المؤلفون: Chia-Hua Lee, Yu-Tang Chang, Hsien-Pin Li, Meei-Feng Huang, Shah-Hwa Chou, Ka-Wo Lee

المصدر: World Journal of Surgery. 34:2383-2388

مصطلحات موضوعية: Adult, Male, medicine.medical_specialty, Caustics, Esophagogastrectomy, Physical examination, Gastrectomy, Predictive Value of Tests, Epidemiology, medicine, Humans, Hospital Mortality, Aged, Retrospective Studies, medicine.diagnostic_test, business.industry, Retrospective cohort study, Perioperative, Middle Aged, Prognosis, Surgery, Cardiac surgery, Esophagectomy, Gastrointestinal Tract, Logistic Models, Predictive value of tests, Acute Disease, Female, business, Abdominal surgery

الوصف: The aim of this study was to identify the preoperative factors that affect the survival of patients who undergo esophagogastrectomy after corrosive ingestion, using analysis of their physiological condition, associated diseases, physical examination, and laboratory data.Between January 1995 and December 2005, 71 consecutive patients who underwent esophagogastrectomy for corrosive ingestion injuries were retrospectively reviewed. Of them, 41 survived and 30 (42.3%) died during the perioperative period. Logistic regression analyses were used to model markers for postoperative mortality, including descriptive data, clinical symptoms/signs, and laboratory data.There were 35 males and 36 females included in the study, with an average age of 54.7 +/- 14.9 years. After adjustments in the logistic regression model, age of over 65 years (p = 0.021), presence of gross hematuria (p = 0.016), twofold level of serum AST (p = 0.012), blood pH level below 7.2 (p = 0.017), and deficit of blood base over 16 (p = 0.007) were found to be independent risk factors for patient mortality.We consider age over 65 years, preoperative pH7.2, base deficit16, twofold level of serum AST, and presence of gross hematuria to be the important factors predicting postoperative hospital mortality in patients presenting with corrosive ingestion injuries who require emergency surgery.

الوصول الحر: https://explore.openaire.eu/search/publication?articleId=doi_dedup___::fc07448320f0404e2b6b1490ef0f551aTest
https://doi.org/10.1007/s00268-010-0646-6Test

المؤلفون: Shah-Hwa Chou, Jui-Ying Lee, Hsien-Pin Li, Ka-Wo Lee, Chia-Hua Lee, Meei-Feng Huang

المصدر: World Journal of Surgery. 34:1832-1839

مصطلحات موضوعية: Adult, Male, medicine.medical_specialty, Esophageal Neoplasms, medicine.medical_treatment, Laryngectomy, Statistics, Nonparametric, Postoperative Complications, Tracheostomy, Intensive care, medicine, Humans, Radical surgery, Aged, Neoplasm Staging, Retrospective Studies, Cervical cancer, Chi-Square Distribution, business.industry, Stomach, Neck dissection, Middle Aged, Plastic Surgery Procedures, Esophageal cancer, Prognosis, medicine.disease, Combined Modality Therapy, Dysphagia, Surgery, Esophagectomy, Treatment Outcome, Thoracotomy, Carcinoma, Squamous Cell, Quality of Life, Neck Dissection, Female, medicine.symptom, business, Chemoradiotherapy

الوصف: The prognosis and quality of life (QOL) for those with cervical esophageal cancer is extremely poor, and chemoradiotherapy remains the mainstay treatment. During the past few years, our surgical teams has implemented a more aggressive and radical resection: total laryngopharyngectomy with neck dissection, total esophagectomy, and reconstruction with stomach. This study compares the results of chemoradiotherapy and that of the aforementioned surgical approach. This is a retrospective study of 15 patients who underwent radical resection and 14 patients who received chemoradiation. Their age, sex, tumor stage and grade, pre- and posttreatment dysphagia scores, operating time, blood loss, length of intensive care and postoperative stay, days to resume oral intake, complications, Eastern Cooperative Oncology Group (ECOG) status, QOL score, and disease-specific survival were recorded and compared. There were no significant differences in age, sex, pretreatment dysphagia score, cancer stage and grade, ECOG status (posttreatment), associate diseases, preoperative QOL, or follow-up period between the two groups. However, the posttreatment dysphagia score was significantly better for the operative group (P

الوصول الحر: https://explore.openaire.eu/search/publication?articleId=doi_dedup___::9d78090c673788e996d37d998d87882aTest
https://doi.org/10.1007/s00268-010-0595-0Test

المؤلفون: Shah-Hwa Chou, Hsien-Pin Li

المصدر: World Journal of Surgery. 35:2365-2365

مصطلحات موضوعية: medicine.medical_specialty, Endoscope, medicine.diagnostic_test, business.industry, General surgery, Perforation (oil well), Vascular surgery, Cardiac surgery, Surgery, Endoscopy, Cardiothoracic surgery, Medicine, business, Laparoscopy, Abdominal surgery

الوصف: To the Editor, We are grateful for the clinical experience and suggestions provided by Dr. Huscher and colleagues concerning their laparoscopic management of caustic injuries to the upper gastrointestinal tract (UGI). Also, we congratulate them on their brilliant results. Minimally invasive surgery such as video-assisted thoroscopic surgery (VATS) and laparoscopy has been performed regularly in our department for more than 10 years. Total minimally invasive esophagectomy and gastric tube reconstruction for esophageal cancer with assist devices, such as the harmonic scalpel and endo-GIA stapler, have also been performed in a certain number of cases. However, the application of endoscopy in emergency surgery for patients with severe caustic UGI injuries remains a contentious issue. The operative indications in our series are listed in our article. Most of our patients underwent operation because of shock or persistent metabolic acidosis despite intensive resuscitation. As you can imagine, clinical conditions (hypotension, acidosis etc.) became even worse during the operation. The only way to save these patients is to remove the necrotic organs and tissue as soon as possible, i.e. to stop the continuous absorption of toxins, which would otherwise cause sepsis. In most cases, we finished resection within 60–90 min. We then irrigated the entire abdominal cavity, using approximately 10,000 ml of warm saline to clear all intraperitoneal soiling and thus prevent postoperative abdominal abscess. The entire anesthesia time should be as short as possible for these patients. The disadvantages of laparoscopic resection that concern us most are: (1) the instillation of carbon dioxide into the peritoneum, further compromising cardiopulmonary function and causing unpredictable intraoperative tragedy; (2) intraperitoneal spillage of gastrointestinal contents due to necrotic perforation—difficult to completely clean up through the endoscope and potentially very time consuming. The operative time achieved by Dr. Huscher was 218 ± 28 min, but is the time used for peritoneal lavage after resection taken into account? We have to point out that one of the main differences in caustic UGI injuries in Western countries and Taiwan is the caustic agent. In Taiwan, acid is the most commonly ingested agent. Unlike the localized lesions caused by ingestion of solid alkaline pellets, the low pH of acid causes diffuse injuries from the midor even upper esophagus down to the gastric body and antrum. This extent of injury greatly increases operative difficulty. We agree that laparoscopy is of value in the management of a limited number of cases of acute caustic GI injuries, provided the patient’s vital signs are stable and there is no perforation. Also, it is a valuable tool for early diagnosis of some cases with equivocal clinical conditions. For the ‘‘very sick patients,’’ as Dr. Huscher has said, what would be more important, a life-saving operation or minimally invasive surgery in order to reduce surgical trauma? Intestinal continuity was restored in two of Dr. Huscher’s young patients; what about the other 4? We appreciate this opportunity to reply to Dr. Huscher’s comments. Also we acknowledge and thank Jadzia Chou for manuscript revision. S.-H. Chou H.-P. Li Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan

الوصول الحر: https://explore.openaire.eu/search/publication?articleId=doi_________::ac4410cfca5b26da1492cb462aa803e4Test
https://doi.org/10.1007/s00268-011-1201-9Test