To optimize the efficiency of ileocolic anastomosis following right hemicolectomy,several variations of the surgical technique have been tested.These include performing the anastomosis intra-or extracorporeally or per...To optimize the efficiency of ileocolic anastomosis following right hemicolectomy,several variations of the surgical technique have been tested.These include performing the anastomosis intra-or extracorporeally or performing a stapled or hand-sewn anastomosis.Among the least studied is the configuration of the two stumps(i.e.,isoperistaltic or antiperistaltic)in the case of a side-to-side anastomosis.The purpose of the present study is to compare the isoperistaltic and antiperistaltic side-to-side anastomotic configuration after right hemicolectomy by reviewing the relevant literature.High-quality literature is scarce,with only three studies directly comparing the two alternatives,and no study has revealed any significant differences in the incidence of anastomosis-related complications such as leakage,stenosis,or bleeding.However,there may be a trend towards an earlier recovery of intestinal function following antiperistaltic anastomosis.Finally,existing data do not identify a certain anastomotic configuration(i.e.,isoperistaltic or antiperistaltic)as superior over the other.Thus,the most appropriate approach is to master both anastomotic techniques and select between the two configurations based on each individual case scenario.展开更多
The theory behind using sentinel node mapping and biopsy in gastric cancer surgery, the so-called sentinel node navigation surgery, is to limit the extent of surgi-cal tissue dissection around the affected organ and s...The theory behind using sentinel node mapping and biopsy in gastric cancer surgery, the so-called sentinel node navigation surgery, is to limit the extent of surgi-cal tissue dissection around the affected organ and subsequently the accompanied morbidity. However, ob-stacles on the clinical correspondence of sentinel node navigation surgery in everyday practice have occasion-ally alleviated researchers' interest on the topic. Only recently with the widespread use of minimally invasive surgical techniques, i.e., laparoscopic gastric cancer resections, surgical community's interest on the topic have been unavoidably reflated. Double tracer methods appear superior compared to single tracer techniques. Ongoing research is now focused on the invention of new lymph node detection methods utilizing sophisti-cated technology such as infrared ray endoscopy, flo-rescence imaging and near-infrared technology. Despite its notable limitations, hematoxylin/eosin is still the mainstay staining for assessing the metastatic status of an identified lymph node. An intra-operatively verified metastatic sentinel lymph node will dictate the need for further conventional lymph node dissection. Thus, laparoscopic resection of the gastric primary tumor combined with the appropriate lymph node dissection as determined by the process of sentinel lymph node status characterization represents an option for early gastric cancer. Patients with T3 or more advanced dis-ease should still be managed conventionally with resec-tion plus standard lymph node dissection.展开更多
AIM:To evaluate whether antiplatelet medication leads to an earlier stage colorectal cancer(CRC) diagnosis.METHODS:From January 2002 until March 2010,patients that presented to our institution with the initial diagnos...AIM:To evaluate whether antiplatelet medication leads to an earlier stage colorectal cancer(CRC) diagnosis.METHODS:From January 2002 until March 2010,patients that presented to our institution with the initial diagnosis of CRC and were submitted to an open curative CRC resection or a palliative procedure were retrospectively reviewed.Exclusion criteria were the use of antithrombotic medication,i.e.,coumarins,and appendiceal malignancies.Data acquired from medical files included age,gender,past medical history,antithrombotic treatment received prior to endoscopic diagnosis,preoperative imaging staging,location of the tumor,surgical and final histopathological report.Patients that did not receive any antithrombotic medication prior to the endoscopic diagnosis comprised the control group of the study,while patients that were on antiplatelet medication comprised the antiplatelet group.Primary end point was a comparison of CRC stage in the two groups of the study.CRC presenting symptoms and the incidence of each cancer stage in the two groups were also evaluated.RESULTS:A total of 387 patients with the diagnosis of CRC were submitted to our department for further surgical treatment.Ninety-eight patients(25.32%),with a median age of 71 years(range 52-91 years),were included in the antiplatelet group,while 289(74.67%) patients,with a median age of 67 years(range 4190 years),were not in any thrombosis prophylaxis medication(control group).Thirty-one patients were treated with some kind of palliative procedure,either endoscopic,such as endoscopic stent placement,or surgical,such as de-compressive colostomy or deviation.Coronary disease(77.55%-76 patients),stroke recurrence prevention(14.28%-14 patients) and peripheral arterial disease(8.16%-8 patients) were the indications for the administration of antiplatelet treatment(aspirin,clopidogrel,ticlopidine or dipyridamole) in the antiplatelet group.All patients on aspirin treatment received a dosage of 100 mg/d,while the minimum prophylactic dosages were also used for the rest of the antiplatelet drugs.Investigation of an iron deficiency anemia(147 patients),per rectum blood loss(84 patients),bowel obstruction and/or perforation(81 patients),bowel habits alterations(32 patients),nonspecific symptoms,such as weight loss,intermittent abdominal pain and fatigue,(22 patients) or population screening(21 patients) were the indications for the endoscopic investigation in both groups.Bleeding,either chronic presenting as anemia or acute was significantly higher(P = 0.002) for the antiplatelet arm of the study(71 patients-72.4% of the antiplatelet group vs 160 patients-55.3% of the control group).The mean tumor,node and metastasis stage was 2.57 ± 0.96 for the control group,2.27 ± 0.93 for the antiplatelet group(P = 0.007) and 2.19 ± 0.92 for the subgroup of patients taking aspirin(P = 0.003).The incidence of advanced disease(stage Ⅳ) was lower for the antiplatelet group of the study(P = 0.033).CONCLUSION:The adverse effect of bleeding that is justifiably attached to this drug category seems to have a favorable impact on the staging characteristics of CRC.展开更多
文摘To optimize the efficiency of ileocolic anastomosis following right hemicolectomy,several variations of the surgical technique have been tested.These include performing the anastomosis intra-or extracorporeally or performing a stapled or hand-sewn anastomosis.Among the least studied is the configuration of the two stumps(i.e.,isoperistaltic or antiperistaltic)in the case of a side-to-side anastomosis.The purpose of the present study is to compare the isoperistaltic and antiperistaltic side-to-side anastomotic configuration after right hemicolectomy by reviewing the relevant literature.High-quality literature is scarce,with only three studies directly comparing the two alternatives,and no study has revealed any significant differences in the incidence of anastomosis-related complications such as leakage,stenosis,or bleeding.However,there may be a trend towards an earlier recovery of intestinal function following antiperistaltic anastomosis.Finally,existing data do not identify a certain anastomotic configuration(i.e.,isoperistaltic or antiperistaltic)as superior over the other.Thus,the most appropriate approach is to master both anastomotic techniques and select between the two configurations based on each individual case scenario.
文摘The theory behind using sentinel node mapping and biopsy in gastric cancer surgery, the so-called sentinel node navigation surgery, is to limit the extent of surgi-cal tissue dissection around the affected organ and subsequently the accompanied morbidity. However, ob-stacles on the clinical correspondence of sentinel node navigation surgery in everyday practice have occasion-ally alleviated researchers' interest on the topic. Only recently with the widespread use of minimally invasive surgical techniques, i.e., laparoscopic gastric cancer resections, surgical community's interest on the topic have been unavoidably reflated. Double tracer methods appear superior compared to single tracer techniques. Ongoing research is now focused on the invention of new lymph node detection methods utilizing sophisti-cated technology such as infrared ray endoscopy, flo-rescence imaging and near-infrared technology. Despite its notable limitations, hematoxylin/eosin is still the mainstay staining for assessing the metastatic status of an identified lymph node. An intra-operatively verified metastatic sentinel lymph node will dictate the need for further conventional lymph node dissection. Thus, laparoscopic resection of the gastric primary tumor combined with the appropriate lymph node dissection as determined by the process of sentinel lymph node status characterization represents an option for early gastric cancer. Patients with T3 or more advanced dis-ease should still be managed conventionally with resec-tion plus standard lymph node dissection.
文摘AIM:To evaluate whether antiplatelet medication leads to an earlier stage colorectal cancer(CRC) diagnosis.METHODS:From January 2002 until March 2010,patients that presented to our institution with the initial diagnosis of CRC and were submitted to an open curative CRC resection or a palliative procedure were retrospectively reviewed.Exclusion criteria were the use of antithrombotic medication,i.e.,coumarins,and appendiceal malignancies.Data acquired from medical files included age,gender,past medical history,antithrombotic treatment received prior to endoscopic diagnosis,preoperative imaging staging,location of the tumor,surgical and final histopathological report.Patients that did not receive any antithrombotic medication prior to the endoscopic diagnosis comprised the control group of the study,while patients that were on antiplatelet medication comprised the antiplatelet group.Primary end point was a comparison of CRC stage in the two groups of the study.CRC presenting symptoms and the incidence of each cancer stage in the two groups were also evaluated.RESULTS:A total of 387 patients with the diagnosis of CRC were submitted to our department for further surgical treatment.Ninety-eight patients(25.32%),with a median age of 71 years(range 52-91 years),were included in the antiplatelet group,while 289(74.67%) patients,with a median age of 67 years(range 4190 years),were not in any thrombosis prophylaxis medication(control group).Thirty-one patients were treated with some kind of palliative procedure,either endoscopic,such as endoscopic stent placement,or surgical,such as de-compressive colostomy or deviation.Coronary disease(77.55%-76 patients),stroke recurrence prevention(14.28%-14 patients) and peripheral arterial disease(8.16%-8 patients) were the indications for the administration of antiplatelet treatment(aspirin,clopidogrel,ticlopidine or dipyridamole) in the antiplatelet group.All patients on aspirin treatment received a dosage of 100 mg/d,while the minimum prophylactic dosages were also used for the rest of the antiplatelet drugs.Investigation of an iron deficiency anemia(147 patients),per rectum blood loss(84 patients),bowel obstruction and/or perforation(81 patients),bowel habits alterations(32 patients),nonspecific symptoms,such as weight loss,intermittent abdominal pain and fatigue,(22 patients) or population screening(21 patients) were the indications for the endoscopic investigation in both groups.Bleeding,either chronic presenting as anemia or acute was significantly higher(P = 0.002) for the antiplatelet arm of the study(71 patients-72.4% of the antiplatelet group vs 160 patients-55.3% of the control group).The mean tumor,node and metastasis stage was 2.57 ± 0.96 for the control group,2.27 ± 0.93 for the antiplatelet group(P = 0.007) and 2.19 ± 0.92 for the subgroup of patients taking aspirin(P = 0.003).The incidence of advanced disease(stage Ⅳ) was lower for the antiplatelet group of the study(P = 0.033).CONCLUSION:The adverse effect of bleeding that is justifiably attached to this drug category seems to have a favorable impact on the staging characteristics of CRC.
