This laparoscopic technique, applied with selective criteria, can be a useful alternative for treating patients with liver hydatidosis because its results are comparable with those for open surgery studies involving similar follow-up time.
INTRODUCTION
Preoperative nutritional status is a predictive modifiable factor of survival in gastrointestinal oncology surgery. The aim of the study was to analyze the influence of nutritional risk (NR) on survival in patients undergoing gastric cancer (GC) surgery.
MATERIAL AND METHODS
Retrospective study of 50 patients with gastric adenocarcinoma who underwent surgery over a 2-year period. To identify patients with malnutrition, the malnutrition criteria of the European Society for Clinical Nutrition and Metabolism (ESPEN) were followed, and the nutritional risk was calculated with The nutritional Risk Screening (NRS2002). Patients were divided into two groups: NR (NRS≥3) and non-NR (NRS≤2), and survival was compared between the two.
RESULTS
The 5-year survival of GC patients was 22%, with a median survival of 15.8 months [SEM: 4.760, 95% CI = (6.473-25.132)]. NR patients had lower 5-year survivals (14% vs 57%, p = 0.004). Additionally, they had 4.4 times [95% CI = (1.714-11.495)] higher risk of mortality during oncological follow-up than patients without NR.
CONCLUSIONS
NR patients undergoing GC surgery have lower long-term survival. The preoperative NR can be considered a prognostic factor for survival and it should be evaluated preoperatively in gastrointestinal cancer surgery.
Introduction:The diagnosis of symptomatic epiphrenic esophageal diverticulum is rare (15-20%). Esophageal leiomyoma and epiphrenic diverticula are both uncommon, but may rarely occur together. In this patient a leiomyoma was found within an epiphrenic diverticulum.
Methods:We report the case of a 58-year-old man referred to our unit with a 4-year history of progressive and intermittent dysphagia, mainly to solids, and weight loss. Barium swallow revealed a distal esophageal stenosis secondary to a diverticulum; upper endoscopy showed an extrinsic submucosal compression of the cardia; and CT scan showed an infradiaphragmatic saccular dilation of the esophagus with a thickened wall. The patient was diagnosed with distal esophageal diverticulum with a submucosal tumor inside. Laparoscopic hiatal diverticulectomy including tumor, cardiomyotomy and a partial fundoplication was performed. Our objective is to discuss the diagnosis and treatment of this disease.
Results:The pathological study confirmed a leiomyoma of 5x4 cm in an esophageal diverticulum. On the 3rd postoperative day, barium swallow confirmed good esophageal passage and gastric emptying. The patient was discharged on day 4. In the follow-up monitoring after one month and one year the patient was asymptomatic with good quality of life. Discussion: Traditionally, treatment for an epiphrenic diverticulum consists of a diverticulectomy with or without myotomy, performed through a thoracotomy. Hiatal laparoscopy obviates the need for thoracotomy and placement of a chest tube. It would also allow an easier fundoplication after myotomy and diverticulectomy. This case has several unique aspects. Firstly, an esophageal diverticulum with a leiomyoma inside, which is in a subdiaphragmatic location; and secondly, the fact that it is not associated with primary motor disorder. Here, the leiomyoma causes the epiphrenic diverticulum.
Conclusion:Whenever a submucosal tumor within the diverticulum is present careful consideration should be given to the possibility of an associated neoplasm. We suggest that the majority of epiphrenic diverticula of the distal esophagus can be treated successfully by laparoscopic approach, which makes it possible to remove the associated tumor; and that it is at least as safe and effective as conventional transthoracic access but with the advantages of an early postoperative recovery.
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