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Journal of Gastrointestinal Surgery :... May 2018Mesopancreas dissection with central vascular ligation and the superior mesenteric artery (SMA)-first approach represent the cornerstone of current principles for... (Meta-Analysis)
Meta-Analysis
BACKGROUND AND PURPOSE
Mesopancreas dissection with central vascular ligation and the superior mesenteric artery (SMA)-first approach represent the cornerstone of current principles for radical resection for pancreatic head cancer. The surgeon dissecting around the SMV and SMA should be aware regarding the anatomical variants in this area. The aims of this systematic review and meta-analysis are to detail the surgical anatomy of the superior mesenteric vessels and to propose a standardized terminology with impact in pancreatic cancer surgery.
METHODS
We conducted a systematic search to identify all published studies in PubMed/MEDLINE and Google Scholar databases from their inception up to March 2017.
RESULTS
Seventy-eight studies, involving a total of 18,369 specimens, were included. The prevalence of the mesenteric-celiac trunk, replaced/accessory right hepatic artery (RRHA), common hepatic artery, and SMV inversion was 2.8, 13.2, 2.6, and 4.1%, respectively. The inferior pancreaticoduodenal artery has its origin into the first jejunal artery, SMA, and RRHA, in 58.7, 35.8, and 1.2% of cases, respectively. The SMV lacks a common trunk in 7.5% of cases. The first jejunal vein has a trajectory posterior to the SMA in 71.8% of cases. The left gastric vein drains into the portal vein in 58%, in splenic vein (SV) in 35.6%, and into the SV-PV confluence in 5.8% of cases.
CONCLUSIONS
Complex pancreaticoduodenal resections require detailed knowledge of the superior mesenteric artery and vein, which is significantly different from the one presented in the classical textbooks of surgery. We are proposing the concept of the first jejunopancreatic vein which impacts the current oncological principles of pancreatic head cancer resection.
Topics: Celiac Artery; Dissection; Hepatic Artery; Humans; Mesenteric Artery, Superior; Mesenteric Veins; Pancreas; Pancreatic Neoplasms; Pancreaticoduodenectomy; Portal Vein; Splenic Vein
PubMed: 29363018
DOI: 10.1007/s11605-018-3669-1 -
Journal of Gastrointestinal and Liver... Dec 2017Celiac disease (CD) is a common and chronic disorder requiring a long-life gluten-free diet. There is evidence that asymptomatic or subclinical presentation of CD has... (Review)
Review
Celiac disease (CD) is a common and chronic disorder requiring a long-life gluten-free diet. There is evidence that asymptomatic or subclinical presentation of CD has increased in the last decades, so that several cases are diagnosed during adulthood or even in the elderly. Celiac disease patients are at an increased risk of developing malignancies, particularly when the disease is diagnosed in the elderly. We describe a case of a challenging diagnosis of small bowel adenocarcinoma which developed in a patient with CD discovered only in the elderly. We also performed a systematic review of the literature. A tailored follow-up in a sub-group of CD patients at an increased risk of developing intestinal adenocarcinoma could be implemented.
Topics: Adenocarcinoma; Aged; Capsule Endoscopy; Celiac Disease; Female; Humans; Jejunal Neoplasms; Neoplasm Staging
PubMed: 29253057
DOI: 10.15403/jgld.2014.1121.264.zet -
Gastric Cancer : Official Journal of... Apr 2016Remnant gastric cancer, most frequently defined as cancer detected in the remnant stomach after distal gastrectomy for benign disease and those cases after surgery of... (Meta-Analysis)
Meta-Analysis Review
Remnant gastric cancer, most frequently defined as cancer detected in the remnant stomach after distal gastrectomy for benign disease and those cases after surgery of gastric cancer at least 5 years after the primary surgery, is often reported as a tumor with poor prognosis. The Task Force of Japanese Gastric Cancer Association for Research Promotion evaluated the clinical impact of remnant gastric cancer by systematically reviewing publications focusing on molecular carcinogenesis, lymph node status, patient survival, and surgical complications. A systematic literature search was performed using PubMed/MEDLINE with the keywords "remnant," "stomach," and "cancer," revealing 1154 relevant reports published up to the end of December 2014. The mean interval between the initial surgery and the diagnosis of remnant gastric cancer ranged from 10 to 30 years. The incidence of lymph node metastases at the splenic hilum for remnant gastric cancer is not significantly higher than that for primary proximal gastric cancer. Lymph node involvement in the jejunal mesentery is a phenomenon peculiar to remnant gastric cancer after Billroth II reconstruction. Prognosis and postoperative morbidity and mortality rates seem to be comparable to those for primary proximal gastric cancer. The crude 5-year mortality for remnant gastric cancer was 1.08 times higher than that for primary proximal gastric cancer, but this difference was not statistically significant. In conclusion, although no prospective cohort study has yet evaluated the clinical significance of remnant gastric cancer, our literature review suggests that remnant gastric cancer does not adversely affect patient prognosis and postoperative course.
Topics: Gastrectomy; Gastric Stump; Humans; Lymphatic Metastasis; Prognosis; Stomach Neoplasms
PubMed: 26667370
DOI: 10.1007/s10120-015-0582-0 -
The American Journal of Gastroenterology Nov 2009Whether reconstruction after total gastrectomy for gastric malignancies should be done with or without a pouch is a controversial issue in clinical research. There is... (Meta-Analysis)
Meta-Analysis Review
OBJECTIVES
Whether reconstruction after total gastrectomy for gastric malignancies should be done with or without a pouch is a controversial issue in clinical research. There is still no consensus on the reconstruction technique of choice. The aim of this report was to assess the value of pouch formation as a gastric substitute after total gastrectomy compared with reconstruction techniques without a pouch.
METHODS
A systematic literature search of the Medline database and the Cochrane Library was carried out and a meta-analysis executed according to the Quality of Reporting Meta-Analyses (QUOROM) statement. Only randomized controlled trials (RCTs) comparing reconstruction techniques with and without a pouch were eligible for inclusion. All trials were independently assessed by two authors. Data on perioperative parameters, postgastrectomy symptoms, eating capability, body weight, and quality of life were extracted from the RCTs for meta-analysis using random-effects models for the calculation of pooled estimates of treatment effects.
RESULTS
Nine RCTs comparing Roux-en-Y reconstructions with and without pouch and four RCTs comparing jejunal interpositions with and without a pouch were included. The results of the meta-analyses show that additional pouch formation does not significantly increase morbidity or mortality and does not considerably extend the operating time or the hospital stay. Patients with a pouch complained significantly less of dumping and heartburn and showed a significantly better food intake postoperatively. Quality of life was significantly improved in patients with a pouch compared with patients without a pouch. This difference even increased over time from 6 to 12 and 24 months postoperatively.
CONCLUSIONS
This meta-analysis highlights some clinical advantages of pouch reconstruction after total gastrectomy.
Topics: Anastomosis, Roux-en-Y; Female; Follow-Up Studies; Gastrectomy; Humans; Jejunum; Male; Neoplasm Recurrence, Local; Postoperative Complications; Randomized Controlled Trials as Topic; Plastic Surgery Procedures; Risk Assessment; Stomach Neoplasms; Surgically-Created Structures; Survival Analysis; Treatment Outcome
PubMed: 19672251
DOI: 10.1038/ajg.2009.456