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Push-type percutaneous endoscopic gastrostomy with ultrathin endoscope in patients with severe trismus or obstruction due to head and neck cancers: A case series

Aim: Endoscopically-placed, push-type percutaneous endoscopic gastrostomies (PEG) have recently been made possible through the use of a gastropexy device. However, the safety and efficacy of the procedure in patients suffering from severe trismus or malignant obstruction due to head and neck cancers have rarely been reported. The aim of this study was thus to investigate the feasibility, safety and risk of endoscopic push-type PEG in this group of patients. Patients and Methods: Consecutive patients who were indicated for PEG and suffered from severe trismus or malignant obstruction due to head and neck cancers, precluding the introduction of a 9.8mm oesophagogastroduodenoscope were included. Push-type PEG was performed under endoscopic control with a 5-mm endoscope and the loop fixture device. Results: Eleven patients had push-type PEG performed under conscious sedation. All procedures were successful, and minor complications occurred in one patient with a dislodged gastrostomy tube and another with wound infection. There were no mortalities or major morbidities related to the procedure. Conclusions: Push-type PEG with gastropexy inserted under endoscopic control by an ultrathin endoscope is a feasible alternative to open gastrostomy in patients with severe trismus or pharyngeal obstruction. © 2011 The Authors. Surgical Practice © 2011 College of Surgeons of Hong Kong.link_to_subscribed_fulltex

A case-controlled comparison of single-site access versus conventional three-port laparoscopic appendectomy

Background: The aim of this study was to compare patients who underwent single-site access laparoscopic appendectomy (SSALA) to those who underwent conventional three-port laparoscopic appendectomy (TPLA) in a case-controlled manner. Methods: Consecutive patients who underwent SSALA for suspected acute appendicitis between April and September 2009 were retrospectively compared to those who underwent TPLA between January and December 2008 in a case-controlled manner. The patients were matched for age, gender, and pathological findings. The main outcome measurements included postoperative recovery, morbidities, and mortalities. Results: During the study period, a total of 30 patients underwent SSALA and these were matched with 60 TPLA patients. There were no significant differences in the mean operative time, hospital stay, and 30-day morbidity rate between the two groups. None of the patients required conversion. Two patients with significant contamination and abscess collection noted during SSALA required a relaparotomy for peritoneal lavage and adhesiolysis due to prolonged ileus. Conclusions: SSALA is feasible and the perioperative outcome was comparable to that of TPLA. However, future prospective studies will need to evaluate whether SSALA can adequately tackle patients with significant peritoneal contamination. © 2010 Springer Science+Business Media, LLC.link_to_subscribed_fulltex

A comparison of angiographic embolization with surgery after failed endoscopic hemostasis to bleeding peptic ulcers

Background: In patients with bleeding peptic ulcers in whom endoscopic hemostasis fails, surgery usually follows. Transarterial embolization (TAE) has been proposed as an alternative. Objective: To compare the outcomes of TAE and salvage surgery for patients with peptic ulcers in whom endoscopic hemostasis failed. Design: Retrospective study. Setting: A university hospital. Patients: Patients with peptic ulcer bleeding in whom endoscopic hemostasis failed. Interventions: TAE and surgery as salvage of peptic ulcer bleeding. Main Outcomes Measurements: All-cause mortality, rebleeding, reintervention, and complication rate. Results: Thirty-two patients underwent TAE and 56 underwent surgery. In those who underwent TAE, the bleeding vessels were gastroduodenal artery (25 patients), left gastric artery (4 patients), right gastric artery (2 patients), and splenic artery (1 patient). Active extravasation was seen in 15 patients (46.9%). Embolization was attempted in 26 patients, and angiographic coiling was successful in 23 patients (88.5%). Bleeding recurred in 11 patients (34.4%) in the TAE group and in 7 patients (12.5%) in the surgery group (P = .01). More complications were observed in patients who underwent surgery (40.6% vs 67.9%, P = .01). There was no difference in 30-day mortality (25% vs 30.4%, P = .77), mean length of hospital stay (17.3 vs 21.6 days, P = .09), and need for transfusion (15.6 vs 14.2 units, P = .60) between the TAE and surgery groups. Limitations: Retrospective study. Conclusions: In patients with ulcer bleeding after failed endoscopic hemostasis, TAE reduces the need for surgery without increasing the overall mortality and is associated with fewer complications. © 2011 American Society for Gastrointestinal Endoscopy.link_to_subscribed_fulltex

Functional performance and quality of life in patients with squamous esophageal carcinoma receiving surgery or chemoradiation: Results from a randomized trial

Objective: The aim of this study was to compare the 2-year functional performance and quality of life in patients with operable squamous cell carcinoma of the esophagus, who have received either surgery or definitive chemoradiation (CRT). Summary Background Data: The functional outcomes and quality of life in patients receiving esophagectomy or definitive CRT is uncertain. Methods: Data were extracted from the database of a prospective randomized controlled trial that included patients with resectable mid or lower thoracic esophageal cancers. The patients were randomized to either standard esophagectomy or definitive CRT. Quality of life assessments were performed using the EORTC QLQ-C30 and QLQ-OES24 modules. Other functional assessments included pulmonary and eating functions. Results: From July 2000 to December 2004, a total of 81 patients were enrolled into the study. No significant longitudinal changes were detected in the global health status in both groups upon available follow-up. Surgery was associated with worsened physical functioning and fatigue symptoms up to 6 months after treatment (P < 0.001 and P = 0.021, respectively) and these scales improved at 2 years. In terms of pulmonary function, dyspnoic and coughing symptoms were significantly worsened 3 months after surgery (P = 0.024 and P = 0.036, respectively) whereas symptoms in the CRT group progressively deteriorated over time. Concerning the eating function, both groups had improvements in dysphagia but there were frequent need for endoscopic intervention. This study has been registered with clinicaltrials.gov and the clinicaltrials.gov ID number is NCT01032967. Conclusion: Neither surgery nor definitive CRT significantly impaired the global health status of patients. Surgery was associated with a short-term negative impact in some aspects of health related quality of life assessments but these changes became insignificant 2 years after treatment. However, CRT was associated with progressive deteriorations in pulmonary function in the longer term. © 2010 Lippincott Williams & Wilkins.link_to_subscribed_fulltex

A comparison of angiographic embolization with surgery after failed endoscopic hemostasis to bleeding peptic ulcers

Background: In patients with bleeding peptic ulcers in whom endoscopic hemostasis fails, surgery usually follows. Transarterial embolization (TAE) has been proposed as an alternative. Objective: To compare the outcomes of TAE and salvage surgery for patients with peptic ulcers in whom endoscopic hemostasis failed. Design: Retrospective study. Setting: A university hospital. Patients: Patients with peptic ulcer bleeding in whom endoscopic hemostasis failed. Interventions: TAE and surgery as salvage of peptic ulcer bleeding. Main Outcomes Measurements: All-cause mortality, rebleeding, reintervention, and complication rate. Results: Thirty-two patients underwent TAE and 56 underwent surgery. In those who underwent TAE, the bleeding vessels were gastroduodenal artery (25 patients), left gastric artery (4 patients), right gastric artery (2 patients), and splenic artery (1 patient). Active extravasation was seen in 15 patients (46.9%). Embolization was attempted in 26 patients, and angiographic coiling was successful in 23 patients (88.5%). Bleeding recurred in 11 patients (34.4%) in the TAE group and in 7 patients (12.5%) in the surgery group (P = .01). More complications were observed in patients who underwent surgery (40.6% vs 67.9%, P = .01). There was no difference in 30-day mortality (25% vs 30.4%, P = .77), mean length of hospital stay (17.3 vs 21.6 days, P = .09), and need for transfusion (15.6 vs 14.2 units, P = .60) between the TAE and surgery groups. Limitations: Retrospective study. Conclusions: In patients with ulcer bleeding after failed endoscopic hemostasis, TAE reduces the need for surgery without increasing the overall mortality and is associated with fewer complications. © 2011 American Society for Gastrointestinal Endoscopy.link_to_subscribed_fulltex

Improvements in long-term survival after major hepatic resection for small solitary hepatocellular carcinoma in cirrhotic patients

Concurrent Sessions Orals: no. 837This journal suppl. entitled: Special Issue: Abstracts of the Fourth Biennial Congress of the Asian-Pacific Hepato-Pancreato Biliary Association ... 2013Surgery & Surgical SpecialtiesBACKGROUND & AIMS: Extend of liver resection for solitary hepatocellular carcinoma less than 5 cm is controversial. Methods: This is a retrospective review of patients with solitary HCC less than 5 cm, who have undergone liver resection in a tertiary referral centre in Hong Kong, from January 1989 to December 2009. Baseline demographics, liver function, perioperative outcomes and overall survival were …link_to_OA_fulltex

Outcomes of intrahepatic cholangiocarcinoma after liver resection

This journal suppl. entitled: Special Issue: Abstracts of the Fourth Biennial Congress of the Asian-Pacific Hepato-Pancreato Biliary Association ... 2013Surgery & Surgical SpecialtiesConcurrent Sessions Poster: no. 1031BACKGROUND & AIMS: Background and aims: The optimal surgical management for intrahepatic cholangiocarcinoma (IHC) is controversial especially in regard to the need for radical lymphadenectomy. Evidence to demonstrate oncological significance of radical lymphadenectomy is limited. Radical lymphadenectomy is not a routine practice in our centre. The aim of this study is to evaluate the outcomes of these patients who underwent liver resection without radical …link_to_OA_fulltex

Long-term analysis of a prospective randomized trial of hepatic resection versus radiofrequency ablation for early stage hepatocellular carcinoma

Plenary Oral – Best of the Best PresentationBackground: Both hepatic resection (HR) and radiofrequency ablation (RFA) are treatment of choice for early stage hepatocellular carcinoma (HCC). This prospective randomized study aims to test the hypothesis that RFA is superior than HR in terms of reduced tumor recurrence and better long–term survival. Methods: Two hundreds and eighteen patients with early stage HCC (tumor size ≤ 5cm and tumor nodules ≤ 3) were randomized into HR group (n = 109) and RFA group (n = 109). Primary and secondary outcome measure was overall tumor recurrence and patientsʼsurvival, respectively. Results: RFA group had significantly shorter treatment duration, less blood loss and shorted hospital stay when compared with HR group. The 1–year, 3–year, 5–year and 10–year overall survival rates for HR group and RFA group were 94.5%, 80.6%, 66.5%, 47.6% and 95.4%, 82.3%, 66.4%, 41.8%, respectively. Meanwhile, the 1–year, 3–year, 5–year and 10–year disease–free survival rates for HR group and RFA groups were 74.1%, 50.9%, 41.5%, 31.9% and 70.6%, 46.6%, 33.6%, 18. 6%, respectively. No statistical significant difference was found between 2 groups in overall and disease–free survival. Conclusion: Both HR and RFA are effective treatment modalities for early stage HCC in terms of similar overall survival and disease–free survival rates

The friendly incidental portal vein thrombus in liver transplantation

© 2015 American Association for the Study of Liver Diseases. Improved outcomes have been shown in liver transplantation (LT) with portal vein thrombosis (PVT). However, PVT is still discovered incidentally during surgery despite careful preoperative imaging. Data are limited comparing the outcomes of incidental PVT with PVT diagnosed via preoperative imaging before LT. This study aims to compare the overall outcomes of patients with PVT. From 2008 to 2012, 369 patients had LT, and 58 patients with PVT were identified. They were divided into those with non-PVT (group 0; n = 311), preoperatively identified PVT (group 1; n = 28), and incidental PVT (group 2; n = 30). The demographics, characteristics, preoperative assessment, and postoperative outcomes were compared. A survival analysis was also performed. Baseline characteristics and preoperative evaluations of all 3 groups were comparable (P > 0.05) except for Model for End-Stage Liver Disease score, tumor status, platelet levels, and serum bilirubin. A multivariate analysis only showed a high serum bilirubin level to be a predictor of PVT (P = 0.004; odds ratio, 3.395; 95% confidence interval, 1.467-7.861). Postoperative outcomes were also comparable (P > 0.05). Compared to group 2, group 1 had more patients with a Yerdel classification of 3 or 4 with more extensive surgical intervention required (P = 0.02). The survival analysis in all 3 groups was comparable with 5-year survival rate of 87.4%, 84.6%, and 91.8% in group 0, 1, and 2, respectively (P = 0.66). In conclusion, recipients with PVT undergoing LT can have similar outcomes as the non-PVT patients even if PVTs were discovered incidentally. Discovery of incidental PVT only requires thrombectomy with no substantial change of treatment strategy, and the outcome is not adversely affected because most incidental PVTs are of a lower Yerdel grade. Preoperative imaging is useful to identify those with a higher Yerdel grade to allow planning of surgical strategy during transplantation.Link_to_subscribed_fulltex