Near-Infrared Fluorescence Image-Guided Surgery in Esophageal and Gastric Cancer Operations.

BACKGROUND: Near-infrared fluorescence image-guided surgery helps surgeons to see beyond the classical eye vision. Over the last few years, we have witnessed a revolution which has begun in the field of image-guided surgery. PURPOSE, AND RESEARCH DESIGN: Fluorescence technology using indocyanine green (ICG) has shown promising results in many organs, and in this review article, we wanted to discuss the 6 main domains where fluorescence image-guided surgery is currently used for esophageal and gastric cancer surgery. STUDY SAMPLE AND DATA COLLECTION: Visualization of lymphatic vessels, tumor localization, fluorescence angiography for anastomotic evaluation, thoracic duct visualization, tracheal blood flow analysis, and sentinel node biopsy are discussed. CONCLUSIONS: It seems that this technology has already found its place in surgery. However, new possibilities and research avenues in this area will probably make it even more important in the near future.

Who Is a Pathologist According to Oncology Patients and Internet Users? A Survey Study.

The pathologist is frequently called "the doctor's doctor." However, there are many uncertainties about the role of a pathologist among patients and policymakers and even among other medical specialties. The aim of the current study is to analyze the misconceptions of who a pathologist is among inpatients and Internet users, to find where the lack of understanding is originating from, and to confirm the need to educate the general public about pathologists. The survey of Internet users was conducted among Facebook users, utilizing the snowball sampling method. Inpatients were randomly recruited in the Department of Surgical Oncology. Seventy-eight inpatients and 320 Internet users were enrolled in the study. Significantly, more hospital patients than Internet users answered that the pathologist is not an MD (p = 0.00953). A portion of participants stated that pathologists do not make diagnoses (n = 28, 7.03%) and do not influence the treatment plan (n = 37, 9.30%) and that the other specialists do not gain anything from the pathologist's work (n = 67, 16.83%). Only 15.07% of respondents had their information about pathologists from other doctors. The findings from this study should show that even the most basic knowledge of a pathologist being an MD is not known. Pathologists are not recognized for being involved in the diagnosis of diseases. This should provide an incentive to pathologists to teach future doctors, policymakers, and patients about the perplexity of the pathology specialty. It shows obvious gaps in the knowledge of the treatment process as a whole.

Nutritional Status and the Outcomes of Endoscopic Stenting in Benign and Malignant Diseases of Esophagus.

BACKGROUND: Endoscopic stenting (ES) is a widely known method for palliative dysphagia treatment in esophageal strictures. Esophageal cancer is often associated with advanced malnutrition, which may increase the risk of complications of the procedure. The aim of this study was to evaluate complication rates and the impact of nutritional status on the outcomes of ES. PATIENTS AND METHODS: A single-center retrospective study was conducted at Copernicus Hospital in Gdansk, Poland. Adult patients who underwent endoscopic stenting between February 2014 and December 2018 were included. The influence of patient characteristics (age, sex, indications for esophageal stenting, and location of stenosis) and nutritional status (BMI, NRS 2002, GLIM, and dysphagia score) on complication rates and survival were analyzed. RESULTS: Eighty-one patients (69% men) were enrolled in the study. In 69%, the indication for ES was malignancy (mainly esophageal cancer). The median dysphagia score significantly decreased from 2.8 to 0.6 after the procedure (p < 0.001). Complications were observed in 27% (n = 22) of the patients. Early complications were bleeding (2.5%), stent unexpansion (2.5%), and stent migration during the procedure (3.7%). There were no early fatal complications of the procedure. Late complications included: stent migration (6.2%), tissue overgrowth (6.2%), food impaction (2.2%), fistula formation (3.7%), bleeding (3.7%), and stent malposition (1.2%). A total of 76% of the participants scored ≥ 3 points in nutritional screening (NRS2002) and 70% were diagnosed with severe malnutrition (GLIM -stage 2). A stent diameter of < 2.2 cm compared with ≥ 2.2 was associated with a higher rate of migrations (15.5% vs. 2.5%). The median survival time in the malignant group was 90 days. Histopathological diagnosis and patients' nutritional status (BMI, NRS 2002, GLIM, and dysphagia score) had no significant effect on complication rates and survival after esophageal stent insertion. CONCLUSIONS: Endoscopic stenting is a relatively safe procedure for the palliative treatment of esophageal strictures. Severe malnutrition, although common, does not affect the outcomes of the procedure.

Complete Mesogastric Excisions Involving Anatomically Based Concepts and Embryological-Based Surgeries: Current Knowledge and Future Challenges.

Surgeries for gastrointestinal tract malignancies are based on the paradigm that we should remove the tumour together with its lymphatic drainage in one block. This concept was initially proposed in rectal surgery and called a total mesorectal excision. This procedure gained much interest and has improved oncological results in rectal cancer surgery. The same idea for mesogastric and complete mesogastric excisions was proposed but, because of the complexity of the gastric mesentery, it has not become a standard technique. In this review, we analysed anatomical and embryological factors, proposed technical aspects of this operation and incorporated the available initial results of this concept. We also discussed analogies to other gastrointestinal organs, as well as challenges to this concept.