简介：Treatmentofpancreaticcancerismultimodalandsurgeryisanessentialpart,mandatoryforcurativepotential.Alsochemotherapyisessential,andseriouspostoperativecomplicationsorrapiddiseaseprogressionmayprecludecompletionofmultimodaltreatment.Thesequenceoftreatmentinterventionshasthereforebecomeanimportantconcern,andnumerousongoingrandomizedcontrolledtrialscompareclinicaloutcomeafterupfrontsurgeryandneoadjuvanttreatmentwithsubsequentresection.Inpreviousyears,borderlineresectableandlocallyadvancedpancreaticcancerwasmostoftenconsideredunresectable.Moreeffectivechemotherapytogetherwiththelatestimprovementsinsurgicalexpertisehasresultedinextendedoperations,pushingthebordersofresectability.Multivisceralresectionswithorwithoutresectionofmajormesen-tericvesselsarenowperformedinnumerouspatients,resultinginbetteroutcome,recordedasoverallsurvivaland/orpatientreportedoutcome.Butpostoperativemorbidityincreasesconcurrently,andclinicalbenefitmustbecarefullyevaluatedagainstriskofpotentialharm,associatedwithnewcomprehensivemultimodaltreatmentsequences.Eventhoughcost/utilityanalysesaredeficient,extendedsurgeryhasresultedinsignifi-cantlylongerandbetterlifeformanypatientswithnoothertreatmentalternative.Improvedselectionofpatientstosurgeryand/orchemotherapywillinthenearfuturebepossible,basedonbettertumorbiologyinsight.Clinicallyavailablebiomarkersenablingpersonalizedtreatmentareforthcoming,buttheseoptionsarestilllimited.Theimportanceofsurgicalresectionforeachpatient’sprognosisispresentlyincreasing,justifyingsustainedexpansionofthesurgicaltreatmentmodality.

简介：Single-portlaparoscopicsurgery(SPLS)isproposedtobeasteptowardsminimizingtheinvasivenessofsurgery,andhassincegainedpopularityinseveralsurgicalsub-specialtiesincludinghepatopancreatobiliarysurgery.SPLShassincebeenappliedtocholecystectomy,liverresectionaswellaspancreatectomyforamultitudeofpathologies.BenefitsofSPLSoverconventionalmulti-incisionlaparoscopicsurgeryincludeimprovedcosmesisandpotentiallypost-operativepainatspecifictimeperiodsandextra-umbilicalsites.However,itisalsoassociatedwithlongeroperatingtime,increasedrateofcomplications,andincreasedrateofport-sitehernia.Thereisnosignificantdifferencebetweenlengthofhospitalstay.SPLShasasignificantlearningcurvethataffectsoperatingtime,rateofconversionandrateofcomplications.Inthisarticle,wereviewtheliteratureonSPLSinhepatobiliarysurgery-cholecystectomy,hepatectomyandpancreatectomy,andoffertipsonovercomingpotentialtechnicalobstaclesandminimizingthecomplicationswhenperformingSPLS-surgeonposition,positionofportandinstruments,instrumentcrossingposition,standardhandgripvsreversehandgrip,snookercueguideposition,preventionofincisionalhernia.SPLSisapromisingdirectioninlaparoscopicsurgery,andwerecommendstep-wiseprogressionofapplicationsofSPLStovarioushepatopancreatobiliarysurgeriestoensuresafeadoptionofthesurgicaltechnique.

简介：Medicaltherapyfortype2diabetesmellitusisineffectiveinthelongtermduetotheprogressivenatureofthedisease,whichrequiresincreasingmedicationdosesandpolypharmacy.Conversely,bariatricsurgeryhasemergedasacost-effectivestrategyforobesediabeticindividuals;ithaslowcomplicationratesandresultsindurableweightloss,glycemiccontrolandimprovementsinthequalityoflife,obesity-relatedco-morbidityandoverallsurvival.Thefindingthatglucosehomeostasiscanbeachievedwithaweightloss-independentmechanismimmediatelyafterbariatricsurgery,especiallygastricbypass,hasledtotheparadigmofmetabolicsurgery.However,theprimaryfocusofmetabolicsurgeryisthealterationofthephysio-anatomyofthegastrointestinaltracttoachieveglycemiccontrol,metaboliccontrolandcardio-metabolicriskreduction.Todate,metabolicsurgeryisstillnotwelldefined,asitisusedmostfrequentlyforlessobesepatientswithpoorlycontrolleddiabetes.Themechanismofglycemiccontrolisstillincompletelyunderstood.Publishedresearchfindingsonmetabolicsurgeryarepromising,butmanyaspectsstillneedtobedefined.Thispaperexaminestheproposedmechanismofdiabetesremission,theefficacyofdifferenttypesofmetabolicprocedures,thedurabilityofglucosecontrol,andtherisksandcomplicationsassociatedwiththisprocedure.Weproposeatailoredapproachfortheselectionoftheidealmetabolicprocedurefordifferentgroupsofpatients,consideringtheindicationsandprognosticfactorsfordiabetesremission.

简介：Neuroendocrinetumors(NET)areaheterogeneousgroupofcancers,withindolentbehavior.Themostcommonprimaryoriginisthegastro-intestinaltractbutcanalsoappearinthelungs,kidneys,adrenals,ovariesandotherorgans.Ingeneral,NETisusuallydiscoveredinthemetastaticphase(40%-80%).Theliveristhemostcommonorganinvolvedwhenmetastasesoccur(40%-93%),followedbybone(12%-20%)andlung(8%-10%).Anumberofdifferenttherapeuticoptionsareavailableforthetreatmentofhepaticmetastasesincludingsurgicalresection,transplantation,ablation,trans-arterialchemoembolization,chemotherapyandsomatostatinanalogues.Recently,moleculartargetedtherapieshavebeenused,usuallyincombinationwithothertreatmentoptions,toimproveoutcomesinpatientswithmetastases.ThisarticleemphasizesontheroleofsurgeryinthetreatmentoflivermetastasesfromNET.

简介：瞄准：与胆汁的病理为pyogenic肝脓肿(PLA)调查可行性和laparoscopic外科的治疗学的效果。方法：从2004年1月到2010年10月，有与胆汁的病理会议入口标准相结合的PLA的31个病人在我们的医院里收到了外科的管理。31个病人，13经历了laparoscopic外科(LS组)，18经历了开的外科(OS组)。包括操作时间，intraoperative血损失，手术后的复杂并发症率，一些手术后的医院停留，和脓肿复发率的临床的数据回顾地在二个组之间被分析并且比较。结果：所有病人收到了全身的抗菌素治疗。四个病人在手术前经历了指导超声的经皮的导管排水。手术后的复杂并发症发生在5个病人(16.1%，5/31)在LS组包括2并且3在OS组。一个病人在OS组在普通胆汁管和另一吃的肝脓肿复发保留了演算。没有保留的演算和肝脓肿复发发生在LS组。在二个组，在perioperative时期期间没有死亡。在时间，intraoperative血损失和输送，手术后的复杂并发症率和脓肿复发在二个组之间评估的操作没有重要差别。口头的吸入更早(1.9

简介：Sleevegastrectomy(SG)isarestrictivebariatricsurgerytechniquethatwasfirstusedaspartofrestrictivehorizontalgastrectomyintheoriginalScopinarotypebiliopancreaticdiversion.Itsgoodresultsasasingletechniquehaveledtoariseinitsuse,anditiscurrentlythesecondmostperformedtechniqueworldwide.SGachievesclearlybetterresultsthanotherrestrictivetechniquesandiscomparableinsomeaspectstotheRoux-en-Ygastricbypass,thecurrentgoldstandardinbariatricsurgery.Thesebenefitshavebeenassociatedwithdifferentpathophysiologicmechanismsunrelatedtoweightlosssuchasincreasedgastricemptyingandintestinaltransit,andactivationofhormonalmechanismssuchasincreasedGLP-1hormoneanddecreasedghrelin.TheaimofthisreviewwastohighlightthesalientaspectsofSGregardingitshistoricalevolution,pathophysiologicmechanisms,mainresults,clinicalapplicationsandperioperativecomplications.

简介：Laparoscopicrectalsurgerycontinuestobeachallengingoperationassociatedtoasteeplearningcurve.Roboticsurgicalsystemshavedramaticallychangedminimallyinvasivesurgery.Three-dimensional,magnifiedandstableview,articulatedinstruments,andreductionofphysiologictremorsleadingtosuperiordexterityandergonomics.Therefore,roboticplatformscouldpotentiallyaddresslimitationsoflaparoscopicrectalsurgery.Itwasaimedatreviewingcurrentliteratureonshort-termclinicalandoncological(pathological)outcomesafterroboticrectalcancersurgeryincomparisonwithlaparoscopicsurgery.Asystematicreviewwasperformedfortheperiod2002to2014.Atotalof1776patientswithrectalcancerunderwentminimallyinvasiverobotictreatmentin32studies.Afterroboticandlaparoscopicapproachtooncologicrectalsurgery,respectively,meanoperatingtimevariedfrom192-385min,andfrom158-297min;meanestimatedbloodlosswasbetween33and283mL,andbetween127and300mL;meanlengthofstayvariedfrom4-10d;andfrom6-15d.Conversionafterroboticrectalsurgeryvariedfrom0%to9.4%,andfrom0to22%afterlaparoscopy.Therewasnodifferencebetweenrobotic(0%-41.3%)andlaparoscopic(5.5%-29.3%)surgeryregardingmorbidityandanastomoticcomplications(respectively,0%-13.5%,and0%-11.1%).Regardingimmediateoncologicoutcomes,respectivelyamongroboticandlaparoscopiccases,positivecircumferentialmarginsvariedfrom0%to7.5%,andfrom0%to8.8%;themeannumberofretrievedlymphnodeswasbetween10and20,andbetween11and21;andthemeandistalresectionmarginwasfrom0.8to4.7cm,andfrom1.9to4.5cm.Roboticrectalcancersurgeryisbeingundertakenbyexperiencedsurgeons.However,thequalityoftheassembledevidencedoesnotsupportdefiniteconclusionsaboutmoststudiesvariables.Roboticrectalcancersurgeryisassociatedtoincreasedcostsandoperatingtime.Italsoseemstobeassociatedtoreducedconversionrates.Othershort-termo

简介：AIMTounderstandtheinfluenceoffrailtyonpostoperativeoutcomesforlaparoscopicandopencolectomy.METHODSDatawereobtainedfromtheNationalSurgicalQualityImprovementProgram(2005-2012)forpatientsundergoingcolonresection[opencolectomy(OC)andlaparoscopiccolectomy(LC)].Patientswereclassifiedasnon-frail(0points),lowfrailty(1point),moderatefrailty(2points),andseverefrailty(≥3)usingtheModifiedFrailtyIndex.30-dmortalityandcomplicationswereusedastheprimaryendpointandanalyzedfortheoverallpopulation.Complicationsweregroupedintomajorandminor.Subsetanalysiswasperformedforpatientsundergoingcolectomy(totalcolectomy,partialcolectomyandsigmoidcolectomy)andseparatelyforpatientsundergoingrectalsurgery(abdominoperinealresection,lowanteriorresection,andproctocolectomy).WeanalyzedthedatausingSASPlatformJMPProversion10.0.0(SASInstituteInc.,Cary,NC,UnitedStates).RESULTSAtotalof94811patientswereidentified;themajorityunderwentOC(58.7%),werewhite(76.9%),andnon-frail(44.8%).Themedianagewas61.3years.Prolongedlengthofstay(LOS)occurredin4.7%,and30-dmortalitywas2.28%.PatientsundergoingOCwereolder(61.89±15.31vs60.55±14.93)andhadahigherASAscore(48.3%ASA3vs57.7%ASA2intheLCgroup)(P<0.0001).Mostpatientswerenon-frail(42.5%OCvs48%LC,P<0.0001).Complications,prolongedLOS,andmortalityweresignificantlymorecommoninpatientsundergoingOC(P<0.0001).OChadahigherriskofdeathandcomplicationscomparedtoLCforallfrailtyscores(non-frail:OR=4.7,andOR=4.67;mildlyfrail:OR=2.51,andOR=2.47;moderatelyfrail:OR=2.94,andOR=2.02,severelyfrail:OR=2.37,andOR=2.34,P<0.05)andanincreaseinabsolutemortalitywithincreasingfrailty(non-frail0.68%OC,mildlyfrail1.39%,moderatelyfrail3.44%,andseverelyfrail5.83%,P<0.0001).CONCLUSIONLCisassociatedwithimprovedoutcomes.Althoughtheoddsofmortalityarehigherin

简介：AIMToprovideanupdatedassessmentofthesafetyandefficacyofenhancedrecoveryaftersurgery(ERAS)protocolsinelectivegastriccancer(GC)surgery.METHODSPubMed,Medline,EMBASE,WorldHealthOrganizationInternationalTrialRegister,andCochraneLibraryweresearcheduptoJune2017forallavailablerandomizedcontrolledtrials(RCTs)comparingERASprotocolsandstandardcare(SC)inGCsurgery.ThirteenRCTs,withatotalof1092participants,wereanalyzedinthisstudy,ofwhom545underwentERASprotocolsand547receivedSCtreatment.RESULTSNosignificantdifferencewasobservedbetweenERASandcontrolgroupsregardingtotalcomplications(P=0.88),mortality(P=0.50)andreoperation(P=0.49).Theincidenceofpulmonaryinfectionwassignificantlyreduced(P=0.03)followinggastrectomy.However,thereadmissionrateafterGCsurgerynearlytripledunderERAS(P=0.009).ERASprotocolssignificantlydecreasedthelengthofpostoperativehospitalstay(P<0.00001)andmedicalcosts(P<0.00001),andacceleratedbowelfunctionrecovery,asmeasuredbyearliertimetothefirstflatus(P=0.0004)andthefirstdefecation(P<0.0001).Moreover,ERASprotocolswereassociatedwithalowerlevelofseruminflammatoryresponse,higherserumalbumin,andsuperiorshorttermqualityoflife(QOL).CONCLUSIONCollectively,ERASresultsinacceleratedconvalescence,reductionofsurgicalstressandmedicalcosts,improvednutritionalstatus,andbetterQOLforGCpatients.However,high-qualitymulticenterRCTswithlargesamplesandlong-termfollow-upareneededtomorepreciselyevaluateERASinradicalgastrectomy.

简介：AIM:Toperformameta-analysistoanswerwhetherlong-termrecurrenceratesafterlaparoscopic-assistedsurgeryarecomparabletothosereportedafteropensurgery.METHODS:AcomprehensiveliteraturesearchoftheMEDLINEdatabase,EMBASEdatabase,andtheCochraneCentralRegisterofControlledTrialsfortheyears1991-2010wasperformed.Prospectiverandomizedclinicaltrials(RCTs)wereeligibleiftheyincludedpatientswithcoloncancertreatedbylaparoscopicsurgeryvsopensurgeryandfollowedformorethanfiveyears.RESULTS:Threestudiesinvolving2147patientsreportedlong-termoutcomesbasedonfive-yeardataandwereincludedintheanalysis.Theoverallmortalitywassimilarinthetwogroups(24.9%,268/1075inthelaparoscopicgroupand26.4%,283/1072inopengroup).Nosignificantdifferencesbetweenlaparoscopicandopensurgerywerefoundinoverallmortalityduringthefollow-upperiodofthesestudies[OR(fixed)0.92,95%confidenceintervals(95%CI):0.76-1.12,P=0.41].Nosignificantdifferenceinthedevelopmentofoverallrecurrencewasfoundincoloncancerpatients,whencomparinglaparoscopicandopensurgery[2147pts,19.3%vs20.0%;OR(fixed)0.96,95%CI:0.78-1.19,P=0.71].CONCLUSION:Thismeta-analysissuggeststhatlaparoscopicsurgerywasasefficaciousandsafeasopensurgeryforcoloncancer,basedonthefive-yeardataoftheseincludedRCTs.