Crohn's disease(CD) is a chronic inflammatory disease of digestive tract. Approximately 70% of patients with CD require surgical intervention within 10 years of their initial diagnosis, despite advanced medical tr...Crohn's disease(CD) is a chronic inflammatory disease of digestive tract. Approximately 70% of patients with CD require surgical intervention within 10 years of their initial diagnosis, despite advanced medical treatment alternatives including biologics, immune suppressive drugs and steroids. Refractory to medical treatment in CD patients is the common indication for surgery. Unfortunately, surgery cannot cure the disease. Minimally invasive treatment modalities can be suitable for CD patients due to the benign nature of the disease especially at the time of index surgery. However,laparoscopic management in fistulizing or recurrent disease is controversial. Intractable fibrotic strictures with obstruction, fistulas with abscess formation and hemorrhage are the surgical indications of recurrent CD,which are also complicating laparoscopic treatments.Nevertheless, laparoscopy can be performed in selected CD patients with safety, and may provide better outcomes compared to open surgery. The common complication after laparoscopic intervention is postoperative ileus seems and this may strongly relate excessive manipulation of the bowel during dissection. But additionally, unsuccessful laparoscopic attempts requiring conversion to open surgery have been a major concern due to presumed risk of worse outcomes. However, recent data show that conversions do not to worsen the outcomes of colorectal surgery in experienced hands. In conclusion, laparoscopic treatment modalities in recurrent CD patients have promising outcomes when it is used selectively.展开更多
AIM: To report our experience on management of colorectal neoplasia during pregnancy and in the postpartum period.METHODS: Patients who were diagnosed with colorectal cancer during pregnancy or in the postpartum perio...AIM: To report our experience on management of colorectal neoplasia during pregnancy and in the postpartum period.METHODS: Patients who were diagnosed with colorectal cancer during pregnancy or in the postpartum period(< 6 mo), between 8/1997 and 4/2013, in our department were reviewed. Patient characteristics, operations, fetal health and follow-up during pregnancy, type of delivery and oncologic outcomes were analyzed.RESULTS: Eight patients met our study criteria. Median age at the time of diagnosis of colorectal cancer was 31 years. Median follow-up after surgery was 36 mo. Median duration of symptoms before diagnosis was 16 wk. Three patients were diagnosed with colorectal cancer during pregnancy and underwent surgery prior to delivery. None of the patients received adjuvant treatment during pregnancy. Five patients were diagnosed with colorectal cancer within a median of 2.1 mo after delivery and underwent surgery. No adverse neonatal outcomes were noted. All deliveries were at term(2 cesarean sections) except for one preterm delivery following low anterior resection on the 34 th week of pregnancy.CONCLUSION: There has been a significant delay in the diagnosis of colorectal cancer which is probably due to overlap of symptoms and signs between these tumors and a normal pregnancy. Surgery for colorectal cancer during pregnancy can be performed safely without compromisingmaternal and fetal outcomes.展开更多
A standard hepaticojejunostomy technique might be difficult to perform, especially when the bile duct is small and located deep in the liver hilum. Herein we present a new procedure, the Hand-Fan technique, that was u...A standard hepaticojejunostomy technique might be difficult to perform, especially when the bile duct is small and located deep in the liver hilum. Herein we present a new procedure, the Hand-Fan technique, that was used to enhance the exposure and ease the performance of these challenging anastomoses. Thirty-one patients who had had hepaticojejunostomy with this technique for bile duct injury and other benign biliary pathologies from July 2004 to June 2011 were included into the study. Median postoperative hospital stay was 7 days (6-25 days) and median follow-up time was 33 months (2-84 months). Liver function tests revealed that the blood bilirubin levels of the patients were normalized after hepaticojejunostomy. Follow-up showed that there were no signs of clinical recurrence or impaired bile flow. The Hand-Fan technique considerably facilitates challenging hepaticojejunostomies. Surgeon’s comfort is exceptional and the clinical results are satisfactory.展开更多
In the last few decades,the treatment strategy for locally advanced resectable gastric cancer(GC)has shifted to a multimodal approach,which potentially decreases recurrence risk and improves survival rates.Perioperati...In the last few decades,the treatment strategy for locally advanced resectable gastric cancer(GC)has shifted to a multimodal approach,which potentially decreases recurrence risk and improves survival rates.Perioperative therapy leads to downstaging,increased curative resection rates,and prolonged disease-free and overall survival,by preventing micrometastases in patients with resectable GC.Application of neoadjuvant therapy provides information about tumor biology and in vivo sensitivity.A consensus regarding the therapeutic approach for non-metastatic GC does not exist,and many clinical trials aim to clarify this aspect.Advances in precision medicine and the role of immunotherapy have been the focus of research in GC treatment.Herein,the current status and possible future developments of perioperative therapy for locally advanced resectable GC are reviewed,based on the most recent randomized clinical trials.展开更多
文摘Crohn's disease(CD) is a chronic inflammatory disease of digestive tract. Approximately 70% of patients with CD require surgical intervention within 10 years of their initial diagnosis, despite advanced medical treatment alternatives including biologics, immune suppressive drugs and steroids. Refractory to medical treatment in CD patients is the common indication for surgery. Unfortunately, surgery cannot cure the disease. Minimally invasive treatment modalities can be suitable for CD patients due to the benign nature of the disease especially at the time of index surgery. However,laparoscopic management in fistulizing or recurrent disease is controversial. Intractable fibrotic strictures with obstruction, fistulas with abscess formation and hemorrhage are the surgical indications of recurrent CD,which are also complicating laparoscopic treatments.Nevertheless, laparoscopy can be performed in selected CD patients with safety, and may provide better outcomes compared to open surgery. The common complication after laparoscopic intervention is postoperative ileus seems and this may strongly relate excessive manipulation of the bowel during dissection. But additionally, unsuccessful laparoscopic attempts requiring conversion to open surgery have been a major concern due to presumed risk of worse outcomes. However, recent data show that conversions do not to worsen the outcomes of colorectal surgery in experienced hands. In conclusion, laparoscopic treatment modalities in recurrent CD patients have promising outcomes when it is used selectively.
文摘AIM: To report our experience on management of colorectal neoplasia during pregnancy and in the postpartum period.METHODS: Patients who were diagnosed with colorectal cancer during pregnancy or in the postpartum period(< 6 mo), between 8/1997 and 4/2013, in our department were reviewed. Patient characteristics, operations, fetal health and follow-up during pregnancy, type of delivery and oncologic outcomes were analyzed.RESULTS: Eight patients met our study criteria. Median age at the time of diagnosis of colorectal cancer was 31 years. Median follow-up after surgery was 36 mo. Median duration of symptoms before diagnosis was 16 wk. Three patients were diagnosed with colorectal cancer during pregnancy and underwent surgery prior to delivery. None of the patients received adjuvant treatment during pregnancy. Five patients were diagnosed with colorectal cancer within a median of 2.1 mo after delivery and underwent surgery. No adverse neonatal outcomes were noted. All deliveries were at term(2 cesarean sections) except for one preterm delivery following low anterior resection on the 34 th week of pregnancy.CONCLUSION: There has been a significant delay in the diagnosis of colorectal cancer which is probably due to overlap of symptoms and signs between these tumors and a normal pregnancy. Surgery for colorectal cancer during pregnancy can be performed safely without compromisingmaternal and fetal outcomes.
文摘A standard hepaticojejunostomy technique might be difficult to perform, especially when the bile duct is small and located deep in the liver hilum. Herein we present a new procedure, the Hand-Fan technique, that was used to enhance the exposure and ease the performance of these challenging anastomoses. Thirty-one patients who had had hepaticojejunostomy with this technique for bile duct injury and other benign biliary pathologies from July 2004 to June 2011 were included into the study. Median postoperative hospital stay was 7 days (6-25 days) and median follow-up time was 33 months (2-84 months). Liver function tests revealed that the blood bilirubin levels of the patients were normalized after hepaticojejunostomy. Follow-up showed that there were no signs of clinical recurrence or impaired bile flow. The Hand-Fan technique considerably facilitates challenging hepaticojejunostomies. Surgeon’s comfort is exceptional and the clinical results are satisfactory.
文摘In the last few decades,the treatment strategy for locally advanced resectable gastric cancer(GC)has shifted to a multimodal approach,which potentially decreases recurrence risk and improves survival rates.Perioperative therapy leads to downstaging,increased curative resection rates,and prolonged disease-free and overall survival,by preventing micrometastases in patients with resectable GC.Application of neoadjuvant therapy provides information about tumor biology and in vivo sensitivity.A consensus regarding the therapeutic approach for non-metastatic GC does not exist,and many clinical trials aim to clarify this aspect.Advances in precision medicine and the role of immunotherapy have been the focus of research in GC treatment.Herein,the current status and possible future developments of perioperative therapy for locally advanced resectable GC are reviewed,based on the most recent randomized clinical trials.
