Surgical endoscopy
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Minimally invasive surgery (MIS) has emerged as a treatment of choice for early-stage gastric cancer. However, applying MIS to gastric patients with high body mass index (BMI) is technically challenging, especially when performing D2 lymphadenectomy. Recently, robotic systems have been adopted to overcome the technical limitations of conventional laparoscopic surgery. Nevertheless, studies on the impact of the use of robotic systems to perform D2 lymphadenectomy in high BMI patients are lacking. Accordingly, this study was designed to compare the quality of lymphadenectomy, together with surgical outcomes, by robotic distal subtotal gastrectomy with D2 lymphadenectomy (RDGD2) to those by laparoscopic distal subtotal gastrectomy with D2 lymphadenectomy (LDGD2) in patients of different BMI status. ⋯ The benefits of a robotic approach were more evident in high BMI patients than in normal BMI patients when performing distal subtotal gastrectomy with D2 lymphadenectomy, particularly in terms of blood loss and consistent quality of lymphadenectomy. Robotic surgery could be an effective alternative to conventional laparoscopic surgery in treating gastric cancer patients with high BMI.
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Considering the low incidence of colon cancer after an initial episode of colonic diverticulitis in some categories of patients, some authors suggested to exempt them from colonoscopy. However, this incidence has never been compared to that of a reference population, and predictors of cancer are still poorly investigated. We aimed to determine the 1-year incidence of colon cancer at the site of diverticulitis in patients diagnosed with left colonic or sigmoid acute diverticulitis, to compare this incidence to a reference population to state whether endoscopy is required or not, and to identify predicting factors of cancer to better target subpopulations needing that examination. ⋯ Colonoscopy should be continued after an initial diagnosis of left colonic or sigmoid acute diverticulitis, irrespective of the clinical or radiological presentations.