AIM: To assess the efficacy and safety of intracorporeal esophagojejunostomy in patients undergoing laparoscopic total gastrectomy(LTG) for gastric cancer.METHODS: A retrospective review of 81 consecutive patients who...AIM: To assess the efficacy and safety of intracorporeal esophagojejunostomy in patients undergoing laparoscopic total gastrectomy(LTG) for gastric cancer.METHODS: A retrospective review of 81 consecutive patients who underwent LTG with the same surgical team between November 2007 and July 2014 was performed. Four types of intracorporeal esophagojejunostomy using staplers or hand-sewn suturing were performed after LTG. Data on clinicopatholgoical characteristics, occurrence of complications, postoperative recovery, anastomotic time, and operation time among the surgical groups were obtained through medical records.RESULTS: The average operation time was 288.7 min, the average anastomotic time was 54.3 min, and the average estimated blood loss was 82.7 m L. There were no cases of conversion to open surgery. The first flatus was observed around 3.7 d, while the liquid diet was started, on average, from 4.9 d. The average postoperative hospital stay was 10.1 d. Postoperative complications occurred in 14 patients, nearly 17.3%.However, there were no cases of postoperative death.CONCLUSION: LTG performed with intracorporeal esophagojejunostomy using laparoscopic staplers or hand-sewn suturing is feasible and safe. The surgical results were acceptable from the perspective of minimal invasiveness.展开更多
AIM:To evaluate the feasibility and safety of laparoscopic distal pancreatectomy(LDP) compared with open distal pancreatectomy(ODP).METHODS:Meta-analysis was performed using the databases,including PubMed,the Cochrane...AIM:To evaluate the feasibility and safety of laparoscopic distal pancreatectomy(LDP) compared with open distal pancreatectomy(ODP).METHODS:Meta-analysis was performed using the databases,including PubMed,the Cochrane Central Register of Controlled Trials,Web of Science and BIOSIS Previews.Articles should contain quantitative data of the comparison of LDP and ODP.Each article was reviewed by two authors.Indices of operative time,spleen-preserving rate,time to fluid intake,ratio of malignant tumors,postoperative hospital stay,incidence rate of pancreatic fistula and overall morbidity rate were analyzed.RESULTS:Nine articles with 1341 patients who underwent pancreatectomy met the inclusion criteria.LDP was performed in 501(37.4%) patients,while ODP was performed in 840(62.6%) patients.There were significant differences in the operative time,time to fluid intake,postoperative hospital stay and spleen-preserving rate between LDP and ODP.There was no difference between the two groups in pancreatic fistula rate [random effects model,risk ratio(RR) 0.996(0.663,1.494),P = 0.983,I2 = 28.4%] and overall morbidity rate [random effects model,RR 0.81(0.596,1.101),P = 0.178,I2 = 55.6%].CONCLUSION:LDP has the advantages of shorter hospital stay and operative time,more rapid recovery and higher spleen-preserving rate as compared with ODP.展开更多
AIM:To compare short-and long-term outcomes of laparoscopic vs open distal pancreatectomy for solid pseudopapillary tumor(SPT)of the pancreas.METHODS:This retrospective study included 28 patients who underwent distal ...AIM:To compare short-and long-term outcomes of laparoscopic vs open distal pancreatectomy for solid pseudopapillary tumor(SPT)of the pancreas.METHODS:This retrospective study included 28 patients who underwent distal pancreatectomy for SPT of the pancreas between 1998 and 2012.The patients were divided into two groups based on the surgical approach:the laparoscopic surgery group and the open surgery group.The patients’demographic data,operative results,pathological reports,hospital courses,morbidity and mortality,and follow-up data were compared between the two groups.RESULTS:Fifteen patients with SPT of the pancreas underwent laparoscopic distal pancreatectomy(LDP),and 13 underwent open distal pancreatectomy(ODP).Baseline characteristics were similar between the two groups except for a female predominance in the LDP group(100.0%vs 69.2%,P=0.035).Mortality,morbidity(33.3%vs 38.5%,P=1.000),pancreatic fistula rates(26.7%vs 30.8%,P=0.728),and reoperation rates(0.0%vs 7.7%,P=0.464)were similar in the two groups.There were no significant differences in the operating time(171 min vs 178 min,P=0.755)between the two groups.The intraoperative blood loss(149 mL vs 580 mL,P=0.002),transfusion requirement(6.7%vs 46.2%,P=0.029),first flatus time(1.9d vs 3.5 d,P=0.000),diet start time(2.3 d vs 4.9 d,P=0.000),and postoperative hospital stay(8.1 d vs 12.8d,P=0.029)were significantly less in the LDP group than in the ODP group.All patients had negative surgical margins at final pathology.There were no significant differences in number of lymph nodes harvested(4.6 vs6.4,P=0.549)between the two groups.The median follow-up was 33(3-100)mo for the LDP group and 45(17-127)mo for the ODP group.All patients were alive with one recurrence.CONCLUSION:LDP for SPT has short-term benefits compared with ODP.Long-term outcomes of LDP are similar to those of ODP.展开更多
Some laterally advanced cholangiocarcinomas behave as ductal spread or local invasion, and hepatopancreatoduodenectomy (HPD) may be performed for R0 resection. To date, there have been no reports of laparoscopic HPD (...Some laterally advanced cholangiocarcinomas behave as ductal spread or local invasion, and hepatopancreatoduodenectomy (HPD) may be performed for R0 resection. To date, there have been no reports of laparoscopic HPD (LHPD) in the English literature. We report the first case of LHPD for the resection of a Bismuth IIIa cholangiocarcinoma invading the duodenum. The patient underwent laparoscopic pancreaticoduodenectomy and right hemihepatectomy. Child’s approach was used for the reconstruction. The patient recovered well with bile leakage from the 2<sup>nd</sup> postoperative day and was discharged on the 16<sup>th</sup> postoperative day with a drainage tube in place which was removed 2 wk after discharge. Postoperative pathology revealed a well-differentiated cholangiocarcinoma and the margin of liver parenchyma, pancreas and stomach was negative for metastases. The results suggest that LHPD is a feasible and safe procedure when performed in highly specialized centers and in suitable patients with cholangiocarcinoma.展开更多
AIM: To describe the clinical characteristics, technical procedures, and outcomes of patients undergoing laparoscopic spleen-preserving distal pancreatectomy (LSPDP) for benign and malignant pancreatic neoplasms.
Synchronous gastric cancer and primary small intestinal lymphoma are extremely rare. A 49-year-old woman was referred to our hospital with a history of upper abdominal pain for two weeks and was diagnosed with synchro...Synchronous gastric cancer and primary small intestinal lymphoma are extremely rare. A 49-year-old woman was referred to our hospital with a history of upper abdominal pain for two weeks and was diagnosed with synchronous cancer. During hospitalization, the patient underwent laparoscopic distal gastrectomy + resection of bilateral ovaries + partial resection of both small intestine and descending colon. Pathological examination revealed a synchronous cancer consisting of early gastric cancer with poorly differentiated adenocarcinoma located in mucosa, with lymph node metastasis (3+/29) (T1N1M0, stage IB); and diffuse large B cell lymphoma of small intestine involving descending colon and bilateral ovaries, with lymph node metastasis (2+/5) (Ann Arbor IIE). The patient recovered well, without any obvious complications and was discharged on post-operative day 7. The patient received six cycles of chemotherapy after operation. She has been doing well with no evidence of recurrence for 13 mo.展开更多
Objective： To compare the peri-operative outcomes for laparoscopic distal pancreatectomy（LDP） and open distal pancreatectomy（ODP） for benign or premalignant pancreatic neoplasms in two institutions. Methods： Thi...Objective： To compare the peri-operative outcomes for laparoscopic distal pancreatectomy（LDP） and open distal pancreatectomy（ODP） for benign or premalignant pancreatic neoplasms in two institutions. Methods： This prospective comparative study included 91 consecutive patients who underwent LDP（n=45） or ODP（n=46） from Jan. 2010 to Dec. 2012. Demographics, intra-operative characteristics, and post-operative outcomes were compared. Results： The median operating time in the LDP group was（158.7±38.3） min compared with（92.2±24.1） min in the ODP group（P〈0.001）. Patients had lower blood loss in LDP than in the ODP（（122.6±61.1） ml vs.（203.1±84.8） ml, P〈0.001）. The rates of splenic conservation between the LDP and ODP groups were similar（53.3% vs. 47.8%, P=0.35）. All spleen-preserving distal pancreatectomies were conducted with vessel preservation. LDP also demonstrated better post-operative outcomes. The time to oral intake and normal daily activities was faster in the LDP group than in the ODP group（（1.6±0.5） d vs.（3.2±0.7） d, P〈0.01;（1.8±0.4） d vs.（2.1±0.6） d, P=0.02, respectively）, and the postoperative length of hospital stay in LDP was shorter than that in ODP（（7.9±3.8） d vs.（11.9±5.8） d, P=0.006）. No difference in tumor size（（4.7±3.2） cm vs.（4.5±1.8） cm, P=0.77） or overall pancreatic fistula rate（15.6% vs. 19.6%, P=0.62） was found between the groups, while the overall post-operative complication rate was lower in the LDP group（26.7% vs. 47.8%, P=0.04）. Conclusions： LDP is safe and effective for benign or premalignant pancreatic neoplasms, featuring lower blood loss and substantially faster recovery.展开更多
基金Supported by Natural Science Foundation of Zhejiang Province,No.LY12H16026Chinese Medical Technology Foundation of Zhejiang Province,China,No.2012ZA087
文摘AIM: To assess the efficacy and safety of intracorporeal esophagojejunostomy in patients undergoing laparoscopic total gastrectomy(LTG) for gastric cancer.METHODS: A retrospective review of 81 consecutive patients who underwent LTG with the same surgical team between November 2007 and July 2014 was performed. Four types of intracorporeal esophagojejunostomy using staplers or hand-sewn suturing were performed after LTG. Data on clinicopatholgoical characteristics, occurrence of complications, postoperative recovery, anastomotic time, and operation time among the surgical groups were obtained through medical records.RESULTS: The average operation time was 288.7 min, the average anastomotic time was 54.3 min, and the average estimated blood loss was 82.7 m L. There were no cases of conversion to open surgery. The first flatus was observed around 3.7 d, while the liquid diet was started, on average, from 4.9 d. The average postoperative hospital stay was 10.1 d. Postoperative complications occurred in 14 patients, nearly 17.3%.However, there were no cases of postoperative death.CONCLUSION: LTG performed with intracorporeal esophagojejunostomy using laparoscopic staplers or hand-sewn suturing is feasible and safe. The surgical results were acceptable from the perspective of minimal invasiveness.
基金Supported by The key project grant from the Science and Technology Department of Zhejiang Province,No.2011C13036-2
文摘AIM:To evaluate the feasibility and safety of laparoscopic distal pancreatectomy(LDP) compared with open distal pancreatectomy(ODP).METHODS:Meta-analysis was performed using the databases,including PubMed,the Cochrane Central Register of Controlled Trials,Web of Science and BIOSIS Previews.Articles should contain quantitative data of the comparison of LDP and ODP.Each article was reviewed by two authors.Indices of operative time,spleen-preserving rate,time to fluid intake,ratio of malignant tumors,postoperative hospital stay,incidence rate of pancreatic fistula and overall morbidity rate were analyzed.RESULTS:Nine articles with 1341 patients who underwent pancreatectomy met the inclusion criteria.LDP was performed in 501(37.4%) patients,while ODP was performed in 840(62.6%) patients.There were significant differences in the operative time,time to fluid intake,postoperative hospital stay and spleen-preserving rate between LDP and ODP.There was no difference between the two groups in pancreatic fistula rate [random effects model,risk ratio(RR) 0.996(0.663,1.494),P = 0.983,I2 = 28.4%] and overall morbidity rate [random effects model,RR 0.81(0.596,1.101),P = 0.178,I2 = 55.6%].CONCLUSION:LDP has the advantages of shorter hospital stay and operative time,more rapid recovery and higher spleen-preserving rate as compared with ODP.
基金Supported by The Key Project Grant from the Science and Technology Department of Zhejiang Province,No.2011C13036-2
文摘AIM:To compare short-and long-term outcomes of laparoscopic vs open distal pancreatectomy for solid pseudopapillary tumor(SPT)of the pancreas.METHODS:This retrospective study included 28 patients who underwent distal pancreatectomy for SPT of the pancreas between 1998 and 2012.The patients were divided into two groups based on the surgical approach:the laparoscopic surgery group and the open surgery group.The patients’demographic data,operative results,pathological reports,hospital courses,morbidity and mortality,and follow-up data were compared between the two groups.RESULTS:Fifteen patients with SPT of the pancreas underwent laparoscopic distal pancreatectomy(LDP),and 13 underwent open distal pancreatectomy(ODP).Baseline characteristics were similar between the two groups except for a female predominance in the LDP group(100.0%vs 69.2%,P=0.035).Mortality,morbidity(33.3%vs 38.5%,P=1.000),pancreatic fistula rates(26.7%vs 30.8%,P=0.728),and reoperation rates(0.0%vs 7.7%,P=0.464)were similar in the two groups.There were no significant differences in the operating time(171 min vs 178 min,P=0.755)between the two groups.The intraoperative blood loss(149 mL vs 580 mL,P=0.002),transfusion requirement(6.7%vs 46.2%,P=0.029),first flatus time(1.9d vs 3.5 d,P=0.000),diet start time(2.3 d vs 4.9 d,P=0.000),and postoperative hospital stay(8.1 d vs 12.8d,P=0.029)were significantly less in the LDP group than in the ODP group.All patients had negative surgical margins at final pathology.There were no significant differences in number of lymph nodes harvested(4.6 vs6.4,P=0.549)between the two groups.The median follow-up was 33(3-100)mo for the LDP group and 45(17-127)mo for the ODP group.All patients were alive with one recurrence.CONCLUSION:LDP for SPT has short-term benefits compared with ODP.Long-term outcomes of LDP are similar to those of ODP.
基金Supported by Zhejiang Key Subject of Medical Science Foundation,grant No.11-CX-21The Health and Family Planning Commission of Zhejiang Province,No.2012KYB113
文摘Some laterally advanced cholangiocarcinomas behave as ductal spread or local invasion, and hepatopancreatoduodenectomy (HPD) may be performed for R0 resection. To date, there have been no reports of laparoscopic HPD (LHPD) in the English literature. We report the first case of LHPD for the resection of a Bismuth IIIa cholangiocarcinoma invading the duodenum. The patient underwent laparoscopic pancreaticoduodenectomy and right hemihepatectomy. Child’s approach was used for the reconstruction. The patient recovered well with bile leakage from the 2<sup>nd</sup> postoperative day and was discharged on the 16<sup>th</sup> postoperative day with a drainage tube in place which was removed 2 wk after discharge. Postoperative pathology revealed a well-differentiated cholangiocarcinoma and the margin of liver parenchyma, pancreas and stomach was negative for metastases. The results suggest that LHPD is a feasible and safe procedure when performed in highly specialized centers and in suitable patients with cholangiocarcinoma.
基金Supported by Grants from Department of Health of Zhejiang Province,China,No.2011ZHB003 and No.2013RCB010
文摘AIM: To describe the clinical characteristics, technical procedures, and outcomes of patients undergoing laparoscopic spleen-preserving distal pancreatectomy (LSPDP) for benign and malignant pancreatic neoplasms.
基金Supported by Major Science and Technology Projects of Zhejiang Province,China,No.2012C13014-4Traditional Chinese Medicine Science and Technology Program of Zhejiang Province,China,No.2012ZA087
文摘Synchronous gastric cancer and primary small intestinal lymphoma are extremely rare. A 49-year-old woman was referred to our hospital with a history of upper abdominal pain for two weeks and was diagnosed with synchronous cancer. During hospitalization, the patient underwent laparoscopic distal gastrectomy + resection of bilateral ovaries + partial resection of both small intestine and descending colon. Pathological examination revealed a synchronous cancer consisting of early gastric cancer with poorly differentiated adenocarcinoma located in mucosa, with lymph node metastasis (3+/29) (T1N1M0, stage IB); and diffuse large B cell lymphoma of small intestine involving descending colon and bilateral ovaries, with lymph node metastasis (2+/5) (Ann Arbor IIE). The patient recovered well, without any obvious complications and was discharged on post-operative day 7. The patient received six cycles of chemotherapy after operation. She has been doing well with no evidence of recurrence for 13 mo.
基金Project supported by the Department of Health of Zhejiang Province,China(Nos.2011ZHB003 and 2013RCB010)
文摘Objective： To compare the peri-operative outcomes for laparoscopic distal pancreatectomy（LDP） and open distal pancreatectomy（ODP） for benign or premalignant pancreatic neoplasms in two institutions. Methods： This prospective comparative study included 91 consecutive patients who underwent LDP（n=45） or ODP（n=46） from Jan. 2010 to Dec. 2012. Demographics, intra-operative characteristics, and post-operative outcomes were compared. Results： The median operating time in the LDP group was（158.7±38.3） min compared with（92.2±24.1） min in the ODP group（P〈0.001）. Patients had lower blood loss in LDP than in the ODP（（122.6±61.1） ml vs.（203.1±84.8） ml, P〈0.001）. The rates of splenic conservation between the LDP and ODP groups were similar（53.3% vs. 47.8%, P=0.35）. All spleen-preserving distal pancreatectomies were conducted with vessel preservation. LDP also demonstrated better post-operative outcomes. The time to oral intake and normal daily activities was faster in the LDP group than in the ODP group（（1.6±0.5） d vs.（3.2±0.7） d, P〈0.01;（1.8±0.4） d vs.（2.1±0.6） d, P=0.02, respectively）, and the postoperative length of hospital stay in LDP was shorter than that in ODP（（7.9±3.8） d vs.（11.9±5.8） d, P=0.006）. No difference in tumor size（（4.7±3.2） cm vs.（4.5±1.8） cm, P=0.77） or overall pancreatic fistula rate（15.6% vs. 19.6%, P=0.62） was found between the groups, while the overall post-operative complication rate was lower in the LDP group（26.7% vs. 47.8%, P=0.04）. Conclusions： LDP is safe and effective for benign or premalignant pancreatic neoplasms, featuring lower blood loss and substantially faster recovery.
