147 research outputs found
Completion total gastrectomy with intracorporeal robot-sewn esophago-jejunal anastomosis
Many technical reports concern minimally invasive surgery for stomach cancer; however, there is poor evidence about employing this approach for gastric stump cancer, which can arise at the anastomotic site in patients who have undergone previous partial gastrectomy for benign diseases such as gastric ulcer. Such surgery was quite common before the introduction of proton pump inhibitors (PPIs), and so today, according to different statistics, gastric stump cancer can be revealed in up to 8% of these patients. This report seeks to highlight the possibility of employing a minimally invasive approach in patients who already had an operation for gastric resection.
The video shows technical notes about the hybrid laparoscopic-robotic approach performed in a patient who previously underwent open distal gastrectomy. Is the previous laparotomy an absolute or relative counterindication to reperform a surgery through a minimally invasive approach
Semi-automatic Liver Tumor Segmentation in Dynamic Contrast-Enhanced CT Scans Using Random Forests and Supervoxels
International audiencePre-operative locoregional treatments (PLT) delay the tumor progression by necrosis for patients with hepato-cellular carcinoma (HCC). Toward an efficient evaluation of PLT response, we address the estimation of liver tumor necrosis (TN) from CT scans. The TN rate could shortly supplant standard criteria (RECIST, mRECIST, EASL or WHO) since it has recently shown higher correlation to survival rates. To overcome the inter-expert variability induced by visual qualitative assessment, we propose a semi-automatic method that requires weak interaction efforts to segment parenchyma, tumoral active and necrotic tissues. By combining SLIC supervoxels and random decision forest, it involves discriminative multi-phase cluster-wise features extracted from registered dynamic contrast-enhanced CT scans. Quantitative assessment on expert groundtruth annotations confirms the benefits of exploiting multi-phase information from semantic regions to accurately segment HCC liver tumors
Oral Bacterial Microbiota in Digestive Cancer Patients: A Systematic Review
The relation between the gut microbiota and human health is increasingly recognized.
Recently, some evidence suggested that dysbiosis of the oral microbiota may be involved in the
development of digestive cancers. A systematic review was conducted according to the PRISMA
guidelines to investigate the association between the oral microbiota and digestive cancers. Several
databases including Medline, Scopus, and Embase were searched by three independent reviewers,
without date restriction. Over a total of 1654 records initially identified, 28 studies (2 prospective
cohort studies and 26 case-controls) were selected. They investigated oral microbiota composition
in patients with esophageal squamous cell carcinoma (n = 5), gastric cancer (n = 5), colorectal
cancer (n = 9), liver carcinoma (n = 2), and pancreatic cancer (n = 7). In most of the studies, oral
microbiota composition was found to be different between digestive cancer patients and controls.
Particularly, oral microbiota dysbiosis and specific bacteria, such as Fusobacterium nucleatum and
Porphyromonas gingivalis, appeared to be associated with colorectal cancers. Current evidence suggests
that differences exist in oral microbiota composition between patients with and without digestive
cancers. Further studies are required to investigate and validate oral–gut microbial transmission
patterns and their role in digestive cancer carcinogenesis
Laparoscopic R1 vascular hepatectomy for hepatocellular carcinoma (with video)
Surgical resection is considered the standard of treatment
for hepatocellular carcinoma (HCC), when realized
with negative margins (R0)1. Not infrequently, R0 resection
is unachievable, thus the concept of R1 vascular
hepatectomy has been introduced and has been defined as
exposure of the tumor on the specimen surface due to its
detachment from vascular structure
Correction to: The Role of Laparoscopic Surgery in Localized Pancreatic Neuroendocrine Tumours
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What is the best surgical option for the resection of transverse colon cancer?
Transverse colon is an infrequent localization of colon cancer and it is burdened by a poor prognosis. The principle of oncological radicality includes primary tumor resection with adequate lymphadenectomy. To date, there is still no consensus on which type of surgical resection perform in case of transverse colon cancer (TCC). Lymphatic drainage and vascularization of this section of the colon is highly variable presenting with different anatomical variants. Moreover, mobilization of the transverse colon can be particularly challenging in comparison to other colon tracts. Despite a lack of standardized definitions, three main surgical options are proposed: segmental colectomy of the transverse colon [transverse colectomy (TC)], extended right colectomy (ERC) and subtotal colectomy (STC). The aim of the present review is to describe the outcomes, limitations and advantages of TC, ERC, and STC for TCC in order to identify possible trends in the current literature suggesting which is the best treatment option in both elective and emergency settings
Lactate Dehydrogenase in Hepatocellular Carcinoma: Something Old, Something New
Hepatocellular carcinoma (HCC) is the most common primary liver tumour (80-90%) and represents more than 5.7% of all cancers. Although in recent years the therapeutic options for these patients have increased, clinical results are yet unsatisfactory and the prognosis remains dismal. Clinical or molecular criteria allowing a more accurate selection of patients are in fact largely lacking. Lactic dehydrogenase (LDH) is a glycolytic key enzyme in the conversion of pyruvate to lactate under anaerobic conditions. In preclinical models, upregulation of LDH has been suggested to ensure both an efficient anaerobic/glycolytic metabolism and a reduced dependence on oxygen under hypoxic conditions in tumour cells. Data from several analyses on different tumour types seem to suggest that LDH levels may be a significant prognostic factor. The role of LDH in HCC has been investigated by different authors in heterogeneous populations of patients. It has been tested as a potential biomarker in retrospective, small, and nonfocused studies in patients undergoing surgery, transarterial chemoembolization (TACE), and systemic therapy. In the major part of these studies, high LDH serum levels seem to predict a poorer outcome. We have reviewed literature in this setting trying to resume basis for future studies validating the role of LDH in this disease
Laparoscopic vs. open surgery for the treatment of iatrogenic colonoscopic perforations: a systematic review and meta-analysis
Quality assessment of the included non-randomized studies based on the Newcastle-Ottawa Scale (NOS). (DOCX 57Â kb
Liver resection vs radiofrequency ablation in single hepatocellular carcinoma of posterosuperior segments in elderly patients
Background: Liver resection and radiofrequency ablation are considered curative options for hepatocellular carcinoma. The choice between these techniques is still controversial especially in cases of hepatocellular carcinoma affecting posterosuperior segments in elderly patients. Aim: To compare post-operative outcomes between liver resection and radiofrequency ablation in elderly with single hepatocellular carcinoma located in posterosuperior segments. Methods: A retrospective multicentric study was performed enrolling 77 patients age ≥ 70-years-old with single hepatocellular carcinoma (≤ 30 mm), located in posterosuperior segments (4a, 7, 8). Patients were divided into liver resection and radiofrequency ablation groups and preoperative, peri-operative and long-term outcomes were retrospectively analyzed and compared using a 1:1 propensity score matching. Results: After propensity score matching, twenty-six patients were included in each group. Operative time and overall postoperative complications were higher in the resection group compared to the ablation group (165 min vs 20 min, P < 0.01; 54% vs 19% P = 0.02 respectively). A median hospital stay was significantly longer in the resection group than in the ablation group (7.5 d vs 3 d, P < 0.01). Ninety-day mortality was comparable between the two groups. There were no significant differences between resection and ablation group in terms of overall survival and disease free survival at 1, 3, and 5 years. Conclusion: Radiofrequency ablation in posterosuperior segments in elderly is safe and feasible and ensures a short hospital stay, better quality of life and does not modify the overall and disease-free survival
Left hemicolectomy and low anterior resection in colorectal cancer patients: Knight–griffen vs. transanal purse-string suture anastomosis with no-coil placement
BackgroundColorectal cancer (CRC) is considered one of the most frequent neoplasms of the digestive tract with a high mortality rate. Left hemicolectomy (LC) and low anterior resection (LAR) with minimally invasive laparoscopic and robotic approaches or with the open technique are the gold standard curative treatment.Materials and methodsSeventy-seven patients diagnosed with CRC were recruited between September 2017 and September 2021. All patients underwent a preoperative staging with a full-body CT scan. The goal of this study was to compare both types of surgeries, LC-LAR LS with Knight–Griffen colorectal anastomosis and LC-LAR open with Trans-Anal Purse-String Suture Anastomosis (the TAPSSA group), by positioning a No-Coil transanal tube (SapiMed Spa, Alessandria, Italy), in terms of postoperative complications such as prolonged postoperative ileus (PPOI), anastomotic leak (AL), postoperative ileus (POI), and hospital stay.ResultsThe patients were divided into two groups: the first with 39 patients who underwent LC and LAR in LS with Knight–Griffen anastomosis (Knight–Griffen group) and the second with 38 patients who underwent LC and LAR by the open technique with the TAPSSA group. Only one patient who underwent the open technique suffered AL. POI was 3.76 ± 1.7 days in the TAPSSA group and 3.07 ± 1.3 days in the Knight–Griffen group. There were no statistically significant differences in terms of AL and POI between the two different groups.ConclusionThe important point that preliminarily emerged from this retrospective study was that the two different techniques showed similarities in terms of AL and POI, and therefore, all the advantages reported in the previous studies pertaining to No-Coil also hold good in this study regardless of the surgical technique used. However, randomized controlled trials are needed to confirm these findings
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