Naso-gastric or naso-jejunal decompression after partial distal gastrectomy for gastric cancer. Final results of a multicenter prospective randomized trial Fabio PacelliFausto RosaDaniele MarrelliPaolo MorgagniMassimo Framarini • Luigi CristadoroCorrado PedrazzaniRiccardo CasadeiLuca CozzaglioMar... (original) (raw)
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Gastric Cancer, 2013
Background Only a few, small, monocentric randomized controlled trials (RCTs) have compared routine vs. no placement of a nasogastric or nasojejunal tube decompression (NG/NJT) in patients undergoing partial distal gastrectomy (PDG) for gastric cancer. However, to our knowledge, no multicenter prospective RCT has analyzed the role of decompression after both the Billroth II (BII) procedure and Roux-en-Y (RY) gastrojejunostomy. The aim of this study was to determine whether NG/NJT prevents the consequences of postoperative ileus after PDG for gastric cancer after both BII reconstruction and RY. Methods Two hundred seventy patients undergoing PDG for gastric cancer were randomly assigned NG/NJT placement (NG/NJT group) or not (no-NG/NJT group) with either Billroth II gastrojejunostomy or Roux-en-Y gastrojejunostomy. The patients were monitored for postoperative complications, mortality, and postoperative course. Results By January 2010 to June 2012, among 270 patients undergoing PDG for gastric cancer, 134 were randomly assigned to NG/NJT placement (NG/NJT group) and 136 to no decompression (no-NG/NJT group). Time to passage of flatus was significantly shorter in the NG/NJT group than in the no-NG/NJT group, but only after RY reconstruction (3.3 ± 1.5 vs. 4.3 ± 1.6 days, P \ 0.001, respectively). Postoperative abdominal distention was significantly lower in The results of this trial were presented as the Best Free Presentation at the 10th International Gastric Cancer Congress held in Verona (Italy) on 19-22 June 2013. On Behalf of the Italian Research Group for Gastric Cancer-G.I.R.C.G. (Gruppo Italiano di Ricerca per il Cancro Gastrico).
Early Complications after Gastrectomies for Locally Advanced Gastric Cancer
Chirurgia, 2021
Background: The post-operative results as well as the short and middle-term outcome of surgical procedures for gastric cancer depend on several general and local conditions, mainly on the stage of neoplasia. Delayed diagnosis and intervention are correlated with a high rate of postoperative morbidity and mortality. Methods: 76 consecutive patients underwent surgical treatment for gastric cancer over a time span of 5 years (2015-2019), in the 1st Surgical Department of "Dr.I.Cantacuzino" Clinical Hospital. There have been 46 distal gastrectomies, 12 DI total gastrectomies and 18 DII total gastrectomies, 8 of them with multi-organ resection. Results: Among them, 50 patients had a favorable evolution, 7 developed complications which were manageable through a conservative approach, while 19 needed one or more reinterventions. We encountered 10 cases of severe sepsis and MSOF, followed by exitus. Conclusions: The surgical treatment of locally advanced gastric cancer poses many ...
Digestive Decompression to Prevent Digestive Fistulas After Gastric Neoplasm Resection
Chirurgia, 2016
Decompresia digestivã în prevenåia fistulelor digestive dupã rezecåia gastricã pentru neoplasm Introducere: Riscul de fistulã digestivã la pacienåii operaåi pentru neoplasm gastric este crescut datoritã dezechilibrelor biologice generate de evoluåia cancerului, de stadiile avansate la prezentare aei de amploarea intervenåiei. În aceste condiåii utilizarea unor metode tehnice care sã protejeze suturile digestive la aceaeti pacienåi este utilã. Scop: Analiza eficienåei mijloacelor tehnice de protejare a suturilor digestive la pacienåii operaåi în diferite stadii de evoluåie a cancerului gastric. Material aei metodã: Am efectuat un studiu retrospectiv pentru un lot format din 130 pacienåi operaåi pentru cancer gastric în Clinica de Chirurgie Generalã aei Oncologicã I IOB, între 2010-2014. Rezultate: În lotul studiat 38,46% dintre pacienåi au fost în stadiul IV cu complicaåii aei multiple dezechilibre biologice. S-au efectuat 52 de gastrectomii totale, 40 de rezecåii gastrice, iar la 34 pacienåi s-au efectuat "excizii tumorale" paliative sau alte tipuri de intervenåii chirurgicale paliative. La 15 pacienåi dintre cei cu rezecåii gastrice s-a utilizat sondã de decompresie duodenalã, iar la 13 pacienåi dintre cei cu gastrectomie totalã s-a utilizat sonda de aspiraåie esojejunalã alãturi de sonda de alimentaåie jejunalã ca mãsuri tehnice suplimentare de prevenire a fistulei. Incidenåa fistulei de bont duodenal a fost de 7,69%, cea a fistulei de anastomoza esojejunalã de 2,3%, cu o mortalitate generalã de 3,07%, iar la anastomoza gastro-jejunalã a fost de 0,76%. Concluzie: Având în vedere riscul de fistulã la pacienåii cu cancer gastric precum aei creaeterea acestui risc în stadiile avansate de evoluåie, apreciem cã utilizarea mijloacelor tehnice de protecåie a suturilor digestive este beneficã aei oportunã ducând la scãderea incidenåei fistulelor, la scãderea debitului aei a efectelor fiziopatologice ale acestora precum aei la reducerea mortalitãåii.
Total gastrectomy and its early postoperative complications in gastric cancer
Archive of Oncology, 2000
Background: The study shows operative results and complications occuring in the first 30 days after total gastrectomy because of stomach cancer. Materials and methods: Retrograde analysis was performed using medical documentation and histologic findings of 76 patients after total gastrectomy done between 1990 and 1997. Mortality and postoperative complications were analysed. Complications were sorted as specific and non-specific. All operations were done either for intestinal gastric cancer located in proximal stomach or for diffuse stomach cancer. All anastomoses were sewn by hand. Eight surgeons were performing the operations. Results: There were 43 male and 33 female patients. Postoperative mortality was 14.4%. Most frequent complications were: dehiscence of oesophago-jejuno anastomosis, which happened in 15.8% of operated patients, postoperative temperature without apparent infection in 5.2%, thrombophebitis in 5.2%. Pneumothorax with a frequency of 3.9%, hepatic necrosis in one patient 1.3%, and perforation of jejunal loop with nasogastric tube in 1.3%, which all ended fatally contributed to the relatively high mortality. Mean postoperative intrahospital treatment lasted 12.3 days. Dehiscence of oesophagoentero-anastomosis, resulted in generalised peritonitis in 66.6%. Six patients succumbed as a consequence, while two survived with subphrenic and intraansal abscesses. Pneumothorax in combination with total gastrectomy was always fatal. Conclusion: Routine use of stapling surgery, sub-specialisation in surgery and better early intensive care monitoring and treatment could improve mortality rate.