Role of surgery in the treatment of gastric cancer. Personal experience.

BACKGROUND: Although the decreased incidence of gastric cancer, nevertheless many surgical questions are topical, especially the entity of resection and the extent of lymph node dissection. METHODS: We analyzed retrospectively 38 patients operated for gastric adenocarcinoma in our Surgical Division from January 1997 to December 2001. We excluded cancers of cardia and gastroesophageal junction. We evaluated gastric site, macroscopic and microscopic aspect, TNM staging and grading of gastric cancer (UICC 1997), surgical treatment, postoperative complications and survival, in order to identify the rationale surgical approach to gastric cancer in a suburban hospital. RESULTS: Most of patients affected by gastric cancer were older than 60 years (28/38=73.68%). The cancer was prevalently localized in the antral-pyloric region (21/38=55.27%), in the ulcerated form (27/38=71.05%) and differentiated as intestinal subtype (21/38=55.27%). Regarding the UICC staging we found an almost unvarying distribution, but most of cancers were at stage IV (12/38=31.58%). In 71.05% of cases (27/38) a radical operation was feasible. The most performed operation was a total gastrectomy (19/27=70.37%). We performed a D1 dissection in 85.18% of radical operations (23/27). In the resective surgery we reconstructed the intestinal continuity by a mechanical circular stapler Roux en Y anastomosis. CONCLUSIONS: When possible we perform a total gastrectomy. D1 is our standard lymph node dissection, awaiting a defined D2 role in gastric cancer surgery. In the resective surgery we reconstruct the intestinal continuity by a mechanical circular stapler Roux en Y anastomosis. Morbidity was 10.5% (4/38) and mortality was 7.89% (3/38). Old age and pre-existing pathologies have an important role on surgical outcome. Prognosis of advanced gastric cancer is poor, despite a resective surgical treatment. We emphasize the importance of prevention and early diagnosis as fundamental steps of the oncological gastric surgery.

[A case of acute pancreatitis and ileal volvulus]. / Su di un caso di pancreatite acuta e volvolo ileale.

A case of pancreatitis that preceded and complicated, in the postoperative phase, one of ileal volvulus imprisoned in the Douglas and operated two days after admittance is reported. Clinical and laboratory data only permit hypotheses and this uncommon case of associated pathology is reported so that the situation can be borne in mind in the practical solution of surgical emergency.

[Complicated torsion of the gallbladder. Presentation of a clinical case]. / Torsione complicata della colecisti. Presentazione di un caso clinico.

A case of gallbladder torsion complicated by sigmoid volvulus and sub-torsion of the ileus is reported because of the difficulty of diagnosis, conditioned by polymorphic symptomatology, the expression of a variety of causes and contributing causes that play an important role in the greater or less onset of dramatic symptomatology, and because of the rarity of the pathology.

[An unusual feature of Meckel's diverticulum in association with phlegmonous appendicitis and mesenteric cyst. A clinical case]. / Un particolare aspetto del diverticolo di Meckel con contemporanea presenza di flemmone appendicolare e cisti mesenteriale. Caso clinico.

A particular case of Meckel's diverticulum, with phlegmonous appendicitis and mesenteric cyst associated, is presented. The Authors discuss the etiophatology, explaining the anatomic and clinical found situation.

[The Ogilvie syndrome. Review of literature and report of 2 cases]. / La sindrome di Ogilvie. Revisione della letteratura e presentazione di due casi.

Two cases of pseudo-obstruction of the colon (Ogilvie's syndrome) are presented. Increasing abdominal distension and the pain suggested surgical treatment for both patients. The operation showed in the first case a marked dilatation of the transverse colon and sigmoid, in the second the dilatation of the ascending and transverse colon, without any distal obstruction. Enterotomy was performed only in the first case, as the diameter of the colon was more then 10 cm. The authors, by review of the literature and their own experience, propose a critical revision of the syndrome, discussing the physiopathology of the rising disease.

[Proposal for anatomo-functional instrumental control of dysfunctional bilio-digestive Roux-en-Y anastomosis]. / Proposta di controllo strumentale anatomo-funzionale di anastomosi bilio-digestiva su ansa defunzionalizzata secondo Roux.

Various techniques are used for the anatomo-functional study of bilio-digestive anastomoses on jejunal loop autonomized according to Roux. Here a transparietojejunal endoscopic investigation is proposed that permits direct sight of the anastomosis, biliary sampling for cultural examination and dilatative type therapeutic manoeuvres, biopsies or extractions of residual stones from the bile ways that would not otherwise be possible without further surgery. A clinical case is reported.

[Intraoperative calibration of the Vater's papilla using Fogarty's biliary catheter]. / Calibratura intraoperatoria della papilla di Vater mediante catetere biliare di Fogarty.

The study included 20 patients affected by cholelithiasis and choledocholithiasis. Al patients underwent cholecystectomy; after choledochotomy, choledochal stones were removed using a Fogarty's biliary catheter (no. 5) and, subsequently, the papilla was calibrated by inserting the end balloon of the catheter, which and been filled with 0.3 cc of water, beyond the level of the papilla itself. The catheter was then withdrawn. No T-tubes were left in the common bile duct in any patient, no post-operative complications were observed and all patients were dismissed within seven days.

Helicobacter pylori-positive duodenal ulcer: a long-term double-blind randomized study in patients healed with H2-receptor antagonists.

BACKGROUND: The NIH Consensus Conference in 1994 (1) concluded that all patients with peptic ulcer disease should be tested and treated for Helicobacter pylori and that further evaluation was needed for patients in remission. MATERIALS AND METHODS: We evaluated in a double blind randomization 30 patients whose duodenal ulcers had been healed with H2-receptor antagonists and who remained in remission on maintenance therapy. After ulcer healing and the presence of H. pylori had been confirmed, these patients were randomized to receive eradication therapy or placebo and were followed for a mean period of 23 months. RESULTS: Almost all patients receiving placebo had ulcer recurrence, whereas the patients treated with antibiotics demonstrate a low recurrence rate. CONCLUSION: These data suggest, for the first time to our knowledge, the importance of treating with antibiotics duodenal ulcer patients whose disease is in remission.

La duodeno-cefalo-pancreatectomía: técnica de anastomosis pancreático gástrico término lateral con drenaje naso-pancreático / Duodeno-cephalo-pancreatectomy: pancreatic-gastric terminal-lateral anastomosis technique with naso-pancreatic drainage

Se proponen algunas modificaciones a la técnica operatoria de la Duodeno-Céfalo-Pancreatectomía en la fase de anastomosis Pancreática-gástrica término lateral con drenaje Naso-Pancreático. La técnica fue aplicada en 12 pacientes con cáncer de cabeza de páncreas o de la Ampolla de Vater, encontrando reducción del riesgo de complicaciones postoperatorias comunes en las técnicas tradicionales. La técnica comenzó a utilizarse en 1993 y la serie incluye los casos tratados hasta mayo de 1995, encontrándose los 12 pacientes vivos y sin síntomas de enfermedad, cumpliendo con la quimioterapia indicada.