The gastric pull-up reconstruction is a safe, effective operation with a low mortality rate and excellent long-term functional results for patients with extensive carcinoma of the hypopharynx, larynx, and cervical esophagus.
The 5-year survival rate for patients with hypopharyngeal squamous cell carcinoma invading the upper esophagus is below 25% regardless of therapy. Most patients with advanced disease--unable to eat or breathe--die within 18 months of diagnosis. Because these patients, on average, have a limited time to live, surgical treatment should aim to maximize the quality of remaining life. Essential to this goal are complete tumor removal and rapid return to oral feeding. Furthermore, short hospital stay and low perioperative morbidity are especially important in these patients. We performed total laryngopharyngoesophagectomy (LPE) with gastric transposition in 34 patients with hypopharyngeal and cervical esophageal squamous cell carcinoma. There has been one perioperative death (3%) and 1 temporary fistula (3%). No major mediastinal or intrathoracic complication occurred. On average, patients began oral feeding by postoperative day 10, with return to a full diet and discharge home within 16 days, maximizing both quality and quantity of time remaining outside the hospital.
The relationship between gastrointestinal neoplasms and Crohn's disease is poorly defined. The purpose of this study was to characterize the features of gastrointestinal malignancies that developed in Crohn's patients. In this retrospective review the authors identified six patients with Crohn's disease who developed such lesions over a 20-year period: four patients had colorectal cancers and two had ileal malignant neoplasms. Patients averaged 52.7 years of age (range, 21 to 61 years). Three patients were men and three women. Five of the six patients had endured Crohn's disease for more than 20 years. Only two lesions were diagnosed before surgery. The colorectal lesions were predominantly right-sided and all occurred in bowel segments with active Crohn's disease. The lesions demonstrated aggressive histologic features: three of six tumors were poorly differentiated, one of the five adenocarcinomas was mucinous, and three of the colorectal cancers were Dukes' B or C lesions. Four of six patients survived five or more years. There was a single malignant carcinoid, which represents the seventh case report of a carcinoid tumor occurring in a patient with Crohn's disease. This study indicates that patients with Crohn's disease develop a wide variety of small bowel and colorectal cancers. Furthermore, it suggests that Crohn's patients with colonic disease should periodically undergo surveillance colonoscopy.
Percutaneous transhepatic cholangiography is a safe, effective diagnostic procedure for use in evaluating the jaundiced patient. As is the case with most invasive diagnostic procedures there is a risk: an overall mortality rate of 0.5% and morbidity rate of 3-10%. Fortunately hemobilia is an uncommon complication, encountered only four times in our series of 102 percutaneous cholangiograms. In every case of hemobilia the clotting parameters were normal. The one factor common to each case was distal obstruction of the extra hepatic bile ducts. However, this one factor may play an important role in the etiology and therapy of post cholangiographic hemobilia. The hemorrhage subsided spontaneously in every case following surgical decompression of the bile ducts and there was no further active bleeding postoperatively. The possible explanation for the cause of bleeding and the fact that it subsided following demcompression of the bile ducts is discussed. All four patients survived this complication and in the 102 patients there were no deaths attributable to percutaneous transhepatic cholangiography.
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