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Endoscopic multiple metal stenting for the treatment of enteral leaks near the biliary orifice: A novel effective rescue procedure

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World Journal of Gastrointestinal endoscopy 2016年第15期8卷 533-540页

作者： Massimiliano Mutignani Lorenzo Dioscoridi Stefanos Dokas Paolo Aseni Pietro Carnevali Edoardo Forti Raffaele Manta Mariano Sica Alberto Tringali Francesco Pugliese Digestive and interventional endoscopy Unit Ospedale Ca’Granda Niguarda endoscopy department St Lukes Hospital Emergency department Ospedale Ca’Granda Niguarda General oncology and Mini-Invasive surgical Unit Ospedale Ca’ Granda Niguarda

Between April 2013 and October 2015, 6 patients developed periampul ary duodenal or jejunal/biliary leaks after major abdominal surgery. In all patients, percutaneous drainage of the collection or re-operation with primary surgical repair was attempted at first but failed. A fully covered enteral metal stent was placed in all patients to seal the leak. Subsequently, we cannulated the common bile duct and, in some cases, and the main pancreatic duct inserting hydrophilic guidewires through the stent after dilating the stent mesh with a dilatation balloon or breaking the meshes with Argon Plasma Beam. Finally, we inserted a fully covered biliary metal stent to drain the bile into the lumen of the enteral stent. In cases of normal proximal upper gastrointestinal anatomy, a pancreatic plastic stent was also inserted. Oral food intake was initiated when the abdominal drain outflow stopped completely. Stent removal was scheduled four to eight weeks later after a CT scan to confirm the complete healing of the fistula and the absence of any perilesional residual fluid collection. The leak resolved in five patients. One patient died two days after the procedure due to severe, pre-existing, sepsis. The stents were removed endoscopically in four weeks in four patients. In one patient we experiencedstent migration causing small bowel obstruction. In this case, the stents were removed surgically. Four patients are still alive today. They are still under follow-up and doing well. Bilio-enteral fully covered metal stenting with or without pancreatic stenting was feasible, safe and effective in treating postoperative enteral leaks near the biliopancreatic orifice in our small series. This minimally invasive procedure can be implemented in selected patients as a rescue procedure to repair these challenging leaks.

关键词： Endoscopic retrograde pancreatic duct Fully covered metal stent Duodenal leak Postoperative complications Enteral leak Enteral stent Biliary stent Pancreatic stent

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Role of endoscopic ultrasound-guided biliary drainage for palliation of malignant biliary obstruction

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World Journal of Gastrointestinal Surgery 2024年第8期16卷 2369-2373页

作者： Sahib Singh Saurabh Chandan Antonio Facciorusso department of Internal Medicine Sinai HospitalBaltimoreMD 21215United States Center for interventional endoscopy(CIE) Advent HealthOrlandoFL 32803United States Gastroenterology Unit Department of Medical and Surgical SciencesUniversity of FoggiaFoggia 71122Italy

Endoscopic ultrasound-guided biliary drainage(EUS-BD)directs bile flow into the digestive tract and has been mostly used in patients with malignant biliary obstruction(MBO)where endoscopic retrograde cholangiopancreatography-guided biliary drainage was unsuccessful or was not *** apposing metal stents(LAMS)are deployed during EUS-BD,with the newer electrocautery-enhanced LAMS reducing procedure time and complication rates due to the inbuilt cautery at the catheter ***-BD with electrocautery-enhanced LAMS has high technical and clinical success rates for palliation of MBO,with bleeding,cholangitis,and stent occlusion being the most common adverse *** studies have even suggested comparable efficacy between EUS-BD and endosc-opic retrograde cholangiopancreatography as the primary approach for distal *** this editorial,we commented on the article by Peng et al published in the recent issue of the World Journal of Gastrointestinal Surgery in 2024.

关键词： Endoscopic ultrasound Endoscopic ultrasound guided biliary drainage Cancer Pancreas Bile duct endoscopy

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UNILATERAL BIG HOCKEY STICK INCISION FOR NECK DISSECTION IN HEAD AND NECK CARCINOMA

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Chinese Journal of Cancer Research 2004年第3期16卷 193-196页

作者：刘宝国赵振生李明强陈荣鋭王建军张乃嵩 department of Head and Neck Surgery and surgical oncology Peking University School of Oncology Beijing Institute for Cancer Research Beijing Cancer Hospital department of Surgery Liangxiang Hospital department of Head and Neck Surgery and surgical oncology Peking University Shougang Hospital

Objective: To investigate for the feasibility and advantages performed by the unilateral big hockey stick incision (BHSI) in head and neck carcinoma. Methods: Neck dissection by using the unilateral big hockey stick incision (BHSI) was performed on 93 patients with head and neck carcinoma. Results: The big hockey stick incision has a cosmetic scar and not scar contraction and is barely visible and easily covered in hair and clothing; sufficient exposure of the operation field; a small area of marginal necrosis was occasionally seen at the apex of the skin flap due to having preoperative radiotherapy. Conclusion: The unilateral big hockey stick incision has adequate surgical access, good healing of skin flaps, and a good cosmetic result.

关键词： Incision Neck dissection Head and neck carcinoma

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Endoscopic and surgical resection of T1a/T1b esophageal neoplasms: A systematic review

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World Journal of Gastroenterology 2013年第9期19卷 1424-1437页

作者： George Sgourakis Ines Gockel Hauke Lang department of General and Abdominal Surgery Johannes Gutenberg University Hospital of Mainz 2nd surgical department and surgical oncology Unit of "Korgialenio-Benakio" Red Cross Hospital of Athens

AIM: To investigate potential therapeutic recommendations for endoscopic and surgical resection of T1a/ T1b esophageal neoplasms. METHODS: A thorough search of electronic databases MEDLINE, Embase, Pubmed and Cochrane Library, from 1997 up to January 2011 was performed. An analysis was carried out, pooling the effects of outcomes of 4241 patients enrolled in 80 retrospective studies. For comparisons across studies, each reporting on only one endoscopic method, we used a random effects meta-regression of the log-odds of the outcome of treatment in each study. "Neural networks" as a data mining technique was employed in order to establish a prediction model of lymph node status in superficial submucosal esophageal carcinoma. Another data mining technique, the "feature selection and root cause analysis", was used to identify the most impor-tant predictors of local recurrence and metachronous cancer development in endoscopically resected patients, and lymph node positivity in squamous carcinoma (SCC) and adenocarcinoma (ADC) separately in surgically resected patients. RESULTS: Endoscopically resected patients: Low grade dysplasia was observed in 4% of patients, high grade dysplasia in 14.6%, carcinoma in situ in 19%, mucosal cancer in 54%, and submucosal cancer in 16% of patients. There were no significant differences between endoscopic mucosal resection and endoscopic submucosal dissection (ESD) for the following parameters: complications, patients submitted to surgery, positive margins, lymph node positivity, local recurrence and metachronous cancer. With regard to piecemeal resection, ESD performed better since the number of cases was significantly less [coefficient: -7.709438, 95%CI: (-11.03803, -4.380844), P < 0.001]; hence local recurrence rates were significantly lower [coefficient: -4.033528, 95%CI: (-6.151498, -1.915559),P < 0.01]. A higher rate of esophageal stenosis was observed following ESD [coefficient: 7.322266, 95%CI: (3.810146, 10.83439), P < 0.001]. A

关键词： Superficial esophageal cancer Endoscopic resection Mucosal infiltration Submucosal involvement Recurrent tumor Controversies in treatment Squamous cell carcinoma Adenocarcinoma Lymphatic invasion Vascular invasion Submucosal layer Superficial submucosal layer Middle third submucosal layer Deep third submucosal layer Esophageal cancer Endoscopic gastrointestinal surgical procedures Endoscopic gastrointestinal surgery Lymph node dissection Dysplasia

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Postoperative pancreatic fistula after distal pancreatectomy: pancreatic thickness and duct size as the only denominators?

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Hepatobiliary Surgery and Nutrition 2023年第2期12卷 229-231页

作者： Antoine Notte Alexandre Doussot department of Digestive surgical oncology Liver Transplantation UnitChu BesanconFrance

We read with great interest the multicenter study from De Pastena and colleagues dealing with the prediction of clinically relevant postoperative pancreatic fistula(CR-POPF)after distal pancreatectomy(DP)(1).The study aimed to develop two *** was solely based on preoperative *** second one relied on both preoperative and intraoperative data.

关键词： fistula dealing distal

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Up-to-date intraoperative computer assisted solutions for liver surgery

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World Journal of Gastrointestinal Surgery 2019年第1期11卷 1-10页

作者： Apollon Zygomalas Ioannis Kehagias surgical oncology OLYMPION General Clinic of Patras department of Surgery University Hospital of Patras

Computer assisted surgical planning allowed for a better selection of patients,evaluation of operative strategy, appropriate volumetric measurements,identification of anatomical risks, definition of tumour resection margins and choice of surgical approach in liver oncologic resections and living donor liver transplantations. Although preoperative computer surgical analysis has been widely used in daily clinical practice, intraoperative computer assisted solutions for risk analysis and navigation in liver surgery are not widely available or still under clinical evaluation. Computer science technology can efficiently assist modern surgeons during complex liver operations, mainly by providing image guidance with individualized 2 D images and 3 D models of the various anatomical and pathological structures of interest. Intraoperative computer assisted liver surgery is particularly useful in complex parenchyma-sparing hepatectomies, for intraoperative risk analysis and for the effective treatment of colorectal metastases after neoadjuvant therapy or when they are multiple. In laparoscopic liver surgery, intraoperative computer aid is definitively more important as, apart from a restricted field of view, there is also loss of the fine haptic feedback. Intraoperative computer assisted developments face challenges that prevent their application in daily clinical practice. There is a vast variety of studies regarding intraoperative computer assisted liver surgery but there are no clear objective measurements in order to compare them and select the most effective solutions. An overview of up-to-date intraoperative computer assisted solutions for liver surgery will be discussed.

关键词： Computer assisted surgery Liver Intraoperative 3D models Navigation Image guidance Augmented reality Hepatic surgery Hepatectomy

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HIGH-INTENSITY FOCUSED ULTRASOUND FOR TREATMENT OF UNRESECTABLE TUMORS LOCATED IN THE WALLS OF CHEST AND ABDOMEN IN 10 PATIENTS

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Chinese Journal of Cancer Research 2003年第3期15卷 217-222页

作者：郑国强郭峰霍苓李正 department of surgical oncology Peking University School of Oncology Beijing Cancer Hospital Beijing Institute for Cancer Research Beijing 100036

Objective: To present our results of high-intensity focused ultrasound (HIFU) treatment in 10 patients with unresectable tumors involved in the walls of chest and abdomen. Methods: Tumors located in the walls of the chest and abdomen in 10 patients were treated by HIFU, including local recurrence of fibrosarcoma in 1 case and local invasion or metastases in 9 cases. All of the 10 patients had received anti-cancer treatments before HIFU, 3 patients were complicated with intercostal neuralgia. Results: Partial responses were obtained in 2 patients, minor response in 1 patient, stable disease in 4, progressive disease in 2 after HIFU treatments. All the intercostal neuralgia in 3 patients was disappeared after HIFU. Bone scan showed that site of rib metastasis before HIFU became normal after HIFU in one patient. Conclusion: Our preliminary results showed that HIFU could get good results for patients with malignant tumors located in the walls of chest and abdomen if they are focal tumors, even if they are complicated with rib metastasis.

关键词： Malignant tumor HIFU Chest wall Metastasis Intercostal neuralgia

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Comparison of open and closed hyperthermic intraperitoneal chemotherapy: Results from the United States hyperthermic intraperitoneal chemotherapy collaborative

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World Journal of Gastrointestinal oncology 2020年第7期12卷 756-767页

作者： Jennifer L Leiting Jordan M Cloyd Ahmed Ahmed Keith Fournier Andrew J Lee Sophie Dessureault Seth Felder Jula Veerapong Joel M Baumgartner Callisia Clarke Harveshp Mogal Charles A Staley Mohammad Y Zaidi Sameer H Patel Syed A Ahmad Ryan J Hendrix Laura Lambert Daniel E Abbott Courtney Pokrzywa Mustafa Raoof Christopher J LaRocca Fabian M Johnston Jonathan Greer Travis E Grotz Division of Hepatobiliary and Pancreas Surgery Mayo ClinicRochesterMN 55901United States Division of surgical oncology Department of SurgeryThe Ohio State University Wexner Medical CenterColumbusOH 43210United States department of surgical oncology University of Texas MD Anderson Cancer CenterHoustonTX 77030United States department of Gastrointestinal oncology Moffitt Cancer CenterDepartment of Oncologic SciencesMorsani College of MedicineTampaFL 33612United States Division of surgical oncology Department of SurgeryUniversity of CaliforniaSan DiegoCA 92093United States Division of surgical oncology Department of SurgeryMedical College of WisconsinMilwaukeeWI 53226United States Division of surgical oncology Winship Cancer InstituteEmory UniversityAtlantaGA 30322United States department of Surgery University of Cincinnati College of MedicineCincinnatiOH 45267United States Division of surgical oncology Department of SurgeryUniversity of Massachusetts Medical SchoolWorcesterMA 01655United States Peritoneal Surface Malignancy Program Section of surgical oncology Huntsman Cancer InstituteUniversity of UtahSalt Lake CityUT 84112United States Division of surgical oncology Department of SurgeryUniversity of WisconsinMadisonWI 53792United States Christopher La Rocca Division of Surgical OncologyDepartment of SurgeryCity of Hope National Medical CenterDuarteCA 91010United States department of Surgery Johns Hopkins UniversityBaltimoreMD 21287United States

BACKGROUND Cytoreductive surgery(CRS)with hyperthermic intraperitoneal chemotherapy(HIPEC)for peritoneal carcinomatosis can be performed in two ways:Open or closed abdominal *** To evaluate the impact of HIPEC method on post-operative and long-term survival *** Patients undergoing CRS with HIPEC from 2000-2017 were identified in the United States HIPEC collaborative ***-operative,recurrence,and overall survival outcomes were compared between those who received open vs closed *** Of the 1812 patients undergoing curative-intent CRS and HIPEC,372(21%)patients underwent open HIPEC and 1440(79%)underwent closed *** was no difference in re-operation or severe complications between the two *** HIPEC had higher rates of 90-d readmission while open HIPEC had a higher rate of 90-d *** multi-variable analysis,closed HIPEC technique was not a significant predictor for overall survival(hazards ratio:0.75,95%confidence interval:0.51-1.10,P=0.14)or recurrence-free survival(hazards ratio:1.39,95%confidence interval:1.00-1.93,P=0.05)in the entire *** findings remained consistent in the appendiceal and the colorectal *** In this multi-institutional analysis,the HIPEC method was not independently associated with relevant post-operative or long-term *** technique may be left to the discretion of the operating surgeon.

关键词： Mucinous appendiceal carcinoma Cytoreductive surgery Multi-institutional

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LOOSENING　AND　LENGTHENING　OF　INTESTINAL　TRACT　AFTER　RECTAL　ISOLATION　IN　ANUS－SAVING　RESECTION　FOR　RECTAL　CARCINOMA

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Chinese Journal of Cancer Research 1995年第2期7卷 127-129页

作者：张保宁余宏迢邵永孚 department surgical oncology Cancer Hospital Chinese Academy of Medical Sciences Beijing

In low rectal cancer surgery,the section of rectum destal to the lower tumor maigin is relaxed and lengthened after fully isolation of the organ. This would facilitate the adoption of anus saving *** and after fully isolation of the rectum in low ratal cancer surgery, the distance between the lower tumor margin and the anorectal line was measured by the same rectuscope introduced through the *** two results were compared .The average lengthening was less than 1 cm if the lower tumor marginanorectal line distance was 5 *** was 1─2 cm if the lower tumor margin-anorectal distance was 6 *** was more than 2 cm if the distance was 7─9 *** loosening and lengthening of the rectal canal was related to the presence of lymphnode metastasis and the skill of the *** lengthening was also influenced by the body build of the patient,involvement of the rectal circumference and the Dukes stage. Modified Park's operation,trans abdominosacral resection with anastormosis of rectum,and anterior resection on transpubic approach are indicated for those in whom the lower tumor margin-anorectal line distance was 5 cm The rectectomy-anastomosis in the abdominal cavity(Dixon's operation)is indicated for those in whom the lower tumor margin-anorectal line was 6 *** manual anastomosis is difficult,stapling device may be used. The anus saving resection is easy if the distance was 7─9 cm.

关键词： Rectal carcinoma Lateral ligament Isolation of rectum Loosening and lengthening of intestinal tract Anus-saving resection.

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Trends with neoadjuvant radiotherapy and clinical staging for those with rectal malignancies

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World Journal of Gastrointestinal Surgery 2017年第4期9卷 97-102页

作者： Sanjay S Reddy Beth Handorf Jeffrey M Farma Elin R Sigurdson department of surgical oncology Fox Chase Cancer Center department of Biostatistics Fox Chase Cancer Center

AIM To see how patterns of care changed over time,and how institution type effected these *** A retrospective analysis was performed using the National Cancer Database,looking at all patients that were diagnosed with rectal cancer from 1998 to 2011. We tested differences in rates of treatment and stage migration using χ~2 tests and logistic regression models. RESULTS A review of ninety thousand five hundred and ninety four subjects underwent multimodality therapy for cancer of the rectum. Staging and response to treatment varied greatly between centers. Forty-six percent of the time staging was missing in academic practices,vs fiftyfour percent of the time in community centers(P < 0.001). As a result,twenty-percent were down-staged and eight percent up-staged in academia,whereas only fifteen percent were down-staged and 8% up-staged in community practices(P < 0.001). Forty-two percent of individuals underwent radiation before surgery in *** two years this increased to fifty-three percent. This increased to eighty-six percent by 2011(P < 0.001). Institution specific treatment varied greatly. Fifty-one percent received therapy before surgery in academic centers in 1998. Thirty-nine percent followed this pattern in the same year in the community(P < 0.001). By 2011,ninety-one percent received radiation before their procedure in academic centers,vs eighty-four percent in the community(P < 0.001). Rates of adoption were better in academia,although an increase was seen in both center types. CONCLUSION From the study dates of 1998 to 2011,preoperative treatment with radiation has been on the rise. There is certainly an increased rate of use of radiation in academia,however,this trend is also seen in the community. Practice patterns have evolved over time,although rates of assigning clinical stage are grossly underreported prior to initiation of preoperative therapy.

关键词： Neoadjuvant therapy Community Rectal cancer Academic

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