Pub Date : 2020-10-29DOI: 10.9738/intsurg-d-20-00022.1
Hangjiong Cheng, Kuo-Hung Huang, Ming-Huang Chen, W. Fang, Chien-Hsing Lin, Y. Chao, S. Lo, A. Li, Chew‐Wun Wu, Y. Shyr
ObjectiveThe Lauren classification is an important histological classification of gastric cancer (GC) with different biological behaviors between histological types.BackgroundTo date, there are few reports on the genetic alterations and survival differences between different histological types according to the Lauren classification.MethodsIn total, 433 GC patients undergoing surgery were enrolled. The clinicopathological features, prognoses, and genetic alterations of the different Lauren types were compared.ResultsDiffuse-type GC was associated with a younger age, female predominance, more Borrmann type 3 and 4 tumors, more advanced pathological tumor (T) and node (N) categories, more tumor recurrences (especially peritoneal recurrence), and worse 5-year overall survival and disease-free survival rates than intestinal-type GC and mixed-type GC. Regarding genetic alterations, mixed-type GC was associated with more TP53 mutations than intestinal-type GC and diffuse-type GC. Multivariate analysis demonstrated the following independent prognostic factors: age, Lauren classification, and pathological T and N categories. Regarding mixed-type GC, diffuse-type major tumors were associated with more lymphovascular invasion, a more advanced N category and TNM stage, and fewer PI3K/AKT pathway mutations than intestinal-type major tumors.ConclusionsDiffuse-type GC had unfavorable clinicopathological features and a worse prognosis than intestinal-type GC. For mixed-type GC, the clinicopathological features and genetic alterations were different between intestinal-type major tumors and diffuse-type major tumors.
{"title":"The clinicopathological characteristics and genetic alterations of gastric cancer patients according to the Lauren classification","authors":"Hangjiong Cheng, Kuo-Hung Huang, Ming-Huang Chen, W. Fang, Chien-Hsing Lin, Y. Chao, S. Lo, A. Li, Chew‐Wun Wu, Y. Shyr","doi":"10.9738/intsurg-d-20-00022.1","DOIUrl":"https://doi.org/10.9738/intsurg-d-20-00022.1","url":null,"abstract":"ObjectiveThe Lauren classification is an important histological classification of gastric cancer (GC) with different biological behaviors between histological types.BackgroundTo date, there are few reports on the genetic alterations and survival differences between different histological types according to the Lauren classification.MethodsIn total, 433 GC patients undergoing surgery were enrolled. The clinicopathological features, prognoses, and genetic alterations of the different Lauren types were compared.ResultsDiffuse-type GC was associated with a younger age, female predominance, more Borrmann type 3 and 4 tumors, more advanced pathological tumor (T) and node (N) categories, more tumor recurrences (especially peritoneal recurrence), and worse 5-year overall survival and disease-free survival rates than intestinal-type GC and mixed-type GC. Regarding genetic alterations, mixed-type GC was associated with more TP53 mutations than intestinal-type GC and diffuse-type GC. Multivariate analysis demonstrated the following independent prognostic factors: age, Lauren classification, and pathological T and N categories. Regarding mixed-type GC, diffuse-type major tumors were associated with more lymphovascular invasion, a more advanced N category and TNM stage, and fewer PI3K/AKT pathway mutations than intestinal-type major tumors.ConclusionsDiffuse-type GC had unfavorable clinicopathological features and a worse prognosis than intestinal-type GC. For mixed-type GC, the clinicopathological features and genetic alterations were different between intestinal-type major tumors and diffuse-type major tumors.","PeriodicalId":14474,"journal":{"name":"International surgery","volume":" ","pages":""},"PeriodicalIF":0.1,"publicationDate":"2020-10-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45111118","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-10-19DOI: 10.9738/intsurg-d-20-00009.1
K. Enomoto
Introduction: Patients with liver metastases arising from breast cancer presenting with jaundice have poor prognoses; most patients are not treated aggressively. However, we report an improvement in the quality of life (QOL) of the patient by inserting a biliary stent as palliative surgical treatment.Case presentation: The patient was a 63-year-old woman. She had left breast cancer and had undergone total mastectomy and axillar lymph node dissection (Bt+Ax) approximately 20 years ago. Thereafter, chemotherapy and hormonal therapy were continued for approximately 5 years. Sixteen years after the surgery, the patient presented with hepatic failure; furthermore, total bilirubin (T-Bil) levels had increased to 5.5 mg/dl. Imaging revealed multiple liver metastases and dilatation of the intrahepatic bile duct. A biliary stent was placed, and treatment for obstructive jaundice was administered. After 3 months, the patient was able to maintain QOL without any increase in T-Bil levels.Conclusion: Palliative surgical treatment via biliary stenting for the onset of obstructive jaundice due to liver metastases arising from breast cancer can be useful for maintaining patient QOL.
{"title":"Palliative surgical treatment for liver metastases arising from breast cancer","authors":"K. Enomoto","doi":"10.9738/intsurg-d-20-00009.1","DOIUrl":"https://doi.org/10.9738/intsurg-d-20-00009.1","url":null,"abstract":"Introduction: Patients with liver metastases arising from breast cancer presenting with jaundice have poor prognoses; most patients are not treated aggressively. However, we report an improvement in the quality of life (QOL) of the patient by inserting a biliary stent as palliative surgical treatment.Case presentation: The patient was a 63-year-old woman. She had left breast cancer and had undergone total mastectomy and axillar lymph node dissection (Bt+Ax) approximately 20 years ago. Thereafter, chemotherapy and hormonal therapy were continued for approximately 5 years. Sixteen years after the surgery, the patient presented with hepatic failure; furthermore, total bilirubin (T-Bil) levels had increased to 5.5 mg/dl. Imaging revealed multiple liver metastases and dilatation of the intrahepatic bile duct. A biliary stent was placed, and treatment for obstructive jaundice was administered. After 3 months, the patient was able to maintain QOL without any increase in T-Bil levels.Conclusion: Palliative surgical treatment via biliary stenting for the onset of obstructive jaundice due to liver metastases arising from breast cancer can be useful for maintaining patient QOL.","PeriodicalId":14474,"journal":{"name":"International surgery","volume":" ","pages":""},"PeriodicalIF":0.1,"publicationDate":"2020-10-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43623426","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-10-18DOI: 10.9738/intsurg-d-20-00011.1
Shuji Suzuki, M. Shimoda, J. Shimazaki, Y. Oshiro, Kiyotaka Nishida, Yatsuka Sahara, Y. Nagakawa, A. Tsuchida
BackgroundPancreatic ductal adenocarcinoma (PDAC) is a lethal disease with poor, albeit gradually improving, prognosis. We evaluated predictive clinicophysiological outcomes of elderly patients with PDAC.MethodsWe retrospectively examined 260 patients who underwent pancreatic resection classified into two groups: (A) those ≤ 80 (B) and those > 80 years. Operative characteristics, preoperative clinicophysiological parameters (body mass index, jaundice decompression, total bilirubin, albumin, creatinine, HbA1c, amylase, C-reactive protein, white blood cells, lymphocytes, hemoglobin, platelets, cancer antigen 19-9, carcinoembryonic antigen, neutrophil/lymphocyte ratio, prognostic nutritional index, platelet/lymphocyte ratio, and CRP/Alb ratio), disease-free survival (DFS), and overall survival (OS) were reported.ResultsThere were no differences noted in morbidity, mortality, and preoperative clinicophysiological parameters. Median DFS of groups A and B were 15.4 and 15.5 months respectively. One year and 3-year OS of groups A and B were 86.7/68% and 88.4/69.3%, respectively. There were no differences between the groups for DFS and OS.ConclusionCurative resection for PDAC can be safely performed in elderly and younger patients and elderly patients with PDAC can benefit from curative surgery without a significant decrease in survival rates.
{"title":"Outcomes of pancreatic resection for elderly patients with pancreatic cancer","authors":"Shuji Suzuki, M. Shimoda, J. Shimazaki, Y. Oshiro, Kiyotaka Nishida, Yatsuka Sahara, Y. Nagakawa, A. Tsuchida","doi":"10.9738/intsurg-d-20-00011.1","DOIUrl":"https://doi.org/10.9738/intsurg-d-20-00011.1","url":null,"abstract":"BackgroundPancreatic ductal adenocarcinoma (PDAC) is a lethal disease with poor, albeit gradually improving, prognosis. We evaluated predictive clinicophysiological outcomes of elderly patients with PDAC.MethodsWe retrospectively examined 260 patients who underwent pancreatic resection classified into two groups: (A) those ≤ 80 (B) and those > 80 years. Operative characteristics, preoperative clinicophysiological parameters (body mass index, jaundice decompression, total bilirubin, albumin, creatinine, HbA1c, amylase, C-reactive protein, white blood cells, lymphocytes, hemoglobin, platelets, cancer antigen 19-9, carcinoembryonic antigen, neutrophil/lymphocyte ratio, prognostic nutritional index, platelet/lymphocyte ratio, and CRP/Alb ratio), disease-free survival (DFS), and overall survival (OS) were reported.ResultsThere were no differences noted in morbidity, mortality, and preoperative clinicophysiological parameters. Median DFS of groups A and B were 15.4 and 15.5 months respectively. One year and 3-year OS of groups A and B were 86.7/68% and 88.4/69.3%, respectively. There were no differences between the groups for DFS and OS.ConclusionCurative resection for PDAC can be safely performed in elderly and younger patients and elderly patients with PDAC can benefit from curative surgery without a significant decrease in survival rates.","PeriodicalId":14474,"journal":{"name":"International surgery","volume":" ","pages":""},"PeriodicalIF":0.1,"publicationDate":"2020-10-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42529645","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-10-13DOI: 10.9738/intsurg-d-20-00019.1
S. Tsujinaka, Rintaro Fukuda, Ryo Maemoto, Erika Machida, Nao Kakizawa, Tsutomu Takenami, Y. Miyakura, N. Toyama, T. Rikiyama
IntroductionTrocar site hernia (TSH) is an uncommon complication after laparoscopic surgery, but may potentially require surgical intervention. The available data have shown the importance of prediction and prevention, and the optimal surgical approach for TSH remains unclear and its long-term outcome is scarcely available. Here, we present a case of a lateral TSH after laparoscopic incisional hernia repair, which was successfully repaired using the onlay technique with a self-gripping mesh.Case PresentationA 74-year-old woman presented with an abdominal incisional hernia at the midline after an open cholecystectomy. She underwent laparoscopic surgery for incisional hernia with intraperitoneal onlay mesh repair. Fascial closure was performed for trocar sites. After 12 months, she noticed a painful bulge in the left upper quadrant suggestive of TSH. At the time of diagnosis, her body mass index was 32 kg/m2. TSH repair was performed under general anesthesia. A 3 × 3 cm defect was identified, and the hernial content was found to be the omentum. Defect closure was performed using interrupted sutures followed by placement of a self-gripping mesh (11 × 11 cm in size, obtaining a 4 cm overlap for the defect). The operative time was 80 min. The postoperative course was uneventful except for a spontaneously resolved seroma. CT scan at the 1-year follow-up and physical examination at the 2-year visit showed no recurrence.ConclusionOur proposed onlay repair using self-gripping mesh may be considered as the treatment of choice for cases of lateral TSH after laparoscopic incisional hernia repair.
{"title":"Onlay repair using self-gripping mesh for lateral trocar site hernia after laparoscopic incisional hernia repair: A case report with short and mid-term outcomes","authors":"S. Tsujinaka, Rintaro Fukuda, Ryo Maemoto, Erika Machida, Nao Kakizawa, Tsutomu Takenami, Y. Miyakura, N. Toyama, T. Rikiyama","doi":"10.9738/intsurg-d-20-00019.1","DOIUrl":"https://doi.org/10.9738/intsurg-d-20-00019.1","url":null,"abstract":"IntroductionTrocar site hernia (TSH) is an uncommon complication after laparoscopic surgery, but may potentially require surgical intervention. The available data have shown the importance of prediction and prevention, and the optimal surgical approach for TSH remains unclear and its long-term outcome is scarcely available. Here, we present a case of a lateral TSH after laparoscopic incisional hernia repair, which was successfully repaired using the onlay technique with a self-gripping mesh.Case PresentationA 74-year-old woman presented with an abdominal incisional hernia at the midline after an open cholecystectomy. She underwent laparoscopic surgery for incisional hernia with intraperitoneal onlay mesh repair. Fascial closure was performed for trocar sites. After 12 months, she noticed a painful bulge in the left upper quadrant suggestive of TSH. At the time of diagnosis, her body mass index was 32 kg/m2. TSH repair was performed under general anesthesia. A 3 × 3 cm defect was identified, and the hernial content was found to be the omentum. Defect closure was performed using interrupted sutures followed by placement of a self-gripping mesh (11 × 11 cm in size, obtaining a 4 cm overlap for the defect). The operative time was 80 min. The postoperative course was uneventful except for a spontaneously resolved seroma. CT scan at the 1-year follow-up and physical examination at the 2-year visit showed no recurrence.ConclusionOur proposed onlay repair using self-gripping mesh may be considered as the treatment of choice for cases of lateral TSH after laparoscopic incisional hernia repair.","PeriodicalId":14474,"journal":{"name":"International surgery","volume":"31 1","pages":""},"PeriodicalIF":0.1,"publicationDate":"2020-10-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"71208049","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-09-30DOI: 10.9738/INTSURG-D-20-00021.1
Emad Aljohani, Fahad Almadi, Rami Basardah, M. Banjar, Khadeejah A. Almufawez, H. Tamimi
Background There seems to be a general consensus in the current published literature on postponing elective, non-urgent surgery on COVID-19-positive patients. But so far no recommendations have been published on when and how to start carrying out elective, non-urgent surgery on COVID-19-negative patients after the epidemic peak. Objective: to determine the best approach for reintroduction of elective procedures during COVID-19 based on their preoperative screening by the respiratory scoring system. Methodology: retrospective chart review of patients who underwent bariatric surgery between March to June in 2020, during the pandemic of Covid 19. The study was conducted in Riyadh, Saudi Arabia in two different health institutions. Results: The total number of patients were 90. The mean age of the patients was 32.73 ± 7.81 years. Moreover, (n=36; 40.0%) of the patients presented with comorbidities. Only (n=1; 1.1%) of the patient was tested for Covid19 by RT-PCR before surgery and tested negative. Majority of the patients (n=80; 88.9% ) underwent Lap sleeve gasterecomy. Post surgery no patients developed any complications and none of them were admitted to the ICU. Post surgery only (n=2; 2.2%) of the patient were tested for Covid19 by RT-PCR and 100% tested negative. Conclusion: During COVID-19 pandemic before considering patients for elective surgery they should be screened. If their respiratory score is ≤ 3 indicating low risk of respiratory illness, elective procedures should continue. Strict precautionary measures should be followed and limited number of surgeries should be performed.
{"title":"Safety of Bariatric Surgery during COVID-19 Pandemic, is there a need to screen low risk patients?","authors":"Emad Aljohani, Fahad Almadi, Rami Basardah, M. Banjar, Khadeejah A. Almufawez, H. Tamimi","doi":"10.9738/INTSURG-D-20-00021.1","DOIUrl":"https://doi.org/10.9738/INTSURG-D-20-00021.1","url":null,"abstract":"Background There seems to be a general consensus in the current published literature on postponing elective, non-urgent surgery on COVID-19-positive patients. But so far no recommendations have been published on when and how to start carrying out elective, non-urgent surgery on COVID-19-negative patients after the epidemic peak. Objective: to determine the best approach for reintroduction of elective procedures during COVID-19 based on their preoperative screening by the respiratory scoring system. Methodology: retrospective chart review of patients who underwent bariatric surgery between March to June in 2020, during the pandemic of Covid 19. The study was conducted in Riyadh, Saudi Arabia in two different health institutions. Results: The total number of patients were 90. The mean age of the patients was 32.73 ± 7.81 years. Moreover, (n=36; 40.0%) of the patients presented with comorbidities. Only (n=1; 1.1%) of the patient was tested for Covid19 by RT-PCR before surgery and tested negative. Majority of the patients (n=80; 88.9% ) underwent Lap sleeve gasterecomy. Post surgery no patients developed any complications and none of them were admitted to the ICU. Post surgery only (n=2; 2.2%) of the patient were tested for Covid19 by RT-PCR and 100% tested negative. Conclusion: During COVID-19 pandemic before considering patients for elective surgery they should be screened. If their respiratory score is ≤ 3 indicating low risk of respiratory illness, elective procedures should continue. Strict precautionary measures should be followed and limited number of surgeries should be performed.","PeriodicalId":14474,"journal":{"name":"International surgery","volume":" ","pages":""},"PeriodicalIF":0.1,"publicationDate":"2020-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48445633","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-08-19DOI: 10.9738/intsurg-d-17-00039.1
H. Maehira, M. Ogawa, Masayasu Kawasaki, Atsuo Imagawa, K. Yuu, Aya Itoh, Naoto Mizumura, Kansuke Yamamoto, H. Yasuda, Sho Toyoda, H. Kawashima, S. Okumura, M. Yoshimura, M. Kameyama
Endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) is often used to diagnose pancreatic tumors. In rare cases, preoperative EUS-FNA can be complicated by gastric wall implantation of pancreatic cancer. A 66-year-old woman with pancreatic tail cancer underwent evaluation by EUS-FNA, followed by distal pancreatectomy and splenectomy. Twelve months postoperatively, a submucosal tumor was detected at the posterior gastric wall, at the location where the EUS-FNA was performed, and a boring biopsy from the submucosal tumor showed an adenocarcinoma. Therefore, we performed partial gastrectomy. Immunostaining results of the resected specimen were identical to those of the resected pancreatic cancer. The patient was diagnosed as having gastric wall implantation of pancreatic cancer due to EUS-FNA. This case emphasizes the importance of monitoring the site of EUS-FNA for gastric wall implantation of pancreatic cancer, and boring biopsy is a useful diagnostic tool.
{"title":"Gastric Wall Implantation of Pancreatic Cancer Due to Preoperative Endoscopic Ultrasound-Guided Fine Needle Aspiration: A Case Report","authors":"H. Maehira, M. Ogawa, Masayasu Kawasaki, Atsuo Imagawa, K. Yuu, Aya Itoh, Naoto Mizumura, Kansuke Yamamoto, H. Yasuda, Sho Toyoda, H. Kawashima, S. Okumura, M. Yoshimura, M. Kameyama","doi":"10.9738/intsurg-d-17-00039.1","DOIUrl":"https://doi.org/10.9738/intsurg-d-17-00039.1","url":null,"abstract":"\u0000 \u0000 Endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) is often used to diagnose pancreatic tumors. In rare cases, preoperative EUS-FNA can be complicated by gastric wall implantation of pancreatic cancer.\u0000 \u0000 \u0000 \u0000 A 66-year-old woman with pancreatic tail cancer underwent evaluation by EUS-FNA, followed by distal pancreatectomy and splenectomy. Twelve months postoperatively, a submucosal tumor was detected at the posterior gastric wall, at the location where the EUS-FNA was performed, and a boring biopsy from the submucosal tumor showed an adenocarcinoma. Therefore, we performed partial gastrectomy. Immunostaining results of the resected specimen were identical to those of the resected pancreatic cancer. The patient was diagnosed as having gastric wall implantation of pancreatic cancer due to EUS-FNA.\u0000 \u0000 \u0000 \u0000 This case emphasizes the importance of monitoring the site of EUS-FNA for gastric wall implantation of pancreatic cancer, and boring biopsy is a useful diagnostic tool.\u0000","PeriodicalId":14474,"journal":{"name":"International surgery","volume":" ","pages":""},"PeriodicalIF":0.1,"publicationDate":"2020-08-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42054405","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-08-19DOI: 10.21203/rs.3.rs-60965/v1
Hiroka Kondo, Y. Hirano, Toshimasa Ishii, Shintaro Ishikawa, Takatsugu Fujii, Masahiro Asari, Atsuko Kataoka, M. Kataoka, S. Shimamura, S. Yamaguchi
Background A prognosis for stage IV colorectal cancer is generally poor. As a result, the development of an appropriate treatment strategy for each individual with this disease within a limited time frame is important. Few studies have been made of CRP in stage IV cases of colorectal cancer so it is unclear whether CRP is a useful prognostic marker for this disease. Thus, the purpose of this study was to clarify the relationship between the preoperative CRP level and the prognosis of stage IV colorectal cancer. Patients and methods Between April 2007 and December 2015, 384 patients with stage IV colorectal cancer who underwent primary resection were included. Patients were divided into high (HCG) and low (LCG) CRP groups based on a preoperative CRP cut-off value of ≥1.0 mg/dL. Postoperative short- and long-term results were examined retrospectively. Results The 5-year survival rate was 24.6% for HCG and 36.7% for LCG, indicating the survival rate for HCG was lower. The study was limited to patients who were unable to undergo R0 surgery. Preoperative CEA levels were higher in HCG while the postoperative chemotherapy induction rate was lower. HCG also showed a significantly lower survival rate than LCG. Multivariate analysis showed that CRP levels above 1.0 mg/dL, poorly differentiated histopathology, and the absence of chemotherapy were risk factors affecting overall survival. Conclusion These results suggest that the preoperative CRP level may be a useful biomarker for the prognosis of incurable stage IV colorectal cancer.
{"title":"Preoperative C-reactive protein as a prognostic factor in stage IV colorectal cancer","authors":"Hiroka Kondo, Y. Hirano, Toshimasa Ishii, Shintaro Ishikawa, Takatsugu Fujii, Masahiro Asari, Atsuko Kataoka, M. Kataoka, S. Shimamura, S. Yamaguchi","doi":"10.21203/rs.3.rs-60965/v1","DOIUrl":"https://doi.org/10.21203/rs.3.rs-60965/v1","url":null,"abstract":"Background A prognosis for stage IV colorectal cancer is generally poor. As a result, the development of an appropriate treatment strategy for each individual with this disease within a limited time frame is important. Few studies have been made of CRP in stage IV cases of colorectal cancer so it is unclear whether CRP is a useful prognostic marker for this disease. Thus, the purpose of this study was to clarify the relationship between the preoperative CRP level and the prognosis of stage IV colorectal cancer. Patients and methods Between April 2007 and December 2015, 384 patients with stage IV colorectal cancer who underwent primary resection were included. Patients were divided into high (HCG) and low (LCG) CRP groups based on a preoperative CRP cut-off value of ≥1.0 mg/dL. Postoperative short- and long-term results were examined retrospectively. Results The 5-year survival rate was 24.6% for HCG and 36.7% for LCG, indicating the survival rate for HCG was lower. The study was limited to patients who were unable to undergo R0 surgery. Preoperative CEA levels were higher in HCG while the postoperative chemotherapy induction rate was lower. HCG also showed a significantly lower survival rate than LCG. Multivariate analysis showed that CRP levels above 1.0 mg/dL, poorly differentiated histopathology, and the absence of chemotherapy were risk factors affecting overall survival. Conclusion These results suggest that the preoperative CRP level may be a useful biomarker for the prognosis of incurable stage IV colorectal cancer.","PeriodicalId":14474,"journal":{"name":"International surgery","volume":" ","pages":""},"PeriodicalIF":0.1,"publicationDate":"2020-08-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43776365","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-08-05DOI: 10.9738/intsurg-d-20-00014.1
Tareef S Daqqaq
This meta-analysis highlights the diagnostic efficacy of computed tomography (CT), computed tomography angiography (CTA), magnetic resonance image (MRI), as well as magnetic resonance spectroscopy (MRS). This paper assesses the detection of the primary outcome comprising choline/creatine ratio, relative cerebral blood volume (rCBV), as well as choline/N-acetyl aspartate. Cochrane, Medline, ScienceDirect, Google Scholar, and EMBASE databases were searched for extracting the relevant studies. A sample of 12 studies on radiologic assessment of brain tumors was selected. The evidence provides that the heterogeneity exists concerning the CBV of 311.623, I2 = 96.12%, with a significance value of P < 0.001. The pooled difference showed rCBV mean (as 2.18, 95% confidence interval = 0.85 to 3.50) substantially enhances lesion. The study concluded that radiological interventions, particularly the combination of MRS and MRI, help in the brain patient's precise diagnosis and treatment.
{"title":"Role of Radiological Intervention in Brain Tumor: A Meta-Analysis","authors":"Tareef S Daqqaq","doi":"10.9738/intsurg-d-20-00014.1","DOIUrl":"https://doi.org/10.9738/intsurg-d-20-00014.1","url":null,"abstract":"\u0000 \u0000 This meta-analysis highlights the diagnostic efficacy of computed tomography (CT), computed tomography angiography (CTA), magnetic resonance image (MRI), as well as magnetic resonance spectroscopy (MRS). This paper assesses the detection of the primary outcome comprising choline/creatine ratio, relative cerebral blood volume (rCBV), as well as choline/N-acetyl aspartate. Cochrane, Medline, ScienceDirect, Google Scholar, and EMBASE databases were searched for extracting the relevant studies.\u0000 \u0000 \u0000 \u0000 A sample of 12 studies on radiologic assessment of brain tumors was selected.\u0000 \u0000 \u0000 \u0000 The evidence provides that the heterogeneity exists concerning the CBV of 311.623, I2 = 96.12%, with a significance value of P < 0.001. The pooled difference showed rCBV mean (as 2.18, 95% confidence interval = 0.85 to 3.50) substantially enhances lesion.\u0000 \u0000 \u0000 \u0000 The study concluded that radiological interventions, particularly the combination of MRS and MRI, help in the brain patient's precise diagnosis and treatment.\u0000","PeriodicalId":14474,"journal":{"name":"International surgery","volume":" ","pages":""},"PeriodicalIF":0.1,"publicationDate":"2020-08-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.9738/intsurg-d-20-00014.1","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49419271","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-08-04DOI: 10.21203/rs.3.rs-43719/v1
Hassan Al-Turaihi, E. Blears, K. Sugumar, Ganesh R. Deshmukh
Background:Fistula-in-ano is a common problem encountered by surgeons which can be classified as either simple or complex. Complex fistulas (CF) cause higher morbidity and are much more challenging to treat. Although numerous treatment options are available for CF, none are proven to be 100% effective. The endorectal advancement flap (EAF) procedure was developed as an alternative to conventional surgical treatments for CF. Herein, we describe a novel modification of the EAF procedure along with surgical outcomes in terms of recurrence, fecal incontinence and factors associated with flap failure. Methods:A retrospective review of patients with CF who underwent EAF between 2004-2019 was done. The conventional EAF procedure was modified by performing transverse imbrication of the internal sphincter over the internal fistula opening. The incidence of post-operative recurrence and fecal incontinence were calculated from chart documentation at the last available date of follow-up. Also, the association between various clinical and demographic factors and post-operative flap failure were using statistical significance at alpha of 0.05. Results: With a median follow-up of 6.6 months (range: 3.3-24 months), 99 patients with CFs underwent a modified EAF. Of these, 93% (92/99) had a successful procedure, 7% (7/99) experienced recurrence and 1% (1/99) experienced new-onset fecal incontinence. Systemic steroid or immunomodulatory therapy use (p=0.001) and patients with diagnosed inflammatory bowel disease (p<0.0001) were associated with increased rate of recurrence.Conclusion:EAF with transverse imbrication of the internal opening using interrupted, absorbable suture is an effective technique to treat complex or recurrent anal fistulas. It is associated with a low risk of recurrence (7%) and fecal incontinence (1%) and a valid treatment option for CFs.
{"title":"A novel modification of the Endorectal Advancement Flap for complex anal fistulas: surgical technique and outcomes","authors":"Hassan Al-Turaihi, E. Blears, K. Sugumar, Ganesh R. Deshmukh","doi":"10.21203/rs.3.rs-43719/v1","DOIUrl":"https://doi.org/10.21203/rs.3.rs-43719/v1","url":null,"abstract":"\u0000 Background:Fistula-in-ano is a common problem encountered by surgeons which can be classified as either simple or complex. Complex fistulas (CF) cause higher morbidity and are much more challenging to treat. Although numerous treatment options are available for CF, none are proven to be 100% effective. The endorectal advancement flap (EAF) procedure was developed as an alternative to conventional surgical treatments for CF. Herein, we describe a novel modification of the EAF procedure along with surgical outcomes in terms of recurrence, fecal incontinence and factors associated with flap failure. Methods:A retrospective review of patients with CF who underwent EAF between 2004-2019 was done. The conventional EAF procedure was modified by performing transverse imbrication of the internal sphincter over the internal fistula opening. The incidence of post-operative recurrence and fecal incontinence were calculated from chart documentation at the last available date of follow-up. Also, the association between various clinical and demographic factors and post-operative flap failure were using statistical significance at alpha of 0.05. Results: With a median follow-up of 6.6 months (range: 3.3-24 months), 99 patients with CFs underwent a modified EAF. Of these, 93% (92/99) had a successful procedure, 7% (7/99) experienced recurrence and 1% (1/99) experienced new-onset fecal incontinence. Systemic steroid or immunomodulatory therapy use (p=0.001) and patients with diagnosed inflammatory bowel disease (p<0.0001) were associated with increased rate of recurrence.Conclusion:EAF with transverse imbrication of the internal opening using interrupted, absorbable suture is an effective technique to treat complex or recurrent anal fistulas. It is associated with a low risk of recurrence (7%) and fecal incontinence (1%) and a valid treatment option for CFs.","PeriodicalId":14474,"journal":{"name":"International surgery","volume":" ","pages":""},"PeriodicalIF":0.1,"publicationDate":"2020-08-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43588012","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-07-30DOI: 10.21203/rs.3.rs-44867/v1
H. Nozawa, K. Kawai, K. Sasaki, S. Emoto, K. Murono, H. Sonoda, H. Ishii, S. Ishihara
Background Endoscopic treatment for gastrointestinal cancer can cause inflammation, edema, and fibrosis formation in the surrounding tissue. Recently, we reported that preceding endoscopic treatment increased the volume of intraoperative blood loss and slightly prolonged the operative time of laparoscopic surgery for rectal cancer. In this study, we addressed which factors, including endoscopic submucosal dissection (ESD)- related parameters, affect the difficulty of laparoscopic rectal surgery. Methods We retrospectively reviewed 24 consecutive patients who underwent ESD followed by laparoscopic surgery for rectal cancer in our hospital. Short-term surgical outcomes were evaluated by intraoperative blood loss and operative time for laparoscopic surgery. The correlations between the surgical outcomes and preoperative parameter were analyzed by scatter diagrams and multiple linear regression analyses. Results The patient cohort comprised 12 men and 12 women. The median distance between primary cancer and anal verge was 7 cm. The median procedure time of ESD was 120 minutes (21 available cases). The scatter diagram graph revealed a positive correlation between the ESD procedure time and estimated blood loss during rectal surgery (rs = 0.26). There was no association between the ESD procedure time and operative time for rectal surgery. Based on multiple linear regression analyses, the ESD procedure time (p = 0.007) and tumor location from the anal verge (p = 0.046) were independently predictive of intraoperative blood loss. On the other hand, only tumor location was found an independent predictor of surgical time (p = 0.014). Conclusions A long session of ESD for rectal cancer may make subsequent laparoscopic surgery difficult based on intraoperative blood loss.
{"title":"Impact of Procedure Time of Preceding Endoscopic Submucosal Dissection on the Difficulty of Laparoscopic Rectal Surgery","authors":"H. Nozawa, K. Kawai, K. Sasaki, S. Emoto, K. Murono, H. Sonoda, H. Ishii, S. Ishihara","doi":"10.21203/rs.3.rs-44867/v1","DOIUrl":"https://doi.org/10.21203/rs.3.rs-44867/v1","url":null,"abstract":"\u0000 Background\u0000\u0000Endoscopic treatment for gastrointestinal cancer can cause inflammation, edema, and fibrosis formation in the surrounding tissue. Recently, we reported that preceding endoscopic treatment increased the volume of intraoperative blood loss and slightly prolonged the operative time of laparoscopic surgery for rectal cancer. In this study, we addressed which factors, including endoscopic submucosal dissection (ESD)- related parameters, affect the difficulty of laparoscopic rectal surgery.\u0000Methods\u0000\u0000We retrospectively reviewed 24 consecutive patients who underwent ESD followed by laparoscopic surgery for rectal cancer in our hospital. Short-term surgical outcomes were evaluated by intraoperative blood loss and operative time for laparoscopic surgery. The correlations between the surgical outcomes and preoperative parameter were analyzed by scatter diagrams and multiple linear regression analyses.\u0000Results\u0000\u0000The patient cohort comprised 12 men and 12 women. The median distance between primary cancer and anal verge was 7 cm. The median procedure time of ESD was 120 minutes (21 available cases). The scatter diagram graph revealed a positive correlation between the ESD procedure time and estimated blood loss during rectal surgery (rs = 0.26). There was no association between the ESD procedure time and operative time for rectal surgery. Based on multiple linear regression analyses, the ESD procedure time (p = 0.007) and tumor location from the anal verge (p = 0.046) were independently predictive of intraoperative blood loss. On the other hand, only tumor location was found an independent predictor of surgical time (p = 0.014).\u0000Conclusions\u0000\u0000A long session of ESD for rectal cancer may make subsequent laparoscopic surgery difficult based on intraoperative blood loss.","PeriodicalId":14474,"journal":{"name":"International surgery","volume":" ","pages":""},"PeriodicalIF":0.1,"publicationDate":"2020-07-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41977888","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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