Background: Laparoscopic surgery has many advantages among which are, decrease post operatory pain and complications. It’s practice in the capital of Cameroon is still a luxury and it is almost non-existent in periph...Background: Laparoscopic surgery has many advantages among which are, decrease post operatory pain and complications. It’s practice in the capital of Cameroon is still a luxury and it is almost non-existent in peripheral zones. The aim of this study is to present the results of the first laparoscopy surgeries done at the Yokadouma district hospital located in the east region at 600 km from Yaoundé. Methods: This is a descriptive prospective study carried out from march 2020 to march 2021 in the general surgery department of the Yokadouma district hospital. Patients operated by laparoscopy during this period were included in the study giving a sample size of 40 patients. The data collected were analyzed by “Census software and Survey Processing System” (CSPRO). Results: Majority of patients, 57.5% were males and aged between 16 and 30 years (32.5% of cases). Most patients (30% of patients) were farmers. Transabdominal preperitoneal prosthesis plasty for hernia represented 55% of interventions followed by appendicectomy (15%) and cholecystectomy (7.5%). Two procedures (0.8%) required conversion into open surgery. Post-operative complications were very rare and were encountered just by one patient who presented a parietal suppuration. Interventions in 77% of cases cost less than 200,000 CFA FRANCS (400$). Conclusion: The example of Yokadouma shows that laparoscopy should be developed in peripheral zones so that its residents can benefit from its multiple advantages.展开更多
Experimental therapies targeting immune and stromal cells,such as mast cells,cancer-associated fibroblasts,dendritic cells,and tumor endothelial cells,in the treatment of gastrointestinal solid tumors pose new and com...Experimental therapies targeting immune and stromal cells,such as mast cells,cancer-associated fibroblasts,dendritic cells,and tumor endothelial cells,in the treatment of gastrointestinal solid tumors pose new and complex surgical and medico-legal challenges.These innovative treatments require that informed consent not be limited to simple acceptance of the medical procedure,but instead reflect a true relational and cognitive process grounded in understanding,free choice,and the ability to revoke consent at any time.In particular,it is essential that the patient understands the experimental nature of the therapy,its development stage,potential benefits and risks,as well as the implications for their health and personal dignity.In the case of stromal cell-based treatments,which may exert complex immunomodulatory effects or activate angiogenic pathways that are not yet fully understood,patients must be made fully aware that they are participating in a non-standardized therapy whose outcomes,whether beneficial or harmful,cannot yet be predicted with certainty.This requires particularly careful medical communication,using simple yet scientifically accurate explanations delivered in appropriate language,along with a final verification of the patient’s actual understanding.展开更多
The development of microsurgery has been dependent on experimental animals. Microsurgery could be a very valuable technique to improve experimental models of liver diseases. Microdissection and microsutures are the tw...The development of microsurgery has been dependent on experimental animals. Microsurgery could be a very valuable technique to improve experimental models of liver diseases. Microdissection and microsutures are the two main microsurgical techniques that can be considered for classifying the experimental models developed for liver research in the rat. Partial portal vein ligation, extrahepatic cholestasis and hepatectomies are all models based on microdissection. On the other hand, in portacaval shunts, orthotopic liver transplantation and partial heterotopic liver transplantation, the microsuture techniques stand out. By reducing surgical complications, these microsurgical techniques allow for improving the resulting experimental models. If good experimental models for liver research are successfully developed, the results obtained from their study might be particularly useful in patients with liver disease. Therefore experimental liver microsurgery could be an invaluable way to translate laboratory data on liver research into new clinical diagnostic and therapeutic strategies.展开更多
The evolution of loco-regional treatments has occurred in the last two decades and has deeply changed the natural history of primitive and secondary peritoneal surface malignancies.Several phase Ⅱ-Ⅲ studies have pro...The evolution of loco-regional treatments has occurred in the last two decades and has deeply changed the natural history of primitive and secondary peritoneal surface malignancies.Several phase Ⅱ-Ⅲ studies have proved the effectiveness of the combination of cytoreductive surgery with peritoneal chemohyperthermia.Cytoreductive surgery allows the reduction of the neoplastic mass and increases tumoral chemosensitivity.The development of chemohyperthermia finds its origins in the necessity to exceed the limits of intraperitoneal chemotherapy performed in normothermia.It permits a continuous high concentration gradient of chemotherapeutic drugs between the peritoneal cavity and the plasma compartment to and a more uniform distribution throughout the abdominal cavity compared to systemic administration.展开更多
Obesity is increasing worldwide,and this has major implications in the setting of kidney transplantation.Patients with obesity may have limited access to transplantation and increased posttransplant morbidity and mort...Obesity is increasing worldwide,and this has major implications in the setting of kidney transplantation.Patients with obesity may have limited access to transplantation and increased posttransplant morbidity and mortality.Most transplant centers incorporate interventions aiming to target obesity in kidney transplant candidates,including dietary education and lifestyle modifications.For those failing nutritional restriction and medical therapy,the use of bariatric surgery may increase the transplant candidacy of patients with obesity and endstage renal disease(ESRD)and may potentially improve the immediate and late outcomes.Bariatric surgery in ESRD patients is associated with weight loss ranging from 29.8% to 72.8% excess weight loss,with reported mortality and morbidity rates of 2% and 7%,respectively.The most commonly performed bariatric surgical procedures in patients with ESRD and in transplant patients are laparoscopic sleeve gastrectomy(LSG)and laparoscopic Roux-en-Y gastric bypass.However,the correct timing of bariatric surgery and the ideal type of surgery have yet to be determined,although pretransplant LSG seems to be associated with an acceptable risk-benefit profile.We review the impact of obesity on kidney transplant candidates and recipients and in potential living kidney donors,exploring the potential impact of bariatric surgery in addressing obesity in these populations,thereby potentially improving posttransplant outcomes.展开更多
Laparoscopic sleeve gastrectomy is a surgical procedure that is being increasingly performed on obese patients. Among its complications, leaks are the most serious and life threatening. The placement of esophageal, co...Laparoscopic sleeve gastrectomy is a surgical procedure that is being increasingly performed on obese patients. Among its complications, leaks are the most serious and life threatening. The placement of esophageal, covered, self-expandable metal stents in these cases has been performed by many authors but reports on the outcome of this procedure are limited and the technical aspects are not well defined. Stent migration is the main complication of the procedure and poses a challenge to the surgeon, with a limited number of options. Here we evaluate the technical and clinical outcome of a new, dedicated, self-expanding metal stent, comparing the advantages of this stent to those traditionally used to treat staple-line leak after sleeve gastrectomy. While published data are limited, they seem support the use of this kind of new stent as the best option for the stenting treatment of a staple-line leak after sleeve gastrectomy, over other kinds of stents. Further studies based on larger series are needed to better evaluate patient outcome.展开更多
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
AIM To investigate by meta-analytic study and systematic review,advantages of colonic stent placement in comparison with emergency surgery.METHODS We conducted an extensive literature search by PubMed,Google Scholar,E...AIM To investigate by meta-analytic study and systematic review,advantages of colonic stent placement in comparison with emergency surgery.METHODS We conducted an extensive literature search by PubMed,Google Scholar,Embase and the Cochrane Libraries.We searched for all the papers in English published till February 2016,by applying combinations of the following terms:Obstructive colon cancer,colon cancer in emergency,colorectal stenting,emergency surgery for colorectal cancer,guidelines for obstructive colorectal cancer,stenting vs emergency surgery in the treatment of obstructive colorectal cancer,selfexpanding metallic stents,stenting as bridge to surgery.The study was designed following the PrismaStatement.By our search,we identified 452 studies,and 57 potentially relevant studies in full-text were reviewed by 2 investigators;ultimately,9 randomized controlled trials were considered for meta-analysis and all the others were considered for systematic review.RESULTS In the meta-analysis,by comparing colonic stenting(CS)as bridge to surgery and emergency surgery,the pooled analysis showed no significant difference between the two techniques in terms of mortality[odds ratio(oR)=0.91],morbidity(oR=2.38)or permanent stoma rate(oR=1.67);primary anastomosis was more frequent in the stent group(oR=0.45;P=0.004)and stoma creation was more frequent in the emergency surgery group(oR=2.36;P=0.002).No statistical difference was found in disease-free survival and overall survival.The pooled analysis showed a significant difference between the colonic stent and emergency surgery groups(oR=0.37),with a significantly higher 1-year recurrence rate in the stent group(P=0.007).CONCLUSION CS improves primary anastomosis rate with significantly high 1-year follow-up recurrence and no statistical difference in terms of disease-free survival and overall survival.展开更多
Hilar cholangiocarcinoma is a biliary malignancy arising from the perihilar biliary tree,which is associated with poor oncological outcomes due to its aggressive biology,chemo-resistance and insidious onset[1].As stat...Hilar cholangiocarcinoma is a biliary malignancy arising from the perihilar biliary tree,which is associated with poor oncological outcomes due to its aggressive biology,chemo-resistance and insidious onset[1].As stated by Di Martino et al.,the standard of care is radical resection,and during the last decades,there have been great efforts to improve survival of potentially resectable hilar cholangiocarcinoma,with surgery being the treatment associated with longer survival[2].However,radical resection still represents a challenging operation with high risk of intraoperative and postoperative complications.展开更多
Carotid-cavernous fistula is an abnormal communication between the carotid artery and the cavernous sinus. The fistula is classified based on its etiology, haemodynamic and anatomical configuration. The most common ty...Carotid-cavernous fistula is an abnormal communication between the carotid artery and the cavernous sinus. The fistula is classified based on its etiology, haemodynamic and anatomical configuration. The most common type is the direct high flow fistula resulting from trauma. Indirect fistula which is less common results from underlying conditions such as hypertension, collagen vascular diseases, pregnancy amongst others. It is in regards with this uncommon occurrence of indirect fistula that we report a case of forty year</span><span>s</span><span> old woman who presented with a left protruding eyeball and headache a month after delivery and was diagnosed with spontaneous type D indirect carotid cavernous fistula with rapidly progressing symptoms. She was referred abroad for interventional radiological services due to unavailability of such services in our facility and country.展开更多
Mucinous cystic neoplasms of the liver(MCN-L)are rare cystic lesions characterized by mucin-producing epithelium and ovarian-like stroma.Although they constitute fewer than 5%of hepatic cystic lesions,MCN-L poses sign...Mucinous cystic neoplasms of the liver(MCN-L)are rare cystic lesions characterized by mucin-producing epithelium and ovarian-like stroma.Although they constitute fewer than 5%of hepatic cystic lesions,MCN-L poses significant diagnostic challenges due to overlapping features with other cystic lesions and their potential for malignant transformation.Early recognition and definitive surgical intervention are therefore critical to ensure optimal patient outcomes.A literature review was conducted to summarize epidemiology,clinical presentation,diagnostic modalities,and management strategies for MCN-L.Additionally,from 2019 to 2025,9 patients with MCN-L were identified at our center.Clinical data and outcomes were retrospectively analyzed.MCN-L predominantly affects middle-aged women and presents as large,multiloculated cystic lesions without biliary communication.The revised 2010 World Health Organization classification emphasizes the presence of ovarian-like stroma for definitive diagnosis.Contrast-enhanced computed tomography or magnetic resonance imaging are often suggestive but not pathognomonic,reinforcing the need for histopathological confirmation.MCN-L remains a diagnostic and therapeutic challenge due to its resemblance to other cystic liver lesions.Complete surgical resection is the treatment of choice to prevent recurrence and malignant transformation,reinforcing the importance of early intervention.Further research is needed to improve diagnostic accuracy and refine management strategies.展开更多
BACKGROUND Hepatocellular carcinoma(HCC)remains a leading cause of cancer-related mortality worldwide.Despite improvements in surgical techniques and systemic therapies,long-term outcomes after liver resection are lim...BACKGROUND Hepatocellular carcinoma(HCC)remains a leading cause of cancer-related mortality worldwide.Despite improvements in surgical techniques and systemic therapies,long-term outcomes after liver resection are limited by high recurrence rates.While adjuvant strategies have shown limited benefit,the role of neoadjuvant immunotherapy in resectable HCC is still under investigation.AIM To assess the efficacy,feasibility,and safety of neoadjuvant immunotherapy in resectable HCC through a meta-analysis of current literature.METHODS A systematic search was conducted across PubMed,Web of Science,EMBASE,Cochrane Library,and Scopus for studies published in the past five years evaluating neoadjuvant immunotherapy in resectable HCC.Primary endpoints included major pathological response(MPR),pathological complete response(pCR),overall response rate(ORR),resection rate,and grade 3-4 treatment-related adverse events(TRAEs).A random-effects meta-analysis was conducted using log odds ratios(ORs)and pooled event rates were calculated to provide absolute estimates of clinical endpoints.RESULTS Twelve studies were included in the final analysis.The pooled ORs were 0.28(95%CI:0.19-0.41)for MPR,0.54(95%CI:0.25-1.14)for ORR,0.26(95%CI:0.11-0.66)for pCR,5.37(95%CI:2.70-10.66)for resection rate,and 0.33(95%CI:0.22-0.50)for grade 3-4 TRAEs.Corresponding pooled event rates were 19%for MPR,35%for ORR,22%for pCR,81%for resection feasibility,and 19%for severe TRAEs.CONCLUSION Neoadjuvant immunotherapy appears to be a feasible and safe approach in patients with resectable HCC,achieving moderate pathological responses and high resection rates.展开更多
Recently introduced in the treatment algorithms and guidelines for the treatment of ulcerative colitis,biological therapy is an effective treatment option for patients with an acute severe flare not responsive to conv...Recently introduced in the treatment algorithms and guidelines for the treatment of ulcerative colitis,biological therapy is an effective treatment option for patients with an acute severe flare not responsive to conventional treatments and for patients with steroid dependent disease.The reduction in hospitalization and surgical intervention for patients affected by ulcerative colitis after the introduction of biologic treatment remains to be proven.Furthermore,these agents seem to be associated with increase in cost of treatment and risk for serious postoperative complications.Restorative proctocolectomy with ileal pouch-anal anastomosis is the surgical treatment of choice in ulcerative colitis patients.Surgery is traditionally recommended as salvage therapy when medical management fails,and,despite advances in medical therapy,colectomy rates remain unchanged between 20% and 30%.To overcome the reported increase in postoperative complications in patients on biologic therapies,several surgical strategies have been developed to maintain long-term pouch failure rate around 10%,as previously reported.Surgical staging along with the development of minimally invasive surgery are among the most promising advances in this field.展开更多
AIM To investigate the epidemiology,treatment and outcomes of acute appendicitis(AA)in a large population study.METHODS This is a retrospective cohort study derived from the administrative dataset of the Bergamo distr...AIM To investigate the epidemiology,treatment and outcomes of acute appendicitis(AA)in a large population study.METHODS This is a retrospective cohort study derived from the administrative dataset of the Bergamo district healthcare system(more than 1 million inhabitants)from 1997 to 2013.Data about treatment,surgery,length of stay were collected.Moreover for each patients were registered data about relapse of appendicitis and hospital admission due to intestinal obstruction.RESULTS From 1997 to 2013 in the Bergamo district we collected 16544 cases of AA,with a crude incidence rate of 89/100000 inhabitants per year;mean age was 24.51±16.17,54.7%were male and the mean Charlson's comorbidity index was 0.32±0.92.Mortality was<0.0001%.Appendectomy was performed in 94.7%of the patients and the mean length of stay was 5.08±2.88 d;the cumulative hospital stay was 5.19±3.36 d and 1.2%of patients had at least one further hospitalization due intestinal occlusion.Laparoscopic appendectomy was performed in 48%of cases.Percent of 5.34 the patients were treated conservatively with a mean length of stay of 3.98±3.96 d;the relapse rate was 23.1%and the cumulative hospital stay during the study period was 5.46±6.05 d.CONCLUSION The treatment of acute appendicitis in Northern Italy is slowly changing,with the large diffusion of laparoscopic approach;conservative treatment of non-complicated appendicitis is still a neglected option,but rich of promising results.展开更多
Gastric carcinoma is one of the most frequent malignancies in the world and its clinical behavior especially depends on the metastatic potential of the tumor.In particular,lymphatic metastasis is one of the main predi...Gastric carcinoma is one of the most frequent malignancies in the world and its clinical behavior especially depends on the metastatic potential of the tumor.In particular,lymphatic metastasis is one of the main predictors of tumor recurrence and survival,and current pathological staging systems reflect the concept that lymphatic spread is the most relevant prognostic factor in patients undergoing curative resection.This is compounded by the observation that two-thirds of gastric cancer in the Western world presents at an advanced stage,with lymph node metastasis at diagnosis.All current therapeutic efforts in gastric cancer are directed toward individualization of therapeutic protocols,tailoring the extent of resection and the administration of preoperative and postoperative treatment.The goals of all these strategies are to improve prognosis towards the achievement of a curative resection(R0 resection) with minimal morbidity and mortality,and better postoperative quality of life.展开更多
Gastrointestinal complications are common after renal transplantation,and they have a wide clinical spectrum,varying from diarrhoea to post-transplant inflammatory bowel disease(IBD).Chronic immunosuppression may incr...Gastrointestinal complications are common after renal transplantation,and they have a wide clinical spectrum,varying from diarrhoea to post-transplant inflammatory bowel disease(IBD).Chronic immunosuppression may increase the risk of post-transplant infection and medication-related injury and may also be responsible for IBD in kidney transplant re-cipients despite immunosuppression.Differentiating the various forms of post-transplant colitis is challenging,since most have similar clinical and histological features.Drug-related colitis are the most frequently encountered colitis after kidney transplantation,particularly those related to the chronic use of mycophenolate mofetil,while de novo IBDs are quite rare.This review will explore colitis after kidney transplantation,with a particular focus on different clinical and histological features,attempting to clearly identify the right treatment,thereby improving the final outcome of patients.展开更多
AIM: To evaluate the protective effects on kidney tissue of frequently used intravenous anesthetics (ketamine, propofol, thiopental, and fentanyl) in rats with obstructive jaundice.
Peritoneal surface malignancies (PSM) are a clinical entity with an unfavourable prognosis.They comprise peritoneal carcinomatosis,pseudomyxoma peritonei,and primitive tumors of the peritoneum.Because the treatment of...Peritoneal surface malignancies (PSM) are a clinical entity with an unfavourable prognosis.They comprise peritoneal carcinomatosis,pseudomyxoma peritonei,and primitive tumors of the peritoneum.Because the treatment of PSM presents unique and challenging problems to the cancer clinician,many new approaches have been attempted in recent years.In the current and next issues of World Journal of Gastrointestinal Oncology,some international groups of researchers discuss the most important and innovative aspects of PSM treatment,with particular accuracy for cytoreductive surgery and hyperthermic intraperitoneal chemotherapy.In conclusion,because this new approach to PSM has a reputation for being based more on common sense than on experimental data,I hope that highlighting this topic can make a contribution to the treatment of this group of diseases.展开更多
AIM: To study possible gynecological organ pathologies in the differential diagnosis of acute right lower abdominal pain in patients of reproductive age.
Gastric cancer surgical management differs between Eastern Asia and Western countries. Extended lymphadenectomy (D2) is the standard of care in Japan and South Korea since decades, while the majority of United States ...Gastric cancer surgical management differs between Eastern Asia and Western countries. Extended lymphadenectomy (D2) is the standard of care in Japan and South Korea since decades, while the majority of United States patients receive at most a limited lymphadenectomy (D1). United States and Northern Europe are considered the scientific leaders in medicine and evidence-based procedures are the cornerstone of their clinical practice. However, surgeons in Eastern Asia are more experienced, as there are more new cases of gastric cancer in Japan (107898 in 2012) than in the entire European Union (81592), or in South Korea (31269) than in the entire United States (21155). For quite a long time evidence-based medicine (EBM) did not solve the question whether D2 improves long-term prognosis with respect to D1. Indeed, eastern surgeons were reluctant to perform D1 even in the frame of a clinical trial, as their patients had a very good prognosis after D2. Evidence-based surgical indications provided by Western trials were questioned, as surgical procedures could not be properly standardized. In the present study we analyzed indications about the optimal extension of lymphadenectomy in gastric cancer according to current scientific literature (2008-2012) and surgical guidelines. We searched PubMed for papers using the key words “lymphadenectomy or D1 or D2” AND “gastric cancer” from 2008 to 2012. Moreover, we reviewed national guidelines for gastric cancer management. The support to D2 lymphadenectomy increased progressively from 2008 to 2012: since 2010 papers supporting D2 have achieved a higher overall impact factor than the other papers. Till 2011, D2 was the procedure of choice according to experts’ opinion, while three meta-analyses found no survival advantage after D2 with respect to D1. In 2012-2013, however, two meta-analyses reported that D2 improves prognosis with respect to D1. D2 lymphadenectomy was proposed as the standard of care for advanced gastric cancer by Japanese National Guidelines since 1981 and was adopted as the standard procedure by the Italian Research Group for Gastric Cancer since the Nineties. D2 is now indicated as the standard of surgical treatment with curative intent by the German, British and ESMO-ESSO-ESTRO guidelines. At variance American NCCN guidelines recommend a D1<sup>+</sup> or a modified D2 lymph node dissection. In conclusion, D2 lymphadenectomy, originally developed by Eastern surgeons, is now becoming the procedure of choice also in the West. In gastric cancer surgery EBM is lagging behind national guidelines, rather than preceding and orienting them. To eliminate this lag, EBM should value to a larger extent Eastern Asian literature and should evaluate not only the quality of the study design but also the quality of surgical procedures.展开更多
文摘Background: Laparoscopic surgery has many advantages among which are, decrease post operatory pain and complications. It’s practice in the capital of Cameroon is still a luxury and it is almost non-existent in peripheral zones. The aim of this study is to present the results of the first laparoscopy surgeries done at the Yokadouma district hospital located in the east region at 600 km from Yaoundé. Methods: This is a descriptive prospective study carried out from march 2020 to march 2021 in the general surgery department of the Yokadouma district hospital. Patients operated by laparoscopy during this period were included in the study giving a sample size of 40 patients. The data collected were analyzed by “Census software and Survey Processing System” (CSPRO). Results: Majority of patients, 57.5% were males and aged between 16 and 30 years (32.5% of cases). Most patients (30% of patients) were farmers. Transabdominal preperitoneal prosthesis plasty for hernia represented 55% of interventions followed by appendicectomy (15%) and cholecystectomy (7.5%). Two procedures (0.8%) required conversion into open surgery. Post-operative complications were very rare and were encountered just by one patient who presented a parietal suppuration. Interventions in 77% of cases cost less than 200,000 CFA FRANCS (400$). Conclusion: The example of Yokadouma shows that laparoscopy should be developed in peripheral zones so that its residents can benefit from its multiple advantages.
文摘Experimental therapies targeting immune and stromal cells,such as mast cells,cancer-associated fibroblasts,dendritic cells,and tumor endothelial cells,in the treatment of gastrointestinal solid tumors pose new and complex surgical and medico-legal challenges.These innovative treatments require that informed consent not be limited to simple acceptance of the medical procedure,but instead reflect a true relational and cognitive process grounded in understanding,free choice,and the ability to revoke consent at any time.In particular,it is essential that the patient understands the experimental nature of the therapy,its development stage,potential benefits and risks,as well as the implications for their health and personal dignity.In the case of stromal cell-based treatments,which may exert complex immunomodulatory effects or activate angiogenic pathways that are not yet fully understood,patients must be made fully aware that they are participating in a non-standardized therapy whose outcomes,whether beneficial or harmful,cannot yet be predicted with certainty.This requires particularly careful medical communication,using simple yet scientifically accurate explanations delivered in appropriate language,along with a final verification of the patient’s actual understanding.
基金Supported by grants from the Mutua Madrile a Foundation, No. FMM Ref.no AP 69772009the National Department of Science and Innovation, No. MICINN, Ref. no PSIC2010-19348, in part
文摘The development of microsurgery has been dependent on experimental animals. Microsurgery could be a very valuable technique to improve experimental models of liver diseases. Microdissection and microsutures are the two main microsurgical techniques that can be considered for classifying the experimental models developed for liver research in the rat. Partial portal vein ligation, extrahepatic cholestasis and hepatectomies are all models based on microdissection. On the other hand, in portacaval shunts, orthotopic liver transplantation and partial heterotopic liver transplantation, the microsuture techniques stand out. By reducing surgical complications, these microsurgical techniques allow for improving the resulting experimental models. If good experimental models for liver research are successfully developed, the results obtained from their study might be particularly useful in patients with liver disease. Therefore experimental liver microsurgery could be an invaluable way to translate laboratory data on liver research into new clinical diagnostic and therapeutic strategies.
文摘The evolution of loco-regional treatments has occurred in the last two decades and has deeply changed the natural history of primitive and secondary peritoneal surface malignancies.Several phase Ⅱ-Ⅲ studies have proved the effectiveness of the combination of cytoreductive surgery with peritoneal chemohyperthermia.Cytoreductive surgery allows the reduction of the neoplastic mass and increases tumoral chemosensitivity.The development of chemohyperthermia finds its origins in the necessity to exceed the limits of intraperitoneal chemotherapy performed in normothermia.It permits a continuous high concentration gradient of chemotherapeutic drugs between the peritoneal cavity and the plasma compartment to and a more uniform distribution throughout the abdominal cavity compared to systemic administration.
基金Supported by FIR-14 Research Project of the University of Catania。
文摘Obesity is increasing worldwide,and this has major implications in the setting of kidney transplantation.Patients with obesity may have limited access to transplantation and increased posttransplant morbidity and mortality.Most transplant centers incorporate interventions aiming to target obesity in kidney transplant candidates,including dietary education and lifestyle modifications.For those failing nutritional restriction and medical therapy,the use of bariatric surgery may increase the transplant candidacy of patients with obesity and endstage renal disease(ESRD)and may potentially improve the immediate and late outcomes.Bariatric surgery in ESRD patients is associated with weight loss ranging from 29.8% to 72.8% excess weight loss,with reported mortality and morbidity rates of 2% and 7%,respectively.The most commonly performed bariatric surgical procedures in patients with ESRD and in transplant patients are laparoscopic sleeve gastrectomy(LSG)and laparoscopic Roux-en-Y gastric bypass.However,the correct timing of bariatric surgery and the ideal type of surgery have yet to be determined,although pretransplant LSG seems to be associated with an acceptable risk-benefit profile.We review the impact of obesity on kidney transplant candidates and recipients and in potential living kidney donors,exploring the potential impact of bariatric surgery in addressing obesity in these populations,thereby potentially improving posttransplant outcomes.
文摘Laparoscopic sleeve gastrectomy is a surgical procedure that is being increasingly performed on obese patients. Among its complications, leaks are the most serious and life threatening. The placement of esophageal, covered, self-expandable metal stents in these cases has been performed by many authors but reports on the outcome of this procedure are limited and the technical aspects are not well defined. Stent migration is the main complication of the procedure and poses a challenge to the surgeon, with a limited number of options. Here we evaluate the technical and clinical outcome of a new, dedicated, self-expanding metal stent, comparing the advantages of this stent to those traditionally used to treat staple-line leak after sleeve gastrectomy. While published data are limited, they seem support the use of this kind of new stent as the best option for the stenting treatment of a staple-line leak after sleeve gastrectomy, over other kinds of stents. Further studies based on larger series are needed to better evaluate patient outcome.
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AIM To investigate by meta-analytic study and systematic review,advantages of colonic stent placement in comparison with emergency surgery.METHODS We conducted an extensive literature search by PubMed,Google Scholar,Embase and the Cochrane Libraries.We searched for all the papers in English published till February 2016,by applying combinations of the following terms:Obstructive colon cancer,colon cancer in emergency,colorectal stenting,emergency surgery for colorectal cancer,guidelines for obstructive colorectal cancer,stenting vs emergency surgery in the treatment of obstructive colorectal cancer,selfexpanding metallic stents,stenting as bridge to surgery.The study was designed following the PrismaStatement.By our search,we identified 452 studies,and 57 potentially relevant studies in full-text were reviewed by 2 investigators;ultimately,9 randomized controlled trials were considered for meta-analysis and all the others were considered for systematic review.RESULTS In the meta-analysis,by comparing colonic stenting(CS)as bridge to surgery and emergency surgery,the pooled analysis showed no significant difference between the two techniques in terms of mortality[odds ratio(oR)=0.91],morbidity(oR=2.38)or permanent stoma rate(oR=1.67);primary anastomosis was more frequent in the stent group(oR=0.45;P=0.004)and stoma creation was more frequent in the emergency surgery group(oR=2.36;P=0.002).No statistical difference was found in disease-free survival and overall survival.The pooled analysis showed a significant difference between the colonic stent and emergency surgery groups(oR=0.37),with a significantly higher 1-year recurrence rate in the stent group(P=0.007).CONCLUSION CS improves primary anastomosis rate with significantly high 1-year follow-up recurrence and no statistical difference in terms of disease-free survival and overall survival.
文摘Hilar cholangiocarcinoma is a biliary malignancy arising from the perihilar biliary tree,which is associated with poor oncological outcomes due to its aggressive biology,chemo-resistance and insidious onset[1].As stated by Di Martino et al.,the standard of care is radical resection,and during the last decades,there have been great efforts to improve survival of potentially resectable hilar cholangiocarcinoma,with surgery being the treatment associated with longer survival[2].However,radical resection still represents a challenging operation with high risk of intraoperative and postoperative complications.
文摘Carotid-cavernous fistula is an abnormal communication between the carotid artery and the cavernous sinus. The fistula is classified based on its etiology, haemodynamic and anatomical configuration. The most common type is the direct high flow fistula resulting from trauma. Indirect fistula which is less common results from underlying conditions such as hypertension, collagen vascular diseases, pregnancy amongst others. It is in regards with this uncommon occurrence of indirect fistula that we report a case of forty year</span><span>s</span><span> old woman who presented with a left protruding eyeball and headache a month after delivery and was diagnosed with spontaneous type D indirect carotid cavernous fistula with rapidly progressing symptoms. She was referred abroad for interventional radiological services due to unavailability of such services in our facility and country.
文摘Mucinous cystic neoplasms of the liver(MCN-L)are rare cystic lesions characterized by mucin-producing epithelium and ovarian-like stroma.Although they constitute fewer than 5%of hepatic cystic lesions,MCN-L poses significant diagnostic challenges due to overlapping features with other cystic lesions and their potential for malignant transformation.Early recognition and definitive surgical intervention are therefore critical to ensure optimal patient outcomes.A literature review was conducted to summarize epidemiology,clinical presentation,diagnostic modalities,and management strategies for MCN-L.Additionally,from 2019 to 2025,9 patients with MCN-L were identified at our center.Clinical data and outcomes were retrospectively analyzed.MCN-L predominantly affects middle-aged women and presents as large,multiloculated cystic lesions without biliary communication.The revised 2010 World Health Organization classification emphasizes the presence of ovarian-like stroma for definitive diagnosis.Contrast-enhanced computed tomography or magnetic resonance imaging are often suggestive but not pathognomonic,reinforcing the need for histopathological confirmation.MCN-L remains a diagnostic and therapeutic challenge due to its resemblance to other cystic liver lesions.Complete surgical resection is the treatment of choice to prevent recurrence and malignant transformation,reinforcing the importance of early intervention.Further research is needed to improve diagnostic accuracy and refine management strategies.
文摘BACKGROUND Hepatocellular carcinoma(HCC)remains a leading cause of cancer-related mortality worldwide.Despite improvements in surgical techniques and systemic therapies,long-term outcomes after liver resection are limited by high recurrence rates.While adjuvant strategies have shown limited benefit,the role of neoadjuvant immunotherapy in resectable HCC is still under investigation.AIM To assess the efficacy,feasibility,and safety of neoadjuvant immunotherapy in resectable HCC through a meta-analysis of current literature.METHODS A systematic search was conducted across PubMed,Web of Science,EMBASE,Cochrane Library,and Scopus for studies published in the past five years evaluating neoadjuvant immunotherapy in resectable HCC.Primary endpoints included major pathological response(MPR),pathological complete response(pCR),overall response rate(ORR),resection rate,and grade 3-4 treatment-related adverse events(TRAEs).A random-effects meta-analysis was conducted using log odds ratios(ORs)and pooled event rates were calculated to provide absolute estimates of clinical endpoints.RESULTS Twelve studies were included in the final analysis.The pooled ORs were 0.28(95%CI:0.19-0.41)for MPR,0.54(95%CI:0.25-1.14)for ORR,0.26(95%CI:0.11-0.66)for pCR,5.37(95%CI:2.70-10.66)for resection rate,and 0.33(95%CI:0.22-0.50)for grade 3-4 TRAEs.Corresponding pooled event rates were 19%for MPR,35%for ORR,22%for pCR,81%for resection feasibility,and 19%for severe TRAEs.CONCLUSION Neoadjuvant immunotherapy appears to be a feasible and safe approach in patients with resectable HCC,achieving moderate pathological responses and high resection rates.
文摘Recently introduced in the treatment algorithms and guidelines for the treatment of ulcerative colitis,biological therapy is an effective treatment option for patients with an acute severe flare not responsive to conventional treatments and for patients with steroid dependent disease.The reduction in hospitalization and surgical intervention for patients affected by ulcerative colitis after the introduction of biologic treatment remains to be proven.Furthermore,these agents seem to be associated with increase in cost of treatment and risk for serious postoperative complications.Restorative proctocolectomy with ileal pouch-anal anastomosis is the surgical treatment of choice in ulcerative colitis patients.Surgery is traditionally recommended as salvage therapy when medical management fails,and,despite advances in medical therapy,colectomy rates remain unchanged between 20% and 30%.To overcome the reported increase in postoperative complications in patients on biologic therapies,several surgical strategies have been developed to maintain long-term pouch failure rate around 10%,as previously reported.Surgical staging along with the development of minimally invasive surgery are among the most promising advances in this field.
文摘AIM To investigate the epidemiology,treatment and outcomes of acute appendicitis(AA)in a large population study.METHODS This is a retrospective cohort study derived from the administrative dataset of the Bergamo district healthcare system(more than 1 million inhabitants)from 1997 to 2013.Data about treatment,surgery,length of stay were collected.Moreover for each patients were registered data about relapse of appendicitis and hospital admission due to intestinal obstruction.RESULTS From 1997 to 2013 in the Bergamo district we collected 16544 cases of AA,with a crude incidence rate of 89/100000 inhabitants per year;mean age was 24.51±16.17,54.7%were male and the mean Charlson's comorbidity index was 0.32±0.92.Mortality was<0.0001%.Appendectomy was performed in 94.7%of the patients and the mean length of stay was 5.08±2.88 d;the cumulative hospital stay was 5.19±3.36 d and 1.2%of patients had at least one further hospitalization due intestinal occlusion.Laparoscopic appendectomy was performed in 48%of cases.Percent of 5.34 the patients were treated conservatively with a mean length of stay of 3.98±3.96 d;the relapse rate was 23.1%and the cumulative hospital stay during the study period was 5.46±6.05 d.CONCLUSION The treatment of acute appendicitis in Northern Italy is slowly changing,with the large diffusion of laparoscopic approach;conservative treatment of non-complicated appendicitis is still a neglected option,but rich of promising results.
文摘Gastric carcinoma is one of the most frequent malignancies in the world and its clinical behavior especially depends on the metastatic potential of the tumor.In particular,lymphatic metastasis is one of the main predictors of tumor recurrence and survival,and current pathological staging systems reflect the concept that lymphatic spread is the most relevant prognostic factor in patients undergoing curative resection.This is compounded by the observation that two-thirds of gastric cancer in the Western world presents at an advanced stage,with lymph node metastasis at diagnosis.All current therapeutic efforts in gastric cancer are directed toward individualization of therapeutic protocols,tailoring the extent of resection and the administration of preoperative and postoperative treatment.The goals of all these strategies are to improve prognosis towards the achievement of a curative resection(R0 resection) with minimal morbidity and mortality,and better postoperative quality of life.
基金Supported by FIR 2014 Project,University of Catania.
文摘Gastrointestinal complications are common after renal transplantation,and they have a wide clinical spectrum,varying from diarrhoea to post-transplant inflammatory bowel disease(IBD).Chronic immunosuppression may increase the risk of post-transplant infection and medication-related injury and may also be responsible for IBD in kidney transplant re-cipients despite immunosuppression.Differentiating the various forms of post-transplant colitis is challenging,since most have similar clinical and histological features.Drug-related colitis are the most frequently encountered colitis after kidney transplantation,particularly those related to the chronic use of mycophenolate mofetil,while de novo IBDs are quite rare.This review will explore colitis after kidney transplantation,with a particular focus on different clinical and histological features,attempting to clearly identify the right treatment,thereby improving the final outcome of patients.
文摘AIM: To evaluate the protective effects on kidney tissue of frequently used intravenous anesthetics (ketamine, propofol, thiopental, and fentanyl) in rats with obstructive jaundice.
文摘Peritoneal surface malignancies (PSM) are a clinical entity with an unfavourable prognosis.They comprise peritoneal carcinomatosis,pseudomyxoma peritonei,and primitive tumors of the peritoneum.Because the treatment of PSM presents unique and challenging problems to the cancer clinician,many new approaches have been attempted in recent years.In the current and next issues of World Journal of Gastrointestinal Oncology,some international groups of researchers discuss the most important and innovative aspects of PSM treatment,with particular accuracy for cytoreductive surgery and hyperthermic intraperitoneal chemotherapy.In conclusion,because this new approach to PSM has a reputation for being based more on common sense than on experimental data,I hope that highlighting this topic can make a contribution to the treatment of this group of diseases.
文摘AIM: To study possible gynecological organ pathologies in the differential diagnosis of acute right lower abdominal pain in patients of reproductive age.
文摘Gastric cancer surgical management differs between Eastern Asia and Western countries. Extended lymphadenectomy (D2) is the standard of care in Japan and South Korea since decades, while the majority of United States patients receive at most a limited lymphadenectomy (D1). United States and Northern Europe are considered the scientific leaders in medicine and evidence-based procedures are the cornerstone of their clinical practice. However, surgeons in Eastern Asia are more experienced, as there are more new cases of gastric cancer in Japan (107898 in 2012) than in the entire European Union (81592), or in South Korea (31269) than in the entire United States (21155). For quite a long time evidence-based medicine (EBM) did not solve the question whether D2 improves long-term prognosis with respect to D1. Indeed, eastern surgeons were reluctant to perform D1 even in the frame of a clinical trial, as their patients had a very good prognosis after D2. Evidence-based surgical indications provided by Western trials were questioned, as surgical procedures could not be properly standardized. In the present study we analyzed indications about the optimal extension of lymphadenectomy in gastric cancer according to current scientific literature (2008-2012) and surgical guidelines. We searched PubMed for papers using the key words “lymphadenectomy or D1 or D2” AND “gastric cancer” from 2008 to 2012. Moreover, we reviewed national guidelines for gastric cancer management. The support to D2 lymphadenectomy increased progressively from 2008 to 2012: since 2010 papers supporting D2 have achieved a higher overall impact factor than the other papers. Till 2011, D2 was the procedure of choice according to experts’ opinion, while three meta-analyses found no survival advantage after D2 with respect to D1. In 2012-2013, however, two meta-analyses reported that D2 improves prognosis with respect to D1. D2 lymphadenectomy was proposed as the standard of care for advanced gastric cancer by Japanese National Guidelines since 1981 and was adopted as the standard procedure by the Italian Research Group for Gastric Cancer since the Nineties. D2 is now indicated as the standard of surgical treatment with curative intent by the German, British and ESMO-ESSO-ESTRO guidelines. At variance American NCCN guidelines recommend a D1<sup>+</sup> or a modified D2 lymph node dissection. In conclusion, D2 lymphadenectomy, originally developed by Eastern surgeons, is now becoming the procedure of choice also in the West. In gastric cancer surgery EBM is lagging behind national guidelines, rather than preceding and orienting them. To eliminate this lag, EBM should value to a larger extent Eastern Asian literature and should evaluate not only the quality of the study design but also the quality of surgical procedures.
