Magnetic resonance imaging in preoperative staging of gastric cancer: initial experience

BACKGROUND: The aim of the present study is to present an initial experience in the clinical value of magnetic resonance imaging (MRI) in the preoperative T staging of gastric cancer. METHODS: In total, 15 patients with gastric cancer were investigated between September 2017 and September 2018. All patients underwent abdomen MRI with T2 weighted sequences (on axial, coronal and parasagittal planes), diffusion-weighted imaging sequences and axial gadolinium fat suppressed T1 weighted sequences, after the oral administration of 1 L of jellify water, obtained by mixing water and food thickener. The results of the MRI T staging (cT and cN) were compared to postoperative pathological diagnosis (pT and pN), according to the VIII edition of tumor-node-metastasis by AJCC. RESULTS: Seven patients out of 15 patients underwent gastric surgery. The MRI localization of gastric cancer were confirmed by the histopathological exam after surgery in all case, even in case of pT1 tumors. In 3/7 cases a concordance was obtained between the cT and the pT, while in the remaining 3/7 cases MRI slightly overestimated the real T and in 1/7 cases the histological examination revealed the presence of a gastrointestinal stromal tumors. Regarding the N agreement, this was found in only 2/7 cases. Of the unoperated patients, 6/8 patients had a cT3 cN2 cM0, 1/8 cT3 cN2 cM1 (hepatic) and 1/8 cT4a cN2 cM0 radiological stage. All unoperated patients underwent neo-adjuvant therapy, with the exception of one patient who died shortly after the diagnosis. CONCLUSIONS: The results were encouraging. In particular, with reference to pathological diagnosis, the MRI method could be a useful preoperative assessment. However, in order to obtain results of greater scientific evidence, it is our intention to expand the sample under examination and compare the MRI data with those of computed tomography

SARS‐CoV‐2 infection and venous thromboembolism after surgery: an international prospective cohort study

SARS-CoV-2 has been associated with an increased rate of venous thromboembolism in critically ill patients. Since surgical patients are already at higher risk of venous thromboembolism than general populations, this study aimed to determine if patients with peri-operative or prior SARS-CoV-2 were at further increased risk of venous thromboembolism. We conducted a planned sub-study and analysis from an international, multicentre, prospective cohort study of elective and emergency patients undergoing surgery during October 2020. Patients from all surgical specialties were included. The primary outcome measure was venous thromboembolism (pulmonary embolism or deep vein thrombosis) within 30 days of surgery. SARS-CoV-2 diagnosis was defined as peri-operative (7 days before to 30 days after surgery); recent (1-6 weeks before surgery); previous (>= 7 weeks before surgery); or none. Information on prophylaxis regimens or pre-operative anti-coagulation for baseline comorbidities was not available. Postoperative venous thromboembolism rate was 0.5% (666/123,591) in patients without SARS-CoV-2; 2.2% (50/2317) in patients with peri-operative SARS-CoV-2; 1.6% (15/953) in patients with recent SARS-CoV-2; and 1.0% (11/1148) in patients with previous SARS-CoV-2. After adjustment for confounding factors, patients with peri-operative (adjusted odds ratio 1.5 (95%CI 1.1-2.0)) and recent SARS-CoV-2 (1.9 (95%CI 1.2-3.3)) remained at higher risk of venous thromboembolism, with a borderline finding in previous SARS-CoV-2 (1.7 (95%CI 0.9-3.0)). Overall, venous thromboembolism was independently associated with 30-day mortality (5.4 (95%CI 4.3-6.7)). In patients with SARS-CoV-2, mortality without venous thromboembolism was 7.4% (319/4342) and with venous thromboembolism was 40.8% (31/76). Patients undergoing surgery with peri-operative or recent SARS-CoV-2 appear to be at increased risk of postoperative venous thromboembolism compared with patients with no history of SARS-CoV-2 infection. Optimal venous thromboembolism prophylaxis and treatment are unknown in this cohort of patients, and these data should be interpreted accordingly