RESUMEN
BACKGROUND AND OBJECTIVES: An experimental study was undertaken to evaluate whether a previously described technique for laparoscopic sigmoid resection with intracorporeal resection-anastomosis and specimen removal via a suprapubic incision could be facilitated and applied to the rectum. METHODS: Ten domestic pigs (median weight 41 kg) underwent low anterior resection of the rectum, which was transected with an articulating endoscopic stapler. Pursestring sutures were fashioned intracorporeally with a laparoscopic pursestring clamp. The anvil of a circular stapler was inserted through a 33 mm port into the colon and pursestring tied intracorporeally. A circular gun with a spike fixed to its shaft was introduced per anum and a double-stapled anastomosis performed. RESULTS: Complete doughnuts were obtained in all cases and anastomoses were all methylene blue tight. All porcine subjects had an uneventful 5-week postoperative course. The median anastomotic level from the anal verge was 5.2 cm. Histology of colorectal anastomoses revealed healing mucosa. CONCLUSIONS: The use of articulating endoscopic stapler, laparoscopic pursestring clamp, and circular stapler with a spike fixed to its shaft seems to facilitate a previously described intracorporeal approach to sigmoid resection which was safely applied to the rectum in a porcine model.
Asunto(s)
Colon/cirugía , Laparoscopía/métodos , Recto/cirugía , Enfermedades del Sigmoide/cirugía , Anastomosis Quirúrgica/métodos , Animales , Modelos Animales de Enfermedad , Diseño de Equipo , Laparoscopios , Sensibilidad y Especificidad , Instrumentos Quirúrgicos , Grapado Quirúrgico , PorcinosRESUMEN
The influence of clinical and tumour-related variables on long-term survival in patients with gastric carcinoma was studied in a national prospective multicentre study. A total of 532 patients underwent curative surgery with a 5-year survival rate of 40 per cent. In a Cox multivariate analysis, age, stage of disease and macroscopic appearance of tumour were the only factors that independently affected survival. The estimated probability of survival to 5 years for a 50-year-old patient with a flattened tumour type and stage I disease was 71 per cent, but 50 per cent for an 80-year-old with the same tumour type and stage. For stage II disease the rates were 56 and 32 per cent, for stage III 39 and 13 per cent and for stage IV 19 and 3 per cent, respectively. A 70-year-old patient with stage II linitis plastica tumour type had an estimated probability of 5-year survival of 20 per cent. Stage of disease was the single most important factor in determining survival. Laurén histopathological type and location of tumour, Karnofsky performance index, weight loss and type of resection had no significant effect on long-term survival.
Asunto(s)
Neoplasias Gástricas/mortalidad , Factores de Edad , Anciano , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estadificación de Neoplasias , Noruega/epidemiología , Pronóstico , Estudios Prospectivos , Neoplasias Gástricas/patología , Neoplasias Gástricas/cirugía , Tasa de SupervivenciaRESUMEN
This study was performed to investigate the association between Lauren's histopathological classification system and different clinico-pathological characteristics in patients with gastric carcinoma. We revealed that the percentage of intestinal type tumour (ITT) increased with advancing age (52% in patients less than 60 years compared to 73% of octogenarians (P less than 0.001)). The male:female ratio was 1.7 for ITT versus 1.3 for diffuse type tumour (DTT (P = 0.12)). ITT was more common in proximally (fundus) localized tumours than in distal lesions (77% vs 65%; P less than 0.05). The proportion of patients with ITT decreased with advancing stages of the disease (70% in stage I and II vs 52% in stage IV (P less than 0.0001)). More patients with DTT had tumour infiltration in the resection margin (21% vs 9%; P less than 0.001). Intestinal metaplasia was found in 48% of those with ITT compared with 28% of those with DTT (P less than 0.001). No association was found between Lauren's classification and the ABO blood group or between the tumour types and infiltration in lymphatic or blood vessels. We conclude that gastric adenocarcinoma occurs in at least two different biological forms and that differentiation between the two is of relevance for treatment.
Asunto(s)
Neoplasias Gástricas/patología , Adulto , Anciano , Anciano de 80 o más Años , Tumor Carcinoide/patología , Carcinoma/patología , Diagnóstico Diferencial , Femenino , Humanos , Linfoma/patología , Masculino , Persona de Mediana Edad , Noruega , Sarcoma/patologíaRESUMEN
The effect and consequences of treatment delay were studied in 1165 patients with stomach cancer included in a Norwegian multicentre study. Median patient delay was 42 days; median doctor delay 37 days; and median total treatment delay 107 days. By Cox proportional hazards model analyses we found that an increase in weight loss was associated with an increase in total delay, whereas a more advanced stage of disease was related to a short total delay. Physician delay was more pronounced in women, increased with increasing Karnofsky performance index, but decreased in patients with stage-IV disease. By logistic regression analyses we found no association between delays and postoperative complication rate. The relationship between physician delay and postoperative mortality was statistical significant, with increasing number of deaths with decreasing delay. In conclusion, there is no evidence that long treatment delay is an important negative factor in relation to outcome of surgery.
Asunto(s)
Pacientes , Médicos , Neoplasias Gástricas/terapia , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Masculino , Persona de Mediana Edad , Noruega , Cuidados Paliativos , Complicaciones Posoperatorias , Estudios Prospectivos , Análisis de Regresión , Neoplasias Gástricas/mortalidad , Neoplasias Gástricas/cirugía , Factores de TiempoRESUMEN
Of 1165 patients with stomach cancer included in a national, prospective multicenter study with 51 surgical units participating, information about weight loss before diagnosis was available for 855 patients (73%). Median weight loss was 5 kg; 259 patients (31%) experienced no weight loss. By logistic regression analysis the authors found that weight loss increased with age and advancing stages of disease (TNM Stage I-IV), with decreasing Karnofsky index, in Lauren's diffuse versus intestinal tumor type, and with tumors located at the cardia/esophagus. Increasing weight loss reduced the resectability rate significantly, but no association between weight loss and postoperative complication rate was found. The odds ratio for postoperative mortality was 2.5 to 1 for the weight loss group 5 to 10kg versus 0 kg. In conclusion, weight loss reflects a less favorable tumor status. Weight loss did not increase postoperative morbidity but did lead Weight to a higher death rate after surgery.