Readmissions following elective radical total gastrectomy for early gastric cancer: A case-controlled study

AbstractBackgroundReadmission after gastrectomy is one of the factors that reflect quality of life. Therefore, we analyzed the several factors related to readmissions after total gastrectomy for early gastric cancer.MethodsFrom January 2002 through December 2009, 102 consecutive patients who underwent radical total gastrectomy for early gastric cancer were enrolled in this study. We evaluated the incidence, cause, time point, and type of treatment for readmission after discharge; we compared the readmission and non-readmission groups in regard to clinicopathologic features and postoperative outcomes.ResultsThe readmission rate during the five years after total gastrectomy was 22 of 102 (21.6%). The most common cause for readmission was esophagojejunostomy stricture (5 cases). The treatment given for 31 readmissions included 23 conservative therapies, 3 radiologic or endoscopic interventions, and 5 re-operations. No significant differences were detected in the clinicopathologic feature, postoperative outcomes, or 5-year survival rates between the readmission and non-readmission group. No specific risk factor was found to be associated with readmission.ConclusionAlthough we could not determine a specific risk factor associated with readmission after radical total gastrectomy, prevention of readmission by evaluating the causes and treatments after radical total gastrectomy can improve the patient's quality of life

Laparoscopic splenectomy for sclerosing angiomatoid nodular transformation of the spleen

Primary splenic tumors are rare and mainly found incidentally on radiologic studies. Among them, sclerosing angiomatoid nodular transformation (SANT) of the spleen is a new entity defined as a benign pathologic lesion. Most SANTs have no clinical symptoms and are occasionally accompanied by other splenic diseases such as malignancies. So, the exact diagnosis of the nature of the splenic tumor is mandatory for further treatment. But, preoperative diagnosis is not easy since it is difficult to obtain the tissue from the spleen for pathological study. Recently, laparoscopic splenectomy has become the more standard procedure for the spleen for diagnosis and treatment. Here, we report a rare case of SANT diagnosed following laparoscopic splenectomy

Comparative Study of Complete and Partial Omentectomy in Radical Subtotal Gastrectomy for Early Gastric Cancer

∙ The authors have no financial conflicts of interest. © Copyright: Yonsei University College of Medicine 2011 This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial Licens

Cellular and peritoneal immune response after radical laparoscopy-assisted and open gastrectomy for gastric cancer

BACKGROUND AND OBJECTIVES: The aim of this study was to assess cellular and peritoneal immune responses after radical laparoscopic surgery in gastric cancer. METHODS: Peripheral heparinized plasma and plain serum tube samples were collected preoperatively, and at 2 hr, 1 day, and 4 days postoperatively for analysis o; white blood cells, total lymphocytes, T-helper lymphocytes, T-suppressor lymphocytes, B-lymphocytes, natural killer cells, plasma C-reactive protein and serum amyloid-A. Twenty-four hours peritoneal fluid collection was performed on days 1 and 4 for TNF-alpha, IL-6, and IL-10 analysis. RESULTS: No statistical differences were observed between the two groups with respect to immunocompetent cell counts. The serum levels of plasma CRP and SAA gradually increased significantly with time in both groups, but these temporal increases were lower in the LADG group (CRP; P = 0.03, SAA; P = 0.01). Peritoneal TNF-alpha levels in the CODG group at 4 days postoperatively were significantly higher than at day 1, but remained almost unchanged in the LADG group, and this difference was significant (P = 0.02). CONCLUSION: Because of its association with reduced peritoneal immune activity, laparoscopic surgery for advanced gastric cancer may require careful consideration in practice. Additional, larger prospective multicenter trials are required before a consensus can be reached

Long term survival results for gastric GIST: is laparoscopic surgery for large gastric GIST feasible?

Abstract Background Recently, laparoscopic resection for relatively small sized gastric gastrointestinal stromal tumors (GISTs) has been widely accepted as minimally invasive surgery. However, no report on the long-term safety and efficacy of this surgery for large sized gastric GISTs has been published to date. Methods Between July 1998 and January 2011, 104 consecutive patients who underwent resection for gastric GISTs were enrolled in this retrospective study. We assessed the clinicopathological characteristics, postoperative outcomes, patient survival, and tumor recurrence. Results Of the 104 patients with gastric GISTs who were included in the study, there were 47 males and 57 females whose mean age was 59.8 years. Sixty-four patients (61.5%) had symptoms associated with tumor. Ten patients included in the group 1, 49 in the group 2, 15 in the group 3a, 9 in the group 5, 14 in the group 6a, and 7 in the group 6b. There was one minor complication and no mortalities. Recurrence was noted in 5 patients, with a median follow-up period of 49.3 months (range, 8.4 to 164.4). The 5-year overall and disease free survival rates of 104 patients were 98.6% and 94.8%, respectively. When comparing large tumor (5–10 cm) between laparoscopic and open surgery, there were statistically differences in age, tumor size, tumor location, and length of hospitalization. There were no statistical differences in the 5-year survival rate between laparoscopic and open surgery for large tumor (5-10cm). Conclusion Laparoscopic surgery is feasible and effective as an oncologic treatment of gastric GISTs. Moreover, laparoscopic surgery can be an acceptable alternative to open methods for gastric GISTs of size bigger than 5 cm.</p