A Proposal of a Practical and Optimal Prophylactic Strategy for Peritoneal Recurrence

Peritoneal metastasis, which often arises in patients with advanced gastric cancer, is well known as a miserable and ill-fated disease. Once peritoneal metastasis is formed, it is extremely difficult to defeat. We advocated EIPL (extensive intraoperative peritoneal lavage) as a useful and practical adjuvant surgical technique for those gastric cancer patients who are likely to suffer from peritoneal recurrence. In this paper, we review the effect of EIPL therapy on prevention of peritoneal recurrence on patients with peritoneal free cancer cells without overt peritoneal metastasis (CY+/P−) through the prospective randomized study, and we verified its potential as an optimal and standard prophylactic therapeutic strategy for peritoneal recurrence

Splanchnicectomy for Pancreatic Cancer Pain

Persistent pain is a serious problem that often contributes to a poor quality of life in pancreatic cancer patients. Medical management by opioid analgesics is often accompanied by side effects and incomplete pain relief. A celiac plexus block is a simple treatment which relieves pain, but the procedure demands a certain degree of proficiency and the duration of the effects obtained can be rather limited. Transhiatal bilateral splanchnicectomy achieves a certain denervation of splanchnic nerves, but it requires a laparotomy. Unilateral thoracoscopic splanchnicectomy is a minimally invasive procedure to cause definite denervation. Bilateral thoracoscopic splanchnicectomy is recommended for unsatisfactory cases or recurrent pain occurring after the initial unilateral splanchnicectomy. It is important to select the most suitable treatment depending on patients’ actual medical state and the predicted outcomes

Pancreaticojejunostomy by reinforcing the pancreas without covering the anastomotic line reduces pancreatic fistula

AbstractBackground/objectivePostoperative pancreatic fistula (POPF) is the most common and an intractable complication after pancreaticoduodenectomy (PD). Many efforts have been made to lessen POPF, but nevertheless its incidence still remains high. The aim of this study was to evaluate the efficacy of reinforcing the pancreatic remnant, but the non-reinforcement of the anastomotic line, by using a modified polyethylene glycolic acid (PGA) felt pasting method after PD, especially in cases with a soft pancreas.MethodsPancreaticojejunostomy (PJ) anastomosis was performed with the end-to-side 2-layer manner in which the cut end of the pancreatic remnant was pasted with PGA felts using a fibrin sealant in 31 patients (PGA group). The postoperative outcome was then compared with historical control subjects (control group, 33 patients).ResultsIncidences of overall, Grade A and Grade B of POPF in the PGA group were 29.0, 22.6 and 6.5%, respectively, and tended to be lower than that in the control group (48.5, 33.3 and 15.2%), although no statistical significance was observed. There was no Grade C of POPF in this study. Referring only to the soft pancreas, however, the overall incidence of POPF in the PGA group was significantly lower than that in the control group (39.1 vs. 70.0%, p = 0.042).ConclusionApplying PGA felt pasting to PJ anastomosis could be one effective measure for reducing POPF after PD

Standard Prophylactic Strategy against Peritoneal Dissemination Metastasis in Gastric Cancer

У раду ћe бити представљени они видови функционалне раслојености језика који су карактеристични за савремени српски језик - за његове идиоме и функционалне стилове и који могу бити индикативни за његово нормирање. Имамо у виду раслојеност која се испољава на лексичком нивоу и која се на одређени начин представља у дескриптивним речницима савременог српског језика