Does N ratio affect survival in D1 and D2 lymph node dissection for gastric cancer?

AIM:To identify whether there could have been changes in survival if lymph node ratio (N ratio) had been used.METHODS:We assessed 334 gastric adenocarcinoma cases retrospectively between 2001 and 2009.Two hundred and sixteen patients out of 334 were included in the study.Patients were grouped according to disection1 (D1) or dissection 2 (D2) dissection.We compared the estimated survival and actual survival determined by Pathologic nodes (pN) class and N ratio,and SPSS 15.0 software was used for statistical analysis.RESULTS:Ninety-six (44.4%) patients underwent D1 dissection and 120 (55.6%) had D2 dissection.When groups were evaluated,23 (24.0%) patients in D1 and 21 (17.5%) in D2 had stage migration (P=0.001).When both D1 and D2 groups were evaluated for number of pathological lymph nodes,despite the fact that there was no difference in N ratio between D1 and D2 groups,a statistically significant difference was found between them with regard to pN1 and pN2 groups (P=0.047,P=0.044 respectively).In D1,pN0 had the longest survival while pN3 had the shortest.In D2,pN0 had the longest survival whereas pN3 had the shortest survival.CONCLUSION:N ratio is an accurate staging system for defining prognosis and treatment plan,thus decreasing methodological errors in gastric cancer staging.

Where are we at with short bowel syndrome and small bowel transplant?

Intestinal failure can be defined as the critical reduction of functional gut mass below the minimal amount necessary for adequate digestion and absorption to satisfy body nutrient and fluid requirements in adults or children.Short bowel syndrome(SBS)is characterized by a state of malabsorption following extensive resection of the small bowel.SBS may occur after resection of more than 50%and is certain after resection of more than 70%of the small intestine,or if less than 100 cm of small bowel is left.Several treatment modalities other than total parenteral nutrition,including hormones(recombinant human growth hormone,glucagon-like peptide-2)and tailoring surgeries(Bianchi procedure,serial transverse enteroplasty),had been proposed,however these were either experimental or inefficient.Small bowel transplant is a rather new approach for SBS.The once feared field of solid organ transplantation is nowadays becoming more and more popular,even in developing countries.This is partially secondary to the developments in immunosuppressive strategy.In this regard,alemtuzumab deserves special attention.There are more complex surgeries,such as multivisceral transplantation,for multi-organ involvement including small bowel.This latter technique is relatively new when compared to small bowel transplant,and is performed in certain centers worldwide.In this review,an attempt is made to give an insight into small bowel syndrome,small bowel transplantation,and related issues.