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Journal of Gastrointestinal Surgery :... Sep 2017Perforated diverticulitis carries the risk of significant comorbidity and mortality. Although colon resection provides adequate source control, the procedure itself... (Comparative Study)
Comparative Study Meta-Analysis Review
IMPORTANCE
Perforated diverticulitis carries the risk of significant comorbidity and mortality. Although colon resection provides adequate source control, the procedure itself carries morbidity, as well as later stoma reversal procedures. The effectiveness of laparoscopic lavage to treat perforated diverticulitis remains unclear.
OBJECTIVE
We aimed to conduct a meta-analysis to evaluate current studies comparing laparoscopic lavage with colon resection in cases of perforated diverticulitis for the effectiveness in source control, without the need for subsequent interventions, stoma formation, and death.
DATA SOURCES
Electronic database searches were conducted using EMBASE, Pubmed, CINAHL, Cochrane databases, and clinicaltrials.gov following PRISMA guidelines.
STUDY SELECTION
Randomized controlled trials (RCTs) were included that compared laparoscopic lavage against colon resection for perforated diverticulitis.
DATA EXTRACTION AND SYNTHESIS
Risk of bias in RCT's was assessed the Cochrane Assessment of Bias risk tool and Jadad scale. A meta-analysis was performed using random-effects risk ratios (RR) and 95% confidence intervals (CI).
MAIN OUTCOME
Outcome measures included the total rate of reoperation, rate of reoperation for infection, need for subsequent percutaneous drainage, stoma formation, and mortality rate within 90 days.
RESULTS
Three eligible randomized controlled studies were identified, with a combined total of 372 patients. Laparoscopic lavage carried an increased rate of total reoperations (RR 2.07; CI 1.12-3.84; p = 0.021) and an increased rate of reoperation for infection (RR 5.56; CI 1.97-15.69; p = 0.001) compared with colon resection. In addition, laparoscopic lavage increased the rate of subsequent percutaneous drainage (RR 6.54; CI 1.77-24.16; p = 0.005) compared with colon resection, but a lesser risk of stoma formation within 90 days (RR 0.18; CI 0.12-0.27; p < 0.001). No difference in mortality rate was observed between treatments (RR 1.03; CI 0.45-2.34; p = 0.950).
CONCLUSION
Despite decreased rates of stoma formation and equivalent mortality rates as compared with colon resection, laparoscopic lavage for Hinchey III diverticulitis fails to completely control the source of infection. Our data show that laparoscopic lavage is associated with increased rates of total reoperations, increased rates of reoperation for infections, and need for subsequent percutaneous drainage.
Topics: Colectomy; Diverticulitis, Colonic; Drainage; Humans; Intestinal Perforation; Laparoscopy; Peritoneal Lavage; Peritonitis; Randomized Controlled Trials as Topic; Reoperation; Surgical Stomas
PubMed: 28608041
DOI: 10.1007/s11605-017-3462-6 -
JAMA Surgery Jul 2019Peritoneal metastasis is the most frequent pattern of postoperative recurrence in patients with gastric cancer. Extensive intraoperative peritoneal lavage (EIPL) is a... (Randomized Controlled Trial)
Randomized Controlled Trial
IMPORTANCE
Peritoneal metastasis is the most frequent pattern of postoperative recurrence in patients with gastric cancer. Extensive intraoperative peritoneal lavage (EIPL) is a new prophylactic strategy for treatment of peritoneal metastasis of locally advanced gastric cancer; however, the safety and efficacy of EIPL is currently unknown.
OBJECTIVE
To evaluate short-term outcomes of patients with advanced gastric cancer who received combined surgery and EIPL or surgery alone.
DESIGN, SETTING, AND PARTICIPANTS
From March 2016 to November 2017, 662 patients with advanced gastric cancer receiving D2 gastrectomy were enrolled in a large, multicenter, randomized clinical trial from 11 centers across China. In total, 329 patients were randomly assigned to receive surgery alone, and 333 patients were randomly assigned to receive surgery plus EIPL. Clinical characteristics, operative findings, and postoperative short-term outcomes were compared between the 2 groups in the intent-to-treat population.
MAIN OUTCOMES AND MEASURES
Short-term postoperative complications and mortality.
RESULTS
The present analysis included data from 550 patients, 390 men and 160 women, with a mean (SD) age of 60.8 (10.7) years in the surgery alone group and 60.6 (10.8) in the surgery plus EIPL group. Patients assigned to the surgery plus EIPL group exhibited reduced mortality (0 of 279 patients) compared with those assigned to surgery alone (5 of 271 patients [1.9%]) (difference, 1.9%; 95% CI, 0.3%-3.4%; P = .02). A significant difference in the overall postoperative complication rate was observed between patients receiving surgery alone (46 patients [17.0%]) and those receiving surgery plus EIPL (31 patients [11.1%]) (difference, 5.9%; 95% CI, 0.1%-11.6%; P = .04). Postoperative pain occurred more often following surgery alone (48 patients [17.7%]) than following surgery plus EIPL (30 patients [10.8%]) (difference, 7.0%; 95% CI, 0.8%-13.1%; P = .02).
CONCLUSIONS AND RELEVANCE
Inclusion of EIPL can increase the safety of D2 gastrectomy and decrease postoperative short-term complications and wound pain. As a new, safe, and simple procedure, EIPL therapy is easily performed anywhere and does not require any special devices or techniques. Our study suggests that patients with advanced gastric cancer appear to be candidates for the EIPL approach.
TRIAL REGISTRATION
ClinicalTrials.gov identifier: NCT02745509.
Topics: China; Disease-Free Survival; Female; Follow-Up Studies; Gastrectomy; Humans; Incidence; Intraoperative Period; Male; Middle Aged; Neoplasm Staging; Peritoneal Lavage; Postoperative Complications; Retrospective Studies; Stomach Neoplasms; Survival Rate; Treatment Outcome
PubMed: 30916742
DOI: 10.1001/jamasurg.2019.0153 -
International Journal of Molecular... Nov 2023The omentum is the predominant site of ovarian cancer metastasis, but it is difficult to remove the omentum in its entirety. There is a critical need for effective... (Review)
Review
The omentum is the predominant site of ovarian cancer metastasis, but it is difficult to remove the omentum in its entirety. There is a critical need for effective approaches that minimize the risk of colonization of preserved omental tissues by occult cancer cells. Normal saline (0.9% sodium chloride) is commonly used to wash the peritoneal cavity during ovarian cancer surgery. The omentum has a prodigious ability to absorb fluid in the peritoneal cavity, but the impact of normal saline on the omentum is poorly understood. In this review article, we discuss why normal saline is not a biocompatible solution, drawing insights from clinical investigations of normal saline in fluid resuscitation and from the cytopathologic evaluation of peritoneal washings. We integrate these insights with the unique biology of the omentum and omental metastasis, highlighting the importance of considering the absorptive ability of the omentum when administering agents into the peritoneal cavity. Furthermore, we describe insights from preclinical studies regarding the mechanisms by which normal saline might render the omentum conducive for colonization by cancer cells. Importantly, we discuss the possibility that the risk of colonization of preserved omental tissues might be minimized by using balanced crystalloid solutions for peritoneal washing.
Topics: Humans; Female; Saline Solution; Peritoneal Cavity; Peritoneal Neoplasms; Peritoneal Lavage; Ovarian Neoplasms
PubMed: 38003636
DOI: 10.3390/ijms242216449 -
European Journal of Surgical Oncology :... Jun 2024Gastric cancer often presents in advanced stage with a significant risk for peritoneal dissemination. Staging laparoscopy can be used to detect peritoneal carcinomatosis...
INTRODUCTION
Gastric cancer often presents in advanced stage with a significant risk for peritoneal dissemination. Staging laparoscopy can be used to detect peritoneal carcinomatosis (PC+) and free cancer cells in peritoneal lavage cytology (CY+). The current study aimed to present the outcomes of staging laparoscopy and the prognosis of PC+ and CY+ in a Swedish high-volume center.
MATERIALS AND METHODS
A cohort study including all consecutive patients with locally advanced gastric cancer who underwent staging laparoscopy between February 2008 and October 2022. The laparoscopy findings were categorized as PC+, PC-CY+ (positive cytology without peritoneal carcinomatosis) or negative laparoscopy (PC-CY-). The primary endpoint was overall survival (OS) stratified by laparoscopy findings. The secondary endpoint was OS within each laparoscopy finding group stratified by subsequent treatment.
RESULTS
Among 168 patients who underwent staging laparoscopy, 78 patients (46%) had PC-CY-, 29 patients (17%) had PC-CY+ and 61 patients (36%) had PC+. Decreased OS was observed for both PC-CY+ patients (aHR 2.14, 95% CI 1.13-4.06) and PC+ patients (aHR 5.36, 95% CI 3.21-8.93), compared to PC-CY-. Patients with PC-CY+ who converted to PC-CY- after chemotherapy and underwent tumor resection seemed to have a better prognosis compared to patients with persisting PC-CY+.
CONCLUSIONS
Staging laparoscopy is an important tool in the staging of locally advanced gastric cancer. Tumor resection for patients with PC-CY+ who convert to PC-CY- may lead to improved survival for these patients.
Topics: Humans; Stomach Neoplasms; Peritoneal Lavage; Peritoneal Neoplasms; Laparoscopy; Male; Female; Middle Aged; Neoplasm Staging; Aged; Sweden; Survival Rate; Prognosis; Retrospective Studies; Gastrectomy
PubMed: 38503223
DOI: 10.1016/j.ejso.2024.108059 -
The Journal of Trauma and Acute Care... Nov 2021Focused Assessment with Sonography for Trauma (FAST) has supplanted diagnostic peritoneal lavage (DPL) as the preferred bedside evaluation for traumatic hemoperitoneum.... (Observational Study)
Observational Study
BACKGROUND
Focused Assessment with Sonography for Trauma (FAST) has supplanted diagnostic peritoneal lavage (DPL) as the preferred bedside evaluation for traumatic hemoperitoneum. Diagnostic peritoneal aspiration (DPA) is a simpler, faster modification of DPL with an unclear role in contemporary practice. This study delineated modern roles for DPA and defined its diagnostic yield.
METHODS
All trauma patients presenting to our Level I center who underwent DPA were included (May 2015 to May 2020). Demographics, comorbidities, clinical/injury data, and outcomes were collected. The diagnostic yield and accuracy of DPA were calculated against the criterion standard of hemoperitoneum at exploratory laparotomy or computed tomography scan.
RESULTS
In total, 41 patients underwent DPA, typically after blunt trauma (n = 37, 90%). Patients were almost exclusively hypotensive (n = 20, 49%) or in arrest (n = 18, 44%). Most patients had an equivocal or negative FAST and hypotension or return of spontaneous circulation after resuscitative thoracotomy (n = 32, 78%); or had a positive FAST and known cirrhosis (n = 4, 10%). In two (5%) patients, one obese, the catheter failed to access the peritoneal cavity. Diagnostic peritoneal aspiration sensitivity, specificity, positive predictive value, and negative predictive value were 80%, 100%, 100%, and 90%, with an accuracy of 93%. One (2%) complication, a small bowel injury, occurred.
CONCLUSION
Despite near ubiquitous FAST availability, DPA remains important in diagnosing or excluding hemoperitoneum with exceedingly low rates of failure and complications. Diagnostic peritoneal aspiration is most conclusive when positive, without false positives in this study. Diagnostic peritoneal aspiration was most used among blunt hypotensive or postarrest patients who had an equivocal or negative FAST, in whom the preliminary diagnosis of hemoperitoneum is a critically important decision making branch point.
LEVEL OF EVIDENCE
Diagnostic, level III.
Topics: Adult; Clinical Decision-Making; Feasibility Studies; Female; Focused Assessment with Sonography for Trauma; Hemoperitoneum; Humans; Male; Middle Aged; Paracentesis; Peritoneal Lavage; Predictive Value of Tests; Retrospective Studies; Tomography, X-Ray Computed; Wounds, Nonpenetrating
PubMed: 34108417
DOI: 10.1097/TA.0000000000003232 -
Journal of Blood Medicine 2019Bleeding remains one of the most serious complications of laparoscopic cholecystectomy and can increase mortality. Even if several patient-related and intraoperative...
Bleeding remains one of the most serious complications of laparoscopic cholecystectomy and can increase mortality. Even if several patient-related and intraoperative factors increase the risk of bleeding, complete hemostasis should be achieved at the end of each surgical procedure. Although irrigation is a standard step, its importance is often underestimated. This commentary highlights the efficacy of peritoneal lavage in identifying bleeding sources and the effect of saline temperature.
PubMed: 31695538
DOI: 10.2147/JBM.S215438 -
Minerva Chirurgica Dec 2019Although the true prevalence is unknown, colonic diverticulosis is one of the most common disease of the digestive tract in Western countries. Based on administrative... (Review)
Review
Although the true prevalence is unknown, colonic diverticulosis is one of the most common disease of the digestive tract in Western countries. Based on administrative data of hospitalized patients, the incidence of diverticulitis has been increasing in last decades. In general, elderly patients undergo less frequently an elective colonic resection; but a substantial part of emergency surgeries is performed in elderly patients. In these older patients the choice of any clinical and surgical option is to be correlated not only to the severity of diverticulitis, but also to general status and the co-existing comorbidities. In this regard, it is mandatory that all patients undergo a multidimensional, comprehensive geriatric assessment to correctly identify those who are fit, vulnerable or frail. The analysis of data currently available highlights three relevant elements: type and severity of peritoneal contamination, hemodynamic conditions (stable or unstable), and concomitant comorbidities (fit or frail status). There is no single ideal surgical treatment that can be considered as gold standard for all clinical presentations; the final clinical decision-making should always be based on patient's general health status, severity of peritonitis and of sepsis. In a septic elderly patient who is hemodynamically unstable, treatment should be as prompt as possible independent of the Hinchey's stage, and could include either a Mickulicz stoma or a DCS strategy. In an elderly patient who is fit and hemodynamically stable, the surgical options are similar to those in a younger patient. If a patient is frail but hemodynamically stable, he should be treated with a Hartmann's procedures.
Topics: Acute Disease; Age Distribution; Aged; Aged, 80 and over; Clinical Decision-Making; Comorbidity; Diverticulitis, Colonic; Elective Surgical Procedures; Emergency Treatment; Frailty; Geriatric Assessment; Humans; Incidence; Laparoscopy; Middle Aged; Peritoneal Lavage; Peritonitis; Prevalence; Sepsis; Severity of Illness Index
PubMed: 30306769
DOI: 10.23736/S0026-4733.18.07744-1 -
Acta Cytologica 2019Serous fluids are a common but important specimen type in a cytopathology laboratory. There is as yet no agreed standardized terminology to allow uniformity in reporting...
Serous fluids are a common but important specimen type in a cytopathology laboratory. There is as yet no agreed standardized terminology to allow uniformity in reporting on these specimens. Given that serous fluids are a rich source of cytopathological as well as molecular information on a range of benign and often advanced malignant conditions, a unified approach to handling and reporting these specimens covering the pre-analytical, analytical and postanalytical stages seems timely. Representatives of the international cytology community have come together once again to develop an algorithmic diagnostic and management approach to the reporting of these samples.
Topics: Ascitic Fluid; Consensus; Cytodiagnosis; Humans; Peritoneal Lavage; Predictive Value of Tests; Reproducibility of Results; Terminology as Topic
PubMed: 31234178
DOI: 10.1159/000501536 -
International Journal of Tryptophan... 2022This study aimed to assess the importance of selected kynurenines measured in peritoneal fluid, lavage washings, and blood serum in patients with advanced gastric cancer...
BACKGROUND
This study aimed to assess the importance of selected kynurenines measured in peritoneal fluid, lavage washings, and blood serum in patients with advanced gastric cancer (GC) based on the clinical and pathological staging of TNM for a more precise evaluation of the stage of the disease.
METHODS
Data were collected from a prospectively maintained database of all patients operated on advanced GC between July 2018 and August 2020. In total, 98 patients were eligible for the analysis according to the REMARK guidelines.
RESULTS
Among the various kynurenines analyzed in this study, we found that the median concentration of anthranilic acid (AA) in the peritoneal lavage washings was significantly higher in patients with positive nodes (pN1-3) compared to those with negative nodes (pN0) ( = 0.0100). Based on the ROC analysis, AA showed diagnostic utility in the differentiation of the pN staging ( = 0.0047). Furthermore, there was a positive correlation between AA in peritoneal fluid with stage pN ( = 0.0116) and a positive correlation between AA in peritoneal lavage washings with stage cT ( = 0.0101). We found that the median concentration of kynurenine (Kyn) in peritoneal lavage washings was significantly higher in patients with cM1 compared to cM0 patients ( = 0.0047). Based on the ROC analysis, Kyn showed diagnostic utility in cM staging differentiation ( < 0.0001). There was a positive correlation between peritoneal Kyn and stage of cM ( = 0.0079).
CONCLUSIONS
AA and Kyn measured in peritoneal lavage indicate advanced GC and may be considered in the future as valuable adjunct tools in TNM staging of advanced GC.
PubMed: 35140473
DOI: 10.1177/11786469211065620 -
Surgery Today Jan 2019Positive peritoneal lavage cytology for gastric carcinoma cells (CY1) is considered distant metastasis and is classified as Stage IV. However, patients with CY1 comprise...
PURPOSE
Positive peritoneal lavage cytology for gastric carcinoma cells (CY1) is considered distant metastasis and is classified as Stage IV. However, patients with CY1 comprise a heterogeneous population, and their prognosis varies greatly. The prognostic factors for gastric cancer patients with CY1 were retrospectively reviewed.
METHODS
The participants were 80 gastric cancer patients with CY1 in our institution encountered between 2005 and 2017. Prognostic factors were analyzed using univariate and multivariate analyses.
RESULTS
The operative procedure was distal gastrectomy for 30 patients, total gastrectomy for 27 patients, staging laparoscopy for 10 patients, gastrojejunostomy for 8 patients, and probe laparotomy for 5 patients. Other distant metastases were recognized in 36 patients. A multivariate analysis revealed that other distant metastases were the strongest independent risk factor for the overall survival (p < 0.0001). When the cohort was limited to CY1 patients without other distant metastases, cN2-3 (p = 0.01), the prognostic nutritional index (PNI) < 40 (p = 0.02) and Type 4 (p = 0.03) were independent risk factors according to a multivariate analysis. The survivals of patients with cN2-3 or PNI < 40 after gastrectomy were equivalent to those with other distant metastases, as assessed by log-rank analyses.
CONCLUSIONS
The prognoses of CY1 gastric cancer patients with cN2-3 or PNI < 40 were poor, even after gastrectomy.
Topics: Adult; Aged; Aged, 80 and over; Analysis of Variance; Carcinoma; Cytodiagnosis; Female; Gastrectomy; Gastric Bypass; Humans; Laparoscopy; Laparotomy; Lymphatic Metastasis; Male; Middle Aged; Neoplasm Metastasis; Neoplasm Staging; Nutrition Assessment; Peritoneal Lavage; Prognosis; Retrospective Studies; Risk Factors; Stomach Neoplasms; Survival Rate
PubMed: 30167924
DOI: 10.1007/s00595-018-1704-1