of 54 months in the colorectal metastases group vs 32 months in the non-colorectal liver metastases group (HR = 5.92, P = 0.015). CONCLUSION: Surgery for patients with non-colorectal liver metastases must be considered in the context of a multidisciplinary treatment where chemotherapy plays the main role. International guidelines and a specific consensus on this field are desirable to offer the best available therapy for the metastatic liver disease. ETHICS AND DISSEMINATION: This study is conducted in compliance with ethical principles originating from the Helsinki Declaration, within the guidelines of Good Clinical Practice and relevant laws/regulations. TRIAL REGISTRATION NUMBER: researchregistry898.


Assuntos
Neoplasias Colorretais/patologia , Hepatectomia/métodos , Neoplasias Hepáticas/secundário , Neoplasias Hepáticas/cirurgia , Adulto , Idoso , Feminino , Humanos , Estimativa de Kaplan-Meier , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Taxa de Sobrevida , Resultado do Tratamento
20.
Medicine (Baltimore) ; 94(49): e1922, 2015 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-26656323

RESUMO

Gastric cancer constitutes a major health problem. Robotic surgery has been progressively developed in this field. Although the feasibility of robotic procedures has been demonstrated, there are unresolved aspects being debated, including the reproducibility of intracorporeal in place of extracorporeal anastomosis.Difficulties of traditional laparoscopy have been described and there are well-known advantages of robotic systems, but few articles in literature describe a full robotic execution of the reconstructive phase while others do not give a thorough explanation how this phase was run.A new reconstructive approach, not yet described in literature, was recently adopted at our Center.Robotic total gastrectomy with D2 lymphadenectomy and a so-called "double-loop" reconstruction method with intracorporeal robot-sewn anastomosis (Parisi's technique) was performed in all reported cases.Preoperative, intraoperative, and postoperative data were collected and a technical note was documented.All tumors were located at the upper third of the stomach, and no conversions or intraoperative complications occurred. Histopathological analysis showed R0 resection obtained in all specimens. Hospital stay was regular in all patients and discharge was recommended starting from the 4th postoperative day. No major postoperative complications or reoperations occurred.Reconstruction of the digestive tract after total gastrectomy is one of the main areas of surgical research in the treatment of gastric cancer and in the field of minimally invasive surgery.The double-loop method is a valid simplification of the traditional technique of construction of the Roux-limb that could increase the feasibility and safety in performing a full hand-sewn intracorporeal reconstruction and it appears to fit the characteristics of the robotic system thus obtaining excellent postoperative clinical outcomes.


Assuntos
Gastrectomia/métodos , Robótica , Neoplasias Gástricas/cirurgia , Idoso , Idoso de 80 Anos ou mais , Anastomose em-Y de Roux/métodos , Esôfago/cirurgia , Feminino , Humanos , Jejuno/cirurgia , Excisão de Linfonodo/métodos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias , Técnicas de Sutura , Resultado do Tratamento
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