Surgical oncology
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Observational Study
Drainage after distal pancreatectomy: Still an unsolved problem.
The use of intraperitoneal drainage after distal pancreatectomy is still controversial. Its use increases fistula risk, but its absence increases the severity of the fistula. Therefore, since 2014, we have systematically used two drains. ⋯ Since changing the drainage strategy, we have observed a dramatic decrease in pancreatic abscess formation and fluid collections needing percutaneous drainage. The results of this study show that the strategy of double drainage after distal pancreatectomy may reduce the severity of POPF, thus avoiding reoperation or further interventions.
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To develop and validate a radiomics-based nomogram for the preoperative prediction of posthepatectomy liver failure (PHLF) in patients with hepatocellular carcinoma (HCC). ⋯ A nomogram based on the Rad-score, MELD, and PS can predict PHLF.
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Gastric cancer with the presence of peritoneal metastases (pmgc) is associated with a very poor prognosis. Despite the wide utilization and promising results of the multimodal treatment regimens including cytoreductive surgery (CRS) and a subsequent hyperthermic intraperitoneal chemotherapy (HIPEC), it is still not fully understood which patient group is suitable for this treatment. ⋯ Neoadjuvant chemotherapy using the FLOT-protocol followed by CRS + HIPEC seems to be associated with prolonged OS in patients with peritoneal carcinomatosis from gastric cancer. This treatment needs a critical evaluation for patients with a PCI ≥12. Furthermore, the accurate selection of patients suffering of PMGC by using the developed score can improve the OS of up to 24 months for a suitable group and it can avoid the extensive treatment for unsuitable patients.
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Upper extremity lymphoedema after axillary node dissection is an iatrogenic disease particularly associated with treatment for breast or skin cancer. Anatomical studies and lymphangiography in healthy subjects identified that axillary node dissection removes a segment of the lymphatic drainage pathway running from the upper limb to the sub-clavicular vein, creating a surgical break. It is reasonable to infer that different patterns of lymphatic drainage may occur in the upper limb following surgery and contribute to the various presentations of lymphoedema from none to severe. ⋯ Lymphoscintigraphy shows that restoration of the original lymphatic pathway to the axilla after its initial disruption by nodal dissection was not uncommon and may prevent lymphoedema. We found that regenerated lymphatic vessels and dermal backflow (the reflux of lymph to the skin) contributed to either restoration of the original pathway or rerouting of the lymphatic pathway to other regional nodes. Variation in the lymphatic drainage pathway and the mechanisms of fluid drainage itself are the foundation of new lymphatic drainage patterns considered to be significant in determining the severity with which lymphoedema develops.
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Laparoscopic liver resection (LLR) has gained significant popularity over the last 10 years. First experiences of LLR compared to open liver resection (OLR) reported a similar survival and a better safety profile for LLR. ⋯ Minor LLR appeared significantly safer compared to minor OLR for HCC. LLR was associated with fewer post-operative complication, lower operative blood loss and a shorter hospital stay along with similar survival and recurrence-free survival rates.