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Neuroendocrinology 2016
Topics: Consensus; Europe; Humans; Ileal Neoplasms; Jejunal Neoplasms; Neuroendocrine Tumors
PubMed: 26758972
DOI: 10.1159/000443170 -
Diagnostic and Interventional Imaging Mar 2015Recent refinements in cross-sectional imaging have dramatically modified the investigation of the jejunum. Improvements in multidetector row computed tomography (MDCT)... (Review)
Review
Recent refinements in cross-sectional imaging have dramatically modified the investigation of the jejunum. Improvements in multidetector row computed tomography (MDCT) and magnetic resonance (MR) imaging technology have made detection and characterization of jejunal abnormalities easier. Current options include MDCT and MR imaging using either enterography or enteroclysis. The goal of this pictorial review is to outline the current imaging techniques that are used to investigate the jejunum and illustrate the most common conditions that affect this small bowel segment with a specific focus on MDCT and MR imaging using enterography or enteroclysis. MR imaging used in conjunction with optimal jejunal distension appears as the modality of choice for the diagnosis of a wide range of jejunal abnormalities. MDCT remains the first line imaging modalities because of an acute presentation in a substantial number of patients.
Topics: Clinical Protocols; Humans; Jejunal Diseases; Jejunal Neoplasms; Magnetic Resonance Imaging; Multidetector Computed Tomography
PubMed: 25482665
DOI: 10.1016/j.diii.2014.11.008 -
Postgraduate Medical Journal Aug 19741. Gastro-bronchial fistula is a rare condition occurring most commonly as a complication of a subphrenic abscess. 2. Other causes include trauma and necrosis within an...
1. Gastro-bronchial fistula is a rare condition occurring most commonly as a complication of a subphrenic abscess. 2. Other causes include trauma and necrosis within an infiltrating neoplasm. 3. The treatment of those fistulae which are secondary to a subphrenic abscess should be by drainage of the abscess, jejunal tube feeding and continuous gastric aspiration.
Topics: Aged; Bronchial Fistula; Gastric Fistula; Humans; Male; Pancreatic Neoplasms; Radiography
PubMed: 4464513
DOI: 10.1136/pgmj.50.586.504 -
World Journal of Gastroenterology Jul 2016Surgery used to be the only therapy for gastric cancer, and since its ability to cure gastric cancer was the focus of attention, less attention was paid to... (Review)
Review
Surgery used to be the only therapy for gastric cancer, and since its ability to cure gastric cancer was the focus of attention, less attention was paid to function-preserving surgery in gastric cancer, though it was studied for gastroduodenal ulcer. Maki et al developed pylorus-preserving gastrectomy for gastric ulcer in 1967. At the same time, the definition of early gastric cancer (EGC) was being considered, histopathological investigations of EGC were carried out, and the validity of modified surgery was sustained. After the development of H2-blockers, the number of operations for gastroduodenal ulcers decreased, and the number of EGC patients increased simultaneously. As a result, the indications for pylorus-preserving gastrectomy for EGC in the middle third of the stomach extended, and various alterations were added. Since then, many kinds of function-preserving gastrectomies have been performed and studied in other fields of gastric cancer, and proximal gastrectomy, jejunal pouch interposition, segmental gastrectomy, and local resection have been performed. On the other hand, from the overall perspective, it can be said that endoscopic resection, which was launched at almost the same time, is the ultimate function-preserving surgery under the current circumstances. The current function-preserving gastrectomies that are often performed and studied are pylorus-preserving gastrectomy and proximal gastrectomy. The reasons for this are that these procedures that can be performed with systemic lymph node dissection, and they include three important elements: (1) reduction of the extent of gastrectomy; (2) preservation of the pylorus; and (3) preservation of the vagal nerve. In addition, these operations are more likely to be performed with a laparoscopic approach as minimally invasive surgery. Of the above-mentioned three elements, reduction of the extent of gastrectomy is the most important in our view. Therefore, we should try to reduce the extent of gastrectomy if curability of the gastric cancer can still be achieved. However, if we preserve a wider residual stomach in function-preserving gastrectomy, we should pay attention to the development of metachronous gastric cancer.
Topics: Adenocarcinoma; Anastomosis, Surgical; Gastrectomy; Gastric Stump; Humans; Japan; Lymph Node Excision; Neoplasm Staging; Organ Sparing Treatments; Pylorus; Stomach Neoplasms; Vagus Nerve
PubMed: 27468183
DOI: 10.3748/wjg.v22.i26.5888 -
Journal of Reconstructive Microsurgery Nov 2015Free jejunal transfer for pharyngoesophageal reconstruction has often been criticized for its associated donor-site morbidity. Conversely, the same argument has been...
BACKGROUND
Free jejunal transfer for pharyngoesophageal reconstruction has often been criticized for its associated donor-site morbidity. Conversely, the same argument has been invoked to support use of fasciocutaneous flaps, given their low incidence of donor-site complications. The purpose of the current study was to document donor-site complication rate with free jejunal flaps for pharyngoesophageal reconstruction, in the hands of an experienced surgeon.
METHODS
A retrospective chart review was performed for consecutive patients who underwent free jejunal transfer between 1992 and 2012 by the senior author (P.G.C.). Demographic data, abdominal complications, surgical characteristics of small bowel anastomoses, and postoperative bowel function were specifically noted.
RESULTS
Overall, 92 jejunal flap reconstructions were performed in 90 patients. The mean follow-up time was 29 months. Twelve (13%) patients had prior abdominal surgery. Donor-site complications included ileus (n = 2), wound cellulitis (n = 1), wound dehiscence (n = 1), and small bowel obstruction (n = 1). Mean time to initiation of tube feeds after reconstruction was 5 days. A total of 77 (86.5%) patients were discharged on an oral diet. The perioperative mortality rate of 2% was not associated with any donor-site complication.
CONCLUSION
Free jejunal transfer is associated with minimal and acceptable donor-site complication rates. The choice of flap for pharyngoesophageal reconstruction should be determined by the type of defect, potential recipient site complications, and the surgeon's familiarity with the flap. Potential donor-site complications should not be a deterrent for free jejunal flaps given the low rate described in this study.
Topics: Adolescent; Adult; Aged; Aged, 80 and over; Child; Esophageal Neoplasms; Female; Free Tissue Flaps; Head and Neck Neoplasms; Humans; Jejunum; Male; Middle Aged; Pharyngeal Neoplasms; Postoperative Complications; Plastic Surgery Procedures; Retrospective Studies; Transplant Donor Site; Treatment Outcome
PubMed: 26220434
DOI: 10.1055/s-0035-1556872 -
Gastroenterologie Clinique Et Biologique 2004We report here case of a 57-year-old woman presenting with a metastatic vipoma revealed by secretory diarrhea and severe ionic disorders successfully treated by...
We report here case of a 57-year-old woman presenting with a metastatic vipoma revealed by secretory diarrhea and severe ionic disorders successfully treated by somatostatin administration. The primitive tumour, located in the jejunum, was identified peroperatively. Both the primitive lesion and the liver metastases were resected at the same time. Early tumour relapse occurred and was unsuccessfully treated by systemic chemotherapy (5-fluorouracil, streptozotocin and doxorubin) and chemoembolization. Finally, a liver transplantation was proposed.
Topics: Female; Humans; Jejunal Neoplasms; Middle Aged; Vipoma
PubMed: 15646540
DOI: 10.1016/s0399-8320(04)95130-5 -
BMC Surgery Oct 2014Free jejunal interposition is a useful technique for reconstruction of the cervical esophagus. However, the distal anastomosis between the graft and the remaining... (Review)
Review
BACKGROUND
Free jejunal interposition is a useful technique for reconstruction of the cervical esophagus. However, the distal anastomosis between the graft and the remaining thoracic esophagus or a gastric conduit can be technically challenging when located very low in the thoracic aperture. We here describe a modified technique for retrograde stapling of a jejunal graft to a failed gastric conduit using a circular stapler on a delivery system.
CASE PRESENTATION
A 56 year-old patient had been referred for esophageal squamous cell carcinoma at 20 cm from the incisors. On day 8 after thoracoabdominal esophagectomy with gastric pull-up, an anastomotic leakage was diagnosed. A proximal-release stent was successfully placed by gastroscopy and the patient was discharged. Two weeks later, an esophagotracheal fistula occurred proximal to the esophageal stent. Cervical esophagostomy was performed with cranial closure of the gastric conduit, which was left in situ within the right hemithorax. Three months later, reconstruction was performed using a free jejunal interposition. The anvil of a circular stapler (Orvil®, Covidien) was placed transabdominally through an endoscopic rendez-vous procedure into the gastric conduit. A free jejunal graft was retrogradely stapled to the proximal end of the conduit. Microvascular anastomoses were performed subsequently. The proximal anastomosis of the conduit was completed manually after reperfusion.
CONCLUSIONS
This modified technique allows stapling of a jejunal interposition graft located deep in the thoracic aperture and is therefore a useful method that may help to avoid reconstruction by colonic pull-up and thoracotomy.
Topics: Anastomosis, Surgical; Carcinoma, Squamous Cell; Esophageal Neoplasms; Esophageal Squamous Cell Carcinoma; Esophagectomy; Esophagus; Humans; Jejunum; Male; Middle Aged; Surgical Stapling
PubMed: 25319372
DOI: 10.1186/1471-2482-14-78 -
World Journal of Surgery Jan 2014Salvage surgery after definitive chemoradiotherapy for cervical esophageal cancer and hypopharyngeal cancer remains a challenge because of the high rate of...
BACKGROUND
Salvage surgery after definitive chemoradiotherapy for cervical esophageal cancer and hypopharyngeal cancer remains a challenge because of the high rate of complications. The purpose of this study was to evaluate the safety and efficacy of free jejunal transfer as salvage surgery for cervical esophageal cancer and hypopharyngeal cancer after definitive chemoradiotherapy.
METHODS
We enrolled eight patients with cervical esophageal cancer and 11 patients with hypopharyngeal cancer who underwent free jejunal transfer as salvage surgery following radiotherapy or chemoradiotherapy. In this study, we reviewed the surgical procedures, perioperative complications, and survival rates.
RESULTS
The median duration of surgery was 514 min, and the median blood loss was 439 ml. In surgical procedures, the recipient vessels for the anastomosis of the free jejunum consisted of one artery and one vein (63 %), one artery and two veins (5 %), and two arteries and two veins (31 %). The postoperative morbidity rate was 57.9 % (11 patients), with six cases of partial necrosis of the tracheal margin and no cases of graft necrosis or postoperative in-hospital death. The overall 5-year survival rate after surgery was 58.1 %.
CONCLUSIONS
Our findings suggest that with careful attention to the potential development of necrosis of the tracheal margin, pharyngolaryngoesophagectomy and free jejunal transfer can be safely performed, even in patients who received radiotherapy or chemoradiotherapy.
Topics: Aged; Esophageal Neoplasms; Female; Humans; Hypopharyngeal Neoplasms; Jejunum; Male; Middle Aged; Neck; Retrospective Studies; Salvage Therapy
PubMed: 24081534
DOI: 10.1007/s00268-013-2229-9 -
Current Oncology Reports May 2021Small intestinal neuroendocrine neoplasms (siNENs) are slowly growing tumours with a low malignant potential. However, more than half of the patients present with... (Review)
Review
PURPOSE OF REVIEW
Small intestinal neuroendocrine neoplasms (siNENs) are slowly growing tumours with a low malignant potential. However, more than half of the patients present with distant metastases (stage IV) and nearly all with locoregional lymph node (LN) metastases at the time of surgery. The value of locoregional treatment is discussed controversially.
RECENT FINDINGS
In stage I to III disease, locoregional surgery was currently shown to be curative prolonging survival. In stage IV disease, surgery may prolong survival in selected patients with the chance to cure locoregional disease besides radical/debulking liver surgery. It may improve the quality of life and may prevent severe local complications resulting in a state of chronic malnutrition and severe intestinal ischaemia or bowel obstruction. Locoregional tumour resection offers the opportunity to be curative or to focus therapeutically on liver metastasis, facilitating various other therapeutic modalities. Risks and benefits of the surgical intervention need to be balanced individually.
Topics: Humans; Ileal Neoplasms; Jejunal Neoplasms; Liver Neoplasms; Lymphatic Metastasis; Neoplasm Staging; Neuroendocrine Tumors
PubMed: 34018081
DOI: 10.1007/s11912-021-01074-2 -
Annals of Surgical Oncology Jun 2022Implementing a prospective lymphadenectomy protocol, we investigated the nodal yields and metastases per anatomical stations and nodal echelon following upfront...
BACKGROUND
Implementing a prospective lymphadenectomy protocol, we investigated the nodal yields and metastases per anatomical stations and nodal echelon following upfront pancreatoduodenectomy (PD) for cancer. Next, the relationship between the extension of nodal dissection, the number of examined and positive nodes (ELN/PLN), disease staging and prognosis was assessed.
METHODS
Lymphadenectomy included stations 5, 6, 8a-p, 12a-b-p, 13, 14a-b, 17, and jejunal mesentery nodes. Data were stratified by N-status, anatomical stations, and nodal echelons. First echelon was defined as stations embedded in the main specimen and second echelon as stations sampled as separate specimens. Recurrence and survival analyses were performed by using standard statistics.
RESULTS
Overall, 424 patients were enrolled from June 2013 through December 2018. The median number of ELN and PLN was 42 (interquartile range [IQR] 34-50) and 4 (IQR 2-8). Node-positive patients were 88.2%. The commonest metastatic sites were stations 13 (77.8%) and 14 (57.5%). The median number of ELN and PLN in the first echelon was 28 (IQR 23-34) and 4 (IQR 1-7). While first-echelon dissection provided enough ELN for optimal nodal staging, the aggregate rate of second-echelon metastases approached 30%. Nodal-related factors associated with recurrence and survival were N-status, multiple metastatic stations, metastases to station 14, and jejunal mesentery nodes.
CONCLUSIONS
First-echelon dissection provides adequate number of ELN for optimal staging. Nodal metastases occur mostly at stations 13/14, although second-echelon involvement is frequent. Only station 14 and jejunal mesentery nodes involvement was prognostically relevant. This latter station should be included in the standard nodal map and analyzed pathologically.
Topics: Carcinoma, Pancreatic Ductal; Humans; Lymph Node Excision; Lymph Nodes; Lymphatic Metastasis; Neoplasm Staging; Pancreatic Neoplasms; Pancreaticoduodenectomy; Prognosis; Prospective Studies
PubMed: 35192154
DOI: 10.1245/s10434-022-11417-3