Gastric cancer (GC) used to be one of the most common malignancies in the world and still is the second leading cause of malignancy-related death in the Far East. The most significant factors that were found to be associated with the clinical outcome in patients with non-metastatic (M0) gastric cancer is tumor's depth of invasion, the presence and the extend of lymphnode involvement, as well as the histological type according to Lauren (intestinal or diffuse). Although it is generally accepted that D2 gastrectomy is the procedure of choice to achieve adequate oncologic excision, there are quite many concerns for its use in patients with early gastric cancer (EGC), where No or N1 specimens are frequently reported. The last two decades, with the evolvement of cancer cell detection techniques, the attend of the medical community is focused on GC patients with solitary lymphnode metastasis (SLN) or micrometastasis (mM). There is a discussion whether SLN should be attributed as the “real” sentinel node (SN) and its projection on patients' survival. The aim of this study is to review the recent literature and attempt to clarify the clinical significance of SLN in gastric cancer.

Aim Α giant hiatal hernia is defined as a type III paraesophageal hernia, where more than 30% of the stomach lies within the thoracic cavity, with or without any other abdominal viscera, such as pancreas, spleen, or colon. It suggests a rare clinical entity, accounting for less than 0,3% of all hiatal hernias. As a consequence, the surgical treatment, and in particular the laparoscopic approach, is considered challenging and demanding. The purpose of this study is to prove, through our center's experience, that the laparoscopic approach is a safe and effective method of giant hiatal hernia repair. Material and Methods 8 patients, 4 men and 4 women, 63,83 years old on average, with giant hiatal hernias, are included in this study. In all cases, laparoscopic hiatal hernia repair was performed, without any conversions, in combination with Nissen fundoplication. In addition, in three cases, a poly-4-hydroxybutyrate mesh (Phasix) was applied. Results Two patients were reoperated, one due to persistant dysphagia and one due to ileus. The rest of the patients followed an uneventful postoperative course with a short hospital stay and elimination of their symptoms, during a 12-month follow-up period. Conclusions Laparoscopic repair of giant hiatal hernias suggests is a challenging operation, which is accompanied by high morbidity and recurrence rates, up to 12% and 10% respectively, as reported in the literature. However, it is a safe and effective procedure when performed in experienced centers.

Besides respiratory and gastrointestinal symptoms, SARS-CoV-2 also has potential neurotropic effects. Acute hemorrhagic necrotizing encephalopathy is a rare complication of Covid-19. This article presents a case of an 81-year-old female, fully vaccinated, who underwent laparoscopic transhiatal esophagectomy due to gastroesophageal junction cancer. In the early postoperative period, the patient developed persistent fever accompanied by acute quadriplegia, impaired consciousness, and no signs of respiratory distress. Imaging with Computed Tomography and Magnetic Resonance revealed multiple bilateral lesions both in gray and white matter, as well as pulmonary embolism. Covid-19 infection was added to the differential diagnosis three weeks later, after other possible causes were excluded. The molecular test obtained at that time for coronavirus was negative. However, the high clinical suspicion index led to Covid-19 antibody testing (IgG and IgΑ), which confirmed the diagnosis. The patient was treated with corticosteroids with noticeable clinical improvement. She was discharged to a rehabilitation center. Six months later, the patient was in good general condition, although a neurological deficit was still present. This case indicates the significance of a high clinical suspicion index, based on a combination of clinical manifestations and neuroimaging, and the confirmation of the diagnosis with molecular and antibody testing. Constant awareness of a possible Covid-19 infection among hospitalized patients is mandatory.