Effect of perioperative blood transfusion on clinical outcomes in hepatic surgery for cancer

Allogeneic blood transfusion during liver resection for malignancies has been associated with an increased incidence of different types of complications: infectious complications, tumor recurrence, decreased survival. Even if there is clear evidence of transfusion-induced immunosuppression, it is difficult to demonstrate that transfusion is the only determinant factor that decisively affects the outcome. In any case there are several motivations to reduce the practice of blood transfusion. The advantages and drawbacks of different transfusion alternatives are reviewed here, emphasizing that surgeons and anesthetists who practice in centers with a high volume of liver resections, should be familiar with all the possible alternatives.

胃的癌症的多模式的治疗

Gastric cancer is the second leading cause of death from malignant disease worldwide.Although complete surgical resection remains the only curative modality for early stage gastric cancer,surgery alone only provides long-term survival in 20%of patients with advancedstage disease.To improve current results,it is necessary to consider multimodality treatment,including chemotherapy,radiotherapy and surgery.Recent clinical trials have shown survival benefit of combining different neoadjuvant or adjuvant protocols compared with surgery with curative intent.Furthermore,the implementation of chemotherapy with novel targeted agents could play an important role in the multimodal management of advanced gastric cancer.In this paper,we focus on a multidisciplinary approach in the treatment of gastric cancer and discuss future strategies to improve the outcome for these patients.

seventh tumor-node-metastasis staging of gastric cancer: Five-year follow-up

Seventh tumor-node-metastasis(TNM) classification for gastric cancer,published in 2010,introduced changes in all of its three parameters with the aim to increase its accuracy in prognostication. The aim of this review is to analyze the efficacy of these changes and their implication in clinical practice. We reviewed relevant Literature concerning staging systems in gastric cancer from 2010 up to March 2016. Adenocarcinoma of the esophago-gastric junction still remains a debated entity,due to its peculiar anatomical and histological situation: further improvement in its staging are required. Concerning distant metastases,positive peritoneal cytology has been adopted as a criterion to define metastatic disease: however,its search in clinical practice is still far from being routinely performed,as staging laparoscopy has not yet reached wide diffusion. Regarding definition of T and N: in the era of multimodal treatment these parameters should more influence both staging and surgery. The changes about T-staging suggested some modifications in clinical practice. Differently,many controversies on lymph node staging are still ongoing,with the proposal of alternative classification systems in order to minimize the extent of lymphadenectomy. The next TNM classification should take into account all of these aspects to improve its accuracy and the comparability of prognosis in patients from both Eastern and Western world.

In advanced gastric cancer:Prognosis and treatment of patients with positive peritoneal cytology

Positive peritoneal cytology in gastric cancer is classified as M1 disease by the 7thEdition of American Joint Committee on Cancer staging system.With the introduction of laparoscopy and peritoneal washing cytology in the staging of gastric cancer a new category of patients has been identified.These are patients with no macroscopic peritoneal metastases but with peritoneal cytology positive(P0C1).Prognosis and treatment of such patientsrepresent a controversial issue.We evaluate the state of the art of staging system in gastric cancer and discusss tandardisation in staging and treatment procedures.There is still a lack of uniformity in the use of laparoscopy with peritoneal cytology in clinical decision making and in the surgical treatment for gastric cancer.Survival of this patient subset remains poor.Multimodal therapies and new therapeutic strategies are required to improve the survival of these patients.

A decade in gastric cancer curative surgery:Evidence of progress(1999-2009)

To investigate the progress in evidence-based surgical treatment of non-metastatic gastric cancer,we re- viewed the last ten years'literature.The data used in this review were identified by searches made on MED-LINE,Current Contents,PubMed,and other references taken from relevant original articles(on prospective and retrospective studies)concerning gastric cancer surgery.Only papers published in English between January 1999 and December 2009 were selected.Data from ongoing studies were obtained in December 2009, from the trials registry of the United States National Institutes of Health(http://www.clinicaltrial.gov).The citations list was presented according to evidence based relevance(i.e.,randomized controlled trials,pro- spective studies,retrospective series).In the last ten years,many challenges have been faced relating to the extension of gastric resection and nodal dissection as well as surgical timing,but we found only limited evidence,regardless of latitude of study.The ongoing phase-Ⅲ trials may provide answers that will be valid for the coming decades,and which may bring definitive answers for the currently unresolved questions.

Facial nerve monitoring in parotid gland surgery:Design and feasibility assessment of a potential standardized technique

Background:Even though the use of nerve monitoring during parotid gland surgery is not the gold standard to prevent damage to the nerve,it surely offers some advantages over the traditional approach.Different from thyroid surgery,where a series of steps in intraoperative nerve monitoring have been described to confirm not only the integrity but—most importantly—the function of the recurrent laryngeal nerve,in parotid gland surgery,a formal guideline to follow while dissecting the facial nerve has yet to be described.Methods:A five‐year retrospective study was done reviewing the intraoperative records of patients who underwent parotid gland surgery under neural monitoring.The operative findings regarding the neuromonitoring process,particularly in regard to the amplitude of two main branches,were revised.A literature search was done to search for guidelines to follow when a facial nerve loss of signal is encountered.Results:Fifty‐five patients were operated on using the Nim 3 Nerve Monitoring System(Medtronic);31 were female patients,and 47 patients had benign lesions.Minimum changes were observed in the amplitude records after a comparison was made between the first and the last stimulation.There were only three articles discussing the term loss of signal during parotid gland surgery.Conclusion:Today,no sufficient attention has been given to the facial nerve monitoring process during parotidectomy.This study proposes a formal guideline to follow during this procedure as well as an instruction to consider when a loss of signal is observed to develop a uniform technique of facial nerve stimulation.

Usefulness of PET-CT scan in recurrent thyroid cancer

The aim of this paper is to discuss the risk of recurrence in patients with differentiated thyroid cancer and emphasize the importance of risk-group stratification,early recurrence identification and application of new imaging modalities,what is the PET-CT.Moreover,follow-up of patients with thyroid carcinoma should be carried out by specialized teams throughout life.Therefore,interdisciplinary case discussions in tumor conferences may improve the use of multimodal therapy especially in patients with poorly differentiated thyroid carcinomas.After baseline follow-up,if there is a suspicion of thyroid carcinoma,early PET-CT should be used for early detection and appropriate planning.Fortunately,due to the good localization possibility,the PET-CT enables a focused surgical procedure with avoidance of an unnecessary tumor search and thereby a reduction of the risk of injury of neighboring structures which is a concern with reoperative neck surgery.