AIM To investigate the role of minimally invasive surgery for gastric cancer and determine surgical,clinical,and oncological outcomes.METHODS This is a propensity score-matched case-control study,comparing three treat...AIM To investigate the role of minimally invasive surgery for gastric cancer and determine surgical,clinical,and oncological outcomes.METHODS This is a propensity score-matched case-control study,comparing three treatment arms:robotic gastrectomy(RG),laparoscopic gastrectomy(LG),open gastrectomy(OG).Data collection started after sharing a specific study protocol.Data were recorded through a tailored and protected web-based system.Primary outcomes:harvested lymph nodes,estimated blood loss,hospital stay,complications rate.Among the secondary outcomes,there are:operative time,R0 resections,POD of mobilization,POD of starting liquid diet and soft solid diet.The analysis includes the evaluation of type and grade of postoperative complications.Detailed information of anastomotic leakages is also provided.RESULTS The present analysis was carried out of 1026 gastrectomies.To guarantee homogenous distribution of cases,patients in the RG,LG and OG groups were 1:1:2 matched using a propensity score analysis with a caliper=0.2.The successful matching resulted in a total sample of 604 patients(RG=151;LG=151;OG=302).The three groups showed no differences in all baseline patients characteristics,type of surgery(P=0.42)and stage of the disease(P=0.16).Intraoperative blood loss was significantly lower in the LG(95.93±119.22)and RG(117.91±68.11)groups compared to the OG(127.26±79.50,P=0.002).The mean number of retrieved lymph nodes was similar between the RG(27.78±11.45),LG(24.58±13.56)and OG(25.82±12.07)approach.A benefit in favor of the minimally invasive approaches was found in the length of hospital stay(P<0.0001).A similar complications rate was found(P=0.13).The leakage rate was not different(P=0.78)between groups.CONCLUSION Laparoscopic and robotic surgery can be safely performed and proposed as possible alternative to open surgery.The main highlighted benefit is a faster postoperative functional recovery.展开更多
Acinar cell carcinoma(ACC)is a rare malignant epithelial neoplasm accounting for 1%-2%of all pancreatic exocrine neoplasm,affecting more frequently man with an age between 50 and 70 years.Most patients present with no...Acinar cell carcinoma(ACC)is a rare malignant epithelial neoplasm accounting for 1%-2%of all pancreatic exocrine neoplasm,affecting more frequently man with an age between 50 and 70 years.Most patients present with nonspecific symptoms,which may give rise to difficulties in clinical diagnosis[1].ACC can manifest with diarrhea,weight loss,abdominal pain and,in up to 10%-15%,with lipase hypersecretion syndrome,characterized by elevated lipase production,diffuse subcutaneous fat necrosis and polyarthralgia[1,2].Biliary obstruction and jaundice are infre-quent clinical manifestations,unlike ductal adenocarcinoma,due to pushing rather than infiltrating growth of ACC.展开更多
基金Supported by CARIT Foundation(Fondazione Cassa di Risparmio di Terni e Narni),No.0024137
文摘AIM To investigate the role of minimally invasive surgery for gastric cancer and determine surgical,clinical,and oncological outcomes.METHODS This is a propensity score-matched case-control study,comparing three treatment arms:robotic gastrectomy(RG),laparoscopic gastrectomy(LG),open gastrectomy(OG).Data collection started after sharing a specific study protocol.Data were recorded through a tailored and protected web-based system.Primary outcomes:harvested lymph nodes,estimated blood loss,hospital stay,complications rate.Among the secondary outcomes,there are:operative time,R0 resections,POD of mobilization,POD of starting liquid diet and soft solid diet.The analysis includes the evaluation of type and grade of postoperative complications.Detailed information of anastomotic leakages is also provided.RESULTS The present analysis was carried out of 1026 gastrectomies.To guarantee homogenous distribution of cases,patients in the RG,LG and OG groups were 1:1:2 matched using a propensity score analysis with a caliper=0.2.The successful matching resulted in a total sample of 604 patients(RG=151;LG=151;OG=302).The three groups showed no differences in all baseline patients characteristics,type of surgery(P=0.42)and stage of the disease(P=0.16).Intraoperative blood loss was significantly lower in the LG(95.93±119.22)and RG(117.91±68.11)groups compared to the OG(127.26±79.50,P=0.002).The mean number of retrieved lymph nodes was similar between the RG(27.78±11.45),LG(24.58±13.56)and OG(25.82±12.07)approach.A benefit in favor of the minimally invasive approaches was found in the length of hospital stay(P<0.0001).A similar complications rate was found(P=0.13).The leakage rate was not different(P=0.78)between groups.CONCLUSION Laparoscopic and robotic surgery can be safely performed and proposed as possible alternative to open surgery.The main highlighted benefit is a faster postoperative functional recovery.
文摘Acinar cell carcinoma(ACC)is a rare malignant epithelial neoplasm accounting for 1%-2%of all pancreatic exocrine neoplasm,affecting more frequently man with an age between 50 and 70 years.Most patients present with nonspecific symptoms,which may give rise to difficulties in clinical diagnosis[1].ACC can manifest with diarrhea,weight loss,abdominal pain and,in up to 10%-15%,with lipase hypersecretion syndrome,characterized by elevated lipase production,diffuse subcutaneous fat necrosis and polyarthralgia[1,2].Biliary obstruction and jaundice are infre-quent clinical manifestations,unlike ductal adenocarcinoma,due to pushing rather than infiltrating growth of ACC.
