Whether prophylactic cholecystectomy is indicated for patien

Whether prophylactic cholecystectomy is indicated for patients with adenocarcinoma of the stomach undergoing radical gastrectomy remains unclear. Fukagawa et al examined 672 patients and reported that 173 (25.7%) patients developed gallstones after surgery, and only 12 (6.9% of 173) were symptomatic and required cholecystectomy. They found that prophylactic cholecystectomy is not beneficial for most patients, and that only patients with extensive cholesterol absorption inhibitors node dissection should be considered for prophylactic cholecystectomy. Kobayashi et al demonstrated that most patients with gallstones were asymptomatic after radical gastrectomy, and < 0.5% of the patients required cholecystectomy. Gillen et al reviewed concurrent cholecystectomy during gastric and esophageal resection and reported higher calculated additional morbidity compared with late cholecystectomy. However, the preliminary report of the CHOLEGAS (Gastrectomy Plus Prophylactic Cholecystectomy in Gastric Cancer Surgery) study, a multicenter randomized study examining the safety of prophylactic cholecystectomy during gastrectomy for cancer, found no increase in perioperative morbidity, mortality, and costs. Cholecystectomy is an uncomplicated procedure; the theoretical advantage of prophylactic cholecystectomy is that it avoids reintervention for cholelithiasis. In our study, total gastrectomy was a crucial factor for postoperative gallstone formation and subsequent complications. However, most patients do not benefit from combined cholecystectomy. Prophylactic cholecystectomy is definitely not indicated in patients with distal subtotal gastrectomy. Furthermore, the widespread application of minimally invasive gastrectomy may reduce the necessity of prophylactic gallbladder removal for preventing future open cholecystectomy. For early gastric cancer management, procedures for preserving the vagus nerve may be an alternative.
Introduction Advances in endoscopic instruments and surgical techniques have considerably improved minimally invasive esophagectomy (MIE). The minimally invasive approach to esophagectomy described by Luketich et al has resulted in morbidity, mortality, and oncological outcomes comparable with those of conventional esophagectomy. Gastric tube reconstruction after esophagectomy is associated with a high risk of anastomotic leakage. Anastomotic leaks are multifactorial, with insufficient blood supply at the anastomotic site of the gastric tube being the major cause. Maintaining sufficient blood supply and ensuring adequate gastric tube length are crucial while planning cervical anastomosis. MIE and laparoscopic gastric tube construction were adopted at our institution in 2006 and 2007, respectively. We developed a safe and effective method of gastric tube construction that ensures adequate gastric tube length and vascular supply. Here, we describe albinism novel procedure and analyze its postoperative outcomes.
Methods
Results Between March 2013 and December 2013, 20 patients [18 men and 2 women; mean age, 54.5 years (Table 1)] who had undergone minimally invasive McKeown esophagectomy were treated through gastric tube construction. Perioperative data are listed in Table 2. The mean operative time, namely that of MIE and gastric tube reconstruction, was 7.10 ± 1.08 hours, and the mean estimated operative blood loss was 118.00 ± 79.71 mL. No deaths or conversion to open surgery occurred in this study. The overall complication rate was 45% and predominantly involved postoperative transient hoarseness. One patient experienced minor cervical leakage on postoperative Day 9 and was discharged on postoperative Day 12. All patients had undergone gastric reconstruction through the posterior mediastinal route with cervical anastomosis. The average length of the gastric tubes above the sternal notch was 7.65 ± 2.40 cm (range, 5.0–15.0 cm). The average width of the gastric tubes was 3.74 ± 0.47 cm. In all patients except one, both arterial and venous blood oozing were confirmed at the edge of the gastrostomy on the gastric tube. Venous blood oozing in one patient was not confirmed, but the patient did not experience any leak or stricture (Table 3).