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Clinical Journal of Gastroenterology Oct 2023A 71-year-old woman underwent endoscopic submucosal dissection for early duodenal cancer at the second portion of the duodenum and developed acute peritonitis due to...
A 71-year-old woman underwent endoscopic submucosal dissection for early duodenal cancer at the second portion of the duodenum and developed acute peritonitis due to delayed duodenal perforation. Emergency laparotomy was performed. A huge perforation formed at the descending duodenum without ampulla involvement. Pancreas-sparing partial duodenectomy (PPD) with gastrojejunostomy was performed (250 min operative time) with 50 mL of intraoperative blood loss. She required intensive care for 3 days and was discharged on postoperative day 21 with no severe complications. Emergency treatment for a major duodenal injury or perforation remains challenging because of high morbidity and mortality. An appropriate treatment should be considered according to the nature of the defect. Although PPD is an acceptable procedure for patients with a duodenal neoplasm, its use in emergency surgery is rarely reported. PPD is more reliable than primary repair or anastomosis using a jejunal wall, and less invasive than pancreaticoduodenectomy, for emergency treatment. We performed PPD in this patient because the duodenal perforation was too large to reconstruct and did not involve the ampulla. PPD can be a safe and feasible alternative surgical procedure to pancreaticoduodenectomy for a major duodenal perforation, especially in patients with a duodenal perforation that does not involve the ampulla.
Topics: Female; Humans; Aged; Pancreaticoduodenectomy; Treatment Outcome; Pancreas; Duodenum; Duodenal Neoplasms; Duodenal Ulcer; Anastomosis, Surgical
PubMed: 37389799
DOI: 10.1007/s12328-023-01823-9 -
Immunological Medicine Mar 2024Small bowel adenocarcinoma (SBA) is a rare tumor with an unfavorable prognosis, and due to its rarity, few studies on its treatment are available. Chemotherapy remains... (Review)
Review
Small bowel adenocarcinoma (SBA) is a rare tumor with an unfavorable prognosis, and due to its rarity, few studies on its treatment are available. Chemotherapy remains the standard of treatment in advanced disease. Recently immunotherapy has demonstrated to be a valid therapeutic option for many solid tumors. We reviewed the data published in literature to understand the impact of immunotherapy in this cancer.
Topics: Humans; Intestine, Small; Jejunal Neoplasms; Ileal Neoplasms; Duodenal Neoplasms; Adenocarcinoma; Immunotherapy
PubMed: 37293784
DOI: 10.1080/25785826.2023.2220938 -
Journal of Laparoendoscopic & Advanced... Oct 2023Performing an intracorporeal esophagojejunostomy during laparoscopic-assisted total or proximal gastrectomy is challenging. We developed an ingenious method of...
Performing an intracorporeal esophagojejunostomy during laparoscopic-assisted total or proximal gastrectomy is challenging. We developed an ingenious method of overlapping esophagojejunostomy using a linear stapler to avoid stapler-related intraoperative complications. Following lymph node dissection, the esophagus was transected anterior-posteriorly. A linear stapler was used to divide the jejunum ∼20 cm distal to the Treitz ligament. A small enterotomy was then created 5 cm distal to the elevated jejunal stump to insert the linear stapler cartridge. An electronic knife was used to make a full-thickness incision, with the tip of the nasogastric tube (NGT) pressed against the posterior wall of the esophageal stump as a guide. Full-thickness sutures were placed on both the anterior and posterior walls of the entry hole in the esophageal stump to prevent the anvil fork from being misinserted into the submucosal layer of the esophagus. The thread on the posterior wall was guided through the port to the outside of the abdominal cavity, where the linear stapler was inserted to perform the side-to-side anastomosis. A 45-mm cartridge fork and an anvil fork were inserted into the elevated jejunum and esophageal stump entry holes, respectively, following which the esophageal stump was gently grasped. The thread on the posterior wall side was pulled from outside the abdominal cavity through the port. This step is necessary to close the gap between the esophageal and jejunal walls. After confirming that the anvil fork was not misinserted into the submucosal layer of the esophagus and that there was no gap between the esophagus and the elevated jejunum, the linear stapler was fired to create the anastomosis. The insertion hole was closed with hand-sewn sutures or linear staples to complete the esophagojejunostomy. Eleven patients underwent this procedure with no anastomotic complications. This method enables us to perform an easier and more stable esophagojejunostomy.
Topics: Humans; Stomach Neoplasms; Anastomosis, Surgical; Gastrectomy; Laparoscopy; Jejunum; Surgical Stapling
PubMed: 37172302
DOI: 10.1089/lap.2023.0027 -
Revista Espanola de Enfermedades... Apr 2024It is rare to find a small bowel tumour presenting as intestinal obstruction. This type of cancer is an extremely unusual condition often misdiagnosed until late stages....
It is rare to find a small bowel tumour presenting as intestinal obstruction. This type of cancer is an extremely unusual condition often misdiagnosed until late stages. We report the case of a patient with persistent vomiting secondary to an obstructing jejunal adenocarcinoma not related to intestinal bowel disease. After resection and chemotherapy treatment a huge mass was detected in the left ovary. The anatomopathological findings confirmed a metastatic cancer consequent to the jejunal adenocarcinoma previously resected. This case illustrates a successful outcome of a jejunal adenocarcinoma with very poor prognosis after a extremely unusual ovarian metastasis. It is highly important to suspect other causes than intestinal bowel disease when doing a differential diagnosis in a young patient presenting with clinical symptoms of intestinal obstruction.
Topics: Female; Humans; Adenocarcinoma; Duodenal Neoplasms; Intestinal Obstruction; Intestine, Small; Jejunal Neoplasms; Ovarian Neoplasms; Adult
PubMed: 37170586
DOI: 10.17235/reed.2023.9658/2023 -
Clinical Journal of Gastroenterology Aug 2023Although free-flap jejunal reconstruction is frequently performed after cervical esophagectomy for cervical esophageal cancer, the procedure after gastric surgery has...
Segmental cervical esophagectomy with free jejunal flap reconstruction for cervical esophageal cancer in patients with previous history of gastric surgery: a report of two cases.
Although free-flap jejunal reconstruction is frequently performed after cervical esophagectomy for cervical esophageal cancer, the procedure after gastric surgery has not been reported. We encountered two patients with esophageal cancer and previous gastric surgeries who eventually underwent segmental esophagectomy with free-flap jejunal reconstruction. Case one involved a 75-year-old man who underwent abdominal abscess and duodenal ulcer perforation surgeries (abdominal drainage and subsequent gastrojejunal bypass). A type 0-IIa tumor was located posterior to the cervical esophagus's right wall, 21 cm from the incisor, without lymph node swelling or distant metastasis. The left lobe of the thyroid gland was mobilized to ensure an oral resection margin. Severe abdominal adhesions required careful adhesiolysis to harvest the jejunum (20 cm long) 40 cm from the jejunojejunostomy. An end-to-side and side-to-end esophagojejunostomy were performed for the proximal and distal ends, respectively. Case two involved a 75-year-old male with a history of distal gastrectomy with Billroth I reconstruction for early gastric cancer. A submucosal tumor-like lesion was located on the cervical esophageal wall on the left side, 21 cm from the incisor. The distal esophagus required additional segmental resection because the anal resection line was close to the tumor. Jejunum (10 cm long) 30 cm from Ligament of Treitz was harvested. An end-to-side and end-to-end esophagojejunostomy for the proximal and distal ends, respectively, was performed. This surgery requires a thorough preoperative examination to ensure an adequate surgical margin and a careful free-flap harvest based on post-gastric surgery anatomy.
Topics: Male; Female; Humans; Aged; Esophagectomy; Jejunum; Plastic Surgery Procedures; Esophageal Neoplasms; Uterine Cervical Neoplasms
PubMed: 37165274
DOI: 10.1007/s12328-023-01804-y -
Journal of Reconstructive Microsurgery Feb 2024The transverse cervical artery is less commonly used than other external carotid arteries as a recipient vessel. Therefore, we aimed to compare the utility of the...
BACKGROUND
The transverse cervical artery is less commonly used than other external carotid arteries as a recipient vessel. Therefore, we aimed to compare the utility of the transverse cervical artery as a recipient vessel with that of the external carotid artery system for microvascular head and neck reconstruction by quantitative analysis of dynamic-enhanced computed tomography.
METHODS
Fifty-one consecutive patients who underwent free jejunum transfer following total pharyngolaryngectomy between January 2017 and December 2020 were retrospectively reviewed. Ninety-four pairs of the diameters of the transverse cervical artery, superior thyroid artery, and lingual artery, measured via computed tomography angiography, were analyzed. Operative outcomes were compared between the following groups based on the recipient artery: transverse cervical artery ( = 27), superior thyroid artery ( = 17), and other artery ( = 7) groups.
RESULTS
In the analysis of the computed tomography angiography, nine transverse cervical arteries (9.6%) could not be identified. However, the percentage was significantly lower than the percentage of superior thyroid arteries (20.2%) and lingual arteries (18.1%) ( < 0.01). Among the identified vessels, the transverse cervical arteries (2.09 ± 0.41 mm) and the lingual arteries (1.97 ± 0.40 mm) were significantly larger than the superior thyroid arteries (1.70 ± 0.36 mm) in diameter at the commonly used level ( < 0.01). Multivariate analysis revealed that prior radiation therapy was not an independent factor significantly affecting transverse cervical artery diameter ( = 0.17). Intraoperative anastomotic revision was required in only two cases of the superior thyroid artery.
CONCLUSION
The transverse cervical artery can offer a larger caliber and more reliable candidate than the superior thyroid artery for a recipient artery. More liberal use of the transverse cervical artery may improve the safety of microsurgical head and neck reconstruction.
Topics: Humans; Retrospective Studies; Plastic Surgery Procedures; Head and Neck Neoplasms; Computed Tomography Angiography; Jejunum; Neck; Arteries
PubMed: 37142252
DOI: 10.1055/a-2086-0146 -
The Journal of Thoracic and... Oct 2023The effect of a patient's Social Vulnerability Index (SVI) on complication rates after esophagectomy remains unstudied. The purpose of this study was to determine how...
OBJECTIVES
The effect of a patient's Social Vulnerability Index (SVI) on complication rates after esophagectomy remains unstudied. The purpose of this study was to determine how social vulnerability influences morbidity following esophagectomy.
METHODS
This was a retrospective review of a prospectively collected esophagectomy database at one academic institution, 2016 to 2022. Patients were grouped into low-SVI (<75%ile) and high-SVI (>75%ile) cohorts. The primary outcome was overall postoperative complication rate; secondary outcomes were rates of individual complications. Perioperative patient variables and postoperative complication rates were compared between the 2 groups. Multivariable logistic regression was used to control for covariates.
RESULTS
Of 149 patients identified who underwent esophagectomy, 27 (18.1%) were in the high-SVI group. Patients with high SVI were more likely to be of Hispanic ethnicity (18.5% vs 4.9%, P = .029), but there were no other differences in perioperative characteristics between groups. Patients with high SVI were significantly more likely to develop a postoperative complication (66.7% vs 36.9%, P = .005) and had greater rates of postoperative pneumonia (25.9% vs 6.6%, P = .007), jejunal feeding-tube complications (14.8% vs 3.3%, P = .036), and unplanned intensive care unit readmission (29.6% vs 12.3%, P = .037). In addition, patients with high SVI had a longer postoperative hospital length of stay (13 vs 10 days, P = .017). There were no differences in mortality rates. These findings persisted on multivariable analysis.
CONCLUSIONS
Patients with high SVI have greater rates of postoperative morbidity following esophagectomy. The effect of SVI on esophagectomy outcomes warrants further investigation and may prove useful in identifying populations that benefit from interventions to mitigate these complications.
Topics: Humans; Esophagectomy; Social Vulnerability; Morbidity; Postoperative Complications; Retrospective Studies; Esophageal Neoplasms
PubMed: 37119966
DOI: 10.1016/j.jtcvs.2023.04.027 -
Asian Journal of Surgery Jan 2024Hepatoduodenal ligamentectomy (HL) is a challenging surgery for advanced perihilar cholangiocarcinoma extensively invading the hepatoduodenal ligament. A...
TECHNIQUE
Hepatoduodenal ligamentectomy (HL) is a challenging surgery for advanced perihilar cholangiocarcinoma extensively invading the hepatoduodenal ligament. A liver-transection first approach in HL is a no-touch technique wherein liver transection is performed first, and the affected liver and hepatoduodenal ligament are removed en bloc. This approach allows for the early assessment of resectability and feasibility of vascular reconstruction.
RESULTS
This video shows a 57-year-old man with advanced intrahepatic cholangiocarcinoma in the left hepatic lobe, which had directly invaded the perihilar region and the hepatoduodenal ligament via lymph node metastasis. The lymph node was extensively invasive into both the proper hepatic artery and portal vein. The case was initially deemed unresectable, but after three months of chemotherapy, conversion surgery was considered feasible. The common hepatic artery and gastroduodenal artery and then the common bile duct and main trunk of portal vein were secured at the pancreatic superior border. Hepatic dissection was performed along the Cantlie line. The right Glissonean pedicle was secured, including the right hepatic duct, right hepatic artery and right portal vein, and the operation was deemed feasible. The portal vein was dissected and reconstructed using the right external iliac vein. The left and caudate lobe with the middle hepatic vein and hepatoduodenal ligament were resected en bloc. Subsequentially, the common hepatic artery and right hepatic artery were reconstructed using the jejunal artery.
CONCLUSION
The liver-transection first approach allowed us to determine the resectability of en bloc resection of the hepatoduodenal ligament at an early stage of surgery.
Topics: Male; Humans; Middle Aged; Hepatectomy; Bile Duct Neoplasms; Liver; Cholangiocarcinoma; Bile Ducts, Intrahepatic; Ligaments
PubMed: 37105811
DOI: 10.1016/j.asjsur.2023.04.071 -
Asian Journal of Surgery Oct 2023Surgical procedures for proximal gastric cancer remain a highly debated topic. Total gastrectomy (TG) is widely accepted as a standard radical surgery. However, subtotal... (Clinical Trial)
Clinical Trial
BACKGROUND
Surgical procedures for proximal gastric cancer remain a highly debated topic. Total gastrectomy (TG) is widely accepted as a standard radical surgery. However, subtotal esophagectomy, proximal gastrectomy (PG) or even subtotal gastrectomy, when a small upper portion of the stomach can technically be preserved, are alternatives in current clinical practice.
METHODS
Using a cohort of the PGSAS NEXT trial, consisting of 1909 patients responding to a questionnaire sent to 70 institutions between July 2018 and December 2019, gastrectomy type, reconstruction method, and furthermore the remnant stomach size and the anti-reflux procedures for PG were evaluated.
RESULTS
TG was the procedure most commonly performed (63.0%), followed by PG (33.4%). Roux-en-Y was preferentially employed following TG irrespective of esophageal tumor invasion, while jejunal pouch was adopted in 8.5% of cases with an abdominal esophageal stump. Esophagogastrostomy was most commonly selected after PG, followed by the double-tract method. The former was preferentially employed for larger remnant stomachs (≧3/4), while being used slightly less often for tumors with as compared to those without esophageal invasion in cases with a remnant stomach 2/3 the size of the original stomach. Application of the double-tract method gradually increased as the remnant stomach size decreased. Anti-reflux procedures following esophagogastrostomy varied markedly.
CONCLUSIONS
TG is the mainstream and PG remains an alternative in current Japanese clinical practice for proximal gastric cancer. Remnant stomach size and esophageal stump location appear to influence the choice of reconstruction method following PG.
Topics: Humans; Gastrectomy; Gastric Stump; Gastroesophageal Reflux; Japan; Stomach Neoplasms; Treatment Outcome
PubMed: 36464591
DOI: 10.1016/j.asjsur.2022.11.069 -
Asian Journal of Surgery Oct 2023An innovative method of digestive tract reconstruction following proximal gastrectomy, the uncut interposed jejunum pouch, esophagus and residual stomach double...
Uncut interposed jejunum pouch versus esophago-gastrostomy and double anastomoses of jejunum to the esophagus and residual stomach: An innovative method of digestive tract reconstruction following proximal gastrectomy.
AIM
An innovative method of digestive tract reconstruction following proximal gastrectomy, the uncut interposed jejunum pouch, esophagus and residual stomach double anastomosis(Uncut-D), was established in recent years. In order to fully clarify the superiority of the procedure, this study has conducted a systematic analysis and thorough discussion.
METHODS
118 patients with adenocarcinoma of the esophagogastric junction who underwent proximal gastrectomy were enrolled in this study. According to the methods of digestive tract reconstruction, these patients were divided into three groups: Uncut-D(n = 43), esophagogastrostomy (EG, n = 36), jejunal interposition (JI, n = 39).The preoperative indicators, surgical complications and related indicators of postoperative quality of life were analyzed.
RESULTS
There were no significant differences in preoperative data among all groups (P > 0.05); The digestive tract reconstruction time in Uncut-D group was more than that in EG group, and less than that in JI group (P < 0.05). The incidence of esophageal anastomotic stenosis in Uncut-D group was significantly lower than that in EG group (P < 0.05); In Uncut-D group, the incidence of reflux esophagitis, postoperative nutrition index(PNI), weight recovery and Visick classification were significantly better than those in EG group (P < 0.05), furthermore, the incidence of delayed gastric emptying,PNI and weight recovery were better than those in JI group (P < 0.05).
CONCLUSIONS
The Uncut-D procedure gave full play to jejunal continuity and the advantages of pouch, and played a valuable role in gastric and cardiac replacement, which significantly reduced long-term complications, improved postoperative nutritional status of patients and long-term quality of life.
Topics: Humans; Gastric Stump; Jejunum; Gastrostomy; Quality of Life; Stomach Neoplasms; Gastrectomy; Esophagus; Anastomosis, Surgical; Treatment Outcome
PubMed: 36456439
DOI: 10.1016/j.asjsur.2022.11.067