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1.
Sung Hoon Choi Chang Moo Kang Jee Ye Kim Ho Kyoung Hwang Woo Jung Lee 《Surgical endoscopy》2013,27(4):1412-1413
Background
Spleen-preserving distal pancreatectomy can be performed safely and effectively by resecting both splenic vessels (Warshaw procedure) [1–4]. This simplified spleen-preserving technique might also be applied to minimally invasive distal pancreatectomy of benign and borderline malignant tumor [5, 6].Methods
Although the conservation of both splenic vessels is paramount to preserving the spleen during laparoscopic distal pancreatectomy, preservation of the splenic vessels is not always possible, especially under the following conditions: (1) relatively large tumor, (2) associated with chronic pancreatitis, (3) tumor abutting splenic vascular structures, and (4) bleeding during the splenic vessel conserving procedure, which are potential indications of laparoscopic extended Warshaw procedure. Patient preparation and position was the same as that described in our previous study [7].Results
During the study’s time period, 38 consecutive patients underwent laparoscopic spleen-preserving distal pancreatectomy. Of those, five patients underwent a laparoscopic extended Warshaw procedure, which all included among 16 patients of extended distal pancreatectomy by dividing the pancreas at the pancreatic neck. All patients were women with a median age of 55 (range, 38–75) years. Median total operation time and blood loss were 215 (range, 200–386) minutes and 100 (range, 0–300) ml, respectively. The median length of hospital stay was 8 (range, 5–15) days. All of postoperative complications (two grade A and two grade B postoperative pancreatic fistula; one grade A bleeding) were able to be treated conservatively. During the median follow-up period of 11 (range, 7–42) months, one focal splenic infarction and one gastric varix were noted; however, no clinically significant complications were reported.Conclusions
Laparoscopic spleen-preserving extended distal pancreatectomy with resection of both the splenic vessels is feasible and safe [8]. This surgical technique is thought to increase the chance of preservation of the spleen with minimally invasive distal pancreatectomy in well-selected benign or borderline malignant tumor of the distal pancreas. 相似文献2.
F. Kröpil M. Schauer M. Krausch P. Kröpil S. A. Topp A. M. Raffel C. F. Eisenberger Wolfram T. Knoefel 《World journal of surgery》2013,37(3):591-596
Background
Hemorrhage caused by inflammatory vessel erosion represents a life-threatening complication after upper abdominal surgery such as pancreatic head resection. The gold standard therapeutic choice is an endovascular minimally invasive technique such as embolization or stent placement. Hepatic arterial hemorrhage in presence of pancreatitis and peritonitis is a particular challenge is if a standard therapeutic option is not possible.Methods
The management of five patients with massive bleeding from the common hepatic artery is described. All patients underwent a splenic artery switch. The splenic artery was dissected close to the splenic hilum and transposed end-to-end to the common hepatic artery after resection of the eroded part. Patients’ medical records, radiology reports, and images were reviewed retrospectively. Technical success was defined as immediate cessation of hemorrhage and preserved liver vascularization. Clinical success was defined as hemodynamic stability and adequate long-term liver function.Results
Total pancreatectomy and splenectomy were performed in four of the five cases. Hemodynamic stability and good liver perfusion was achieved in these patients.Conclusions
Splenic artery switch is an effective, safe procedure for revascularization of the liver in case of hepatic arterial hemorrhage following pancreatic surgery, pancreatitis, and/or peritonitis. The technique is a promising option if a standard procedure—e.g., stent implantation, embolization and surgical repair with alloplastic prosthesis or autologous venous interposition graft—is not possible. 相似文献3.
Ho Kyoung Hwang Chang Moo Kang Young Eun Chung Kyung Ah Kim Sung Hoon Choi Woo Jung Lee 《Surgical endoscopy》2013,27(3):774-781
Background
Advanced and delicate laparoscopic techniques are usually required for safe and successful laparoscopic spleen-preserving distal pancreatectomy. The unique characteristics of robotic surgical system are thought to be useful for this minimally invasive procedure.Methods
From September 2007 to May 2011, patients who underwent robot-assisted, spleen-preserving, distal pancreatectomy for benign and borderline malignant tumors of the pancreas were retrospectively reviewed. Perioperative clinicopathologic surgical outcomes were evaluated.Results
Twenty-two patients were attempted for robot-assisted, spleen-preserving, distal pancreatectomy, and in 21 patients (95.5 %), the spleen was saved either by splenic vessels conservation (SVC; n = 17, 81 %) or by splenic vessels sacrifice (SVS; n = 4, 19 %). Seven patients were male and 15 were female with a mean age of 43.2 ± 15.2 years. Pathologic diagnosis included MCT in five patients, SCT in five, SPT in four, IPMT in three, NET in three, and other benign conditions in two. The mean operation time was 398.9 ± 166.3 min, but it gradually decreased as experiences were accumulated (Rsq = 0.223, p = 0.023). Intraoperative blood loss was 361.3 ± 360.1 ml, and intraoperative transfusion was required in four patients (18.1 %). A soft diet was given for 1.2 ± 0.4 days, and the length of hospital stay was 7.0 ± 2.4 days postoperatively. Clinically relevant pancreatic fistula was noted in two patients (9.1 %) but was successfully managed conservatively. Most patients (87.5 %) showed patency in conserved both splenic vessels, and only two patients (12.5 %) had partially or completely obliterated in splenic veins in the SVC-SpDP group. Partially impaired splenic perfusion was observed in one patient in the SVS-SpDP group. The perfusion defect area decreased without any clinical symptom after 4 months.Conclusions
The robotic surgical system is thought to be beneficial for improving the spleen-preservation rate in laparoscopic distal pancreatectomy. Robot-assisted approach can be chosen for patients who require spleen-preserving distal pancreatectomy. 相似文献4.
Serous cyst adenoma of the pancreas: appraisal of active surgical strategy before it causes problems
Background
Patients who are diagnosed with symptomatic or ambiguous serous cyst adenoma (SCA) need surgery. The purpose of this study is to suggest a potential management plan based on analysis of surgically treated SCAs.Methods
Between August 1995 and December 2010, 38 patients with SCA were surgically treated. Data were analyzed retrospectively.Results
Among 38 patients, 28 were female and ten were male. Mean age was 49.6?±?14.1?years, and five patients (13.2%) were older than 65?years. Among the five patients, two were more than 70?years old. Seventeen patients (44.7%) were symptomatic, and the rest (21, 55.3%) were incidentally found to have SCA. Twenty-seven patients underwent open pancreatectomy, and 11 patients received laparoscopic distal pancreatectomy. Mean tumor size was 4.4?±?2.8?cm. Most asymptomatic patients of SCA had a left-sided pancreatic tumor and distal pancreatectomy with or without splenectomy were frequently performed with short operative time and less blood transfusion (P?0.05). Minimally invasive surgery was mostly applied to left-sided tumors less than 5?cm in size (11/19 vs. 0/6, P?=?0.029). Combined resection of the right colon was performed in two patients (5.3%) due to severe adhesion associated with large tumors. Significant association was noted between age and tumor size in asymptomatic patients (correlation coefficient?=?0.541, R 2?=?0.293, P?=?0.014). Postoperative pancreatic fistula was observed in five patients (13.2%, grade B) but could be managed conservatively. No mortality was found.Conclusion
Before SCA causes symptoms or grows larger than 5?cm, an active surgical approach, such as minimally invasive surgery, needs to be considered. 相似文献5.
Background
We evaluated vascular patency and potential changes in preserved spleens after laparoscopic spleen-preserving distal pancreatectomy (SPDP) with conservation of both splenic vessels.Methods
We retrospectively analyzed the patency of conserved splenic vessels in patients who underwent laparoscopic or robotic splenic vessel-conserving SPDP from January 2006 to August 2010. The patency of the conserved splenic vessels was evaluated by abdominal computed tomography and classified into three grades according to the degree of severity.Results
Among 30 patients with splenic vessel-conserving laparoscopic SPDP, 29 patients with complete follow-up data were included in this study. During the follow-up period (median: 13.2?months), grades 1 and 2 splenic arterial obliteration were observed in one patient each. A total of five patients (17.2%) showed grade 1 or 2 obliteration in conserved splenic veins. Most patients (82.8%) had patent conserved splenic vein. Four patients (13.8%) eventually developed collateral venous vessels around gastric fundus and reserved spleen, but no spleen infarction was found, and none presented clinical relevant symptoms, such as variceal bleeding. There was no statistical difference in vascular patency between the laparoscopic and robotic groups (P?>?0.05).Conclusions
Most patients showed intact vascular patency in conserved splenic vessels and no secondary changes in the preserved spleen after laparoscopic splenic vessel-conserving SPDP. 相似文献6.
Sung Hoon Kim MD Chang Moo Kang MD Woo Jung Lee MD PhD 《Annals of surgical oncology》2013,20(2):547-547
Background
The duodenum is a rare origin for gastrointestinal stromal tumors (GISTs).1 , 2 A decision of pancreatoduodenectomy or limited resection is a dilemma for surgeons. Recent reviews have suggested that types of surgery did not influence prognosis and limited resection was indicated for small GIST located some distance away from the ampulla of Vater (AOV).3 , 4 However, a laparoscopic, pancreas-preserving, subtotal duodenectomy was rarely performed.5 , 6Methods
A 20-year-old female was referred to our institution because of a duodenal submucosal mass. Computer tomography and endoscopy revealed a 3.8-cm–sized mass that was ~2 cm from AOV. A minimally invasive and function-preserving resection was scheduled.Results
Meticulous dissection of the duodenum from the pancreatic head was a critical point. Even small breakages of vessels could provoke massive bleeding, possibly resulting in the surgeon’s view being obstructed, longer operating times, or a decreased chance of performing a minimally invasive and limited resection. Therefore, an especially meticulous and careful dissection was performed. An upper gastrointestinal series revealed no leakage, and the patient received a soft diet on postoperative day 3. The patient was discharged on postoperative day 8. Pathologic examination reported a low-risk GIST group.Conclusions
Although clearly malignant tumors are not suitable for this approach due to poor oncologic outcomes, laparoscopic pancreas-preserving subtotal duodenectomy is a feasible and effective strategy to treat benign or borderline tumors. This approach will offer successful oncologic results and laparoscopic merits. We feel that this demonstration would advocate clinical feasibility of minimally invasive and function-preserving resections in well-selected duodenal GISTs. 相似文献7.
Sven-Petter Haugvik Bård Ingvald Røsok Anne Waage Øystein Mathisen Bjørn Edwin 《Langenbeck's archives of surgery / Deutsche Gesellschaft fur Chirurgie》2013,398(8):1091-1096
Purpose
Laparoscopic distal pancreatectomy is becoming increasingly established at specialized surgical institutions worldwide. The purpose of this study was to compare single-incision laparoscopic distal pancreatectomy (panLESS) with conventional laparoscopic distal pancreatectomy (panLAP) to assess feasibility and 30-day morbidity.Methods
Eight consecutive patients who underwent panLESS were matched with patients who underwent panLAP in the same time period. Matching criteria were age, body mass index, and American Society of Anesthesiologists score. Feasibility was based on tumor size, operative time, intraoperative bleeding, resection status, and hospital stay. Thirty-day morbidity was defined by the revised Accordion Classification system and the International Study Group on Pancreatic Fistula definition.Results
Over a 19-month period, 8 and 16 patients were identified for panLESS and panLAP, respectively. There were no significant differences in tumor size, operative time, intraoperative bleeding, resection status, and hospital stay between the two groups. Surgical complications developed in four panLESS patients and five panLAP patients, and out of which, two patients from each group developed a postoperative pancreatic fistula (grade B).Conclusions
This study indicates that panLESS is comparable to panLAP in terms of feasibility. More experience is needed to define what role single-incision distal pancreatectomy should have in minimal invasive pancreatic surgery. 相似文献8.
Keiichi Suzuki Osamu Itano Go Oshima Masayoshi Osaku Fumiki Asanuma Yuko Kitagawa 《World journal of surgery》2014,38(5):1205-1210
Background
Laparoscopic splenic vessel-preserving distal pancreatectomy (lap-SVPDP) is a popular procedure in pancreatic surgery. However, postoperative complications include false aneurysms of the splenic artery, splenic vein stenosis and thrombosis, pancreatic fistulas, abscess, and perigastric varices.Methods
Eight patients (three men, five women, average age 66.1 years) with benign tumors underwent lap-SVPDP. Lap-SVPDP was performed in the lithotomy position with the head slightly elevated. The splenic vein was peeled longitudinally toward the pancreatic tail. A vessel-sealing system was used to detach the pancreatic body from the greater omentum, and the pancreas was transected using a surgical stapler.Results
Mean operation time was 254 min; mean blood loss was 163 ml; and mean post-surgical hospitalization time was 13 days. No postoperative bleeding from the preserved splenic vessels occurred, and there were no splenic infarcts or splenic abscesses.Conclusions
For safe performance of lap-SVPDP, the posterior surface of the pancreas should be completely exposed. The splenic vein should be ‘peeled away’, starting from its central rear, enabling easy detection of its course to avoid inadvertent sealing. With improved operational techniques, lap-SVPDP can be adopted as a standard procedure in pancreatic surgery. 相似文献9.
A. N. Krepline K. K. Christians K. Duelge A. Mahmoud P. Ritch B. George B. A. Erickson W. D. Foley E. J. Quebbeman K. K. Turaga F. M. Johnston T. C. Gamblin D. B. Evans S. Tsai 《Journal of gastrointestinal surgery》2014,18(11):2016-2025
Background
Pancreatectomy with venous reconstruction (VR) for pancreatic cancer (PC) is occurring more commonly. Few studies have examined the long-term patency of the superior mesenteric-portal vein confluence following reconstruction.Methods
From 2007 to 2013, patients who underwent pancreatic resection with VR for PC were classified by type of reconstruction. Patency of VR was assessed using surveillance computed tomographic imaging obtained from date of surgery to last follow-up.Results
VR was performed in 43 patients and included the following: tangential resection with primary repair (7, 16 %) or saphenous vein patch (9, 21 %); segmental resection with splenic vein division and either primary anastomosis (10, 23 %) or internal jugular vein interposition (8, 19 %); or segmental resection with splenic vein preservation and either primary anastomosis (3, 7 %) or interposition grafting (6, 14 %). All patients were instructed to take aspirin after surgery; low molecular weight heparin was not routinely used. An occluded VR was found in four (9 %) of the 43 patients at a median follow-up of 13 months; median time to detection of thrombosis in the four patients was 72 days (range 16–238).Conclusions
Pancreatectomy with VR can be performed with high patency rates. The optimal postoperative pharmacologic therapy to prevent thrombosis requires further investigation. 相似文献10.
Partelli S Crippa S Barugola G Tamburrino D Capelli P D'Onofrio M Pederzoli P Falconi M 《Annals of surgical oncology》2011,18(13):3608-3614
Background
The value of splenic vessels invasion (which identified T3 tumors) in prognosis after resection for pancreatic ductal adenocarcinoma (PDA) of the body and tail has not been extensively investigated. The goal of this study was to evaluate prognostic factors in PDA of the body/tail, emphasizing the role of splenic vessels infiltration.Methods
Between 1990 and 2008, 87 patients who underwent distal pancreatectomy (DP) for histologically proven PDA of the body and tail were analyzed. Clinicopathological prognostic factors for survival were evaluated. Univariate and multivariable analyses were performed.Results
Postoperative morbidity was 31% with no mortality. The 1-, 3-, and 5-year overall survival rates were 77%, 48%, and 24.5%, respectively. Invasion of the splenic artery (SA) was observed in 19 patients (22%). Patients with SA invasion had a significantly poorer prognosis compared with those without SA invasion (median survival: 15 vs. 39 months, P = 0.014). On multivariable analysis, adjuvant therapy, poor differentiation (G3/G4), R2 resection, the presence of lymph node metastases, and SA invasion were independent predictors of survival.Conclusions
Along with other well-known prognostic factors, invasion of SA is an independent predictor of poor survival in PDA of the body/tail. In case of the presence of SA infiltration, neoadjuvant treatment should be considered. SA infiltration might be reclassified from a T3 to T4 tumor. 相似文献11.
Federico Selvaggi Giuseppe Mascetta Despoina Daskalaki Marco dal Molin Roberto Salvia Giovanni Butturini Carlo Cellini Claudio Bassi 《Langenbeck's archives of surgery / Deutsche Gesellschaft fur Chirurgie》2014,399(5):659-665
Background
Approximately 20 % of patients affected by pancreatic ductal adenocarcinoma are amenable to surgical resection. Several tumours are reported as “borderline resectable” because of their proximity to the major vessels. In the effort to achieve a radical tumour removal, vein resection has been proposed, but its oncological benefits remain debated.Methods
Our aim is to investigate morbidity, mortality and survival after pancreatectomy with vein resection.Results
Forty patients underwent pancreatectomy and vein resection (group A), and 20 patients (group B) underwent bilio-enteric and/or gastro-entero bypass. In group A, cancer vein invasion was microscopically proven in 14 cases (35 %). Vein infiltration, tumour differentiation and node-positive disease were not adverse prognostic variables. No difference in survival was seen over a 1-year follow-up. After this period, group A showed significant survival benefits with a longer stabilisation of the disease (p?=?0.005). Tumour-free resection margins and adjuvant chemoradiotherapy were the most important prognostic factors (p?<?0.05).Conclusions
Suspicion of vein infiltration should not be a contraindication to resection. Pancreatectomy can be safely performed with an acceptable morbidity and better survival trend. 相似文献12.
Introduction and purpose
Despite being technically challenging, minimally-invasive pancreatic surgery is increasingly being used to treat pancreatic diseases. Therefore, the evaluation of its oncological safety and its advantages arebecoming increasingly more important. This review focuses on these questions based on the currently available literature.Material and methods
The technically less demanding laparoscopic distal pancreatectomy has been evaluated in numerous meta-analyses. Minimally invasive pancreaticoduodenectomy has only been reported from a few centers worldwide.Results and conclusion
Minimally invasive pancreatic surgery, in particular laparoscopic distal pancreatectomy, is increasingly being used to treat pancreatic tumors. The advantages of laparoscopy, such as less intraoperative blood loss, reduced postoperative pain and a shorter length of stay have all been demonstrated in large trials. However, a sufficient oncological treatment was only assessed via indirect surrogate parameters, such as the number of lymph nodes obtained and R0 resection rates; therefore, larger prospective trials are needed to prove adequate oncological treatment. To date, minimally invasive techniques should only be employed in trials on treatment of pancreatic malignancies. 相似文献13.
14.
Joseph DiNorcia Minna K. Lee Patrick L. Reavey Jeanine M. Genkinger James A. Lee Beth A. Schrope John A. Chabot John D. Allendorf 《Journal of gastrointestinal surgery》2010,14(10):1536-1546
Background
Increasingly, surgeons apply minimally invasive and parenchyma-sparing techniques to the management of pancreatic neuroendocrine tumor (PNET). The aim of this study was to evaluate the impact of these approaches on patient outcomes.Methods
We retrospectively collected data on patients with PNET and compared perioperative and pathologic variables. Survival was analyzed using the Kaplan–Meier method. Factors influencing survival were evaluated using a Cox proportional hazards model.Results
One hundred thirty patients underwent resection for PNET. Traditional resections included 43 pancreaticoduodenectomies (PD), 38 open distal pancreatectomies (DP), and four total pancreatectomies. Minimally invasive and parenchyma-sparing resections included 25 laparoscopic DP, 11 central pancreatectomies, five enucleations, three partial pancreatectomies, and one laparoscopic-assisted PD. Compared to traditional resections, the minimally invasive and parenchyma-sparing resections had shorter hospital stays. By univariate analysis of neuroendocrine carcinoma, liver metastases and positive resection margins correlated with poor survival. There was an increase in minimally invasive or parenchyma-sparing resections over the study period with no differences in morbidity, mortality, or survival.Conclusion
In this series, there has been a significant increase in minimally invasive and parenchyma-sparing techniques for PNET. This shift did not increase morbidity or compromise survival. In addition, minimally invasive and parenchyma-sparing operations yielded shorter hospital stays. 相似文献15.
Wuilker Knoner Campos MD Alessandro Gasbarrini MD Stefano Boriani MD 《Clinical orthopaedics and related research》2013,471(2):680-685
Background
A spinal osteoid osteoma is a rare benign tumor. The usual treatment involves complete curettage including the nidus. In the thoracic spine, conventional open surgical treatment usually carries relatively high surgical risks because of the close anatomic relationship to the spinal cord, nerve roots, and thoracic vessels, and pulmonary complications and postoperative pain.Case Report
We report the case of a 16-year-old girl with a symptomatic osteoid osteoma at the T9 level whose lesion was currettaged using video-assisted thoracoscopic surgery (VATS) guided by a navigation system (VATS-NAV). There were no complications and the patient had immediate relief of the characteristic pain after surgery and was asymptomatic at 5 months’ followup.Literature Review
Progressive advances in the technology of spinal surgery have evolved to offer greater safety and less morbidity for patients. The advent of minimally invasive surgery has expanded the indications for VATS for anterior spinal disorders. Spinal navigation systems have become useful tools allowing localization and excision of the nidus of osteoid osteomas with minimal bone resection and without radiation exposure.Clinical Relevance
The VATS-NAV combination in our patient allowed accurate localization and guidance for complete excision of a spinal osteoid osteoma through a minimally invasive approach without compromising spinal stability. 相似文献16.
17.
Sascha Santosh Chopra Sven Christian Schmidt Robert Eisele Ulf Teichgräber Ivo Van der Voort Christian Seebauer Florian Streitparth Guido Schumacher 《Surgical endoscopy》2010,24(10):2506-2512
Background
The goal of this study was to evaluate high-field open magnetic resonance imaging (MRI) for intraoperative real-time imaging during hand-assisted laparoscopic liver resection. MR guidance has several advantages compared to ultrasound and may represent a future technique for abdominal surgery. Various MRI-safe and -compatible instruments were developed, tested, and applied to realize minimally invasive liver surgery under MR guidance. As proof of the concept, liver resection was performed in a porcine model.Methods
All procedures were conducted in a 1.0-T open MRI unit. Imaging quality and surgical results were documented during three cadaveric and two live animal procedures. A nonferromagnetic hand port was used for manual access and the liver tissue was dissected using a Nd:YAG laser.Results
The intervention time ranged from 126 to 145 min, with a dissection time from 11 to 15 min. Both live animals survived the intervention with a blood loss of 250 and 170 ml and a specimen weight of 138 and 177 g. A dynamic T2W fast spin-echo sequence allowed real-time imaging (1.5 s/image) with good delineation of major and small hepatic vessels. The newly developed MR-compatible instruments and camera system caused only minor interferences and artifacts of the MR image.Conclusion
MR-guided liver resection is feasible and provides additional image information to the surgeon. We conclude that MR-guided laparoscopic liver resection improves the anatomical orientation and may increase the safety of future minimally invasive liver surgery. 相似文献18.
Young-Dong Yu Ki-Hun Kim Dong-Hwan Jung Jung-Man Namkoong Sam-Youl Yoon Sung-Won Jung Sang-Kyung Lee Sung-Gyu Lee 《Langenbeck's archives of surgery / Deutsche Gesellschaft fur Chirurgie》2014,399(8):1039-1045
Purpose
The significant advantages of robotic surgery have expanded the scope of surgical procedures that can be performed through minimally invasive techniques. The aim of this study was to compare the perioperative outcomes between robotic and laparoscopic liver surgeries at a single center.Methods
From July 2007 to October 2011, a total of 206 patients underwent laparoscopic or robotic liver surgery at the Asan Medical Center, Seoul, Korea. We compared the surgical outcomes between robotic liver surgery and laparoscopic liver surgery during the same period. Only patients who underwent left hemihepatectomy or left lateral sectionectomy were included in this study.Results
The robotic group consisted of 13 patients who underwent robotic liver resection including 10 left lateral sectionectomies and three left hemihepatectomies. The laparoscopic group consisted of 17 patients who underwent laparoscopic liver resection during the same period including six left lateral sectionectomies and 11 left hemihepatectomies. The groups were similar with regard to age, gender, tumor type, and tumor size. There were no significant differences in perioperative outcome such as operative time, intraoperative blood loss, postoperative liver function tests, complication rate, and hospital stay between robotic liver resection and laparoscopic liver resection. However, the medical cost was higher in the robotic group.Conclusions
Robotic liver resection is a safe and feasible option for liver resection in experienced hands. The authors suggest that since the robotic surgical system provides sophisticated advantages, the retrenchment of medical cost for the robotic system in addition to refining its liver transection tool may substantially increase its application in clinical practice in the near future. 相似文献19.
Kfir Ben-David Tad Kim Angel M. Caban Georgios Rossidis Sara S. Rodriguez Steven N. Hochwald 《Journal of gastrointestinal surgery》2013,17(8):1352-1358
Objective
Laparoscopic feeding jejunostomy is a safe and effective means of providing enteral nutrition in the preoperative phase to esophageal cancer patients.Design
This research is a retrospective case series.Setting
This study was conducted in a university tertiary care center.Patients
Between August 2007 and April 2012, 153 laparoscopic feeding jejunostomies were performed in patients 10 weeks prior to their definitive minimally invasive esophagectomy.Main Outcome Measures
The outcome is measured based on the technique, safety, and feasibility of a laparoscopic feeding jejunostomy in the preoperative phase of esophageal cancer patients.Results
One hundred fifty-three patients underwent a laparoscopic feeding jejunostomy approximately 1 and 10 week(s) prior to the start of their neoadjuvant therapy and definitive minimally invasive esophagectomy, respectively. Median age was 63 years. Of the patients, 75 % were males and 25 % were females. One hundred twenty-seven patients had gastroesophageal junction adenocarcinoma and 26 had squamous cell carcinoma. All patients completed their neoadjuvant chemoradiation therapy. The median operative time was 65 min. We had no intraoperative complications, perforation, postoperative bowel necrosis, bowel torsion, herniation, intraperitoneal leak, or mortality as a result of the laparoscopic feeding jejunostomy. Four patients were noted to have superficial skin infection around the tube, and 11 patients required a tube exchange for dislodgment, clogging, and leaking around the tube. All patients progressed to their definitive surgical esophageal resection.Conclusion
A laparoscopic feeding jejunostomy is technically feasible, safe, and can provide appropriate enteral nutrition in the preoperative phase of esophageal cancer patients. 相似文献20.
Cavallini Alvise MD Butturini Giovanni MD Daskalaki Despoina MD Salvia Roberto MD Melotti Gianluigi MD Piccoli Micaela MD Bassi Claudio MD Pederzoli Paolo MD 《Annals of surgical oncology》2011,18(2):352-357