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Advances in gastrointestinal surgery

Alison Luther, Joseph Gabriel, Richard P Watson, Nader K Francis
BACKGROUND: Despite advances in perioperative care, post-operative clinical and functional outcomes after major abdominal surgery can be suboptimal. Prehabilitation programmes attempt to optimise a patient's preoperative condition to improve outcomes. Total body prehabilitation includes structured exercise, nutritional optimisation, psychological support and cessation of negative health behaviours. This systematic review aims to report on the current literature regarding the impact of total body prehabilitation prior to major abdominal surgery...
March 15, 2018: World Journal of Surgery
Annika Mutanen, Agostino Pierro, Augusto Zani
Necrotizing enterocolitis (NEC) is a devastating condition that mainly affects premature infants. Advanced cases of NEC require surgical treatment, which in up to 70% of infants is associated with significant perioperative morbidity including anastomosis- or enterostomy-related complications, sepsis, peritonitis, and wound infections. Moreover, the perioperative complications may compromise the long-term gastrointestinal and neurodevelopmental outcome of patients requiring surgery for NEC.
March 13, 2018: European Journal of Pediatric Surgery
Florin Achim, Silviu Constantinoiu
The treatment of esophageal cancer has become more effective due to advances in surgical techniques, multidisciplinary approach, appropriate use of neoadjuvant therapy and perioperative care at centers of excellence in esophageal surgery. Esophagectomy is one of the most complicated and demanding procedures among all gastrointestinal surgeries with a very long learning curve in which excellence can only be achieved through improvement during all the surgical career. The results of esophagectomy are related not only to the volume of cases operated but also to the experience of surgeons in the management of postoperative complications...
January 2018: Chirurgia
Rosa Falcone, Michela Roberto, Marco Filetti, Elisabetta Anselmi, Paolo Marchetti
RATIONALE: Small bowel adenocarcinoma (SBA) is an uncommon gastrointestinal cancer, thus limited data about treatment for advanced disease are available. The lack of specific guidelines has justified the use of therapeutic protocols usually applied in advanced colorectal cancer. Few and preliminary data have suggested possible clinical benefit from the use of target therapy such as bevacizumab and cetuximab. PATIENT CONCERNS: We present the case of a young woman who was admitted to the emergency department for acute abdominal pain, nausea, and vomiting related to a jejunal stenosis...
January 2018: Medicine (Baltimore)
Q Zhao, Y Li, B Yu, P G Yang, L Q Fan, B B Tan, Y Tian, A B Yang
Objective: To investigate the effect of postoperative precision nutrition therapy on postoperative recovery (PR) of patients with advanced gastric cancer (AGC) after neoadjuvant chemotherapy (NC). Methods: 71 subjects were randomly divided into 2 groups. The 34 patients of research group were treated with postoperative precision nutrition treatment according to the indirect energy measurement method. The 31 patients of control group were treated with traditional postoperative nutrition treatment. All participants were measured for body mass index (BMI), NRS2002, PG-SGA and relevant laboratory test within the 1st day before surgery and 7th day after surgery...
February 23, 2018: Zhonghua Zhong Liu za Zhi [Chinese Journal of Oncology]
Shubin Song, Honggang Liu, Yingwei Xue
OBJECTIVE: To investigate the relationship of prognostic nutritional index (PNI) with clinicopathological factors and the clinical significance of PNI in predicting the survival in patients with advanced gastric cancer. METHODS: Clinicopathological and follow-up data of 1150 patients with advanced gastric cancer who underwent radical gastrectomy from January 2007 to December 2010 at the Department of Gastrointestinal Surgery, Harbin Medical University Cancer Hospital were analyzed retrospectively...
February 25, 2018: Zhonghua Wei Chang Wai Ke za Zhi, Chinese Journal of Gastrointestinal Surgery
Chunchao Zhu, Gang Zhao, Hui Cao
Laparoscopic technology is gradually accepted in gastric cancer surgery, whose efficacy has been demonstrated by some clinical researches. Randomized controlled trials (RCT) are considered as the most important evidence to prove clinical outcomes of laparoscopic surgery for gastric cancer. Korean gastric surgeons have made great contributions to RCT in laparoscopic gastric cancer surgery. KLASS (Korean Laparoscopic Gastrointestinal Surgery Study Group) is one of the most important forerunner and global leader of clinical trials of gastric cancer treatment...
February 25, 2018: Zhonghua Wei Chang Wai Ke za Zhi, Chinese Journal of Gastrointestinal Surgery
Jiankun Hu, Weihan Zhang, Xinzu Chen
Neoadjuvant chemotherapy combined with radical gastrectomy is one of the most important parts of the multimodality therapy strategies for locally advanced gastric cancer. With the development of laparoscopic technique in recent decades, laparoscopic technique plays a more and more important role in the surgical treatment of gastric cancer. Neoadjuvant chemotherapy, as a part of comprehensive treatment of gastric cancer, has gained more and more clinical supports and been recommended for guidelines. With the development of laparoscopic technique and clinical evidence, laparoscopic operation for advanced gastric cancer has been applied more and more widely...
February 25, 2018: Zhonghua Wei Chang Wai Ke za Zhi, Chinese Journal of Gastrointestinal Surgery
Shigeru Fujisaki, Motoi Takashina, Yukari Woo, Ryouichi Tomita, Kenichi Sakurai, Tadatoshi Takayama
We present here a case of transduodenal ampullectomy for an ampullary neoplasm coexisting with gastric and colon cancer. The patient was a 72-year-old man who was referred to our hospital with a positive fecal blood test. Colonoscopy revealed advanced cancer in the descending colon. As part of the preoperative examination, for the colonic cancer, upper gastrointestinal endoscopy was performed. Endoscopy showed a 2 cm elevated lesion(0'-II a type)with subserosalinfil tration on the small curvature side of the upper part of the stomach, and a 2 cm elevated lesion on the papilla of Vater...
February 2018: Gan to Kagaku Ryoho. Cancer & Chemotherapy
Hai-Bo Qiu, Zhong-Guo Zhou, Xing-Yu Feng, Xue-Chao Liu, Jing Guo, Ming-Zhe Ma, Ying-Bo Chen, Xiao-Wei Sun, Zhi-Wei Zhou
The role of palliative surgery is controversial in advanced gastrointestinal stromal tumors (GIST) after tyrosine kinase inhibitors (TKIs) therapy.We evaluated safety and clinical outcomes in a single institution series of advanced GIST patients from January 2002 to December 2008.One hundred and fifty-six patients had been recruited, including 87 patients underwent surgical resection and 69 patients kept on TKIs treatment. Four patients had major surgical complications. Median follow-up was 38.3 months, the overall survival (OS) and progression-free survival (PFS) of the patients in surgical group were longer than the nonsurgical group, PFS: 46...
January 2018: Medicine (Baltimore)
Willem A Bemelman, Todd H Baron
Transmural defects of the gastrointestinal tract can be classified into three distinct entities that include leaks, perforations, and fistulae. Each arise from different mechanisms and are managed accordingly. Leaks occur most often following surgery, while perforations occur most often following flexible endoscopic maneuvers. Fistula arise from a variety of mechanisms, such as an evolution from surgical leaks as well as from specific disease states. Endoscopic management plays a vital role in the treatment of transmural defects as long as the region of interest can be accessed with the appropriate endoscopic accessories...
February 15, 2018: Gastroenterology
Webber Chan Pak Wo, Fadi Mourad, Rupert W L Leong
Crohn's disease (CD) is a chronic relapsing and remitting disease that can affect any segments of the gastrointestinal (GI) tract. More than 50% of patients with CD develop stricturing or penetrating complications within the first 10 years after diagnosis. Strictures can lead to intestinal obstruction, which is a common indication for surgery. Despite significant advances in the understanding of the pathogenesis of intestinal fibrostenosis, imaging and therapeutic armamentarium of CD, the risk of intestinal surgery remained significantly high...
February 10, 2018: Journal of Gastroenterology and Hepatology
Siobhra O'Sullivan, Daniel N Cagney
Primary and secondary malignancies of the liver and pancreas result in significant morbidity and mortality, with increasing incidence and increasing demands on health services worldwide. Surgery is the only curative single modality of treatment and remains the gold standard. Unfortunately, up to 80% of the patients present with unresectable disease, and so, alternative efficacious local and systemic treatments are needed. Technologic advances in radiotherapy over recent decades have meant that precision high-dose treatment with stereotactic body radiotherapy (SBRT) has emerged as a viable cost-effective outpatient-based treatment in the management of these difficult to treat abdominal malignancies...
February 8, 2018: Irish Journal of Medical Science
Emily Higgins, Liam Monaghan, Raghu R Mani
This case report details of a case of cutaneous metastasis from a primary adenocarcinoma of the oesophagus to the right cheek. A 67-year-old male was referred to the maxillofacial department with a 2-3 week history of non-painful swelling of the cheek. A diagnosis of infected sebaceous cyst was made and drainage was attempted with adjunctive antibiotic therapy. Follow up appointments showed no improvement a biopsy was taken. Histology reported presence of metastatic adenocarcinoma, suggesting the gastrointestinal tract as the primary site...
September 2017: Journal of Surgical Case Reports
R Makaryus, T E Miller, T J Gan
Perioperative fluid management impacts outcomes and plays a pivotal role in enhanced recovery pathways (ERPs). There have been major advances in understanding the effects of fluid therapy and administration during the perioperative period. Improving fluid management during this period leads to a decrease in complications, decrease in length of stay (LOS), and enhanced patient outcomes. It is important to consider preoperative and postoperative fluid management to be just as critical as intraoperative management given multiple associated benefits to the patients...
February 2018: British Journal of Anaesthesia
S Andronikou, S Arthur, E Simpson, M Chopra
AIM: To compare "selective duodenograms" performed through nasogastric tubes advanced into the proximal duodenum against traditional contrast studies regarding visualisation of a first-pass bolus distention of the duodenum and frequency of inconclusive results. MATERIALS AND METHODS: Retrospective comparison of "selective duodenograms" and traditional upper gastrointestinal contrast studies in neonates with bile-stained vomiting, regarding demonstration of the duodenal C-loop, first-pass bolus capture, degree of distention of the duodenum, and number of inconclusive studies...
February 1, 2018: Clinical Radiology
Hirotsugu Nagase, Kozo Noguchi, Atsushi Hamabe, Masashi Hirota, Kazuteru Oshima, Tsukasa Tanida, Yoshito Tomimaru, Tomono Kawase, Shunji Morita, Hiroshi Imamura, Takashi Iwazawa, Kenzo Akagi, Keizo Dono
The case was a 70s-year-old man. In July 2016, he was admitted to our hospital with a complaint of epigastralgia. Upper gastrointestinal endoscopy revealed type 3 advanced gastric cancer in the vestibule, directly infiltrating the pancreas and the left lobe of the liver to form an abscess, and swelling of the aortic lymph node and multiple liver metastases were observed. The cancer was diagnosed as cT4b(liver/pancreas), N2M1(H1P0CYX), cStage IV and diagnosed it as a chemotherapy policy. We initiated SOX plus trastuzumab therapy from August 2016...
November 2017: Gan to Kagaku Ryoho. Cancer & Chemotherapy
Kohei Murakami, Atsushi Takeno, Toru Masuzawa, Shigeyuki Tamura, Kenji Kawai, Takuya Sakamoto, Junichi Inatome, Atsushi Naito, Yoshiteru Katsura, Yoshiaki Ohmura, Yoshinori Kagawa, Chiyomi Egawa, Yutaka Takeda, Kohei Murata
A 66-year-old man reporting chest stenosis was examined. Upper gastrointestinal endoscopy showed type 2 esophageal cancer. An enhanced CT scan showed several swollen lymph nodes in the lesser curvature of the esophagus. We diagnosed the patient as having advanced esophageal cancer with multiple lymph node metastases(cT3N2M0, Stage III ). After 2 courses of chemotherapy(DCF), a significant reduction was observed in the esophageal tumor; however, the tumor at the lesser curvature was almost unchanged. MIBG scintigraphy showed high uptake in the left adrenal gland...
November 2017: Gan to Kagaku Ryoho. Cancer & Chemotherapy
Tomoaki Bekki, Nobuaki Fujikuni, Kazuaki Tanabe, Shuji Yonehara, Hironobu Amano, Toshio Noriyuki, Masahiro Nakahara
BACKGROUND: Gastric carcinosarcoma with severe venous invasion is extremely rare, and to the best of our knowledge, this is the first reported case. CASE PRESENTATION: A 79-year-old man visited the Onomichi General Hospital following abnormal upper gastrointestinal series findings. Laboratory data demonstrated no anemia, and the serum carcinoembryonic antigen (CEA) and carbohydrate antigen 19-9 (CA19-9) levels were not elevated. Endoscopy identified a Borrmann type III lesion in the cardiac end of the stomach...
January 30, 2018: Surgical Case Reports
Jonathan Green, Christopher R Schlieve, Ann K Friedrich, Kevin Baratta, David H Ma, May Min, Krunal Patel, David Stein, David R Cave, Demetrius E Litwin, Mitchell A Cahan
BACKGROUND: Small bowel lesions (SBL) are rare, representing diagnostic and management challenges. The purpose of this cross-sectional study was to evaluate diagnostic modalities used and management practices of patients with SBL at an advanced endoscopic referral center. METHODS: We analyzed patients undergoing surgical management for SBL from 2005 to 2015 at a single tertiary care center. Patients were stratified into gastrointestinal bleed/anemia (GIBA) or obstruction/pain (OP)...
January 25, 2018: Journal of Gastrointestinal Surgery: Official Journal of the Society for Surgery of the Alimentary Tract
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