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Appraisal of gastric stump carcinoma and current state of affairs

World Journal of Clinical Cases 2023年第13期11卷 2864-2873页

作者： Ankit Shukla Raja Kalayarasan senthil gnanasekaran Biju Pottakkat Department of Surgical Gastroenterology Jawaharlal Institute of Postgraduate Medical Education and ResearchPuducherry 605006India

Gastric stump carcinoma,also known as remnant gastric carcinoma,is a malignancy arising in the remnant stomach following gastrectomy for a benign or malignant *** reflux and preexisting risk factors in a patient with gastric cancer are the major contributors to the development of gastric stump *** occurrence of gastric stump carcinoma is time-dependent and seen earlier in patients operated on for malignant rather than benign *** tumor location is predominantly at the anastomotic site towards the ***,it can occur anywhere in the remnant *** pattern of lymph node involvement and the type of surgery required is distinctly different compared to primary gastric *** stump carcinoma is traditionally considered a malignancy with a dismal ***,recent advances in diagnostic and therapeutic strategies have improved *** advances in molecular profiling of gastric stump carcinoma have identified distinct molecular subtypes,thereby providing novel therapeutic ***,reports of gastric stump carcinoma following pancreatoduodenectomy and bariatric surgery highlight the need for more research to standardize the diagnosis,staging,and treatment of these *** present review aims to provide an overview of gastric stump carcinoma highlighting the differences in clinicopathological profile and management compared to primary gastric carcinoma.

关键词： Gastric cancer Gastritis Carcinoma Endoscopic surveillance Gastric stump cancer Remnant gastric carcinoma

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Modified binding pancreaticogastrostomy vs modified Blumgart pancreaticojejunostomy after laparoscopic pancreaticoduodenectomy for pancreatic or periampullary tumors

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World Journal of Clinical Oncology 2022年第5期13卷 366-375页

作者： Satyaprakash Ray Choudhury Raja Kalayarasan senthil gnanasekaran Biju Pottakkat Department of Surgical Gastroenterology Jawaharlal Institute of Postgraduate Medical Education and ResearchPuducherry 605006India

BACKGROUND Laparoscopic pancreaticoenteric anastomosis is one of the technically challenging steps of minimally invasive pancreaticoduodenectomy(PD),especially during the learning *** multiple randomized controlled trials and meta-analyses,the type of pancreatico-enteric anastomosis as a risk factor for post-pancreatectomy complications is ***,the ideal technique of pancreatic reconstruction during the learning curve of laparoscopic PD has not been well *** To compare the short-term outcomes of modified binding pancreaticogastrostomy(PG)and Blumgart pancreaticojejunostomy(PJ)during learning curve of laparoscopic *** The first 25 patients with resectable pancreatic or periampullary tumors who underwent laparoscopic PD with modified binding PG or modified Blumgart PJ between January 2015 and May 2020 were retrospectively analyzed to compare perioperative outcomes during the same learning curve.A single layer of the fullthickness purse-string suture was placed around the posterior gastrotomy in the modified binding *** the modified Blumgart technique,only a single transpancreatic horizontal mattress suture was placed on either side of the pancreatic duct(total two sutures)to secure the pancreatic parenchyma to the ***,on the ventral surface,the knot is tied on the jejunal wall without going through the pancreatic *** pancreatectomy complications are graded as per the RESULTS During the study period,modified binding PG was performed in 27 patients and modified Blumgart PJ in 29 *** demographic and clinical parameters of the first 25 patients included in both groups were *** end cholangiocarcinoma and ampullary adenocarcinoma were the primary indications for laparoscopic PD in both groups(32/50,64%).The median operative time for pancreatic reconstruction was significantly lower in the binding PG group(42 vs 58 min,P=0.01).The clinically relevant(Grade B/C)postoperative pancreatic fistula(POP

关键词： Pancreaticoduodenectomy Laparoscopy Pancreatic cancer Pancreaticojejunostomy Neoplasms Tumors

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Do preoperative pancreatic computed tomography attenuation index and enhancement ratio predict pancreatic fistula after pancreaticoduodenectomy?

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World Journal of Radiology 2022年第6期14卷 165-176页

作者： senthil gnanasekaran Satish Durgesh Ramprakash Gurram Raja Kalayarasan Biju Pottakkat M Rajeswari Bheemanathi Hanuman Srinivas A Ramesh Jayaprakash Sahoo Department of Surgical Gastroenterology Jawaharlal Institute of Postgraduate Medical Education and ResearchPuducherry 605006India Department of Biostatistics Jawaharlal Institute of Postgraduate Medical Education and ResearchPuducherry 605006India Department of Pathology Jawaharlal Institute of Postgraduate Medical Education and ResearchPuducherry 605006India Department of Radiodiagnosis Jawaharlal Institute of Postgraduate Medical Education and ResearchPuducherry 605006India Department of Endocrinology Jawaharlal Institute of Postgraduate Medical Education and ResearchPuducherry 605006India

BACKGROUND The commonly used predictors of clinically relevant postoperative pancreatic fistula(CR-POPF)following pancreaticoduodenectomy(PD)have subjective assessment components and can be used only in the postoperative ***,the available objective predictors based on preoperative cross-sectional imaging were not prospectively *** To evaluate the accuracy of the pancreatic attenuation index(PAI)and pancreatic enhancement ratio(PER)for predicting CR-POPF following PD and its correlation with pancreatic fat fraction and *** A prospective observational study included patients who underwent PD for benign and malignant pathology of the periampullary region or pancreatic head between February 2019 and February *** undergoing extended or total pancreatectomy and those with severe atrophy of pancreatic tissue or extensive parenchymal calcifications in the pancreatic head and neck precluding calculation of PAI and PER were excluded from the *** PAI was measured in the neck of the pancreas by marking regions of interest(ROI)in the non-contrast computed tomography(CT),and PER was measured during the contrast phase of the CT ***,the fibrosis score and fat fraction of the pancreatic neck were assessed during the histopathological ***,clinical and preoperative radiological indices(PAI,PER)were evaluated to predict *** pancreatic neck CT indices were correlated with the histopathological assessment of fat fraction and *** Of the 70 patients who underwent PD,61 patients fulfilling the inclusion criteria were included in the *** incidence of CR-POPF was 29.5%(18/61).PAI had no association with the development of *** the preoperative parameters,PER(mean±standard deviation[SD])was significantly lower in patients developing CR-POPF(0.58±0.20 vs 0.81±0.44,P=0.006).The area under the curve for the PER was 0.661(95%CI:0.517-0.804),which was significant(P=0.04

关键词： Pancreatic fistula Minimally invasive Pancreaticoduodenectomy Pancreatic cancer Neoplasms Computed tomography

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