Gamal Amira

Impact of reconstruction methods and pathological factors on survival after pancreaticoduodenectomy

Background: Surgery remains the mainstay of therapy for pancreatic head (PH) and periampullary carcinoma (PC) and provides the only chance of cure. Improvements of surgical technique, increased surgical experience and advances in anesthesia, intensive care and parenteral nutrition have substantially decreased surgical complications and increased survival. We evaluate the effects of reconstruction type, complications and pathological factors on survival and quality of life. Materials and Methods: This is a prospective study to evaluate the impact of various reconstruction methods of the pancreatic remnant after pancreaticoduodenectomy and the pathological characteristics of PC patients over 3.5 years. Patient characteristics and descriptive analysis in the three variable methods either with or without stent were compared with Chi-square test. Multivariate analysis was performed with the logistic regression analysis test and multinomial logistic regression analysis test. Survival rate was analyzed by use Kaplan-Meier test. Results: Forty-one consecutive patients with PC were enrolled. There were 23 men (56.1%) and 18 women (43.9%), with a median age of 56 years (16 to 70 years). There were 24 cases of PH cancer, eight cases of PC, four cases of distal CBD cancer and five cases of duodenal carcinoma. Nine patients underwent duct-to-mucosa pancreatico jejunostomy (PJ), 17 patients underwent telescoping pancreatico jejunostomy (PJ) and 15 patients pancreaticogastrostomy (PG). The pancreatic duct was stented in 30 patients while in 11 patients, the duct was not stented. The PJ duct-to-mucosa caused significantly less leakage, but longer operative and reconstructive times. Telescoping PJ was associated with the shortest hospital stay. There were 5 postoperative mortalities, while postoperative morbidities included pancreatic fistula-6 patients, delayed gastric emptying in-11, GI fistula-3, wound infection-12, burst abdomen-6 and pulmonary infection-2. Factors that predisposed to development of pancreatic leakage included male gender, preoperative albumin < 30g/dl, pre-operative hemoglobin < 10g/dl and non PJ-duct to mucosa type of reconstruction. The ampullary cancers presented at an earlier stage and had a better prognosis than pancreatic cancer and cholangiocarcinoma. Early stage (I and II), negative surgical margin, well and moderate differentiation and absence of lymph node involvement significantly predicted for longer survival. Conclusions: PJ duct-to-mucosa anastomosis was safe, caused least pancreatic leakage and least blood loss compared with the other methods of reconstruction and was associated with early return back to home and prolonged disease free and overall survival.

Three ports laparoscopic resection for colorectal cancer: a step on refining of reduced port surgery.

Background. Reduced port surgery (RPS) is becoming increasingly popular for some surgeries. However, the application of RPS to the field of colectomy is still underdeveloped. Patients and Methods. In this series, we evaluated the outcome of laparoscopic colorectal resection using 3 ports technique (10 mm umbilical port plus another two ports of either 5 or 10 mm) for twenty-four cases of colorectal cancer as a step for refining of RPS. Results. The mean estimated blood loss was 70 mL (40–90 mL). No major intraoperative complications have been encountered. The mean time for passing flatus after surgery was 36 hours (12–48 hrs). The mean time for oral fluid intake was 36 hours and for semisolid food was 48 hours. The mean hospital stay was 5 days (4–7 days). The perioperative period passed without events. All cases had free surgical margins. The mean number of retrieved lymph nodes was 14 lymph nodes (5–23). Conclusion. Three ports laparoscopy assisted colorectal surgeries looks to be safe, effective and has cosmetic advantages. The procedure could maintain the oncologic principles of cancer surgery. Its a step on the way of refining of reduced port surgery.

Global Forum of Cancer Surgeons: A Steady Voice for Cancer Surgeons to Improve Surgical Care for Cancer Patients Globally

Chandrakanth Are, MD, MBA, FRCS, FACS, Kelly M. McMasters, MD, PhD, Armando Giuliano, MD, FACS, FRCSEd, Charles Balch, MD, FACS, FASCO, Benjamin O. Anderson, MD, FACS, Russell Berman, MD, FACS, Riccardo Audisio, MD, FRCS, PhD, Tibor Kovacs, PhD, FRCS, FEBS, Dhairyasheel Savant, MBBS, MS, FICS, Rajendra Toprani, MBBS, MS, Mch, Gamal Amira, MD, FACS, FEBS, Ibrahim Sallam, MSc, PhD, Jeong Heum Baek, MD, PhD, Moo-Jun Baek, MD, Do Joong Park, MD, PhD, Gregorio Quintero Beulo, MD, Enrique Bargallo Rocha, MD, Hector Martinez Said, MD, Muhammad Cheema, MBBS, FCPS, Abul AliKhan, FRCS, MBBS, Lloyd Mack, MD, FRCSC, FACS, Gong Chen, MD, PhD, Claudio Almeida Quadros, MD, Tarcisio Reis, MD, PhD, Heber Salvador de Castro Ribeiro, MD, Douglas Zippel, MD, and Augusto Leon Ramirez, MD