Open rectal cancer resection is associated with a higher rate of sexual dysfunction, but not bladder dysfunction, compared with laparoscopic surgery. Laparoscopic rectal cancer surgery offers a significant advantage with regard to preservation of postoperative sexual function and constitutes a true advance in rectal cancer surgery compared with the open technique. The proposed advantages can be attributed to improvement in visibility by the magnification feature of laparoscopic surgery.
Lymph nodes should be dissected by surgeons with sufficient technical and anatomical experience, and then examined and counted by experienced pathologists to reduce the occurrence of LNA. The results of this anatomical study can serve as a guideline to assess the success of lymph node dissection during gastric cancer surgery. Similar studies should be conducted in every country to establish national guidelines.
Minimally invasive esophagectomy is an increasing trend in surgery. Thoracoscopic esophagectomy is applicable and an alternative procedure to conventional esophagectomy in patients especially with end-stage benign diseases like caustic stricture. A 33-year-old female patient was admitted to the department of general surgery with dysphagia. The patient was suffering from caustic stricture due to ingestion of hydrochloric acid. A totally thoracoscopic and laparoscopic vagal-sparing esophagectomy and colonic interposition was performed. As a more physiologic alternative, vagal-sparing esophagectomy is the ideal operation for these patients.
The aim of this study was to evaluate the sufficiency of the surgical technique according to the extended lymph node dissection in gastric cancer patients (GCPs). We supported our findings with the determination of a number of lymph nodes (LNs) in lymph node stations with an autopsy performed on cadavers without any type of cancer. Method: 55 GCPs were enrolled. Extended lymphadenectomy was performed on 23 autopsy cases as a comparative group. Total gastrectomy and D2 dissection were performed as the standard surgical approach. Results: According to TNM classification, nine cases (18%) were stratified to stage I, three (6%) to stage II, 22 (36%) to stage III, and 21 (40%) to stage IV. The median number of excised LNs from the 55 cases was 47 (24-95), metastatic LNs were 15 (1-71) in patients. In the autopsy group, the median number was 72 (50-91). If D1 dissection had been performed instead of D2 dissection in the 55 cases, the median number of excised LNs would have been 24 (10-57), and metastatic LNs would have been 5 (1-45). If D1 dissection had been performed in the autopsy group, the median number of excised LNs would have been 36 (20-49). Conclusions: The number of LNs harvested does not reflect the width of lymphadenectomy. D2 dissection must be performed stationary to achieve adequate extension of the lymphadenectomy. Possible skip metastasis and stage migration will also be reduced so that more efficient oncological results will be achieved.
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