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Postoperative complications and weight loss following jejunostomy tube feeding after total gastrectomy for advanced adenocarcinomas

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Chinese Journal of Cancer Research 2017年第4期29卷 333-340页

作者： Hylke J.F. Brenkman Stephanie V.S. Roelen Elles Steenhagen Jelle P. Ruurda richard van hillegersberg Cancer Center Department of Surgery University Medical Center Utrecht PO Box 85500 3508 GA Utrecht the Netherlands Internal Medicine and Dermatology Department of Dietetics University Medical Center Utrecht PO Box 85500 3508 GA Utrecht the Netherlands Correspondence to R van Hillegersberg MD PhD. Department of Surgery University Medical Centre Utrecht G04.228 PO Box 85500 3508 GA

Objective： Patients undergoing total gastrectomy for cancer are at risk of malnourishment. The aim of this self- controlled study was to examine the effect of jejunostomy tube feeding （JTF） and other factors on postoperative weight and the incidence of jejunostomy-related complications in patients undergoing total gastrectomy for cancer. Methods： All consecutive patients who underwent total gastrectomy for gastric cancer with jejunostomy plaeement were included from a prospective single-center database （2003-2014）. Jejunostomy-related complications and postoperative weight changes were evaluated up to 12 months after surgery. Multivariable linear regression analysis was performed to identify factors associated with weight loss 12 months after gastreetomy. Results： Of 113 patients operated in the study period, 65 received JTF after total gastrectomy for a median duration of 18 d [interquartile range （IQR）, 10-55 d]. Jejunostomy-related complieations occurred in 11 （17%） patients, including skin leakage （n=3） and peritoneal leakage （n=2）, luxation （n=3）, occlusion （n=2）, infection （n=l） and torsion （n=l）. In 2 （3%） patients, a reoperation was needed due to jejtmostomy-related complications. The mean preoperative weight of patients was 71.8 kg （100%）, and remained stable during JTF （73.9 kg, 103%, P=0.331）. After JTF was stopped, the mean weight of patients decreased to 64.9 kg （90%） at 12 months after surgery （P〈0.001）. A high preoperative body mass index （BMI）（〉_25 kg/m2） was associated with high postoperative weight loss compared to patients with a low BMI （〈25 kg/m2）（16.3% vs. 8.6%, P=0.016）. Conclusions： JTF can prevent weight loss in the early postoperative phase. However, this is at the prize of possible complications. As weight loss in the long term is not prevented, routine JTF should be re-evaluated and balanced against the selected use in preoperatively malnourished patients. Special attention should be paid to patients with a high preoperative BMI, who ar

关键词： Gastric cancer total gastrectomy jejunostomy tube feeding weight

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Worldwide practice in gastric cancer surgery

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World Journal of Gastroenterology 2016年第15期22卷 4041-4048页

作者： Hylke JF Brenkman Leonie Haverkamp Jelle P Ruurda richard van hillegersberg Department of Surgery University Medical Center Utrecht

AIM: To evaluate the current status of gastric cancer surgery ***: An international cross-sectional survey on gastric cancer surgery was performed amongst international upper gastro-intestinal surgeons. All surgical members of the International Gastric Cancer Association were invited by e-mail to participate. An English web-based survey had to be filled in with regard to their surgical preferences. Questions asked included hospital volume, the use of neoadjuvant treatment, preferred surgical approach, extent of the lymphadenectomy and preferred anastomotic technique. The invitations were sent in September 2013 and the survey was closed in January ***: The corresponding specific response rate was 227/615(37%). The majority of respondents: originated from Asia( 5 4 %), performed > 2 1 gastrectomies per year(79%) and used neoadjuvant chemotherapy(73%). An open surgical procedure was performed by the majority of surgeons for distal gastrectomy for advanced cancer(91%) and total gastrectomy for both early and advanced cancer(52% and 94%). A minimally invasive procedure was preferred for distal gastrectomy for early cancer(65%). In Asia surgeons preferred a minimally invasive procedure for total gastrectomy for early cancer also(63%). A D1+ lymphadenectomy was preferred in early gastric cancer(52% for distal, 54% for total gastrectomy) and a D 2 lymphadenectomy was preferred in advanced gastric cancer(93% for distal, 92% for total gastrectomy) CONCLUSION: Surgical preferences for gastric cancer surgery vary between surgeons worldwide. Although the majority of surgeons use neoadjuvant chemotherapy, minimally invasive techniques are still not widely adapted.

关键词： Gastric cancer Gastrectomy Laparoscopy neoplasm minimally invasive surgery

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科学严谨的患者信息登记是高质量胃癌外科研究的基石——荷兰上消化道癌症审计数据库11年经验分享

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中华胃肠外科杂志 2023年第2期26卷 148-153页

作者：王敬普 Eline M de Groot Maurits R Visser Misha D.P Luyer Jelle P Ruurda richard van hillegersberg 荷兰乌特勒支大学医学中心外科部荷兰乌特勒支3584CX 荷兰临床审计研究所科学局荷兰莱顿2333AA 凯瑟琳那医院外科部荷兰埃因霍温5623EJ

随着过去数十年微创技术、围手术期康复干预和集中化医疗制度的逐步应用,胃癌术后30 d病死率和并发症发生率有了显著改善。然而,当前阶段的胃癌术后短期预后依然不容乐观,可能对胃癌手术治疗的疗效产生严重的负面影响,仍有很大的改善空... 详细信息

随着过去数十年微创技术、围手术期康复干预和集中化医疗制度的逐步应用,胃癌术后30 d病死率和并发症发生率有了显著改善。然而,当前阶段的胃癌术后短期预后依然不容乐观,可能对胃癌手术治疗的疗效产生严重的负面影响,仍有很大的改善空间。高质量的临床研究是分析治疗结果和评估新治疗策略的重要工具。因此,严谨的胃癌患者信息登记作为高质量外科研究的基础应受到足够重视。在过去的11年里,荷兰上消化道癌症审计(DUCA)数据库在上消化道肿瘤患者的数据登记和维护方面拥有丰富的经验,它在数据登记、数据质量控制、数据申请和使用以及数据安全等方面采取的有效措施,使得该数据库中患者数据的质量保持在较高水平。这些数据已被广泛用于医疗质量监测和科学研究,对改善上消化道癌症患者的术后短期预后产生了非常积极的影响。DUCA的工作可能对建立基于人群的临床数据库具有一定的参考价值。

关键词：胃肿瘤并发症荷兰上消化道癌症审计,数据库

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Strategies to reduce pulmonary complications after esophagectomy

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World Journal of Gastroenterology 2013年第39期19卷 6509-6514页

作者： Teus J Weijs Jelle P Ruurda Grard AP Nieuwenhuijzen richard van hillegersberg Misha DP Luyer Department of Surgery University Medical Center Utrecht3584 CX UtrechtThe Netherlands Department of Surgery Catharina Hospital Eindhoven5623 EJ EindhovenThe Netherlands

Esophagectomy,the surgical removal of all or part of the esophagus,is a surgical procedure that is associated with high morbidity and *** complications are an especially important postoperative ***,many perioperative strategies to prevent pulmonary complications after esophagectomy have been investigated and introduced in daily clinical ***,we review these strategies,including improvement of patient performance and technical advances such as minimally invasive surgery that have been implemented in recent ***,interventions such as methylprednisolone,neutrophil elastase inhibitor and epidural analgesia,which have been shown to reduce pulmonary complications,are *** of the commonly applied routine nasogastric decompression,delay of oral intake and prophylactic mechanical ventilation are unclear,and many of these strategies are also evaluated ***,we will discuss recent insights and new developments aimed to improve pulmonary outcomes after esophagectomy.

关键词： Esophagectomy Complications Pneumonia Acute lung injury Acute respiratory distress syndrome

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Primary lymphoma of the liver-A complex diagnosis

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World Journal of Radiology 2012年第2期4卷 53-57页

作者： Ernst JA Steller Maarten S van Leeuwen richard van hillegersberg Marguerite EI Schipper Inne HM Borel Rinkes Izaak Q Molenaar Department of Hepato Biliary Surgery University Medical Centre Utrecht Heidelberglaan 100 3584 CX Utrecht The Netherlands Department of Radiology University Medical Centre Utrecht Heidelberglaan 100 3584 CX Utrecht The Netherlands

A 59-year-old woman presented with the clinical symptoms and radiologic investigations of a liver lesion suspect of metastasis. However, postoperative histopathology revealed a primary hepatic lymphoma (PHL). The case of a patient with a solitary PHL, which was treated by resection and subsequent chemotherapy, will be discussed with a short overview of the literature.

关键词： Primary Hepatic Lymphoma Liver Diagnosis Computed tomography Magnetic resonance imaging

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