In this study, there was no difference in morbidity between the three modes of venous reconstruction, and overall survival was similar regardless of tumour infiltration of the vein.

A total of 103 consecutive patients with gastric adenocarcinoma was assessed for intra-abdominal spread of malignancy using ultrasonography, computed tomography (CT) and laparoscopy under general anaesthesia. Histologically proven metastases were to the liver in 27 patients, lymph nodes in 49 and directly to peritoneum in 13. All modalities showed a high specificity (92-100 per cent) for each type of metastasis. Laparoscopy was more sensitive in detecting hepatic, nodal and peritoneal metastases; the relative performance of laparoscopy was best with regard to hepatic metastases. Ultrasonography and CT were particularly poor at detecting nodal and peritoneal metastases. There was no significant morbidity and no mortality associated with laparoscopy, which was more accurate in preoperative staging of gastric cancer than ultrasonography or CT.

BackgroundThe aim of this study was to determine if the post-operative serum arterial lactate concentration is associated with mortality, length of hospital stay or complications following hepatic resection.MethodsSerum lactate concentration was recorded at the end of liver resection in a consecutive series of 488 patients over a seven-year period. Liver function, coagulation and electrolyte tests were performed post-operatively. Renal dysfunction was defined as a creatinine rise of >1.5x the pre-operative value.ResultsThe median lactate was 2.8 mmol/L (0.6 to 16 mmol/L) and was elevated (≥2 mmol/L) in 72% of patients. The lactate concentration was associated with peak post-operative bilirubin, prothrombin time, renal dysfunction, length of hospital stay and 90-day mortality (P < 0.001). The 90-day mortality in patients with a post-operative lactate ≥6 mmol/L was 28% compared to 0.7% in those with lactate ≤2 mmol/L. Pre-operative diabetes, number of segments resected, the surgeon’s assessment of liver parenchyma, blood loss and transfusion were independently associated with lactate concentration.ConclusionsInitial post-operative lactate concentration is a useful predictor of outcome following hepatic resection. Patients with normal post-operative lactate are unlikely to suffer significant hepatic or renal dysfunction and may not require intensive monitoring or critical care.