The effect of albendazole on the prevention of secondary hydatidosis

BACKGROUND/AIMS: Secondary hydatidosis and recurrence are serious complications in hydatid surgery. Although medical treatment and current surgical techniques are more effective in the prevention of cyst formation resulting from spillage of cystic liquid, secondary hydatidosis is still surgically important. Albendazole, a derivative of benzoimidazole, is the most commonly used drug in the medical treatment of echinococcosis. The effectiveness of pre-operative prolonged or single dose applications is supported by the literature. METHODOLOGY: Twenty-two cases of hepatic hydatidosis are evaluated and treated by surgery. Perioperative albendazole treatment was given in a dose of 12-15 mg/kg/day in 4 divided doses. The treatment began 5-20 days before the surgery and continued 3-7 months in a cyclic monthly form, until latex agglutination tests were negative. In the postoperative period, hematological, ultrasonography and computed tomography scan evaluation was carried out. The follow-up period for 21 patients was 6-31 months (mean: 20.52 months). RESULTS: There was no secondary hydatidosis, recurrence or mortality in this study. Early and late morbidity rates were 4.54% and 13.63% respectively. CONCLUSIONS: Our results support that perioperative albendazole treatment is effective in the prevention of secondary hydatidosis.     

Dual treatment of albendazole in hepatic hydatidosis: New therapeutic modality in 52 cases

BACKGROUND: Hepatic hydatidosis still remains as a serious problem in general surgery. Recurrence and/or secondary hydatidosis rates are up to 25% in the cases treated with surgery alone. Albendazole is the most commonly used drug in the medical treatment of echinococcosis. The aim of the present study was to evaluate the effect of albendazole using the intraoperative and perioperative periods as dual therapy. METHODS: Fifty-two cases of hepatic hydatidosis were evaluated and treated by dual treatment of albendazole together with surgery. Perioperative albendazole treatment was given in a dose of 12-15 mg/kg per day in four divided doses. The treatment started 2-28 days before the surgery when the diagnosis was established and continued for 2-24 months (4.76 +/- 3.25) postoperatively in a cyclic monthly form. A total of 1.7 microg/mL albendazole solution was used as a protoscolicidal agent in the cystic cavity intraoperatively. In the postoperative period serology, ultrasonography and computed tomography evaluations were done. The follow-up period was 5-92 months (mean: 62.48 months). RESULTS: There was no recurrence in the present study. One patient died in the 6th postoperative week due to cerebral hydatidosis and multiple organ failure. Early and late morbidity rates were 7.69 and 9.61%, respectively. CONCLUSIONS: Dual albendazole treatment is effective in the prevention of recurrences and/or secondary hydatidosis.     

Transanal endoscopic microsurgery in rectal adenomas: Experience of six Italian centres

BACKGROUND/AIMS: Transanal endoscopic microsurgery is a minimally invasive technique that allows the excision of benign and selected malignant tumours. We present a study for evaluating surgical morbidity, mortality and local recurrence rate of patients with rectal adenomas treated with transanal endoscopic microsurgery in six different Italian centres following the same protocol. METHODS: A total of 882 patients with rectal lesions (adenomas and early stage of carcinomas) underwent transanal endoscopic microsurgery in six different Surgical Departments from January 1993 to October 2004. Five hundred and ninety patients had preoperative diagnosis of adenomas but 588 patients were regularly followed up to determine treatment efficacy in terms of local recurrence rate. RESULTS: The study involved 588 patients, with a median age of 66 years (25th percentile-75th percentile=58-71 years). No postoperative mortality was reported. Intraoperative complications were observed in three patients (0.5%). Minor complications occurred in 48 patients (8.2%) whereas major complications were found only in 7 patients (1.2%). Definitive histology confirmed adenomas in 530 cases (90.1%). Two patients (0.3%) were lost to follow-up so were not included in the paper. At median follow-up of 44 months (25th percentile-75th percentile=15-74 months), 23 (4.3%) adenomas recurred and were successfully retreated by transanal endoscopic microsurgery [20 cases (87%)] and by conventional surgery [3 patients (13%)]. No further recurrences were observed at subsequent follow-up. Thirty-one (5.3%) patients died during follow-up for old age, cardiac disease, etc. CONCLUSIONS: Transanal endoscopic microsurgery is, in our experience, an effective method for local resection of benign rectal tumours with morbidity of 11.4%, no postoperative mortality and with a percentage of local recurrence of 4.3%.     

Hepatic hydatidosis. Radical vs. conservative surgery: 22 years of experience]

OBJECTIVES: the incidence of hepatic hydatidosis has remarkably decreased in the last years due to the preventive measures adopted to stop the transmission of the parasite. However, surgery carries on being the treatment of choice, although the surgical procedure is still a matter of controversy. The aim of the study was to evaluate the results obtained with the treatment of this condition after two decades according to surgical procedure type. MATERIAL AND METHODS: from 1983 to 2005, 372 patients were operated on for hepatic hydatidic cyst in Hospital Ramón y Cajal. Radical surgery was performed for 162 (43.5%) and conservative surgery for 210 (56.5%). RESULTS: average postoperative hospital stay (8.65 vs. 14.9 days), morbidity (13.3 vs. 31.4%, p < 0.001), and mortality (0 vs. 3.8%, p < 0.01) were lower in the radical surgery group. Recurrence rate was 1.85% after radical surgery versus 11.9% in the conservative surgery group (p < 0.0001). CONCLUSION: radical surgery is associated with lower morbidity, mortality, postoperative hospital stay, and recurrence rates, and represents the treatment of choice for hepatic hydatidosis. However, its indication must depend on the patient characteristics, cyst anatomy, and surgical team experience.     

Videolaparoscopic treatment of hepatic hydatid cyst

BACKGROUND/AIMS: Unroofing, cystopericystectomy, or cystic evaluation and omentoplasty have been used in videolaparoscopic treatment in hepatic hydatidosis since 1992. Currently it is shown that videolaparoscopic treatment has been carried out successfully in selected cases. METHODOLOGY: Fifteen hepatic hydatid cysts in 12 cases were treated by videolaparoscopic methods. Formerly in the 5 cases, the cysts were aspirated with a needle designed for a 5-mm trocar, leaving a cystic cavity that was tension-free, then scolicidal solution was injected and aspirated. In the last 7 patients an aspirator-grinder apparatus was used. Intraoperative ultrasonography was applied in all patients. RESULTS: All the cysts were treated by drainage and omentoplasty. In one case cystic cavity infection was diagnosed in the 2nd postoperative month (morbidity rate 8.33%). Another patient died due to cerebral hydatid cyst and multiple organ failure after the postoperative first month (mortality rate 8.33%). Operative mortality was not seen. CONCLUSIONS: Videolaparoscopic treatments of hepatic hydatid cysts may be carried out successfully in selected cases.     

Should intraoperative ultrasonography be used routinely in hepatic hydatidosis?

BACKGROUND/AIMS: Recurrent or secondary hydatidosis are the most important problems of hepatic hydatidosis in the late postoperative period. The spread of cystic liquid, overlooked centrally located or pericystic satellite cysts that are inconspicuous during operation are the basic reasons for the problem. METHODOLOGY: In order to prevent the risk of recurrent or secondary hydatidosis, 22 liver hydatid cystic patients were taken for a prospective study. Beyond the routine investigations and researches, after the completion of conventional surgical procedures, intraoperative ultrasonography was applied to all patients. RESULTS: In three patients the existence of cysts were not found by conventional research (13.63%), in another patient (4.54%) cysto-biliary communication which had been determined clinically but was invisible due to difficulty in anatomic localization was verified by means of intraoperative ultrasonography. CONCLUSIONS: Intraoperative ultrasonography has been thought to be beneficial to find centrally localized cysts which may be inconspicuous especially in cases of multiple cysts.     

Predicting adverse postoperative outcomes in patients aged 80 years or older

OBJECTIVE: The identification of reversible factors that are associated with postoperative morbidity in geriatric surgical patients is critical to improving perioperative outcomes in such patients. Our study aimed to compare the relative importance of intraoperative versus preoperative factors in predicting adverse postoperative outcomes in geriatric patients. DESIGN: Retrospective cohort study of consecutive patients undergoing noncardiac surgery in 1995. SETTING: Two University of California, San Francisco, teaching hospitals--Moffitt/Long and Mount Zion medical centers. PARTICIPANTS: All men and women 80 years of age or older undergoing noncardiac surgery. MEASUREMENTS: Medical records of all patients were reviewed to measure predefined pre- and intraoperative risk factors and postoperative outcomes. Predictors of postoperative outcomes were identified by multivariate logistic regression analyses. RESULTS: Three hundred sixty-seven patients were studied. The most prevalent preoperative risk factors were a history of hypertension and coronary artery, pulmonary, and neurologic diseases. Postoperative in-hospital mortality rate was 4.6%, and 25% of patients developed adverse postoperative outcomes, of which neurological and cardiovascular complications were the leading causes of morbidity (15% and 12%, respectively). By multivariate logistic regression, a history of neurological disease (odds ratio [OR] 4.0, 95% confidence interval [CI] 2.3 - 6.9, P = .0001), congestive heart failure (OR 2.7, 95% CI 1.4 - 5.3, P = .004), and a history of arrhythmia (OR 2.3, 95% CI 1.2 - 4.3, P = .01) increased the odds of adverse postoperative events. The only intraoperative event shown to be predictive of postoperative complications was the use of vasoactive agents (OR 8.0, 95% CI 1.6 - 40.5, P = .009). CONCLUSIONS: In this group of geriatric surgical patients, the overall postoperative in-hospital mortality rate was 4.6%, and 25% of the patients developed adverse postoperative outcomes involving either the neurological, cardiovascular, or pulmonary systems. Intraoperative events appeared to be less important than preoperative comorbidities in predicting adverse postoperative outcomes.     

Surgical treatment of pulmonary recurrence after hepatectomy for colorectal liver metastases

BACKGROUND/AIMS: Although pulmonary recurrence is frequent among the extrahepatic recurrences after hepatectomy, the efficacy of surgical treatment for pulmonary recurrence after hepatectomy has not been confirmed. Surgical resection of pulmonary recurrence after hepatectomy for colorectal metastases was reviewed retrospectively to evaluate the survival benefit. METHODOLOGY: From 1990 to 1995, 10 of the 17 patients with pulmonary recurrence after hepatectomy for colorectal metastases underwent surgical treatment. Ten patients underwent resection of pulmonary recurrence. RESULTS: Operative mortality was 0%, and a postoperative complication was observed in 1 patient after pulmonary metastasectomy. The overall 5-year survival rate after pulmonary metastasectomy was 10.0%, and the median survival was 21.7 (range: 2.4-77.9) months. One patient underwent resection two times for remnant lung recurrence after first lung metastasectomy, and is alive with no evidence of recurrence 77.9 months after the first pulmonary resection, and 50.7 months after the third pulmonary resection. In 3 patients with well-differentiated adenocarcinoma, the median survival time was 6.2 months (range: 2.4-9.7). The other hands, 7 patients with moderately differentiated adenocarcinoma have a longer median survival time of 29.2 months (range: 16.0-77.9). CONCLUSIONS: Pulmonary metastasectomy after hepatectomy for metastases from colorectal cancer is a safe treatment, and might offer prolonged survival for highly selected patients.     

Efficacy of transanal endoscopic microsurgery in the management of rectal polyps

BACKGROUND AND AIM: Transanal endoscopic microsurgery (TEM) was a technique developed to allow the excision of adenomas and early-stage cancers from the rectum and distal sigmoid colon. The aim of this project was to prospectively study surgical morbidity, mortality and the local recurrence rate of all patients treated with this technique. METHODS: All patients undergoing TEM were prospectively evaluated. Endpoints to assess the surgical morbidity and mortality were defined before the study commenced. All patients underwent regular follow up to determine treatment efficacy in terms of the local recurrence rate and survival. RESULTS: The study involved 113 patients, with a mean age of 69 years (standard deviation 14 years, range 30-94 years), and a male to female ratio of 1.4:1. The mean polyp area was 20.5 cm(2) (range 1-169 cm(2)) and the mean height above the anal verge was 9.5 cm (range 4-25 cm). Histology of the tumors found 62 adenomas, 20 carcinomas in situ, and 31 adenocarcinomas. There were no unplanned returns to theater or postoperative deaths. Four patients required readmission within 30 days because of bleeding, and nine patients underwent more radical surgical procedures following histological evaluation of the resected specimens. During a mean follow up of 1.5 +/- 0.8 years (maximum 3.2 years), there have been two recurrences of villous adenomas. The actuarial local recurrence rate at 2 years is 2.4% (95% confidence interval 0.8-4.0%). CONCLUSION: TEM was demonstrated to be a safe surgical procedure, and early follow up has shown it to be an efficacious treatment for benign rectal adenomas and early rectal cancers.     

Tension-free inguinal hernia repair in "one-day surgery". Experience of 1091 cases

BACKGROUND/AIMS: In recent years new techniques to repair inguinal hernia have evolved in order to reduce recurrence rate and the overall costs of treatment of this pathology. This paper analyses our experience in verifying the theoretical advantages of the "tension-free" technique, after six years of this surgical practice. METHODOLOGY: We describe the experience of 1091 "tension-free" hernia repairs with open placement of a mesh in 1034 patients, under local anesthesia with a "one-day surgery" regimen; these patients were observed during the period 1994 to 1999 at the Surgical Unit of Catholic University of Rome. The patients were between American Society of Anesthesia Status I to IV. Eight hundred patients underwent a mean follow-up of 29.7 months (range: 4-72) to evaluate the occurrence of late complications and recurrences. RESULTS: No mortality or major intraoperative complications was observed. The only minor intraoperative or postoperative complications encountered were easily managed. Early pain disappearance, fast convalescence and rapid resumption of working activity were observed. Six recurrences occurred in the patients undergoing follow-up (0.75% recurrence rate). CONCLUSIONS: Our data confirm the safety, rapidity, and reproducibility of the "tension-free" technique under local anesthesia performed with a "one-day surgery" regimen for inguinal hernia repair. These characteristics explain the diffusion of this surgical procedure with reduction of social costs.     

The Altemeier repair: Outpatient treatment of rectal prolapse

PURPOSE: Rectal prolapse typically occurs in elderly patients, who are often poor surgical candidates because of the presence of multiple comorbidities. Abdominal approaches to procidentia have low recurrence rates but are associated with higher rates of morbidity and mortality. Perineal rectosigmoidectomy (Altemeier repair) is a safe and effective approach to the treatment of rectal prolapse and can be done as an outpatient procedure. In this article, the results of a series of 63 consecutive Altemeier repairs are presented. METHODS: Between February 1993 and December 1999, 63 patients (61 females) underwent Altemeier repair of rectal prolapse. The mean patient age was 79 years. Preoperative, intraoperative, and postoperative data were collected and analyzed for all patients. RESULTS: Median follow-up was 20.8 months. Seventy percent of patients were given a regional or local anesthetic. The average resected specimen length was 11.6 cm, and 83 percent of anastomoses were stapled. Sixty-two percent of patients were discharged home on the day of surgery, and 80 percent were home within 24 hours. Complications occurred in 10 percent of patients, but there was no perioperative mortality. There was a 6.4 percent recurrence rate, and all recurrences were successfully treated with repeat Altemeier repair. All 63 patients had complete objective resolution of prolapse, and 87 percent had subjective improvement after repair. CONCLUSIONS: Altemeier repair of rectal prolapse is safe, produces minimal discomfort, and does not require a general anesthetic. It is ideally suited to be done on an outpatient basis, as was done in the majority of patients in our series. The recurrence rate is slightly higher than with abdominal resections, but morbidity and cost are lower, and repeat perineal resections are easily and safely performed.     

Helicoidal suture: alternative treatment for complete rectal prolapse in high-risk patients

BACKGROUND AND AIMS: Optimal treatment for rectal prolapse is controversial. We describe a novel alternative treatment for high-risk patients with complete rectal prolapse. PATIENTS AND METHODS: Sixteen high-risk patients over 60 years old with complete rectal prolapse were examined. All patients had significant past medical history and were classified as grade III (ASA) surgical risk. The helicoidal suture technique is described. Postoperative parameters evaluated were morbidity, mortality, postoperative symptoms, recurrence and anal incontinence score. Median follow-up was 60 months. RESULTS: There were no operative complications or mortality in the series; one patient experienced recurrence. Median postoperative anal incontinence score was 6.06 (range 1-30; preoperative 23.6). CONCLUSION: This technique provides adequate functional outcomes and could be an effective therapeutic strategy against rectal prolapse in high-risk patients.     

Radiofrequency ablation-assisted liver resection a step toward bloodless liver resection

BACKGROUND: Liver resection is currently the most efficient curative approach for a wide variety of liver tumors. The application of modern techniques and new surgical devices has improved operative outcomes. Radiofrequency ablation is used more often for liver parenchymal transection. This study aimed to assess the efficacy and safety of radiofrequency ablation-assisted liver resection.METHODS: A retrospective study of 145 consecutive patients who underwent radiofrequency ablation-assisted liver resection was performed. Intraoperative blood loss, need for transfusion or intraoperative Pringle maneuver, the duration of liver parenchymal transection, perioperative complications, and postoperative morbidity and mortality were all evaluated.RESULTS: Fifty minor and ninety-five major liver resections were performed. The mean intraoperative blood loss was 251 m L, with a transfusion rate of 11.7%. The Pringle maneuver was necessary in 12 patients(8.3%). The mean duration for parenchymal transection was 51.75 minutes. There were 47 patients(32.4%) with postoperative complications. There is no mortality within 30 days after surgery. CONCLUSIONS: Radiofrequency ablation-assisted liver resection permits both major and minor liver resections with minimal blood loss and without occlusion of hepatic inflow. Furthermore it decreases the need for blood transfusion and reduces morbidity and mortality.     

Intraperitoneal hyperthermia in the management of pseudomyxoma peritonei

BACKGROUND/AIMS: Pseudomyxoma peritonei is a rare disease characterized by diffuse intraperitoneal mucinous tumor and massive mucinous ascites. The mainstay of treatment is surgery in combination with adjuvant therapy. METHODOLOGY: From 1995 to 2002, 8 patients with pathologically confirmed pseudomyxoma peritonei were studied. After surgical debulking, intraoperative intraperitoneal hyperthermia was performed followed by 5 days of postoperative intraperitoneal hyperthermia. Normal saline at 46 C was used for hyperthermia. Patients were followed for clinical data, survival, morbidity, and mortality. RESULTS: The appendix was the origin of pseudomyxoma peritonei in 6 patients, the ovary in 1 patient, and the fallopian tube in another. The pathologic diagnosis was mucinous adenocarcinoma in 4 patients, mucinous cystadenocarcinoma in 3, and mucinous cystadenoma in 1. Associated morbidity and mortality was 12.5% and 0, respectively. The recurrence rate was 62.5%, with a median follow-up of 52.5 months. The estimated 1-, 3-, and 5-year survival rates were 100%, 88%, and 49%, respectively. CONCLUSIONS: Surgical debulking followed by 46 C normal saline intraperitoneal hyperthermia resulted in a 5-year survival of 49% with low morbidity and no mortality for the treatment of pseudomyxoma peritonei. We concluded that this is an easy, safe, and efficacious treatment for patients with this rare disease.     

L’hydatidose péritonéale. A propos de 27 cas

Introduction

The peritoneal hydatidosis (PH) is a parasitic affection due to the contamination of the peritoneum by the larvas of Echinococcus granulosus. It is often caused by the rupture or with the cracking of the hepatic hydatic cysts. The radical treatment is surgical and medical treatment prevents the recurrences.

Purpose

To discuss the diagnostic, therapeutic and prognostic problems of peritoneal hydatidosis.

Patients and method

A prospective series of 27 cases was reported in our department from July 2002 to December 2009. The average age was 39,3 years old, with female predominance (77,77%). The rural origin was founded in 74,07%. Eleven patients had already been operated for Hydatid cysts. The clinical table was dominated by abdominal pain (92,59%) and the abdominal masses (40,74%). Ultrasonography (US) has done the positive diagnosis in 90% of all the cases. The reliability of topographic diagnosis of the Computed Tomography was 96,29%. Twenty six patients were operated and a patient considered to be inoperable was treated by antibiotics. The treatment of the PH was the most radical possible. All the patients were put under Albendazole (8 mg/kg/j) three weeks per month during 9 to 12 months.

Results

The mortality was nil and the morbidity was 18,51%, with four cases of biliary fistulas and one case of wall infection. Three cases of recurrences were observed after the mean follow-up of 23 months. The mean duration of hospitalization was 7 days.

Conclusion

The PH diagnosis is often difficult. The imagery allows to pose the positive diagnosis and especially to make a precise topographic diagnosis. The radical treatment is essentially chirurgical and the medical treatment is recommended to prevent the recurrences.     

Resection of localized recurrences after hepatectomy of colorectal cancer metastases

BACKGROUND/AIMS: Hepatectomy is generally considered the only mode of curative treatment available for patients with colorectal liver metastases, even though recurrence occurs in more than 60% of the patients. METHODOLOGY: This is a retrospective study examining the survival of 11 patients undergoing surgical excision of recurrences gained from 46 patients undergoing initial hepatectomy for metastatic colorectal cancer. These 46 patients had curative hepatectomy and no extrahepatic metastasis. RESULTS: Cancer recurred in 29 of the 46 patients after a median follow-up time of 29.5 months (range 2-183 months), and 11 had curative resection of localized recurrences. In 6 patients, the liver was the only site of recurrence and 4 patients had isolated lung metastases. One patient had liver and lung metastases. There was no perioperative mortality. The median survival time and cumulative 5-year survival rate for 11 patients after the repeated resection were 28 months and 43.8%, respectively. These results were comparable to the survival for 46 patients after the initial hepatectomy, in which the median survival was 29.5 months and the 5-year survival rate was 49.0%. CONCLUSIONS: In appropriately selected patients with colorectal cancer, surgical excision of localized recurrences after hepatectomy may be effective in prolonging survival.     

Insulinoma: diagnostic strategies and surgical treatment. A 22-year experience.

BACKGROUND/AIMS: The efficacy of preoperative localization methods and the results of the surgical treatment of insulinoma were studied. METHODOLOGY: Fifty-nine patients referred for surgical treatment were studied and the results of the diagnostic tools for tumor localization were compared with findings at surgical intervention. The influence of the type of surgical procedure in the immediate and late postoperative course was also studied. RESULTS: Ultrasonography had a sensitivity of 30%, computed tomography 25%, angiography 54%, portal vein sampling 94%, endoscopic ultrasonography 27% and magnetic resonance 17%. Intraoperative palpation localized 98.2% of the tumors and by the addition of intraoperative echography, all lesions were identified. In 55 patients with benign lesions, 22 enucleations, 25 distal pancreatectomies, 7 pancreatectomies plus enucleation and one duodenopancreatectomy were performed. Malignant tumors were treated by pancreatic resection, postoperative hepatic artery embolization and systemic chemotherapy. There was no postoperative mortality. Pancreatic fistula was the most common complication. Three patients who underwent distal pancreatectomy developed late diabetes (9.3%). CONCLUSIONS: Extensive preoperative investigation, mainly with invasive methods, is not indicated and by combining intraoperative palpation and echography most of the cases can be adequately dealt with. Preservation of pancreatic tissue with enucleation and preservation of the spleen are the best choice for treatment of benign insulinomas.     

Review of cases with cystic hydatid lung disease in a tertiary referral hospital located in an endemic region: a 10 years' experience

BACKGROUND: Echinococcus disease is endemic in sheep-and cattle-raising areas world wide. Its prevalence is also high in the Mediterranean region including Turkey. OBJECTIVE: To determine the presentation, approach to surgical treatment and outcome of hydatid disease in an endemic region. METHODS: From January 1989 to December 1998 288 patients, aged between 1 and 71 years with a mean age of 31 years (134 female, 154 male), were operated on for pulmonary hydatidosis. Clinical charts of the patients were reviewed retrospectively in a tertiary referral hospital. RESULTS: Of 288 patients, 30 patients were asymptomatic, the rest (89%) were symptomatic, cough and chest pain being the most common symptoms. Fifty-three patients (18%) had associated liver hydatid cysts. Bilateral lung hydatid cysts were present in 18 patients (6%). Recurrent hydatid cysts were observed in 33 patients (11%). Seventy-seven patients (27%) presented with complicated hydatid cysts. Postoperative morbidity was observed in 3 patients [bronchopleural fistula (2), infection of the cyst space (1)] and postoperative mortality in 1 patient who presented with hydatid lung disease associated with liver and brain cysts. In the remaining 98. 6%, no complications were noted. CONCLUSIONS: In conclusion, hydatidosis is still an important public health problem in Turkey and in an endemic country such as Turkey hydatid lung disease should be considered initially in a patient presenting with a corresponding chest roentgenogram and a compatible epidemiologic history. Surgery is indicated in all symptomatic and/or enlarging or infected cysts. When necessary lobectomy or wedge resection can be the procedure of choice. Single-stage combined resection is preferred in hydatid lung disease with associated liver hydatid cysts. Total postoperative complication and mortality rate is low and we recommend a close follow-up of the operated cases to diagnose postoperative recurrence early in its course.     

Transanal local wide excision for rectal adenocarcinoma

BACKGROUND/AIMS: Abdominoperineal resection is associated with high morbidity and mortality, and sphincter preservation is the aim for the patient. Transanal local wide excision of highly selected rectal cancers is an acceptable alternative to radical surgery. METHODOLOGY: This retrospective study of 18 patients with rectal cancer treated with transanal local wide excision at our hospital during a 6-year period (from 1995 to 2001) is discussed. RESULTS: Tumor size ranged from 1 to 6 cm (mean, 2.23 cm). All resection margins were free of tumors. There was no surgical mortality or morbidity. Median follow-up period was 17.9 months. Among 18 patients, 12 patients received radiotherapy and chemoradiotherapy as a postoperative adjuvant treatment. There was one local recurrence with liver metastasis noted within one year after the operation. The 1-yr, 2-yr and 5-yr disease-free survival rate was 92%. CONCLUSIONS: Transanal local wide excision for rectal cancer, when combined with selected chemotherapy or radiotherapy, results in good local-regional control in our series. A Good long-term survival rate was also proven by presented articles. This approach can be safely applied to more advanced tumors (T3 lesion) under accurate pre-op staging, aggressive postoperative adjuvant therapy and careful regular follow-up.     

Utilidad clínica de la ampliación del margen proximal en gastrectomías totales por adenocarcinoma gástrico

Introduction and aimsSurgical resection with negative margins is part of the curative treatment of gastric adenocarcinoma. Positive surgical margins are associated with worse outcome. The aim of the present study was to determine the clinical usefulness of extending the proximal surgical margin in patients undergoing total gastrectomy for gastric adenocarcinoma.Materials and methodsA retrospective analysis of patients that underwent total gastrectomy within the time frame of 2002 and 2017 was conducted. Patients diagnosed with adenocarcinoma that underwent curative surgery were included. Patients were divided into three groups, depending on proximal surgical margin status: negative margin (R0), positive margin with additional resection to achieve negative margin (R1-R0), and positive margin (R1). Demographic and clinical variables were analyzed. The outcome measures to evaluate were recurrence, disease-free survival, and overall survival.ResultsForty-eight patients were included in the study. Thirty-seven were classified as R0, 9 as R1-R0, and 2 as R1. Fifty-two percent of the patients had clinical stage III disease. The overall surgical mortality rate was 2% and the morbidity rate was higher than 29%. The local recurrence rate was 0% in the R1-R0 group vs. 50% in the R1 group (p = 0.02). Disease-free survival was 49 months in the R1-R0 group vs. 32 months in the R1 group (p = 0.6). Overall survival was 51 months for the R1-R0 group vs. 35 months for the R1 group (p = 0.5).ConclusionsIntraoperative extension of the positive surgical margin improved the local recurrence rate but was not associated with improvement in overall survival or disease-free survival and could possibly increase postoperative morbidity.