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Duodenum-preserving local excision of a gastrointestinal stromal tumor

Hepatobiliary & Pancreatic Diseases International 2008年第2期7卷 214-216页

作者： Chandika AH Liyanage Sanjaya Abeygunawardhana sumudu kumarage Kemal I Deen Department of Surgery University of Kelaniya Medical School Ragama Sri Lanka

BACKGROUND:Duodenal gastrointestinal stromal tumors (GISTs) are rare. Because of the complex anatomy of the duodenum, the methods of resection of these tumors are controversial and diverse. METHODS:We report a case of a duodenal GIST in the anterolateral wall of the second part of the duodenum, which was successfully managed by local excision. The surgery was facilitated by preoperative mapping with Indian ink and navigation by endoscopy to assess the adequacy of resection and to avoid injury to the ampulla. RESULT:Reconstruction was successful with a duodeno-jejunostomy and protected by a nasoduodenal drain. CONCLUSION:The patient had no postoperative complications and the tumor was confirmed to be a GIST of the duodenum successful with an adequate resection margin.

关键词： gastrointestinal stromal tumor local excision, duodenum

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Proximal and distal rectal cancers differ in curative resectability and local recurrence

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World Journal of Gastrointestinal Surgery 2011年第8期3卷 113-118页

作者： Wasantha Wijenayake Mahendra Perera Jayantha Balawardena Raeed Deen S Ruwan Wijesuriya sumudu K kumarage Kemal I Deen Department of Surgery National Hospital Department of Oncology National Cancer Institute Maharagama Sri Lanka Department of Surgery University of Kelaniya Medical School

AIM: To evaluate patients with proximal rectal cancer (PRC) (> 6 cm up to 12 cm) and distal rectal cancer (DRC) (0 to 6 cm from the anal verge). METHODS: Two hundred and eighteen patients (120 male, 98 female, median age 58 years, range 19-88 years) comprised 100 with PRC and 118 with DRC. The proportion of T1, T2 vs T3, T4 stage cancers was similar in both groups (PRC: T1+T2 = 29%; T3+T4 = 71% and DRC: T1+T2 = -31%; T3+T4 = 69%). All patients had cancer confined to the rectum -those with synchronous distant metastasis were excluded. Surgical resection was with curative intent with or without pre-operative chemoradiation (c-RT). Follow-up was for a median of 35 mo (range: 12 to 126 mo). End points were: 30 d mortality, complications of operation, microscopic tumour-free margins, resection with a tumour-free circumferential margin (CRM) of 1 to 2 mm and > 2 mm, local recurrence, survival and the permanent stoma rate. RESULTS: Overall 30-d mortality was 6% (12): PRC 7 % and DRC 4%. Postoperative complications occurred in 14% with PRC compared with 21.5% with DRC, urinary retention was the complication most frequently reported (PRC 2% vs DRC 9%, P = 0.04). Twelve percent with PRC compared with 37% with DRC were subjected to preoperative c-RT (P = 0.03). A tumour-free CRM of 1 to 2 mm and > 2 mm was reported in 93% and 82% with PRC and 88% and 75% with DRC respectively (PRC vs DRC, P > 0.05). However, local recurrence was 5% for PRC vs 11% for DRC (P < 0.001). Three and five years survival was 65.6% and 60.2% for PRC vs 67% and 64.3% for DRC respectively. No patient with PRC and 23 (20%) with DRC received an abdomino-perineal resection. CONCLUSION: PRC and DRC differ in the rate of abdomino-perineal resection, post-operative urinary retention and local recurrence. Survival in both groups was similar.

关键词： Rectal cancer Pre-operative chemoradiation Inter-sphincteric resection Local recurrence Survival

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