Background
Dyspnoea in patients with a para-oesophageal hernia (PEH) occurs in 7% to 32% of cases and is very disabling, especially in elderly patients, and its origin is not well defined. The present study aims to assess the impact of PEH repair on dyspnoea and respiratory function.
Methods
From January 2019 to May 2021, all consecutive patients scheduled for PEH repair presenting with a modified Medical Research Council (mMRC) score ≥ 2 for dyspnoea were included. Before and 2 months after surgery, dyspnoea was assessed by both the dyspnoea visual analogue scale (DVAS) and the mMRC scale, as well as pulmonary function tests (PFTs) by plethysmography.
Results
All 43 patients that were included had pre- and postoperative dyspnoea assessments and PFTs. Median age was 70 years (range 63–73.5 years), 37 (86%) participants were women, median percentage of the intrathoracic stomach was 59.9% (range 44.2–83.0%), and median length of hospital stay was 3 days (range 3–4 days). After surgery, the DVAS decreased statistically significant (5.6 [4.7–6.7] vs. 3.0 [2.3–4.4],
p
< 0.001), and 37 (86%) patients had a clinically significant decrease in mMRC score. Absolute forced expiratory volume in one second (FEV1), total lung capacity, and forced vital capacity also statistically significantly increased after surgery by an average of 11.2% (SD 17.9), 5.0% (SD 13.9), and 10.7% (SD 14.6), respectively. Furthermore, from the subgroup analysis, it was identified that patients with a lower preoperative FEV1 were more likely to have improvement in it after surgery. No correlation was found between improvement in dyspnoea and FEV1. There was no correlation between the percentage of intrathoracic stomach and dyspnoea or improvement in PFT parameters.
Conclusion
PEH repair improves dyspnoea and FEV1 in a statistically significant manner in a population of patients presenting with dyspnoea. Patients with a low preoperative FEV1 are more likely to have improvement in it after surgery.
Background and aim
Gastric poorly cohesive carcinoma (PCC) is characterized by a submucosal diffusion, an early lymph node and peritoneal extension associated with a worth prognosis for locally advanced stage (T2-T4) than intestinal type of adenocarcinoma. Total gastrectomy (TG) is still the most frequent procedure realized for distal gastric PCC because of its invasive characteristics. However, subtotal gastrectomy (SG) for antro-pyloric localization could improve morbidity and quality of life without compromising oncological outcomes. At this day, there is no clear recommendation about the type of surgery to realize for distal PCC gastric cancer. The aim of this study was to compare overall survival (OS) and disease-free survival (DFS) for patients with antro pyloric PCC treated by SG vs those treated by TG.
Methods
We use a retrospective European multicentric cohort of 2327 patients treated for gastric cancer between 2007 and 2017 by members of the French Association of Surgery (AFC).
Results
All in all, this study included 271 patients with antro pyloric PCC treated by gastrectomy with 131 who underwent SG and 140 patients who underwent TG. Baseline characteristics were globally similar.
We didn’t observe any significant difference for tumor stage pTNM.
The median length of stay for patients with SG was 11 days (8–16) but for TG it was 13 days (10–18) (P = 0,001). There was no significant difference on surgical reintervention with 13 patients in each group (P = 0,93).
Concerning surgical complications, we used Dindo-Clavien classification: 60% of patients with SG had stage I-IIIa complication against 77% for TG and 8.8% had stage IIIB-IVb against 14,4% (P < 0.001).
There was no significant difference on 5-year overall survival years between SG (53.1% CI95% = 41.5–63.5%) and TG (53.8% CI95% = 43.2–63.3%) (HR = 0,94 CI95% = 0,68-1,29).
We also found no significant difference on 5-year disease free survival between SG (45.3% CI 95% = 34.3–55.6%) and TG (46.0% CI 95% = 35.9–55.5%) (HR = 0,97 CI95% = 0,69-1,33).
Conclusion
Our results show that there was no significant difference between SG and TG for 5-year OS and DFS for distal PCC with a lower complication rate in SG group. SG seems to be a valuable strategy for distal PCC.
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