Management of gastrocutaneous fistulas following gastrostomy: surgery as a therapeutic option.

Gastrocutaneous fistulas (GCF) following removal of gastrostomy tubes are an uncommon complication with many therapeutic options. It is a drawback that concerns both patient and surgeon, hindering the decision to perform an invasive treatment. Despite emerging minimally invasive procedures, we must not forget that surgery continues to be the standard treatment when they all fail

Cervical thyroid remnant consistent with papillary carcinoma as an incidental finding in a patient with benign total thyroidectomy ten years prior

Background: Differential diagnosis of a cervical lesion corresponding with papillary thyroid carcinoma (PTC) after benign total thyroidectomy can be a real challenge. Methods: A cervical thyroid remnant compatible with papillary carcinoma was incidentally found ten years after total thyroidectomy for a non-functional multinodular goitre. Histological analysis of fine needle puncture aspiration (FNPA) was highly suggestive for PTC. Surgical excision of the cervical lesion was performed. Specimen study demonstrated a classic variant of PTC contacting a peripheral margin, applying ablative treatment with radioactive iodine postoperatively. Results: The patient did not present signs of recurrence during follow-up. Small thyroid remnants after benign thyroidectomy are often left behind, although their risk of malignancy is exceptional. Conclusions: It is important to individualize therapeutic approach when facing this rare entity. We decided to treat the patient by removing the lesion followed by ablation therapy with successful results. PTC: Papillary thyroid carcinoma FNPA: Fine needle puncture aspiratio

Rak brodawkowaty wykryty przypadkowo w resztkowym miąższu tarczycy po totalnej tyroidektomii z powodu łagodnej choroby tarczycy przed dziesięcioma latami

Wstęp: Diagnostyka różnicowa zmiany w obrębie szyi, odpowiadającej rakowi brodawkowatemu tarczycy (PTC) po totalnej tyroidektomii, wykonanej z powodu łagodnej choroby tarczycy, może być prawdziwym wyzwaniem. Metody: Dziesięć lat po totalnej tyroidektomii z powodu nietoksycznego wola guzkowego, w obrębie szyi pacjentki przypadkowo wykryto miąższ tarczycy, mogący odpowiadać rakowi brodawkowatemu. Badanie histologiczne materiału z biopsji aspiracyjnej cienkoigłowej (FNPA) wyraźnie sugerowało PTC. Zmiana ta została usunięta chirurgicznie. Badanie jej wycinka wykazało klasyczny wariant PTC, łączący się z marginesem obwodowym. Pooperacyjnie zastosowano leczenie ablacyjne jodem promieniotwórczym. Wyniki: W dalszej obserwacji pacjentka nie prezentowała objawów nawrotu choroby. Po wycięciu tarczycy z powodu nienowotworowej choroby często pozostaje niewielka ilość miąższu tarczycy, przy czym ryzyko złośliwej transformacji jest znikome. Wnioski: W zmaganiach z chorobami rzadkimi istotna jest indywidualizacja terapii. Zdecydowaliśmy o usunięciu zmiany u pacjentki z następowym leczeniem ablacyjnym i osiągnęliśmy pomyślne wyniki

Colecistitis aguda en el embarazo: indicación quirúrgica y recomendaciones de tratamiento

Acute cholecystitis is one of the most frequent non-obstetric surgical pathologies during pregnancy. Laparoscopic cholecystectomy is the treatment of choice for these patients, regardless of the trimester of pregnancy and the delay in treatment implies an increase in the incidence of complications derived from the biliary pathology. This review offers an update for the decision making and medical-surgical management of this entity in the pregnant patient, as well as some recommendations to be carried out in the operating room that we must know and that will optimize the results obtained in the procedure.La colecistitis aguda es una de las patologías quirúrgicas no obstétricas más frecuentes durante el embarazo. La colecistectomía laparoscópica es el tratamiento de elección para estas pacientes, independientemente del trimestre de gestación, y la demora en el tratamiento implicará un aumento de la incidencia de complicaciones derivadas de la propia patología biliar. Esta revisión ofrece una actualización para la toma de decisiones y manejo médico-quirúrgico de esta entidad en la paciente embarazada, así como una serie de recomendaciones a llevar a cabo en quirófano que debemos de conocer y que optimizarán los resultados obtenidos en el procedimiento

Open versus minimally invasive total gastrectomy after neoadjuvant chemotherapy: results of a European randomized trial

Background: Surgical resection with adequate lymphadenectomy is regarded the only curative option for gastric cancer. Regarding minimally invasive techniques, mainly Asian studies showed comparable oncological and short-term postoperative outcomes. The incidence of gastric cancer is lower in the Western population and patients often present with more advanced stages of disease. Therefore, the reproducibility of these Asian results in the Western population remains to be investigated. Methods: A randomized trial was performed in thirteen hospitals in Europe. Patients with an indication for total gastrectomy who received neoadjuvant chemotherapy were eligible for inclusion and randomized between open total gastrectomy (OTG) or minimally invasive total gastrectomy (MITG). Primary outcome was oncological safety, measured as the number of resected lymph nodes and radicality. Secondary outcomes were postoperative complications, recovery and 1-year survival. Results: Between January 2015 and June 2018, 96 patients were included in this trial. Forty-nine patients were randomized to OTG and 47 to MITG. The mean number of resected lymph nodes was 43.4 ± 17.3 in OTG and 41.7 ± 16.1 in MITG (p = 0.612). Forty-eight patients in the OTG group had a R0 resection and 44 patients in the MITG group (p = 0.617). One-year survival was 90.4% in OTG and 85.5% in MITG (p = 0.701). No significant differences were found regarding postoperative complications and recovery. Conclusion: These findings provide evidence that MITG after neoadjuvant therapy is not inferior regarding oncological quality of resection in comparison to OTG in Western patients with resectable gastric cancer. In addition, no differences in postoperative complications and recovery were seen

Correction to: Open versus minimally invasive total gastrectomy after neoadjuvant chemotherapy: results of a European randomized trial (Gastric Cancer, (2021), 24, 1, (258-271), 10.1007/s10120-020-01109-w)

In the original publication of the article, the co-author name “Christoph Reiβfelder” was incorrectly published

Health related quality of life following open versus minimally invasive total gastrectomy for cancer: Results from a randomized clinical trial

Introduction: Minimally invasive techniques show improved short-term and comparable long-term outcomes compared to open techniques in the treatment of gastric cancer and improved survival has been seen with the implementation of multimodality treatment. Therefore, focus of research has shifted towards optimizing treatment regimens and improving quality of life. Materials and methods: A randomized trial was performed in thirteen hospitals in Europe. Patients were randomized between open total gastrectomy (OTG) or minimally invasive total gastrectomy (MITG) after neoadjuvant chemotherapy. This study investigated patient reported outcome measures (PROMs) on health-related quality of life (HRQoL) following OTG or MITG, using the Euro-Qol-5D (EQ-5D) and the European Organization for Research and Treatment of Cancer (EORTC) questionnaires, modules C30 and STO22. Due to multiple testing a p-value < 0.001 was deemed statistically significant. Results: Between January 2015 and June 2018, 96 patients were included in this trial. Forty-nine patients were randomized to OTG and 47 to MITG. A response compliance of 80% was achieved for all PROMs. The EQ5D overall health score one year after surgery was 85 (60–90) in the open group and 68 (50–83.8) in the minimally invasive group (P = 0.049). The median EORTC-QLQ-C30 overall health score one year postoperatively was 83,3 (66,7–83,3) in the open group and 58,3 (35,4–66,7) in the minimally invasive group (P = 0.002). This was not statistically significant. Conclusion: No differences were observed between open total gastrectomy and minimally invasive total gastrectomy regarding HRQoL data, collected using the EQ-5D, EORTC QLQ-C30 and EORTC-QLQ-STO22 questionnaires