Journal of gastrointestinal surgery : official journal of the Society for Surgery of the Alimentary Tract
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J. Gastrointest. Surg. · Jun 2011
Super-selection of a subgroup of hepatocellular carcinoma patients at minimal risk of recurrence for liver transplantation.
A majority of patients with hepatocellular carcinoma (HCC) undergoing liver transplantation (LT) meet the Milan criteria, but these are still regarded as the narrowest criteria for transplantation. Prognostic analysis of incidentally detected HCC after LT suggests that a subgroup of HCC patients is at very low risk of recurrence. To determine the criteria defining this super-selection group, we retrospectively analyzed survival data of 593 adult living-donor LT recipients with HCC in the explanted liver ⋯ Tumor features of incidental HCC in 38 patients not showing recurrence were analyzed. Of these patients, 34 (89.5%) each had ≤2 tumors and tumors ≤2.0 cm in size. Applying these criteria to 555 patients with pretransplant known HCC (pkHCC) allowed us to identify 79 patients with untreated pkHCCs ≤2.0 cm in size. To date, only two of these patients have shown recurrence, making the conditions for super-selection the presence of tumors ≤2.0 cm in size, ≤2 tumors, alpha-fetoprotein ≤200 ng/mL, and no pretransplant treatment. In 87 patients satisfying these criteria, the 10-year recurrence and survival rates were 1.3% and 92.1%, respectively. After excluding patients meeting these criteria, the 5-year recurrence rates in patients satisfying the Milan, University of California at San Francisco, and Asan criteria were increased by 2.9-4.0%. In conclusion, this super-selection or super-Milan category may be used for validation assessment of various indication criteria and for the development of cost-effective post-transplantation HCC surveillance protocols. Further studies should be followed for deceased-donor LT and patients who have undergone pretransplant treatment.
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J. Gastrointest. Surg. · Jun 2011
Comparative StudyLinear stapled esophagogastrostomy is more effective than hand-sewn or circular stapler in prevention of anastomotic stricture: a comparative clinical study.
The aim of this study was to retrospectively compare the operative effects of linear stapled intrathoracic esophagogastrostomy with hand-sewn or circular stapled anastomosis in prevention of anastomotic stricture. ⋯ The linear stapled esophagogastrostomy could decrease anastomotic stricture without increasing gastroesophageal reflux.
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J. Gastrointest. Surg. · May 2011
Randomized Controlled Trial Comparative StudyEffect of antecolic or retrocolic reconstruction of the gastro/duodenojejunostomy on delayed gastric emptying after pancreaticoduodenectomy: a randomized controlled trial.
To study the effect of antecolic vs. retrocolic reconstruction on delayed gastric emptying (DGE) after pancreaticoduodenectomy (PD) and to analyze factors which may be associated with post-PD DGE. DGE is a troublesome complication occurring in 30-40% of patients undergoing PD leading to increased postoperative morbidity. Many factors have been implicated in the pathogenesis of DGE. Among the various methods employed to reduce the incidence, recent reports have suggested that an antecolic reconstruction of gastro/duodenojejunostomy may decrease the incidence of DGE. ⋯ Delayed gastric emptying is a cause of significant morbidity and prolongs the duration of hospitalization following pancreaticoduodenectomy. The incidence of DGE does not appear to be related to the method of reconstruction (antecolic or retrocolic). Older age may be a risk factor for its occurrence.
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J. Gastrointest. Surg. · Apr 2011
Elective resection of colon cancer by high-volume surgeons is associated with decreased morbidity and mortality.
The purpose of this study was to determine whether morbidity and mortality in patients undergoing elective resection of colon cancer are associated with surgeon or hospital volume. ⋯ In patients undergoing elective resection of colon cancer, procedures done by high-volume surgeons are associated with decreased morbidity and mortality.
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J. Gastrointest. Surg. · Apr 2011
Medically managed hypercholesterolemia and insulin-dependent diabetes mellitus preoperatively predicts poor survival after surgery for pancreatic cancer.
Although patients with pancreatic ductal adenocarcinoma (PDAC) frequently require medications to treat pre-existing conditions, the impact of these treatments on outcomes post-resection is unknown. The purpose of this study was to determine the impact of preoperative medications on overall survival after pancreatic resection. ⋯ Patients with PDAC being treated for pre-existing diabetes or hypercholesterolemia with either insulin or statin-based therapy have an increased risk of early postoperative mortality. A simple scoring system based on preoperative medications can be used to predict early and overall survival following resection.