Gianfranco Fegiz

Total gastrectomy in the treatment of adenocarcinoma of the cardia: Review of the results in 73 resected patients

Between January 1, 1971, and December 31, 1978, 73 patients with adenocarcinoma of the cardia were treated by total gastrectomy with distal esophagectomy. The continuity of the alimentary tract was restored by esophagojejunostomy using a Roux-Y procedure in 32 patients and jejunal loop interposition in 41 patients. The early postoperative mortality rate was 18 percent. The overall 5 year survival rate was 26.7 percent, and the 5 year survival rate for stage I and II disease was 91.6 percent and 25 percent, respectively, whereas none of the stage III and IV patients survived more than 4 years. Fifty-eight percent of the patients without nodal involvement lived more than 5 years. The 5 year survival rate was only 9.3 percent in the presence of nodal metastases. Our 5 year survival rates suggest the value of elective total gastrectomy for stage I or II adenocarcinoma of the cardia. Jejunal loop interposition is a time-consuming but functionally superior procedure in comparison to other reconstructive procedures after total gastrectomy.

Belsey and Nissen operations for gastresophageal reflux

From 1972 to 1985, 37 consecutive patients underwent primary Belsey repair and 40 consecutive patients underwent primary Nissen fundoplication because of reflux disease. The operative procedures were performed by a single surgeon in each group. For the purpose of comparison, both groups were divided into two subsets: (1) patients with proved reflux, and (2) patients with different indications. The first subset consisted of 30 patients in the Belsey series and 32 in the Nissen series. The remaining patients were included in the second subset. One death occurred in the Belsey series; morbidity consisted of minor pulmonary complications in the Belsey series (10.8%) and spleen injuries requiring splenectomy (5%) in the Nissen series. In patients with proved reflux good-to-excellent results were achieved in 89.3% of subjects of the Belsey series and 86.6% of patients of the Nissen group. The failures rates were 7.1% and 10%, respectively. Inability to vomit and/or belch was reported in 7.1% of patients with proved reflux of the Belsey group and 10% of patients with proved reflux of the Nissen group. In patients with different indications there were no failures after either operation. Finally 82.2% of subjects in the Belsey group and 73.3% of patients in the Nissen group declared that they were satisfied with the operative results. In conclusion the Belsey and the Nissen procedures are equally able to achieve long-term control of reflux disease in comparable groups of patients. Failures and gastrointestinal symptoms are equally frequent after either procedure and do not affect the overall patient acceptance of antireflux surgery.

Esophagomyotomy with Antireflux Procedures for Achalasia of the Esophagus: Clinical Comparison of Nissen Fundoplication and Belsey Mark IV

Treatment of achalasia of the esophagus continues to be subject of debate. Modified Heller’s myotomy and forceful dilatation are widely accepted as the treatment of choice [4]. However, a definite incidence of esophagitis and stenosis have been observed following Heller’s operation [1, 3], suggesting the addition of reconstruction of the cardia and hiatal hernia repair to myotomy with the purpose of preventing postoperative reflux [2, 5]. In our institution antireflux procedures associated with myotomy have been performed since 1972. Therefore in this study we compare the clinical results of total fundoplication (Nissen procedure) and partial fundoplication (Belsey Mark IV) added to myotomy for treatment of achalasia of the esophagus.

Choice and Limitations of the Various Operations for the Surgical Treatment of Lung Cancer

The total number of patients who have undergone operations for cancer of the lung is by now large enough to permit statistical evaluation of the immediate and long-term results that have been obtained. Particular importance attaches to the long-term results, since from a comparative examination of the results obtained with different techniques it should be possible to draw conclusions that will enable us to select our therapeutic approach for the future. The immediate results are less important: they are shown by all the available statistics to be improving, and the reasons for such improvement are to be found in the greater degree of perfection of surgical techniques and the wider experience accumulated by surgeons, and of course advances in anaesthesia and reanimation. In view of the high technical standards that have been achieved today it is unlikely that these results will undergo much change in future years.