Tunc Eren

Current status of minimally invasive surgery for gastric cancer: A literature review to highlight studies limits *

BACKGROUND Gastric cancer represents a great challenge for health care providers and requires a multidisciplinary approach in which surgery plays the main role. Minimally invasive surgery has been progressively developed, first with the advent of laparoscopy and more recently with the spread of robotic surgery, but a number of issues are currently being investigate, including the limitations in performing effective extended lymph node dissections and, in this context, the real advantages of using robotic systems, the possible role for advanced Gastric Cancer, the reproducibility of completely intracorporeal techniques and the oncological results achievable during follow-up. METHOD Searches of MEDLINE, Embase and Cochrane Central Register of Controlled Trials were performed to identify articles published until April 2014 which reported outcomes of surgical treatment for gastric cancer and that used minimally invasive surgical technology. Articles that deal with endoscopic technology were excluded. RESULTS A total of 362 articles were evaluated. After the review process, data in 115 articles were analyzed. CONCLUSION A multicenter study with a large number of patients is now needed to further investigate the safety and efficacy as well as long-term outcomes of robotic surgery, traditional laparoscopy and the open approach.

Robot-assisted laparoscopic (RAL) surgery for gastric cancer

This literature review focuses on the potential benefits and eventual limitations of robotic surgery with respect to the traditional minimally invasive laparoscopic surgical technique for gastric cancer.

Revisiting stapled and handsewn loop ileostomy closures: a large retrospective series

OBJECTIVE: To compare the surgical outcomes of stapled and handsewn closures in loop ileostomies. METHODS: The data of 225 patients requiring loop ileostomies from 2002 to 2007 were retrospectively evaluated. The patients underwent partial small-bowel resections and either handsewn or stapled anastomoses for the ileostomy closures. They were followed up postoperatively with routine surgical examinations. RESULTS: The study group consisted of 124 men and 101 women with a mean age of 49.12 years. The ileostomy closure was performed with handsewn in 129 patients and with stapled in 96 patients. The mean time to the first postoperative flatus was 2.426 days in the handsewn group and 2.052 days in the stapled group (p<0.05). The mean time to the first postoperative defecation was 3.202 days in the handsewn group and 2.667 days in the stapled group (p<0.05). The mean duration of patient hospital stay was 8.581 days for the handsewn group and 6.063 days for the stapled group (p<0.05). CONCLUSIONS: Patients who underwent ileostomy closure with stapled recovered faster in the postoperative period and required shorter hospital stays than those whose closures were performed with handsewn. In our opinion, stapled should be considered the gold standard for loop ileostomy closures.

Strategies to treat idiopathic granulomatous mastitis: Retrospective analysis of 40 patients

BACKGROUND Idiopathic granulomatous mastitis (IGM) is a rare benign breast disease which often mimics breast carcinoma both clinically and radiologically. Confirmation of diagnosis is only made by histopathological analysis. This study aims to define clinical and demographic features of IGM patients and discuss the results of treatment modalities. METHODS Forty patients with IGM who were assigned in Istanbul Medeniyet University General Surgery Clinic between March 2008 and October 2013 were retrospectively analyzed. RESULTS Mean age was 39.07 ± 11.5. The most common complaint was breast mass (55%). Nipple retraction was present in 6 patients (15%) and 9 patients (22.5%) had fistulizing abscess. Two patients had erythema nodosum on the lower extremity. Breast ultrasonography (USG) (n:40), mammography (MG) (n:20), and magnetic resonance imaging (MRI) (n:20) were used for imaging. Selected treatment methods were antibiotics and anti-inflammatory agents (27.5%), steroids (15%), abscess drainage (40%), and surgical excision (17.5%). Fifteen patients had recurrence after their first line treatment protocol. Mean follow-up period was 24.85 ± 19.7 months. CONCLUSION Surgical excision still seems to be the best treatment method for IGM patients. Administration of steroids for large lesions prior to surgery may help minimize the lesion size and obtain better cosmesis.

Robotic, laparoscopic and open surgery for gastric cancer compared on surgical, clinical and oncological outcomes: a multi-institutional chart review. A study protocol of the International study group on Minimally Invasive surgery for GASTRIc Cancer-IMIGASTRIC.

Introduction Gastric cancer represents a great challenge for healthcare providers and requires a multidisciplinary treatment approach in which surgery plays a major role. Minimally invasive surgery has been progressively developed, first with the advent of laparoscopy and recently with the spread of robotic surgery, but a number of issues are currently being debated, including the limitations in performing an effective extended lymph node dissection, the real advantages of robotic systems, the role of laparoscopy for Advanced Gastric Cancer, the reproducibility of a total intracorporeal technique and the oncological results achievable during long-term follow-up. Methods and analysis A multi-institutional international database will be established to evaluate the role of robotic, laparoscopic and open approaches in gastric cancer, comprising of information regarding surgical, clinical and oncological features. A chart review will be conducted to enter data of participants with gastric cancer, previously treated at the participating institutions. The database is the first of its kind, through an international electronic submission system and a HIPPA protected real time data repository from high volume gastric cancer centres. Ethics and dissemination This study is conducted in compliance with ethical principles originating from the Helsinki Declaration, within the guidelines of Good Clinical Practice and relevant laws/regulations. A multicentre study with a large number of patients will permit further investigation of the safety and efficacy as well as the long-term outcomes of robotic, laparoscopic and open approaches for the management of gastric cancer. Trial registration number NCT02325453; Pre-results.

Parameters That May Be Used for Predicting Failure during Endoscopic Retrograde Cholangiopancreatography

Aim. Endoscopic retrograde cholangiopancreatography (ERCP) is frequently used for the diagnosis and treatment of hepatic, biliary tract, and pancreatic disorders. However, failure during cannulation necessitates other interventions. The aim of this study was to establish parameters that can be used to predict failure during ERCP. Methods. A total of 5884 ERCP procedures performed on 5079 patients, between 1991 and 2006, were retrospectively evaluated. Results. Cannulation was possible in 4482 (88.2%) patients. For each one-year increase in age, the cannulation failure rate increased by 1.01-fold (P = 0.002). A history of previous hepatic biliary tract surgery caused the cannulation failure rate to decrease by 0.487-fold (P < 0.001). A tumor infiltrating the ampulla, the presence of pathology obstructing the gastrointestinal passage, and peptic ulcer increased the failure rate by 78-, 28-, and 3.47-fold, respectively (P < 0.001). Conclusions.Patient gender and duodenal diverticula do not influence the success of cannulation during ERCP. Billroth II and Roux-en-Y gastrojejunostomy surgeries, a benign or malignant obstruction of the gastrointestinal system, and duodenal ulcers decrease the cannulation success rate, whereas a history of previous hepatic biliary tract surgery increases it. Although all endoscopists had equal levels of experience, statistically significant differences were detected among them.

Acute malignant intestinal obstruction accompanied by synchronous multifocal intestinal cancer in Peutz–Jeghers syndrome: report of a case

Acute mechanical intestinal obstruction is one of the most common modes of presentation in patients with Peutz–Jeghers syndrome (PJS). This report presents a case of PJS with malignant acute jejunal obstruction accompanied by synchronous foci of duodenal, jejunal, and ileal cancer originated from hamartomatous polyps. The follow-up endoscopic findings of the patient also revealed severe polyposis of the entire gastrointestinal tract, including the stomach and colon, in addition to the small intestine. Very few cases of multifocal synchronous small intestinal cancer in PJS patients have been reported in the previous literature.

Robot‐assisted laparoscopic (RAL) procedures in general surgery

Robotics was introduced in clinical practice more than two decades ago, and it has gained remarkable popularity for a wide variety of laparoscopic procedures. We report our results of robot‐assisted laparoscopic surgery (RALS) in the most commonly applied general surgical procedures.

Factors Effecting Mastalgia

Background: Breast pain is one of the leading complaints that ends up with referral to breast surgery clinics. The purpose of the present study was to investigate the factors that cause mastalgia, and its relation with benign or malignant breast disease. Methods: The study was performed in 700 patients. Data obtained from surveys, and imaging findings were prospectively recorded, and analyzed. Results: The mean age was 45.20 ± 10.78 years. The mastalgia group included 500 cases; the asymptomatic group comprised 200 individuals. Stressful lifestyle, caffeine consumption, and smoking were associated with mastalgia (p < 0.05). Rates of women who had breast fed 3 times or more were higher in the mastalgia group (p < 0.05). Increased breast density, and breast imaging-reporting and data system (BI-RADS) 2 mammography findings were related with mastalgia (p < 0.05). Cysts and fibroadenomas were more common in the mastalgia group (p < 0.05). The incidence of a past history of malignant breast disease was significantly higher in the mastalgia group (p < 0.05). Conclusions: Stress, caffeine, smoking, lactation frequency, and benign disorders were factors detected to be related with mastalgia. Although a significant relation between mastalgia and malignant breast disease was detected in our study, more controlled studies are still required to investigate this issue further.

Robot assisted laparoscopic (RAL) gastrectomy: case series and a review of the literature

Gastric cancer is the fourth most common cancer type and is the second leading cause of cancer deaths worldwide. The contemporary treatment is gastrectomy and lymphadenectomy, which can be accomplished by either conventional (open), or laparoscopic surgery. With the advances in technology, there is a paradigm shift from conventional laparoscopy. As a result, single incision laparoscopic surgery (SILS), natural orifice transluminal endoscopic surgery (NOTES), and robot assisted laparoscopic surgery (RALS) have evolved as new treatment options for minimal invasive surgery. Herein five patients who were treated via robot assisted laparoscopic gastrectomy were reported together with review of the literature.