The particular benefit of a covering stoma is reduction in the rate of leaks requiring surgery and thus in the severe consequences of an anastomotic leakage.
Heightened awareness of the possible presence of gallbladder cancer (GBC) and the knowledge of appropriate management are important for surgeons practising laparoscopic cholecystectomy (LC). Long-term effects of initial LC versus open cholecystectomy (OC) on the prognosis of patients with GBC remain undefined. Patients who are suspected to have GBC should not undergo LC, since it is advantageous to perform the en-bloc radical surgery at the initial operation. Since preoperative diagnosis of early GBC is difficult, preventive measures, such as preventing bile spillage and bagging the gallbladder should be applied for every LC. Many port-site recurrences (PSR) have been reported after LC, but the incidence of wound recurrence is not higher than after OC. No radical procedure is required after postoperative diagnosis of incidental pT1a GBC. It is unclear if patients with pT1b GBC require extended cholecystectomy. In pT2 GBC, patients should have radical surgery (atypical or segmental liver resection and lymphadenectomy). In advanced GBC (pT3 and pT4), radical surgery can cure only a small subset of patients, if any. Additional port-site excision is recommended, but the effectiveness of such measure is debated.
Based on biomedical literature databases, we tried a first step for constructing a gene expression "data warehouse" specific to human colorectal cancer (CRC). Results of genome-wide transcriptomic research were available from 12 studies, using various technologies, namely, SAGE, cDNA and oligonucleotide arrays, and adaptor-tagged amplification. Three studies analyzed CRC cell lines and nine studies of human samples. The total number of patients was 144. Out of 982 up- or down-regulated genes, 863 (88%) were found to be differentially expressed in a single study, 88 in two studies, 22 in three studies, 7 in four studies, and only 2 genes in six studies. Eight large-scale proteomics studies were published in CRC, using 2-D-, SDS- or free-flow electrophoresis, involving only 11 patients. Out of 408 differentially expressed proteins, 339 (83%) were found to be differentially expressed only in a single study, 16 in three studies, 10 in four studies, 3 in five, and 1 in eight studies. Confirmation at proteome level of results obtained with large-scale transcriptomics studies was possible in 25%. This proportion was higher (67%) for reproducing proteome results using transcriptomics technologies. Obviously, reproducibility and overlapping between published gene expression results at proteome and transcriptome level are low in human CRC. Thus, the development of standardized processes for collecting samples, storing, retrieving, and querying gene expression data obtained with different technologies is of central importance in translational research.
Background: Endoscopic and laparoscopic local resection of gastric tumors has increasingly been performed in recent years. This article describes the technical considerations and early results of laparoscopic-endoscopic rendezvous resection of gastric lesions. Patients and Methods: Rendezvous resection was performed in 26 patients with submucosal gastric tumors (n = 22) and early gastric cancer (n = 4). Laparoscopic wedge resection (LWR) was performed in 16 patients with anterior wall tumors and laparoscopic intragastric resection (LIR) in 7 patients with posterior wall tumors. Conversion to open surgery was carried out in 3 cases. Results: Operation times were 53 min (range 35–115) for LWR and 83 min (range 56–130) for LIR, respectively. In submucosal lesions the mean tumor size was 36 mm (range 16–47) and in early gastric cancer 17.3 mm (range 16–20). Rendezvous resection was performed with curative intent and clear resection margins in all patients without lymphatic or vessel permeation. Postoperative complications occurred in 2 patients. After a mean follow-up of 22.8 months (range 2–71), no local recurrence or metastatic disease and no tumor-related death were observed. Conclusions: When selected properly, the laparoscopic-endoscopic approach is considered to be curative and safe for resection of localized gastric tumors.
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