De novo gastric adenocarcinoma 1 year after sleeve gastrectomy in a transplant patient

AbstractIntroductionIt has been reported in the literature that upper gastrointestinal malignancies after bariatric surgery are mostly gastro-esophageal, although it is not clear whether bariatric surgery represents a risk factor for the development of esophageal and/or gastric cancer. We report a case of a de novo gastric adenocarcinoma occurring in a transplant patient 1 year after a laparoscopic sleeve gastrectomy.Presentation of caseA 44 year-old woman with a BMI of 38kg/m2, hypertension, type 1 diabetes mellitus, multiple malignancies and a pancreas transplant underwent laparoscopic sleeve gastrectomy. The patient presented with intense dysphagias during the follow up. Studies were performed and the diagnoses of grade 2/3 adenocarcinoma were made. The patient underwent a robotic assisted total gastrectomy with a roux-en-y intracorporeal esophagojejunostomy. The procedure resulted in multiple metastasic lymph nodes, focal and transmural invasions to multiple organs with a tumor free margin resection. The patient presented with a postoperative pleural effusion, with no further complications.DiscussionThe diagnosis of gastroesophageal cancer after bariatric surgery is usually late since these patients have common upper gastrointestinal symptoms related to the procedure that could delay the diagnosis. De novo gastric cancer after sleeve gastrectomy has only been reported in one instance, in contrast with other bariatric surgery procedures.ConclusionsNo direct relation has been established between sleeve gastrectomy and the development of gastric cancer. Robotic procedures allow for complex multiorgan resections, while preserving the benefits of minimally invasive surgery

Assessment of adrenal medulla function by means of 131I-Metaiodio- benzylguanidine after spleno-renal derivation according to Warren

--

Effect of Kidney Transplantation on Quality of Life Measures

Assessing the quality of life should be an essential part of the long-term results of surgery, particularly for those procedures that may influence a patient's lifestyle and body image. Eliminating the need for dependence on chronichemodialysis, kidney transplantation improves the patient's autonomy but exposes them to the side-effects of immunosuppression and the constant threat of rejection. The purpose of this study was to compare the quality of life of patients on the waiting list for a kidney transplantation to that of those already transplanted at our Center to quantify carefully the impact of this therapy on the patient's physical, emotional, and social well-being. Computer analysis of the data collected from self-administered questionnaires revealed that the vast majority of successfully transplanted patients experience a significant improvement in almost all the areas investigated compared with the pretransplant group. In addition, we tried to use the questionnaire to predict which type of patient will adjust more fully to the impact of a kidney transplantation and which will probably need posttransplant psychological care and social support. Aside from clinical factors such as the time spent on hemodialysis before transplantation, the gender, the age, as well as the source of the organ (living vs. cadaver donor) seem to play a role in the final outcome of a successful kidney transplantation

Structured training and competence assessment in colorectal robotic surgery : Results of a consensus experts round table

Background: A structured training is a key element for the learning of techniques with a high level of complexity, such as robotic colorectal surgery. Methods: This study reports the results of an expert consensus round table held during the 6th Clinical Robotic Surgery Association (CRSA) congress, focusing on recommendations in robotic colorectal surgery. Results: Three sequential steps are proposed for training: a basic module, to learn basic robotic skills and general competencies; an advanced module, to acquire skills to safely perform a colorectal resection, and tutored clinical practice providing procedures of increasing complexity. Each specific skill of the basic module and performance of each surgical step of a colorectal procedure was evaluated and rated from 1 to 3. Conclusions: Defining requirements to begin robotic colorectal activity, delineation of structured training programs and objectification of the acquired competences are key elements for a safe and efficient learning of robotic colorectal surgery