RESUMO
BACKGROUND: Gastrointestinal cancer surgery requires en bloc removal of the primary tumor and organ-specific mesentery1,2. However, this surgical concept for gastric cancer has not yet been applied because of the morphological complexity of the mesenteries of the stomach. Lymph node dissection in gastric cancer surgery can be roughly performed into three regions: lesser curvature, grater curvature, and suprapancreatic region. In this video, we introduced laparoscopic lymphadenectomy in the suprapancreatic region using a systematic mesogastric excision (SME), which has been reported as a concept to perform en bloc resection3. METHODS: This procedure was divided into three steps. First, mesenterization of the mesogastrium was performed by dissecting the embryological planes, and the mesogastrium was dissected from the retroperitoneal surface (Fig. 1a). Second, soft tissue, including the lymph node, was separated from the pancreas and the splenic artery by tracing the inner dissectable layer (Fig. 1b). Finally, the tumor-specific mesentery was transected according to the extent of the lymphadenectomy (Fig. 1c).Fig. 1Intraoperative findings during the stepwise procedure in dissecting the lymph node in the suprapancreatic region. The red broken line indicates the surgical outline. a The mesogastrium is dissected from the retroperitoneal tissue. b The mesogastrium is separated from the pancreas and splenic artery. c The mesogastric transection line is determined on the basis of the extent of the lymphadenectomy. Inf. phrenic a. inferior phrenic artery; PGA posterior gastric artery; Post. epiploic a. posterior epiploic artery; RV renal vein; SA splenic artery; SV splenic vein RESULTS: Between January 2017 and December 2017, six patients underwent laparoscopic distal gastrectomy with D2 lymphadenectomy using SME. The median time required to complete the suprapancreatic lymphadenectomy was 48 min. No patient underwent conversion to open surgery or experienced intraoperative complications. CONCLUSIONS: We believe that this laparoscopic suprapancreatic lymphadenectomy using SME takes advantage of the surgical anatomy and achieves en bloc removal of the primary tumor and gastric mesentery. This series is a proof of concept that this procedure can be performed in a timely manner and is feasible.
Assuntos
Laparoscopia/métodos , Excisão de Linfonodo/métodos , Mesentério/cirurgia , Pâncreas/cirurgia , Neoplasias Gástricas/cirurgia , Humanos , Mesentério/patologia , Pâncreas/patologia , Prognóstico , Neoplasias Gástricas/patologiaRESUMO
The definition of true esophagogastric junction (EGJ) adenocarcinoma and its surgical treatment are debatable. We review the basis for the current definition and the Japanese surgical strategy in managing true EGJ adenocarcinoma. The Siewert classification is a well-known anatomical classification system for EGJ adenocarcinomas: type II tumors in the region 1 cm above and 2 cm below the EGJ are described as "true carcinoma of the cardia". Coincidentally, this range matches gastric cardiac gland distribution. Conversely, Nishi's classification is generally used to describe EGJ carcinomas, defined as tumors with the center located within 2 cm above and 2 cm below the EGJ, regardless of their histological subtype. This range coincides with the extent of the lower esophageal sphincter combined with gastric cardiac gland distribution. The current Japanese surgical strategy focuses on the tumor range from the EGJ to the esophagus and stomach. According to previous studies, the strategy can be roughly classified into three types. The optimal surgical procedure for true EGJ adenocarcinoma is controversial. However, an ongoing Japanese nationwide prospective trial will help confirm the appropriate standard surgery, including the optimal extent of lymph node dissection.
Assuntos
Adenocarcinoma/classificação , Adenocarcinoma/cirurgia , Procedimentos Cirúrgicos do Sistema Digestório/tendências , Neoplasias Esofágicas/classificação , Neoplasias Esofágicas/cirurgia , Junção Esofagogástrica , Neoplasias Gástricas/classificação , Neoplasias Gástricas/cirurgia , Adenocarcinoma/patologia , Procedimentos Cirúrgicos do Sistema Digestório/métodos , Neoplasias Esofágicas/patologia , Mucosa Gástrica/patologia , Humanos , Excisão de Linfonodo , Neoplasias Gástricas/patologiaRESUMO
PURPOSE: Radical surgery for gastrointestinal cancer involves en bloc removal of the primary tumor and organ-specific mesenteries. However, the surgical concept and technique for lymphadenectomy during gastric cancer surgery remain unclear. We examined a novel technique for laparoscopic modified lymphadenectomy during gastric cancer surgery involving systematic mesogastric excision (SME) and focused on the topographic anatomy, surgical technique, and specimens. METHODS: Our surgical technique involved the following: mesenterization by dissociating embryological planes, separating fat tissue containing lymph nodes from the pancreas and its associated vessels by tracing the intramesenteric dissectable layers, and dissecting the lymph node that is dependent on the D1+ criteria. RESULTS: Between October 2011 and September 2016, 227 patients underwent laparoscopic D1+ gastrectomy using SME. Of these, total gastrectomy was performed in 47 cases and distal gastrectomy was performed in 180 cases. The median operative time was 303 min (range, 201-722 min), and estimated blood loss was 50 mL (range, 0-550 mL). The median number of harvested lymph nodes was 54 (range, 18-163). There was no conversion to open surgery. CONCLUSIONS: SME was adapted for modified gastrectomy and is considered safe. Modified lymphadenectomy during gastrectomy is determined by the resection margin of the mesogastrium.
Assuntos
Gastrectomia/métodos , Laparoscopia/métodos , Excisão de Linfonodo/métodos , Neoplasias Gástricas/cirurgia , Adulto , Idoso , Idoso de 80 Anos ou mais , Perda Sanguínea Cirúrgica , Dissecação , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Duração da CirurgiaRESUMO
BACKGROUND: For patients with early primary gastric cancer, endoscopic management has become a standard of care. However, its efficacy for early remnant gastric cancer (ERGC) remains controversial and an invasive surgical procedure remains the primary choice of treatment. METHODS: A multi-institutional database of ERGC cases was retrospectively reviewed. Efficacy of endoscopic resection was analyzed by reviewing the clinicopathologic features of patients who underwent endoscopic resection and comparing the long-term outcomes with those of surgical resection. RESULTS: Of the 121 patients who were histopathologically diagnosed with ERGC after distal gastrectomy, 80 underwent endoscopic resection and 41 underwent completion gastrectomy (Group S). According to the histopathological criteria, 55 of the 80 endoscopic resection cases were classified as "curative resection" (Group E1) and the remaining 25 were classified as "noncurative resection" (Group E2). Tumor recurrence was observed only in three patients (12%) in Group E2, and no tumor recurrence was confirmed in Group S and Group E1. Multivariate analyses confirmed that completion gastrectomy [hazard ratio (HR), 6.2; 95% confidence interval (CI), 1.5-26.3] was associated with poor survival compared with endoscopic resection, and lymphovascular infiltration (HR 9.5; 95% CI 2.5-36.7) was correlated with tumor recurrence. Histopathological positive resection margin, tumor size, or deeper tumor invasion were not correlated with tumor recurrence after endoscopic resection. CONCLUSIONS: Endoscopic management might be an effective treatment option for ERGC with potential long-term survival advantage over the completion gastrectomy even in cases with histopathological features, suggesting noncurative resection.
Assuntos
Ressecção Endoscópica de Mucosa , Coto Gástrico/patologia , Recidiva Local de Neoplasia/patologia , Segunda Neoplasia Primária/patologia , Segunda Neoplasia Primária/cirurgia , Neoplasias Gástricas/patologia , Neoplasias Gástricas/cirurgia , Idoso , Idoso de 80 Anos ou mais , Feminino , Gastrectomia , Gastroscopia , Humanos , Excisão de Linfonodo , Linfonodos/patologia , Linfonodos/cirurgia , Metástase Linfática , Masculino , Pessoa de Meia-Idade , Neoplasia Residual , Estudos RetrospectivosRESUMO
We report a case of Stage IV gastric cancer showing pathological complete response(pCR)after neo-adjuvant chemotherapy( NAC)using S-1 and oxaliplatin(SOX).A woman 73-year-old was diagnosed as harming type 3 Stage IV gastric cancer with para-aortic lymph node(PAN)metastasis.She underwent 4 courses of NAC with SOX regimen.After the treatment, both the primary tumor and the metastatic PAN decreased in size remarkably.She underwent distal gastrectomy with D2 plus PAN dissection with curative intent.Pathological diagnosis revealed complete disappearance of cancer cells in both the primary lesion of the stomach and all dissected lymph nodes, confirming pCR.She is alive without recurrence 4 months after surgery.
Assuntos
Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Terapia Neoadjuvante , Neoplasias Gástricas/tratamento farmacológico , Neoplasias Gástricas/patologia , Idoso , Combinação de Medicamentos , Feminino , Gastrectomia , Humanos , Estadiamento de Neoplasias , Compostos Organoplatínicos/administração & dosagem , Oxaliplatina , Ácido Oxônico/administração & dosagem , Neoplasias Gástricas/cirurgia , Tegafur/administração & dosagemRESUMO
We analyzed the prognostic factors related to long-term survival in 31 patients, 27 men and 4 women, median age 67 years, who had lymph node recurrence after radical esophagectomy for esophageal cancer. The pathological Stage was Stage I in 2 patients, Stage II in 9 patients, Stage III in 18 patients, and Stage IV a in 2 patients. Seventeen patients were diagnosed with lymph node recurrence in a single area and the other 14 patients were diagnosed with lymph node recurrence in multiple areas(n=3)or lymph node recurrence complicated by hematogenous or disseminated metastases(n=11). Eighteen patients were treated with chemoradiotherapy(CRT), and surgical intervention after CRT was indicated in 5 of them. One patient had surgery alone, 7 were treated with chemotherapy, and 5 were administered best palliative care. The median survival after recurrence was 357 days. The patients with lymph node recurrence in a single area and those treated by CRT or surgery had significantly better prognosis than the others. Although the overall prognosis for patients with tumor recurrence after esophagectomy is poor, lymph node recurrence in a single area or treated with local therapy was associated with better long-term survival.
Assuntos
Neoplasias Esofágicas/terapia , Idoso , Idoso de 80 Anos ou mais , Antineoplásicos/uso terapêutico , Neoplasias Esofágicas/patologia , Esofagectomia , Feminino , Humanos , Excisão de Linfonodo , Metástase Linfática , Masculino , Pessoa de Meia-Idade , Prognóstico , RecidivaRESUMO
BACKGROUND: Microenvironments control cancer growth and progression. We explored the prognostic impact of stromal reaction and cancer stromal cells on relapse risk and survival after curative gastrectomy in gastric cancer patients. METHODS: Tissue samples were obtained from 107 patients with gastric adenocarcinoma who underwent curative (R0) gastrectomy. Primary stromal cells isolated from gastric cancer tissue (GCSC) and normal gastric tissue (Gastric stromal cell: GSC) in each patient were cultured and subjected to comprehensive proteome (LC-MS/MS) and real-time RT-PCR analysis. Expression of Ephrin A2 receptors (EphA2) in cancers and GCSC was evaluated immunohistochemically. Intermingling of EphA2-positive cancer cells and GCSC (IC/A2+) and overexpression of EphA2 in cancer cells (Ca/A2+) in invasive parts of tumors were assessed, as were relationships of IC/A2+, Ca/A2+, and clinicopathological factors with relapse-free survival and overall survival. RESULTS: Proteome analysis showed that EphA2 expression was significantly higher in GCSC than GSC. Real-time RT-PCR analysis showed that levels of EphA1/A2/A3/A5 and EphB2/B4 were ≥2.0-fold higher in GCSC than GSC. Ca/A2 and IC/A2 were positive in 65 (60.7 %) and 26 (24.3 %) patients, respectively. Relapse was significantly more frequent in IC/A2-positive than in IC/A2-negative (HR, 2.12; 95 % CI, 1.16-5.41; p = 0.0207) patients. Among the 54 patients who received S-1 adjuvant chemotherapy, relapse-free survival (RFS) was significantly shorter in those who were IC/A2-positive than in those who were IC/A2-negative and Ca/A2-negative (HR, 2.83; 95 % CI, 1.12-12.12; p = 0.0339). Multivariable analysis indicated that pathological stage (p = 0.010) and IC/A2+ (p = 0.008) were independent risk factors for recurrence. CONCLUSION: IC/A2+ was predictive of relapse after curative (R0) gastrectomy.
Assuntos
Adenocarcinoma/patologia , Receptor EphA2/metabolismo , Neoplasias Gástricas/patologia , Células Estromais/metabolismo , Adenocarcinoma/tratamento farmacológico , Adenocarcinoma/mortalidade , Adenocarcinoma/cirurgia , Quimioterapia Adjuvante , Intervalo Livre de Doença , Combinação de Medicamentos , Humanos , Imuno-Histoquímica , Ácido Oxônico/uso terapêutico , Prognóstico , Receptores Proteína Tirosina Quinases/genética , Receptores Proteína Tirosina Quinases/metabolismo , Receptor EphA2/genética , Receptor EphA3 , Receptor EphA5/genética , Receptor EphA5/metabolismo , Receptor EphB2/genética , Receptor EphB2/metabolismo , Estudos Retrospectivos , Neoplasias Gástricas/tratamento farmacológico , Neoplasias Gástricas/mortalidade , Neoplasias Gástricas/cirurgia , Células Estromais/patologia , Tegafur/uso terapêutico , Microambiente TumoralRESUMO
We examined the treatment outcomes and survival rate of patients treated with salvage thoracoscopic esophagectomy after definitive chemoradiotherapy (dCRT). Twenty-seven patients who were indicated for salvage thoracoscopic esophagectomy after dCRT in our department were enrolled through April 2014. Eight patients had tumor regrowth after a complete response, and 19 had residual tumors. Two patients needed conversion to conventional thoracotomy. The operation time was 340 minutes (thoracic procedure: 125 minutes), and the estimated blood loss was 330 mL (thoracic procedure: 100 mL). The mean number of dissected nodes was 18. None of the patients experienced serious perioperative complications, and R0 surgery was performed in 24 patients. Postoperative complications developed in 15 patients (56%), and anastomotic leakage occurred in 11. Pneumonia developed in 3 patients, but none of the patients had tracheal necrosis or hospital mortality. The 5-year survival rate of all the patients was 40.4%, and the patient who underwent R0 surgery had a significantly better outcome than a patient with R1 or R2. Thoracoscopic esophagectomy is a safe option for salvage treatment of patients in an institution that has physicians experienced and skilled in thoracoscopic esophagectomy. However, it is always necessary to prepare for conversion to conventional thoracotomy.
Assuntos
Neoplasias Esofágicas/terapia , Esofagectomia , Terapia de Salvação , Adulto , Idoso , Quimiorradioterapia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Toracoscopia , Resultado do TratamentoRESUMO
Herein, we report the treatment outcomes of patients with limited cervical lymph node recurrence after esophagectomy for esophageal cancer. Between April 2010 and December 2013, 8 patients with cervical lymph nodes recurrence were diagnosed and treated in our department. All patients were detected with recurrent disease by using positron emission tomography computed tomography(PET-CT), and among these, 5 patients had solitary node recurrence. Initial treatments were irradiation therapy in 5 patients and lymphadenectomy in 3 patients. Four of 5 patients underwent irradiation therapy and lymphadenectomy. Four of 5 patients with solitary node recurrence are still alive without relapse of disease. In conclusion, PET-CT can be useful for early detection of recurrent disease after esophagectomy. Appropriate therapy for patients with solitary cervical lymph node recurrence is associated with long-term survival after recurrence.
Assuntos
Neoplasias Esofágicas/patologia , Pescoço/patologia , Idoso , Neoplasias Esofágicas/terapia , Esofagectomia , Feminino , Humanos , Excisão de Linfonodo , Metástase Linfática , Masculino , Pessoa de Meia-Idade , Imagem Multimodal , Pescoço/cirurgia , Tomografia por Emissão de Pósitrons , Recidiva , Tomografia Computadorizada por Raios X , Resultado do TratamentoRESUMO
In Japan, neoadjuvant chemotherapy followed by esophagectomy has become the standard treatment for resectable advanced esophageal cancer. However, there are few reports on the utility of fludeoxyglucose( FDG)-positron emission tomography (PET) in such cases so far. In this study, we analyzed the utility and drawbacks of FDG-PET in patients who underwent neoadjuvant chemotherapy followed by surgery. Thirty-seven patients with cStage II or III thoracic esophageal cancer who received 2 courses of combination chemotherapy with 5-fluorouracil and cisplatin followed by surgery were enrolled this study. The maximum standardized uptake value (SUVmax) in the main lesion significantly decreased after chemotherapy (38.6%), and there was a greater decrease in SUVmax in patients with downstaging. Following chemotherapy, the esophageal lesions were not detected by FDG-PET in 6 patients. However, in these patients, the histopathological diagnosis of the resected specimens revealed that the cancer cells persisted. The SUVmax increased after chemotherapy in 5 patients, and in 4 of 5 patients recurrent disease was observed. In conclusion, we should understand the characteristics of FDG-PET in esophageal cancer after neoadjuvant chemotherapy and use it precisely.
Assuntos
Neoplasias Esofágicas/diagnóstico por imagem , Terapia Neoadjuvante , Idoso , Neoplasias Esofágicas/tratamento farmacológico , Neoplasias Esofágicas/patologia , Neoplasias Esofágicas/cirurgia , Esofagectomia , Feminino , Fluordesoxiglucose F18 , Humanos , Masculino , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Tomografia por Emissão de PósitronsRESUMO
OBJECTIVE: The aim of this study was to evaluate whether endovascular embolization prior to stereotactic radiosurgery (SRS) has a negative impact on nidus obliteration for patients with arteriovenous malformations (AVMs). METHODS: A total of 704 eligible patients with AVM who did not undergo prior surgery or radiotherapy were evaluated. Of these patients, 593 were treated with SRS only, and 111 were treated with embolization followed by SRS (E+SRS). Most patients in the E+SRS group (88%) underwent embolization with n-butyl-2-cyanoacrylate. In the comparison of radiosurgical outcomes between patients treated with SRS only and E+SRS, these groups were matched in a 1:1 ratio using propensity score matching to eliminate differences in basic characteristics. The primary outcome was to compare the nidus obliteration rates between the SRS-only and E+SRS groups. The secondary outcomes were the comparison of cumulative hemorrhage rates and the incidence of cyst formation or chronic encapsulated hematoma after SRS between these groups. RESULTS: In the unmatched cohorts, the actuarial 3-, 5-, and 8-year nidus obliteration rates after a single SRS session were 49.6%, 69.4%, and 74.1% in the SRS-only group, respectively, and 30.7%, 50.9%, and 68.6% in the E+SRS group, respectively (p = 0.001). In the matched cohort of 98 patients in each group, the rates were 47.1%, 62.0%, and 69.6% in the SRS-only group and 32.5%, 55.3%, and 75.0% in the E+SRS group, respectively (p = 0.24). There was no significant difference in either cumulative hemorrhage or the incidence of cyst formation or chronic encapsulated hematoma between the groups. CONCLUSIONS: Pre-SRS embolization did not affect nidus obliteration rates, cumulative hemorrhage rates, or the incidence of cyst formation or chronic encapsulated hematoma as late adverse radiation effects in patients with AVM treated with SRS.
Assuntos
Cistos , Malformações Arteriovenosas Intracranianas , Radiocirurgia , Humanos , Estudos de Casos e Controles , Radiocirurgia/efeitos adversos , Resultado do Tratamento , Malformações Arteriovenosas Intracranianas/radioterapia , Malformações Arteriovenosas Intracranianas/complicações , Estudos Retrospectivos , Pontuação de Propensão , Encéfalo/cirurgia , Hematoma/complicações , Cistos/complicações , SeguimentosRESUMO
BACKGROUND/AIMS: Severity of inflammation may be a risk factor for negative outcome in non-operative therapy of appendicitis. However, optimal screening test for predicting the pathological severity of appendicitis has not been established. METHODOLOGY: 632 consecutive patients who underwent appendectomy at a single institute were retrospectively reviewed. Clinical parameters are compared among the three pathological grades: simple (G1), gangrenous (G2), and perforated appendicitis (G3). The diagnostic power of inflammatory markers (WBC count and CRP concentration) in discriminating the advanced appendicitis from the milder one was evaluated. RESULTS: CRP concentration was well correlated with the severity of appendicitis (p>0.0001), while WBC count showed only slight increase in advanced pathology (G1 vs. G2-G3). In receiver operating characteristic (ROC) curve analysis, the area under the curve (AUC) was remarkably higher in CRP (AUC 0.809) compared with that in WBC count (AUC 0.617), suggesting that CRP is a more sensitive test in discriminating the pathological severity of appendicitis. Multivariate analysis confirmed that CRP concentration >6.2mg/dL (OR: 5.12; 95% CI: 2.17-12.7) and diameter >12mm (OR: 4.33; 95% CI: 1.98-9.90) were strong predictive factors for advanced appendicitis. CONCLUSIONS: CRP concentration may be a potent objective predictor of pathological severity in appendicitis. Combination with the other diagnostic modalities may improve the diagnostic accuracy in predicting the severity of appendicitis.
Assuntos
Apendicite/diagnóstico , Proteína C-Reativa/análise , Contagem de Leucócitos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Apendicite/sangue , Apendicite/patologia , Biomarcadores/sangue , Criança , Pré-Escolar , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Curva ROC , Índice de Gravidade de DoençaRESUMO
Background: Videoscopic transcervical mediastinal lymphadenectomy has been attempted to reduce thoracotomy-related complications of surgical treatment for esophageal cancer. However, many surgeons would hesitate to attempt this procedure because of the difficulty in understanding the anatomical orientation. In this study, we aimed to create a three-dimensional computer graphic (3D CG) animation and compare it with the real-life operation. Materials and Methods: LightWave 3D® version 7 was used as a rendering software to create the 3D CG. The 3D CG images were superimposed to generate an animation using AfterEffects CC®. Results: The 3D CG animation for videoscopic transcervical upper mediastinal esophageal dissection was successfully created; it dynamically shows the scene, especially the separation between the esophagus and trachea, and enables surgeons to easily understand the anatomical orientation when using transcervical approach. This 3D CG animation was of high quality and similar to the real-life operation. Conclusions: We created a virtual 3D CG animation for the transcervical approach, which will contribute to understanding this procedure for esophageal cancer preoperatively.
Assuntos
Gráficos por Computador , Neoplasias Esofágicas/cirurgia , Esofagectomia/métodos , Imageamento Tridimensional , Excisão de Linfonodo/métodos , Mediastinoscopia , Modelos Anatômicos , Software , Dissecação , Humanos , Mediastino , Interface Usuário-ComputadorRESUMO
We report a case of a 32-year-old woman with episodic right lower quadrant abdominal pain. With the diagnosis of either acute appendicitis or tubo-ovarian abscess, she was treated with antibiotics, which successfully relieved the pain and the inflammatory findings. She repeated the clinical condition a few times and antibiotics worked each time. In a year, her subjective symptoms became milder, however, a giant pelvic cyst appeared. She had an exploratory laparotomy to confirm this diagnosis. Histopathological studies revealed herniated appendiceal mucosa through the muscular layer associated with chronic inflammation and marked fibrosis. Gynecological disorders such as endometriosis or lutein cyst rupture was denied. These findings represent appendiceal diverticulitis. We discuss the clinical features of the disease and its relation with the pelvic pseudocyst.
Assuntos
Apêndice/patologia , Cistos/diagnóstico , Diverticulite/diagnóstico , Gastroenterologia/métodos , Gastroenteropatias/diagnóstico , Dor Abdominal , Adulto , Antibacterianos/uso terapêutico , Diagnóstico Diferencial , Feminino , Humanos , Inflamação , Pelve/patologia , Tomografia Computadorizada por Raios XRESUMO
Catamenial pneumothorax is a subclass of secondary spontaneous pneumothorax occurring in women in their third or fourth decade of life. We describe a classic and typical case of this disease. Although it is believed to be rare historically, the recent study showed the much higher prevalence. It is essential to consider this disease in recurrent spontaneous pneumothorax of a middle-aged woman.
Assuntos
Pneumotórax/diagnóstico , Cirurgia Torácica Vídeoassistida/instrumentação , Adulto , Dor no Peito/etiologia , Dispneia/etiologia , Feminino , Humanos , Pneumotórax/complicações , Recidiva , Cirurgia Torácica Vídeoassistida/métodosRESUMO
Endoscopic submucosal dissection (ESD) for early gastric cancer does not always lead to complete cancer resection. The aim of this study was to determine indicators for cancer residue (CR) status in cases of non-curative ESD. We analyzed 47 cases of non-curative ESD followed by salvage surgery and collected data regarding the rates of CR, which included both local CR and lymph node metastasis (LNM). To elucidate the risk factors for CR status, we compared the CR positive and the CR negative groups among surgical specimens according to the following variables obtained from ESD findings: tumor location, tumor size, depth of invasion, lympho-vascular invasion, histological margin, and histological diagnosis. The eCura system, which is an LNM risk scoring system, was also applied and scores were calculated in each case as follows: 3 points for lymphatic invasion and 1 point each for tumor size >30 mm, positive vertical margin, venous invasion, and submucosal invasion ≥500 µm. There were 9 (19%) CR positive cases, which included 6 cases of local CR and 4 cases of LNM; no cancer was detected in over 80% of the patients. The eCura scoring system was the only significant factor for CR status: the higher the eCura score, the greater the CR positivity (p = 0.0128). In particular, all patients in the low-risk group (score = 0-1 point) had no CR. Although no cancer recurrence was observed during a median follow-up of 4 years, 2 patients died of pneumonia. In conclusion, the eCura system might make it possible to select appropriate cases for salvage surgery.
Assuntos
Gastrectomia/métodos , Neoplasia Residual/patologia , Neoplasia Residual/cirurgia , Terapia de Salvação/métodos , Neoplasias Gástricas/patologia , Neoplasias Gástricas/cirurgia , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos de Casos e Controles , Ressecção Endoscópica de Mucosa , Feminino , Humanos , Metástase Linfática , Masculino , Margens de Excisão , Pessoa de Meia-Idade , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Resultado do Tratamento , Carga TumoralRESUMO
BACKGROUND: Although sepsis after surgery for colorectal perforation frequently results in severe coagulation disorders and consequent death of the patient, the correlation between coagulation abnormalities and postoperative mortality of colorectal perforation has not been clarified. METHODS: The medical records of 101 consecutive patients receiving surgery for colorectal perforations between January 1994 and July 2006 were retrospectively reviewed. The abnormalities of preoperative laboratory data reflecting coagulation disorders and other possible risk factors were analyzed by univariate and multivariate analysis. RESULTS: Prolonged prothrombin time and activated partial thromboplastin time significantly correlated with a poor prognosis (both P < 0.001). Among the several risk factors analyzed, only the presence of coagulation disorders was an independent predictive factor of postoperative mortality. CONCLUSIONS: Prolonged prothrombin time and activated partial thromboplastin time are useful prognostic factors for predicting the surgical outcome for patients with colorectal perforation.
Assuntos
Transtornos da Coagulação Sanguínea/complicações , Doenças do Colo/complicações , Doenças do Colo/mortalidade , Perfuração Intestinal/complicações , Perfuração Intestinal/mortalidade , Doenças Retais/complicações , Doenças Retais/mortalidade , Idoso , Doenças do Colo/cirurgia , Feminino , Humanos , Perfuração Intestinal/cirurgia , Masculino , Prognóstico , Doenças Retais/cirurgia , Estudos RetrospectivosRESUMO
PURPOSE: To evaluate the added clinical value of pretreatment (18)F-FDG PET/CT compared with conventional contrast-enhanced multidetector-row CT (CECT) alone for staging of advanced gastric cancer MATERIALS AND METHODS: We studied 106 patients with locally advanced gastric cancer who underwent pretreatment CECT and (18)F-FDG PET/CT. Two experienced reviewers assessed the diagnostic performance of both CECT alone and the combination of CECT and (18)F-FDG PET/CT for the primary tumor, regional lymph node metastasis (N) and distant metastasis (M), rating their diagnostic confidence with a 5-point scoring system for each location. The two methods were compared using receiver operating characteristic (ROC) curve analysis for histopathologic findings, imaging, and clinical follow-up as the reference standards. RESULTS: Among the 106 patients, 96 primary tumors (90.6%) were detected by CECT, while 101 (95.3%) were clearly identified by (18)F-FDG PET/CT (p=0.074). Patient-based areas under the ROC curves for CECT alone versus the combination of CECT and (18)F-FDG PET/CT for diagnosis of N stage, peritoneal dissemination, liver metastasis, distant lymph node metastasis, bone metastasis, metastasis at other sites and overall M stage were 0.787 vs. 0.858 (p=0.13), 0.866 vs. 0.878 (p=0.31), 0.998 vs. 1.0 (p=0.36), 0.744 vs. 0.865 (p=0.049), 0.786 vs. 0.998 (p=0.034), 0.944 vs. 0.984 (p=0.34), and 0.889 vs. 0.912 (p=0.21), respectively. The diagnostic performance of primary tumor detection and NM staging was not influenced by the histologic subtype. CONCLUSION: Adding (18)F-FDG PET/CT to CECT provides better diagnostic accuracy for detection of distant lymph node metastasis and bone metastasis in patients with untreated advanced gastric cancer.
Assuntos
Fluordesoxiglucose F18 , Tomografia Computadorizada Multidetectores/métodos , Tomografia por Emissão de Pósitrons combinada à Tomografia Computadorizada/métodos , Compostos Radiofarmacêuticos , Neoplasias Gástricas/diagnóstico por imagem , Adulto , Idoso , Idoso de 80 Anos ou mais , Neoplasias Ósseas/diagnóstico por imagem , Neoplasias Ósseas/secundário , Feminino , Humanos , Neoplasias Hepáticas/diagnóstico por imagem , Neoplasias Hepáticas/secundário , Metástase Linfática , Masculino , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Curva ROC , Estudos Retrospectivos , Neoplasias Gástricas/patologiaRESUMO
BACKGROUND/AIMS: In patients with acute mesenteric ischemia, early diagnosis is considered to improve the prognosis by preventing the occurrence of systemic inflammatory response syndrome (SIRS). However, it remains unclear which factors affect the mortality once advanced ischemia and SIRS develop in cases of delayed diagnosis. The aim of this study was to investigate the predictors of in-hospital mortality in the late stage of acute mesenteric ischemia. METHODOLOGY: We retrospectively studied 66 consecutive patients who had acute intestinal infarction associated with SIRS between 1986 and 2002. They included 19 of acute mesenteric thromboembolism and 47 cases of postoperative adhesions or an incarcerated hernia. A multivariate logistic model was used to identify important factors for in-hospital death among the background data. Two models were constructed with/without the cause of intestinal obstruction as a variable, since it might affect the prognosis. RESULTS: The results suggested that concomitant cardiac morbidity, high serum amylase level, and thrombocythemia are important factors for in-hospital mortality of acute intestinal infarction, regardless of the cause of intestinal infarction. CONCLUSIONS: Our results indicated that the prognosis is strongly influenced by associated cardiac morbidity and abnormal coagulopathy in the advanced stage of mesenteric ischemia.