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Gastric Resection (gastric + resection)
Selected AbstractsPancreatic enzyme replacement therapy: exocrine pancreatic insufficiency after gastrointestinal surgeryHPB, Issue 2009J. Enrique Domínguez-Muñoz Abstract Exocrine pancreatic insufficiency (EPI) and resultant maldigestion occurs in up to 80% of patients following gastric, duodenal or pancreatic surgery. Accurate diagnosis is required to determine the appropriate intervention, but the conventional method of faecal fat quantification is time-consuming and not always readily available. The optimized 13C-mixed triglyceride (13C-MTG) breath test is an accurate alternative post-surgery. Pancreatic enzyme replacement therapy (PERT) is indicated post-surgery in patients with clinically evident steatorrhoea, weight loss or maldigestion-related symptoms. Given its favourable safety profile, PERT is also appropriate in asymptomatic patients with high faecal fat excretion as such patients are at high risk for nutritional deficits. However, published data evaluating PERT in this setting are limited. Uncoated powder preparations may be preferred in cases of low gastric acidity and partial or total gastric resection. In clinical studies, enteric-coated microspheres were associated with greater weight gain after surgery vs. uncoated preparations. This was confirmed in a recent study using the 13C-MTG breath test; fat absorption increased from <40% without therapy to almost 60% with enteric-coated minimicrospheres (40 000 lipase units/meal), with >60% of patients achieving normal breath test results (i.e. normal fat digestion) during PERT. A therapeutic algorithm for the treatment of EPI after surgery is also discussed. [source] The risk of pancreatic cancer in patients with gastric or duodenal ulcer diseaseINTERNATIONAL JOURNAL OF CANCER, Issue 2 2007Juhua Luo Abstract Although Helicobacter pylori (H. pylori) seropositivity is linked to an excess risk of pancreatic cancer, the biologic mechanism is unknown. Gastric ulcer is primarily associated with corpus colonization of H. pylori, atrophic gastritis and formation of N -nitrosamines. Duodenal ulcer is a marker of antral colonization, hyperacidity and uninhibited secretin release. We estimated relative risks for pancreatic cancer among patients with gastric or duodenal ulcer, based on a register-based retrospective cohort study with 88,338 patients hospitalized for gastric ulcer and 70,516 patients for duodenal ulcer recorded in the Swedish Inpatient Register between 1965 and 2003. Following operation, the 14,887 patients who underwent gastric resection and 8,205 with vagotomy were analyzed separately. Multiple record-linkages allowed complete follow-up and identification of all incident cases of pancreatic cancer until December 31, 2003. Standardized incidence ratios (SIRs) estimated relative risks. During years 3,38 of follow-up, we observed a 20% excess risk (95% confidence interval [CI] 10,40%) for pancreatic cancer among unoperated gastric ulcer patients. The excess increased to 50% (95% CI 10,110%) 15 years after first hospitalization (p for trend = 0.03). SIR was 2.1 (95% CI 1.4,3.1) 20 years after gastric resection. Unoperated duodenal ulcer was not associated with pancreatic cancer risk, nor was vagotomy. Our results lend indirect support to the nitrosamine hypothesis, but not to the hyperacidity hypothesis in the etiology of pancreatic cancer. © 2006 Wiley-Liss, Inc. [source] Advanced gastric cancer in the middle one-third of the stomach: Should surgenos perform total gastrectomy?JOURNAL OF SURGICAL ONCOLOGY, Issue 6 2010You-Jin Jang MD Abstract Background and Objectives To determine which optimal surgical procedure for middle-third advanced gastric cancer (AGC) based on comparative study of the long-term prognosis between total gastrectomy (TG) and distal gastrectomy (DG). Methods Between March 1993 and December 2005, 402 patients with middle-third AGC who underwent gastric resection were enrolled in this study. We analyzed the long-term prognosis according to the length of the proximal resection margin (PRM) and the extent of gastric resection, and determined independent prognostic factors. Results TG was performed in 244 patients (60.7%) and DG was performed in 158 patients (39.3%). There were no significant differences in the 5-year survival rates according to the length of PRM. The 5-year survival rates of patients who underwent DG were significantly higher than the rates of the patients who underwent TG in curative cases (67.8% vs. 58.4%, P,=,0.037). Nevertheless, there was no significant difference in the stage-stratified survival rates according to the extent of gastric resection. Multivariate analysis revealed that surgical curability, extent of lymphadenectomy, and stage were independent prognostic factors. Conclusion If curative resection can be performed, the long-term prognosis of patients with middle-third AGC was not affected by the length of PRM or the extent of gastric resection. J. Surg. Oncol. 2010; 101:451,456. © 2009 Wiley-Liss, Inc. [source] Braun enteroenterostomy is associated with reduced delayed gastric emptying and early resumption of oral feeding following pancreaticoduodenectomyJOURNAL OF SURGICAL ONCOLOGY, Issue 5 2010Steven N. Hochwald MD Abstract Background and Objectives Morbidity rates following pancreaticoduodenectomy (PD) remain high with delayed gastric emptying (DGE) and slow resumption of oral diet contributing to increased postoperative length of stay. A Braun enteroenterostomy has been shown to decrease bile reflux following gastric resection. We hypothesize that addition of Braun enteroenterostomy during PD would reduce the sequelae of DGE. Methods From our PD database, patients were identified that underwent classic PD with partial gastrectomy from 2001 to 2006. All patients with reconstruction utilizing a single loop of jejunum at the University of Florida Shands Hospital were reviewed. Demographics, presenting signs and symptoms, pathologic diagnoses, and postoperative morbidity were compared in those patients undergoing reconstruction with an additional Braun enteroenterostomy (n,=,70) to those not undergoing a Braun enteroenterostomy (n,=,35). Results Patients undergoing a Braun had NG tubes removed earlier (Braun: 2 days, no Braun: 3 days, P,=,0.002) and no significant change in postoperative vomiting (Braun: 27%, no Braun: 37%, P,=,0.37) or NG tube reinsertion rates (Braun: 17%, no Braun: 29%, P,=,0.21). Median postoperative day with tolerance of oral liquids (Braun: 5, no Braun: 6, P,=,0.01) and solid diets (Braun: 7, no Braun: 9, P,=,0.01) were significantly sooner in the Braun group. DGE defined by two criteria including the inability to have oral intake by postoperative day 10 (Braun: 10%, no Braun: 26%, P,<,0.05) and the international grading criteria (grades B and C, Braun: 7% vs. no Braun: 31%, P,=,0.003) were significantly reduced in those undergoing the Braun procedure. In addition, the median length of stay (Braun: 10 days, no Braun: 12 days, P,<,0.05) was significantly reduced in those undergoing the Braun procedure. The rate of pancreatic anastomotic failure was similar in the two groups (Braun: 17% vs. no Braun: 14%, P,=,0.79). Median bile reflux was 0% in those undergoing a Braun. Conclusions The present study suggests that Braun enteroenterostomy can be safely performed in patients undergoing PD and may reduce the indicence of DGE and its sequelae. Further studies of Braun enteroenterostomy in larger randomized trials of patients undergoing PD are warranted. J. Surg. Oncol. 2010; 101:351,355. © 2010 Wiley-Liss, Inc. [source] Prognosis and surgical treatment of gastric cancer invading adjacent organsANZ JOURNAL OF SURGERY, Issue 7-8 2010Ming Zhang Abstract Background:, The prognostic factors and surgical management of gastric cancer invading adjacent organs remains controversial. The aim was to provide valuable prognostic and surgical information on patients with gastric cancer invading adjacent organs. Methods:, The retrospectively study included 367 patients who underwent gastric resection for gastric cancer invading adjacent organs. Clinicopathologic variables were evaluated as predictors of long-term survival by univariate and multivariate analyses. Multivariate analysis was performed using Cox's proportional hazards model. Results:, The five-year survival rate was 10.1%, and median survival period was 14 months. The five-year survival rate was influenced by histologic type, lymph node metastasis, liver metastasis, peritoneal dissemination, extent of lymph node dissection and curability of operation. Of these, independent prognostic factors were lymph node metastasis (N2, N3 versus N0, N1, relative risk 2.028, P < 0.001), liver metastasis (present versus absent, relative risk 1.582, P= 0.023) and curative resection (no versus yes, relative risk 1.719, P < 0.001). A significant survival benefit for curative resection was observed with a five-year survival rate of 21.5% compared with non-curatively resected cases (5.1%). Conclusions:, In patients with gastric cancer invading adjacent organs, three independent prognostic factors were lymph node metastasis, liver metastasis, and curative resection. For patients with gastric cancer invading adjacent organs, we recommend performing combined organ resection in patients with locally advanced gastric carcinoma regardless of curability. [source] | ||||||||||||||||||||||