Total esophagogastrectomy in the neoplasms of the esophagus and esofagogastric junction: when must be indicated?

to analyse the indications and results of the total esophagogastrectomy in cancers of the distal esophagus and esophagogastric junction. twenty patients with adenocarcinomas were operated with a mean age of 55 ± 9.9 years (31-70 years), and 14 cases were male (60%). Indications were 18 tumors of the distal esophagus and esophagogastric junction (90%) and two with invasion of gastric fundus (10%) in patients with previous gastrectomy. Preoperative colonoscopy to exclude colonic diseases was performed in ten cases. the surgical technique consisted of median laparotomy and left cervicotomy, followed by transhiatal esophagectomy associated with D2 lymphadenectomy. The reconstructions were performed with eight esophagocoloduodenoplasty and the others were Roux-en-Y esophagocolojejunoplasty to prevent the alkaline reflux. Three cases were stage I / II, while 15 cases (85%) were stages III / IV, reflecting late diagnosis of these tumors. The operative mortality was 5 patients (25%): a mediastinitis secondary to necrosis of the transposed colon, abdominal cellulitis secondary to wound infection, severe pneumonia, an irreversible shock and sepsis associated with colojejunal fistula. Four patients died in the first year after surgery: 3 (15%) were due to tumor recurrence and 1 (5%) secondary to bronchopneumonia. The 5-year survival was 15%. the total esophagogastrectomy associated with esophagocoloplasty has high morbidity and mortality, requiring precise indication, and properly selected patients benefit from the surgery, with the risk-benefit acceptable, contributing to increased survival and improved quality of life.To analyse the indications and results of the total esophagogastrectomy in cancers of the distal esophagus and esophagogastric junction. twenty patients with adenocarcinomas were operated with a mean age of 55 ± 9.9 years (31-70 years), and 14 cases were426360365sem informaçãosem informaçã

O MESTRE VIAJANTE. RELATOS DE UM INVENTOR (Resenha)

Resenha de: KOHAN, Walter Omar. O Mestre inventor. Relatos de um viajante educador. Tradução Hélia Freitas. 1. ed. Belo Horizonte: Autêntica Editora, 2013 (Coleção Educação: Experiência e Sentido)

Neoadjuvant Chemoradiotherapy And Surgery Compared With Surgery Alone In Squamous Cell Carcinoma Of The Esophagus.

Despite progress in recent years in methods of diagnosis and surgical treatment of esophageal cancer, there is still controversy about the benefits from neoadjuvant chemoradiotherapy. To analise the survival of patients submitted to esophagectomy for squamous cell carcinoma of the esophagus with or without neoadjuvant chemoradiotherapy. A retrospective, non-randomized study conducted using the medical charts of patients operated for squamous cell carcinoma of the esophagus at the School of Medical Sciences, University of Campinas (UNICAMP), Campinas, São Paulo, Brazil between 1979 and 2006. The Kaplan-Meier analysis was used to calculate survival curves and the log-rank test to compare data in each group. The significance level was settled as 5%. A total of 123 patients were evaluated in this study, divided into three groups: I-26 (21.2%) patients submitted to esophagectomy alone; II-81 (65.8%) patients submitted to neoadjuvant radiotherapy plus esophagectomy and III-16 (13%) patients submitted to neoadjuvant chemoradiotherapy plus esophagectomy. A statistically significant survival was recorded between the groups (log rank=6.007; P=0.05), survival being greatest in the group submitted to neoadjuvant chemoradiotherapy, followed by the group submitted to neoadjuvant radiotherapy compared to the group submitted to esophagectomy alone as the initial treatment of choice. Radiotherapy and chemotherapy neoadjuvants in patients with squamous cell carcinoma of the esophagus offers benefits and increases survival.50101-

Laparoscopic antireflux surgery in patients with extra esophageal symptoms related to asthma

Asthma, laryngitis and chronic cough are atypical symptoms of the gastroesophageal reflux disease. To analyze the efficacy of laparoscopic surgery in the remission of extra-esophageal symptoms in patients with gastroesophageal reflux, related to asthma. Were reviewed the medical records of 400 patients with gastroesophageal reflux disease submitted to laparoscopic Nissen fundoplication from 1994 to 2006, and identified 30 patients with extra-esophageal symptoms related to asthma. The variables considered were: gender, age, gastroesophageal symptoms (heartburn, acid reflux and dysphagia), time of reflux disease, treatment with proton pump inhibitor, use of specific medications, treatment and evolution, number of attacks and degree of esophagitis. Data were subjected to statistical analysis, comparing the pre- and post-surgical findings. The comparative analysis before surgery (T1) and six months after surgery (T2) showed a significant reduction on heartburn and reflux symptoms. Apart from that, there was a significant difference between the patients with daily crises of asthma (T1 versus T2, 45.83% to 16.67%, p=0.0002) and continuous crises (T1, 41.67% versus T2, 8.33%, p=0.0002). Laparoscopic Nissen fundoplication was effective in improving symptoms that are typical of reflux disease and clinical manifestations of asthma.Asthma, laryngitis and chronic cough are atypical symptoms of the gastroesophageal reflux disease. To analyze the efficacy of laparoscopic surgery in the remission of extra-esophageal symptoms in patients with gastroesophageal reflux, related to asthma. W2729295sem informaçãosem informaçã

Gastric Adenocarcinoma After Gastric Bypass For Morbid Obesity: A Case Report And Review Of The Literature.

Gastric adenocarcinoma after gastric bypass for morbid obesity is rare but has been described. The diet restriction, weight loss, and difficult assessment of the bypassed stomach, after this procedure, hinder and delay its diagnosis. We present a 52-year-old man who underwent Roux-en-Y gastric bypass 2 years ago and whose previous upper digestive endoscopy was considered normal. He presented with weight loss, attributed to the procedure, and progressive dysphagia. Upper digestive endoscopy revealed stenosing tumor in gastric pouch whose biopsy showed diffuse-type gastric adenocarcinoma. He underwent total gastrectomy, left lobectomy, distal pancreatectomy and splenectomy, segmental colectomy, and bowel resection with esophagojejunal anastomosis. The histopathological analysis confirmed the presence of gastric cancer. The pathogenesis of gastric pouch adenocarcinoma is discussed with a literature review.201360972

Surgical Gastrostomy: Current Indications And Complications In A University Hospital [gastrostomia Cirúrgica: Indicações Atuais E Complicações Em Pacientes De Um Hospital Universitário]

Objective: To analyze the surgical gastrostomies performed at a public University Hospital, their indications and complications. Methods: We conducted a retrospective, nonrandomized review of medical records of patients who underwent surgical gastrostomy from 2007 to 2011; Results:, In the period of studied, 86 patients underwent surgical gastrostomies for enteral nutrition. The Stamm technique was employed in all cases. Men constituted 76 (88%) of the cases and the mean age was 58.4 years, the maximum age being 87 years and the minimum 19. We observed 16 (18.60%) minor complications, 17 (19.76%) serious complications and 8 (9.3%) perioperative deaths. Conclusion: Surgical gastrostomy, while considered a smaller procedure, is not without complications and mortality. The Stamm technique, despite the complications reported, is easy to perform and to handle, as well as safe.406458462Witzel, O., Zur technik der magenfistulaeinlegung (1891) Zbl Chir, 18, pp. 601-604Stamm, M., Gastrostomy: A new method (1894) Med News, 65, p. 324Grant, J.P., Comparison of percutaneous endoscopic gastrostomy with Stamm gastrostomy (1988) Ann Surg, 207 (5), pp. 598-603Gauderer, M.W., Ponsky, J.L., Izant Jr., R.J., Gastrostomy without laparoscopy: A percutaneous endoscopic technique (1980) J Pediatr Surg, 15 (6), pp. 872-875Kwon, R.S., Banerjee, S., Desilets, D., Diehl, D.L., Farraye, F.A., Enteral nutrition access devices (2010) Gastrointest Endosc, 72 (2), pp. 236-248. , ASGE Technology CommitteeHerman, L.L., Hoskins, W.J., Shike, M., Percutaneous endoscopic gastrostomy for decompression of the stomach and small bowel (1992) Gastrointest Endosc, 38 (3), pp. 314-318Möller, P., Lindberg, C.G., Zilling, T., Gastrostomy by various techniques: Evaluation of indications, outcome, and complications (1999) Scand J Gastroenterol, 34 (10), pp. 1050-1054Wollman, B., D'Agostino, H.B., Walus-Wigle, J.R., Easter, D.W., Beale, A., Radiologic, endoscopic, and surgical gastrostomy: An institutional evaluation and meta-analysis of the literature (1995) Radiology, 197 (3), pp. 699-704Ljungdahl, M., Sundbom, M., Complication rate lower after percutaneous endoscopic gastrostomy than after surgical gastrostomy: A prospective, randomized trial (2006) Surg Endosc, 20 (8), pp. 1248-1251Pisano, G., Calò, P.G., Tatti, A., Farris, S., Erdas, E., Licheri, S., Surgical gastrostomy when percutaneous endoscopic gastrostomy is not feasible: Indications, results and comparison between the two procedures (2008) Chir Ital, 60 (2), pp. 261-266Martins, F.P., Sousa, M.C.B., Ferrari, A.P., New "introducer" PEG-gastropexy with T fasteners: A pilot study (2011) Arq Gastroenterol, 48 (4), pp. 231-235Ocaña, L.F.O., Crocifoglio, V.A., La gastrostomía laparoscópica como una alternative a la gastrostomía endoscópica percutánea (1995) Rev Gastroenterol Mex, 60 (4), pp. 218-220Bergstrom, L.R., Larson, D., Zinsmeister, A.R., Sarr, M.G., Silverstein, M.D., Utilization and outcomes of surgical gastrostomies and jejunostomies in an era of percutaneous endoscopic gastrostomy: A population- based study (1995) Mayo Clin Proc, 70 (9), pp. 829-836Nicholson, F.B., Korman, M.G., Richardson, M.A., Percutaneous endoscopic gastrostomy: A review of indications, complications and outcome (2000) J Gastroenterol Hepatol, 15 (1), pp. 21-25Shellito, P.C., Malt, R.A., Tube gastrostomy. Techniques and complications (1985) Ann Surg, 201 (2), pp. 180-185Cox, W.D., Gillesby, W.J., Gastrostomy in postoperative decompression: Indications and methods (1967) Am J Surg, 113 (2), pp. 298-302Cosentini, E.P., Sautner, T., Gnant, M., Winkelbauer, F., Teleky, B., Jakesz, R., Outcomes of surgical, percutaneous endoscopic, and percutaneous radiologic gastrostomies (1998) Arch Surg, 133 (10), pp. 1076-1083Rustom, I.K., Jebreel, A., Tayyab, M., England, R.J., Stafford, N.D., Percutaneous endoscopic, radiological and surgical gastrostomy tubes: A comparison study in head and neck cancer patients (2006) J Laryngol Otol, 120 (6), pp. 463-466Grilo, A., Santos, C.A., Fonseca, J., Percutaneous endoscopic gastrostomy for nutritional palliation of upper esophageal cancer unsuitable for esophageal stenting (2012) Arq Gastroenterol, 49 (3), pp. 227-231Zorrón, R., Flores, D., Meyer, C.A.F., Castro, L.M., Madureira, F.A.V., Madureira, F.D., Single-wound gastrostomy: A simple method as an option for endoscopy (2005) Rev Col Bras Cir, 32 (3), pp. 153-15

Does adjuvant therapy associated with esophagectomy improve survival in patients with esophagogastric junction adenocarcinoma?

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Identification of preoperative risk factors for persistent postoperative dysphagia after laparoscopic antireflux surgery

BACKGROUND: Postoperative dysphagia is common after antireflux surgery and generally runs a self-limiting course. Nevertheless, part of these patients report long-term dysphagia. Inadequate surgical technique is a well documented cause of this result. AIM: This retrospective study evaluated the preoperative risk factors not surgery-related for persistent dysphagia after primary laparoscopic antireflux surgery. METHODS: Patients who underwent laparoscopic antireflux surgery by the modified technique of Nissen were evaluated in the preoperative period retrospectively. Postoperative severity of dysphagia was evaluated prospectively using a stantardized scale. Dysphagia after six weeks were defined as persistent. Statistical tests of association and logistic regression were used to identify risk factors associated with persistent dysphagia. RESULTS: A total of 55 patients underwent primary antireflux surgery by a single surgeon team. Of these, 25 patients had preoperative dysphagia (45,45%). Persistent postoperaive dysphagia was reported by 20 (36,36%). Ten patients (18,18%) required postoperative endoscopic dilatation for dysphagia. There was statistical association between satisfaction with surgery and postoperative dysphagia and requiring the use of antireflux medication after the procedure; and between preoperative dysphagia and postoperative dysphagia. Logistic regression identified significant preopertive dysphagia as risk factor for persistent postoperative dysphagia. No correlations were found with preoperative manometry. CONCLUSIONS: Patients with significant preoperative dysphagia were more likely to report persistent postoperative dysphagia. This study confirms that the current manometric criteria used to define esophageal dysmotility are not reliable to identify patients at risk for post-fundoplication dysphagia. Minucious review of the clinical history about the presence and intensity of preoperative dysphagia is important in the selection of candidates for antireflux surgery.RACIONAL: Disfagia no pós-operatório é comum após a operação anti-refluxo. No entanto, uma parte dos pacientes relatam disfagia persistente, e técnica cirúrgica inadequada é uma causa bem documentada deste resultado. OBJETIVO: Este estudo retrospectivo avaliou os fatores de risco no pré-operatório para a disfagia persistente após operação anti-refluxo por via laparoscópica. MÉTODOS: Pacientes submetidos à operação anti-refluxo por via laparoscópica pela técnica de Nissen modificada foram avaliados no pré-operatório de forma retrospectiva. A severidade da disfagia pós-operatória foi avaliada prospectivamente usando uma escala estabelecida. A disfagia após seis semanas foi definida como persistente. Os testes estatísticos de associação e regressão logística foram utilizados para identificar os fatores de risco associados à disfagia persistente. RESULTADOS: Um total de 55 pacientes foram submetidos ao procedimento por via laparoscópica por uma única equipe de cirurgiões. Destes, 25 doentes referiam disfagia pré-operatório (45,45%). A disfagia pós-operatória persistente foi relatada por 20 (36,36%) pacientes. Dez (18,18%) necessitaram de dilatações por endoscopia digestiva. Houve associação estatística entre a satisfação com a operação e disfagia no pós-operatório e exigindo o uso de medicação anti-refluxo após o procedimento, e entre disfagia no pré-operatório e disfagia no pós-operatório. A regressão logística identificou a disfagia no pré-operatório, como fator de risco para a disfagia pós-operatória persistente. Não foram observadas correlações com manometria pré-operatória. CONCLUSÕES: Os pacientes com disfagia no pré-operatório foram mais propensos a relatar disfagia pós-operatória persistente. Os critérios manométricos atuais utilizados para definir dismotilidade esofágica não identificaram pacientes com risco de disfagia persistente pós-fundoplicatura. Análise minuciosa da história clínica sobre a presença e intensidade da disfagia no pré-operatório é muito importante na seleção de candidatos à operação anti-refluxo.16516

Surgical gastrostomy: current indications and complications in a university hospital

OBJECTIVE: To analyze the surgical gastrostomies performed at a public University Hospital, their indications and complications. METHODS: We conducted a retrospective, nonrandomized review of medical records of patients who underwent surgical gastrostomy from 2007 to 2011; RESULTS: , In the period of studied, 86 patients underwent surgical gastrostomies for enteral nutrition. The Stamm technique was employed in all cases. Men constituted 76 (88%) of the cases and the mean age was 58.4 years, the maximum age being 87 years and the minimum 19. We observed 16 (18.60%) minor complications, 17 (19.76%) serious complications and 8 (9.3%) perioperative deaths. CONCLUSION: Surgical gastrostomy, while considered a smaller procedure, is not without complications and mortality. The Stamm technique, despite the complications reported, is easy to perform and to handle, as well as safe.OBJETIVO: revizar as indicações e as complicações observadas após a realização de gastrostomias cirúrgicas em pacientes internados em um hospital universitário público de ensino. MÉTODOS:estudo retrospectivo não randomizado de revisão dos prontuários médicos dos pacientes submetidos à gastrostomia cirúrgica nos últimos cinco anos, sobre as indicações e complicações. RESULTADOS: no período de 2007 a 2011, 86 pacientes foram submetidos à gastrostomias cirúrgicas para nutrição enteral. A técnica operatória utilizada foi a de Stamm na totalidade dos casos. Os homens constituíram 76 (88%) dos casos e a média de idade foi 58,4 anos, a idade máxima 87 anos e a mínima de 19 anos. Foram observadas 16 (18,60%) complicações consideradas menores, 17 (19,76%) complicações graves e oito (9,3%) óbitos peri-operatórios. CONCLUSÃO: as gastrostomias cirúrgicas, embora consideradas procedimentos de menor porte, não são isentas de complicações e mortalidade. A técnica operatória de Stamm, apesar das complicações relatadas, é de fácil execução, manuseio e oferece segurança.45846

Postoperative outcomes in oesophagectomy with trainee involvement

BACKGROUND: The complexity of oesophageal surgery and the significant risk of morbidity necessitates that oesophagectomy is predominantly performed by a consultant surgeon, or a senior trainee under their supervision. The aim of this study was to determine the impact of trainee involvement in oesophagectomy on postoperative outcomes in an international multicentre setting. METHODS: Data from the multicentre Oesophago-Gastric Anastomosis Study Group (OGAA) cohort study were analysed, which comprised prospectively collected data from patients undergoing oesophagectomy for oesophageal cancer between April 2018 and December 2018. Procedures were grouped by the level of trainee involvement, and univariable and multivariable analyses were performed to compare patient outcomes across groups. RESULTS: Of 2232 oesophagectomies from 137 centres in 41 countries, trainees were involved in 29.1 per cent of them (n = 650), performing only the abdominal phase in 230, only the chest and/or neck phases in 130, and all phases in 315 procedures. For procedures with a chest anastomosis, those with trainee involvement had similar 90-day mortality, complication and reoperation rates to consultant-performed oesophagectomies (P = 0.451, P = 0.318, and P = 0.382, respectively), while anastomotic leak rates were significantly lower in the trainee groups (P = 0.030). Procedures with a neck anastomosis had equivalent complication, anastomotic leak, and reoperation rates (P = 0.150, P = 0.430, and P = 0.632, respectively) in trainee-involved versus consultant-performed oesophagectomies, with significantly lower 90-day mortality in the trainee groups (P = 0.005). CONCLUSION: Trainee involvement was not found to be associated with significantly inferior postoperative outcomes for selected patients undergoing oesophagectomy. The results support continued supervised trainee involvement in oesophageal cancer surgery