Cases Of Anastomotic Fistula Research Articles

Safety and feasibility of intrathoracic modified overlap esophagojejunostomy in laparoscopic radical resection of Siewert type Ⅱ adenocarcinoma of esophagogastric junction

Objective: The study aimed to investigate the safety and feasibility of intrathoracic modified overlap method in laparoscopic radical resection of Siewert type II adenocarcinoma of the esophagogastric junction (AEG). Methods: A descriptive case series study was conducted. The clinical data of 27 patients with Siewert type II AEG who underwent transthoracic single-port assisted laparoscopic total gastrectomy and intrathoracic modified overlap esophagojejunostomy in Guangdong Provincial Hospital of Chinese Medicine from May 2017 to December 2020 were retrospectively analyzed. The intrathoracic modified overlap esophagojejunostomy was performed as follows: (1) The Roux-en-Y loop was made; (2) The jejunum side was prepared extraperitoneal for overlap anastomosis; (3) The esophagus side was prepared intraperitoneal for overlap anastomosis; (4) The overlap esophagojejunostomy was performed; (5) The common outlet was closed after confirmation of anastomosis integrity without bleeding; (6) A thoracic drainage tube was inserted into the thoracic hole with the diaphragm incision closed. The intraoperative and postoperative results were reviewed. Results: All 27 patients were successfully operated, without mortality or conversion to laparotomy. The operative time, digestive tract reconstruction time and esophageal-jejunal anastomosis time were (327.5±102.0) minute, 50 (28-62) minute and (29.0±7.4) minute, respectively. The blood loss was 100 (20-150) ml. The postoperative time to flatus and postoperative hospital stay were (4.7±3.7) days and 9(6-73) days, respectively. Three patients (11.1%) developed postoperative grade III complications according to the Clavien-Dindo classification, including 1 case of anastomotic fistula with empyema, 1 case of pleural effusion and 1 case of pancreatic fistula, all of whom were cured by puncture drainage and anti-infective therapy. Conclusions: The intrathoracic modified overlap esophagojejunostomy is safe and feasible in laparoscopic radical resection of Siewert type II AEG.

The correlation between common postoperative complications and quality of life, serum tumor markers, and prognosis in patients with esophageal cancer.

BackgroundEsophageal cancer (EC) is highly malignant, with poor prognosis. The main forms of treatment are surgery, radiotherapy, and chemotherapy. In recent years, the incidence and mortality rate of patients with EC has improved. However, the factors that affect the quality of life of EC patients are unclear. This study investigated the postoperative complications and quality of life of EC patients, and identified the related factors. The relationship between complications and quality of life was explored so as to provide guidance for the clinical treatment and rehabilitation these patients.MethodsA total of 120 patients with EC who underwent surgery at the First People’s Hospital of Lianyungang from January 2016 to August 2017 were retrospectively enrolled in this study. The patient’s subjective quality of life evaluation was documented and clinical data were collated. The correlation between the incidence of postoperative complications and the patient’s quality of life, serum tumor markers, and prognosis was analyzed.ResultsA total of 36 (30%) EC patients experienced postoperative complications. There were 12 cases of pulmonary complications (10%), 8 cases of arrhythmia (6.67%), 3 cases of anastomotic fistula (2.5%), 5 cases of pneumothorax and pleural effusion (4.17%), and 4 cases of gastroesophageal reflux (3.33%). Incision infection occurred in 2 patients (1.67%) and there was 1 case (0.83%) of chylothorax. Empyema was reported in 1 patient (0.83%). There were significant differences in the overall condition, physical function, fatigue, pain, and swallowing pain between patients with postoperative complications and those without complications (P<0.05). Preoperative and postoperative expression of the tumor marker CYFRA21-1 was found to be independent risk factors for postoperative complications after EC surgery.ConclusionsEC is a common malignant tumor with a high incidence of postoperative complications. Patients with high CYFRA21-1 expression should be aware of the higher risk of postoperative complications. Patients with complications have poorer quality of life and obvious symptoms of fatigue, pain, and swallowing pain. Health education and dietary guidance should be provided to such patients to improve their symptoms.

Support Vector Machine-Based Backprojection Algorithm for Detection of Gastric Cancer Lesions with Abdominal Endoscope Using Magnetic Resonance Imaging Images

This study was to analyze the diagnostic value of magnetic resonance imaging (MRI) for gastric cancer (GC) lesions and the treatment effect of complete laparoscopic radical resection (CLSRR). A malignant tumor recognition algorithm was constructed in this study based on the backprojection (BP) and support vector machine (SVM), which was named BPS. 78 GC patients were divided into an experimental group (received CLSRR) and a control group (received assisted laparoscopic radical resection (ALSRR)), with 39 cases in each group. It was found that the BPS algorithm showed lower relative mean square error (MSE) in axle x (OMSE, x) and axle y (OMSE, x), but the classification accuracy (CA) was the opposite ( P &lt; 0.05 ). The postoperative hospital stay, analgesia duration, first exhaust time (FET), and first off-bed activity time (FOBA) for patients in the experimental group were less ( P &lt; 0.05 ). The operation time of the experimental group (270.56 ± 90.55 min) was significantly longer than that of the control group (228.07 ± 75.26 min) ( P &lt; 0.05 ). There were 3 cases of anastomotic fistula, 1 case of acute peritonitis, and 2 cases of lung infections in the experimental group, which were greatly less than those in the control group (7 cases, 4 cases, and 3 cases) ( P &lt; 0.05 ). In short, the BPS algorithm was superior in processing MRI images and could improve the diagnostic effect of MRI images. The CLSRR could reduce the length of hospital stay and the probability of complications in GC patients, so it could be used as a surgical plan for the clinical treatment of advanced GC.

Efficacy comparison of robotic and laparoscopic radical surgery in the treatment of middle-low rectal cancer

To compare the clinical efficacy of robotic and laparoscopic radical surgery in the treatment of middle-low rectal cancers. From January 2015 to March 2016, intra-operative and postoperative follow-up data of 30 patients with middle-low rectal cancers who underwent robotic radical resection(robot group) and 32 patients with middle-low rectal cancers who underwent laparoscopic radical resection (laparoscopy group)n in our department were retrospectively collected. The distance from cancer to anal margin was less than 10 cm in both two groups and advanced rectal cancers were confirmed by preoperative colonoscopy biopsy. Associated data were compared between two groups. There were 13 males and 17 females in robot group with age of 27 to 85 (mean 59.7) years, disease course of 3 to 12 (mean 6.2) months and clinical stage T2-3N0-1. There were 16 males and 16 females in laparoscopic group with age of 32 to 79 (mean 60.3) years, disease course of 2 to 10(mean 5.9) months and clinical stage T2-3N0-1. The baseline data of two groups were not significantly different (all P>0.05). All the patients in two groups completed operations successfully without conversion to open operation. Compared with laparoscopic group, the blood loss was less [(100.3±43.7) ml vs. (150.3±68.2) ml, t=3.413, P=0.001], the first flatus time [(49.3±12.4) h vs. (58.6±12.5) h, t=2.838, P=0.006] and urinary catheter removal time [(3.0±0.7) d vs. (4.8±0.9) d, t=5.491, P=0.000] were shorter, while the operation time [(217.3±57.8) min vs. (187.9±23.1) min, t=2.772, P=0.009] was longer in robot group. No cancer tissue was observed in resection margin of two groups. Number of harvested lymph node per case (15.2±7.4 vs. 13.9±4.9, t=-0.764, P=0.448), distance from anal margin to tumor distal edge [(7±3) cm vs. (6.5±3) cm, t=-1.952, P=0.056] and postoperative hospital stay [(13.6±1.3) d vs. (13.8±1.8) d, t=0.925, P=0.359] were not significantly different between two groups. No serious complications occurred in two groups during intra-operative and postoperative period. During following up of 3 to 12 (average 8.7) months, 1 case of anastomotic fistula occurred in each group and was cured by conservative treatment without significant difference [3.3%(1/30) vs. 3.1%(1/32), P=1.000]. No sexual dysfunction was found in either groups. Two cases in laparoscopic group presented relapse and metastasis, but no recurrence and metastasis was observed in robot group. There was no death in two groups. Robotic radical surgery in the treatment of middle-low rectal cancers is safe and effective with the advantages of less trauma, less bleeding, rapid recovery of intestinal function and urinary function.

Technical and early outcomes of Ivor Lewis minimally invasive oesophagectomy for gastric tube construction in the thoracic cavity.

Ivor Lewis minimally invasive oesophagectomy (ILMIE) is a complex surgery aiming to remove an oesophageal tumour and to create a new gastric tube in the abdomen. The objective was to assess the technical and early outcomes of ILMIE for gastric tube construction in the thoracic cavity. A retrospective analysis was conducted in 25 middle or lower oesophageal cancer patients treated with ILMIE between August and December 2012. A gastric tube was constructed in the thoracic cavity in all patients. The gastric tube and the oesophagus were anastomosed using a circular stapler. Clinical data (age, gender, pathological pattern and TNM stage), surgical data (operation time, intraoperative blood loss and intraoperative complications) and follow-up data (postoperative complications, length of stay, thoracic tube drainage time and time before eating) were assessed. The mean age was 61 ± 8 years. Sixteen patients were male and 9 were female. Oesophageal cancer was located in the middle oesophagus in 5 cases and in the lower oesophagus in 20. No conversion to open surgery was performed. The mean operative time and intraoperative blood loss were 320 ± 63 min and 137 ± 95 ml, respectively. A mean of 2.4 ± 0.5 linear stapler cartridges was used per patient. A mean of 14.6 ± 5.4 lymph nodes was dissected per patient. Postoperative hospital stay was 13.2 ± 2.4 days. Intraoperative and postoperative complications occurred in 12% (3 of 25) and 20% (5 of 25) of patients, respectively, including 1 case of anastomotic fistula. The patients were followed up for a mean of 3.5 ± 1.2 months, and there was no relapse or death. The construction of a gastric tube through the thoracic cavity using ILMIE is feasible and safe in patients with middle or lower oesophageal cancer. However, longer follow-up and larger sample sizes are needed to evaluate the oncological efficacy.

General complications following laparoscopic-assisted gastrectomy and analysis of techniques to manage them

The aim of this study was to assess the complications associated with the laparoscopic treatment of gastric cancer and to discuss their management. From March 2004 to June 2007, 302 patients affected by gastric adenocarcinoma underwent laparoscopy-assisted gastrectomy. Of the 302 gastric malignancy cases, distal gastrectomy was performed in 161 cases, proximal gastrectomy in 62 cases, and total gastrectomy in 79 cases. In all cases, D1 or D2 lymph node dissection was performed according to the recommended procedures of the Japanese Gastric Cancer Association. Duration of surgery ranged from 180 to 310 min (median 230 min). There were no deaths during surgery and no anesthesiology complications in our series. We recorded 15 (4.97%) intraoperative complications: one transverse colon perforation, one lesion of the liver, two cases of splenic laceration, one injury of cystic artery leading to gangrene of the gallbladder, nine cases of hemorrhage, and one biliary tract injury. Conversion to open surgery was necessary in only five cases (1.7%). We recorded 21 (7.0%) postoperative complications: four cases of intra-abdominal bleeding, seven cases of duodenal stump leakage, one case of duodenal stump leakage followed by arteriole hemorrhage due to fundus of the stomach, two cases of acute pancreatitis, one case of lymphatic fistula, one case of anastomotic fistula, three cases of delayed gastric emptying, and two cases of obstruction of afferent loop. Six patients underwent reoperation, of whom two died after the procedure while the other four recovered postoperatively; other postoperative complications were treated conservatively. The overall operative morbidity and mortality rates were 11.9% and 0.7%, respectively. Our results show that laparoscopic-assisted gastrectomy is an adequate treatment for gastric cancer as long as the indications are controlled and only suitable cases are enrolled in the series. The complication rate is low enough to be acceptable. Most complications can be treated effectively via conservative treatment, and only a small number of cases require reoperation.