AIM To investigate the role of minimally invasive surgery for gastric cancer and determine surgical, clinical, and oncological outcomes.METHODS This is a propensity score-matched case-control study, comparing three tr...AIM To investigate the role of minimally invasive surgery for gastric cancer and determine surgical, clinical, and oncological outcomes.METHODS This is a propensity score-matched case-control study, comparing three treatment arms: robotic gastrectomy(RG), laparoscopic gastrectomy(LG), open gastrectomy(OG). Data collection started after sharing a specific study protocol. Data were recorded through a tailored and protected web-based system. Primary outcomes: harvested lymph nodes, estimated blood loss, hospital stay, complications rate. Among the secondary outcomes, there are: operative time, R0 resections, POD of mobilization, POD of starting liquid diet and soft solid diet. The analysis includes the evaluation of type and grade of postoperative complications. Detailed information of anastomotic leakages is also provided.RESULTS The present analysis was carried out of 1026 gastrectomies. To guarantee homogenous distribution of cases, patients in the RG, LG and OG groups were 1:1:2 matched using a propensity score analysis with a caliper = 0.2. The successful matching resulted in a total sample of 604 patients(RG = 151; LG = 151; OG = 302). The three groups showed no differences in all baseline patients characteristics, type of surgery(P = 0.42) and stage of the disease(P = 0.16). Intraoperative blood loss was significantly lower in the LG(95.93 ± 119.22) and RG(117.91 ± 68.11) groups compared to the OG(127.26 ± 79.50, P = 0.002). The mean number of retrieved lymph nodes was similar between the RG(27.78 ± 11.45), LG(24.58 ± 13.56) and OG(25.82 ± 12.07) approach. A benefit in favor of the minimally invasive approaches was found in the length of hospital stay(P < 0.0001). A similar complications rate was found(P = 0.13). The leakage rate was not different(P = 0.78) between groups.CONCLUSION Laparoscopic and robotic surgery can be safely performed and proposed as possible alternative to open surgery. The main highlighted benefit is a faster postoperative functional recovery.展开更多
Giant esophageal and hypopharyngeal polyps are benign tumors rarely encountered in clinical practice.In most cases,they are completely asymptomatic;however,despite the rarity of these tumors,interest in giant esophage...Giant esophageal and hypopharyngeal polyps are benign tumors rarely encountered in clinical practice.In most cases,they are completely asymptomatic;however,despite the rarity of these tumors,interest in giant esophageal polyps derives from their degree of growth(characterized by slow growth into the esophageal lumen)and their mobility.In fact,if regurgitation occurs,they can ascend into the oral cavity and be aspirated into the airways,with potentially lethal consequences.The removal of these giant polyps is recommended.An adequate preoperative evaluation to identify the correct origin of the stalk is mandatory for a successful endoscopic or surgical treatment.A 60-year-old man was admitted to our hospital for anemia.The patient underwent gastroscopy,contrast computed tomography and endoscopic ultrasound.At the conclusion of the procedure,during the extraction of the echoendoscope,the patient began retching and regurgitated the polyp,without experiencing respiratory distress.The patient underwent a left cervicotomy and polyp dissection via a pharyngotomy.展开更多
基金Supported by CARIT Foundation(Fondazione Cassa di Risparmio di Terni e Narni),No.0024137
文摘AIM To investigate the role of minimally invasive surgery for gastric cancer and determine surgical, clinical, and oncological outcomes.METHODS This is a propensity score-matched case-control study, comparing three treatment arms: robotic gastrectomy(RG), laparoscopic gastrectomy(LG), open gastrectomy(OG). Data collection started after sharing a specific study protocol. Data were recorded through a tailored and protected web-based system. Primary outcomes: harvested lymph nodes, estimated blood loss, hospital stay, complications rate. Among the secondary outcomes, there are: operative time, R0 resections, POD of mobilization, POD of starting liquid diet and soft solid diet. The analysis includes the evaluation of type and grade of postoperative complications. Detailed information of anastomotic leakages is also provided.RESULTS The present analysis was carried out of 1026 gastrectomies. To guarantee homogenous distribution of cases, patients in the RG, LG and OG groups were 1:1:2 matched using a propensity score analysis with a caliper = 0.2. The successful matching resulted in a total sample of 604 patients(RG = 151; LG = 151; OG = 302). The three groups showed no differences in all baseline patients characteristics, type of surgery(P = 0.42) and stage of the disease(P = 0.16). Intraoperative blood loss was significantly lower in the LG(95.93 ± 119.22) and RG(117.91 ± 68.11) groups compared to the OG(127.26 ± 79.50, P = 0.002). The mean number of retrieved lymph nodes was similar between the RG(27.78 ± 11.45), LG(24.58 ± 13.56) and OG(25.82 ± 12.07) approach. A benefit in favor of the minimally invasive approaches was found in the length of hospital stay(P < 0.0001). A similar complications rate was found(P = 0.13). The leakage rate was not different(P = 0.78) between groups.CONCLUSION Laparoscopic and robotic surgery can be safely performed and proposed as possible alternative to open surgery. The main highlighted benefit is a faster postoperative functional recovery.
文摘Giant esophageal and hypopharyngeal polyps are benign tumors rarely encountered in clinical practice.In most cases,they are completely asymptomatic;however,despite the rarity of these tumors,interest in giant esophageal polyps derives from their degree of growth(characterized by slow growth into the esophageal lumen)and their mobility.In fact,if regurgitation occurs,they can ascend into the oral cavity and be aspirated into the airways,with potentially lethal consequences.The removal of these giant polyps is recommended.An adequate preoperative evaluation to identify the correct origin of the stalk is mandatory for a successful endoscopic or surgical treatment.A 60-year-old man was admitted to our hospital for anemia.The patient underwent gastroscopy,contrast computed tomography and endoscopic ultrasound.At the conclusion of the procedure,during the extraction of the echoendoscope,the patient began retching and regurgitated the polyp,without experiencing respiratory distress.The patient underwent a left cervicotomy and polyp dissection via a pharyngotomy.