scholarly journals The surgical procedure for esophagogastric junction cancer — discussing the tactics

2020 ◽  
Vol 10 (4) ◽  
pp. 109-114
Author(s):  
Roman V. Ischenko ◽  
Rostislav V. Pavlov ◽  
O. A. Kuznetsova
Keyword(s):  
Quality Of Life ◽  
Lymph Nodes ◽  
Esophagogastric Junction ◽  
Resection Margins ◽  
Gastric Stump ◽  
Esophagogastric Junction Cancer ◽  
Surgical Tactics ◽  
The Right ◽  
Lesser Curvature

Introduction. Currently, there is no standardized surgical tactics for the esophagogastric junction cancer treatment. The issues of the resection margin, volume of lymphodissection and the optimal size of the gastric stump are still being discussed. This article analyzes the influence of these parameters on the recurrence-free survival and postoperative quality of life for patients, according to the literature data. Objective. Analysis of the treatment outcomes for patients with esophagogastric junction cancer, depending on the surgical tactics. Materials and Methods. The article analyzes the literature data evaluating various approaches in the surgical treatment of esophagogastric junction cancer. We present an example (from the Yasuyuki Seto study) of a patient with proximal gastric adenocarcinoma with a depth of T3 invasion and the surgical tactics regarding the size of the gastric stump. a A great advantage of the resection margin located at 2 cm from the proximal margin and at 5 cm from the distal margin has been shown. According to the results of our own observations, a patient with proximal gastric adenocarcinoma with an invasion depth of T3 underwent a resection with the proximal and distal resection margins of 13 and 65 mm, respectively. Negative resection margins were diagnosed intraoperatively. The patient's recurrence -free survival was 6 years. A total gastrectomy or esophagectomy are not the operations of choice because of the worsening of the patient's quality of life. When analyzing the depth of invasion according to the literature data, it has been found that an invasion in the esophagus of more than 30 mm is associated with an increased risk of metastatic lymph nodes of the superior and middle mediastinum. With a gastric invasion length of more than 40 mm, lymph nodes of lesser curvature along the right gastric artery are affected. According to the literature, a gastric stump with the size of more than two-thirds of the organ size was favorable in terms of the postoperative quality of life. Many authors indicate the positive effect of maintaining the gastroesophageal sphincter and cardia of the stomach. In the study by Yasuyuki Seto, proximal gastric resection was applied only if it was possible to maintain more than 12 cm in the small curvature and 25 cm in the large curvature. Conclusion. When choosing the surgical tactics for the esophagogastric junction cancer, one needs to focus on the patient's quality of life after the surgery. It is necessary to achieve negative resection margins in each case. The resection margins should be more than 2 and 5 cm for the proximal and distal margins, respectively. Dissection of the lymph nodes of the middle and superior mediastinum should be carried out with invasion of the tumor into the esophagus by more than 30 mm, removal of the lymph nodes of the lesser curvature of the stomach along the right gastric artery must be carried out if the tumor invasion into stomach is more than 40 mm. It is optimal to keep the gastric stump equal to two-thirds of the size of the organ. The issue of the surgical tactics in cancer of the esophageal-gastric transition is of great practical importance and requires a further study.

scholarly journals Exceptional case of surgical treatment of huge inguinal hernia at the woman

2019 ◽  
Vol 21 (2) ◽  
pp. 52-57
Author(s):  
I A Solovyov ◽  
D V Cherkashin ◽  
M V Vasilchenko ◽  
B B Bromberg ◽  
O V Balyura ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Inguinal Hernia ◽  
Postoperative Period ◽  
Clinical Case ◽  
Exceptional Case ◽  
Self Service ◽  
Surgical Tactics ◽  
The Right ◽  
First Time

Despite significant progress in a health care system the started cases of huge inguinal hernias still meet. For successful treatment of such patients objective diagnostics, preoperative preparation, the choice of suitable tactics of surgery and treatment in the postoperative period is important. The clinical case of treatment by not reducible huge inguinal hernia at the patient of 73 years is presented in article. The patient showed complaints to presence of the big sizes of the hernia in the bottom of a stomach limiting movement of the patient and self-service reducing quality of life. For the first time hernial protrusion in inguinal area has appeared in 2008 which gradually increased in sizes. Since 2015 I have noted the intensive growth of hernia. I didn’t ask for medical care. To clinic it is brought by an ambulance crew with the diagnosis of The Restrained Inguinal Hernia direction. At the time of survey data for infringement weren’t. After comprehensive examination to the patient surgery in volume has been executed: a gryzhesecheniye on the right, plasticity across Liechtenstein. The postoperative period proceeded without complications. The patient is written out for the 13th days after operation. Extremely exceptional clinical case, the choice of adequate stage-by-stage preoperative inspection and treatment, optimum surgical tactics and postoperative kuration is shown. The chosen approach led to prevention of development of a cascade of the complications including a compartment syndrome, to elimination of cosmetic defect and restoration of quality of life.

DESCRIPTION OF THE CASE OF METACHRONOUS CANCER OF THE CERVICAL ESOPHAGUS AFTER EXTIRPATION OF THE ESOPHAGUS WITH PRE-STERNUM ESOPHAGOPLASTY BY THE RIGHT HALF OF THE COLON

2018 ◽  
Vol 64 (2) ◽  
pp. 249-252
Author(s):  
Oleg Kit ◽  
Yevgeniy Kolesnikov ◽  
Aleksey Maksimov ◽  
Aleksandr Snezhko ◽  
Mikhail Averkin
Keyword(s):  
Quality Of Life ◽  
Surgical Treatment ◽  
Metachronous Cancer ◽  
High Quality ◽  
Individual Approach ◽  
Patients With Cancer ◽  
Metachronous Tumor ◽  
Surgical Tactics ◽  
The Right

Repeated development of a metachronous tumor in the esophagus resected because of cancer is usually observed in later periods. The period of time between the plasticity of the esophagus and the appearance of tumor can reach several tens of years. Optimal for patients with cancer of their own esophagus after esophagoplasty is early and radical surgical treatment with an individual approach to choosing surgical tactics to achieve the possible high quality of life.

The “RENAISSANCE” Trial: Effect of chemotherapy alone vs. chemotherapy followed by surgical resection on survival and quality of life in patients with limited-metastatic adenocarcinoma of the stomach or esophagogastric junction—A phase III trial of the German AIO/CAO-V/CAOGI.

2017 ◽  
Vol 35 (15_suppl) ◽  
pp. TPS4140-TPS4140 ◽  
Author(s):  
Daniel Wilhelm Mueller ◽  
Stefan Paul Moenig ◽  
Arndt Vogel ◽  
Sylvie Lorenzen ◽  
Nils Homann ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Surgical Resection ◽  
Esophagogastric Junction ◽  
Progression Free Survival ◽  
Phase Iii ◽  
Surgical Morbidity ◽  
Phase Iii Trial ◽  
Trial Effect ◽  
Esophagogastric Junction Cancer

TPS4140 Background: Recent data indicates that surgical resection may bring a benefit for select patients with metastatic gastric / esophagogastric junction cancer. However, no data obtained in randomized trials is available up to now. The current RENAISSANCE trial investigates this long-lasting question about the role of surgical intervention in limited-metastatic gastric / esophagogastric junction cancer. Methods: This is a prospective, multicenter, randomized, investigator initiated phase III trial. In this study, previously untreated patients with limited metastatic stage (retroperitoneal lymph node metastases only or a maximum of one incurable organ site that is potentially resectable or locally controllable with or without retroperitoneal lymph nodes) will receive 4 cycles of FLOT (docetaxel 50 mg/m²; oxaliplatin 85 mg/m²; leucovorin 200 mg/m²; 5-FU 2,600 mg/m²), and if Her2+ with trastuzumab. Patients without disease progression after 4 cycles are randomized 1:1 to receive additional chemotherapy cycles or surgical resection of primary and metastases followed by subsequent chemotherapy. 271 patients are to be allocated to the trial, of which at least 176 patients will be randomized. The primary endpoint is overall survival; main secondary endpoints are quality of life parameters as assessed by EORTC-QLQ-C30 questionnaire, progression free survival and surgical morbidity and mortality. Recruitment has already started; currently (Feb 2017) 21 patients have been enrolled. EudraCT: 2014-002665-30. Clinical trial information: NCT02578368.

scholarly journals Colorectal resection in endometriosis patients: correlation between histopathological findings and postoperative outcome

2021 ◽  
Vol 26 (1) ◽  
Author(s):  
Peter Tschann ◽  
Nikola Vitlarov ◽  
Martin Hufschmidt ◽  
Daniel Lechner ◽  
Paolo N. C. Girotti ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Colorectal Resection ◽  
Postoperative Outcome ◽  
Resection Margins ◽  
Pain Level ◽  
Histopathological Findings ◽  
Vas Score ◽  
Reduction Of Pain

Abstract Introduction Endometriosis is associated with a high number of chronic pelvic pain and reduced quality of life. Colorectal resections in case of bowel involvement of endometriosis are associated with an unneglectable morbidity in young and healthy patients. There is no linear correlation established between the degree of symptoms and stage of endometriosis. The aim of this study was to correlate the histological findings to preoperative pain scores in colorectal resected patients with endometriosis. Methods Twenty-five patients who underwent laparoscopic colorectal resection for endometriosis between 2014 and 2019 were included in this retrospective study. Pain level was assessed preoperatively and postoperatively via phone call in May 2020. Histopathology was correlated to preoperative symptoms and postoperative outcome. Results Average follow-up time was 38.68 months (± 19.92). Preoperative VAS-score was 8.32 (± 1.70). We observed a significant reduction of pain level in all patients after surgery (p ≤ 0.005). Pain levels were equal regarding the presence of satellite spots and various degrees of infiltration depth. The resection margins were clear in all patients. Postoperative complications occurred in 6 cases (24%) and anastomotic leakage was observed in 3 patients (12%). Average VAS-score at time of follow-up was 1.70 (± 2.54). Conclusion Our data demonstrate that adequate colorectal resection leads to reduction of pain and an increase of quality of life irrespective of histopathological findings. An experienced team is necessary to improve intraoperative outcome and to reduce postoperative morbidity in case of complication.

Advantages of a mini right axillary thoracotomy for congenital heart defect repair in children

2021 ◽  
pp. 1-6
Author(s):  
Jannika Dodge-Khatami ◽  
Ali Dodge-Khatami
Keyword(s):  
Quality Of Life ◽  
Physical Activity ◽  
Global Health ◽  
Congenital Heart ◽  
Surgical Repair ◽  
Median Sternotomy ◽  
Axillary Approach ◽  
Post Operative Pain ◽  
The Right

Abstract Objectives: The mini right axillary thoracotomy is an alternative surgical approach to repair certain congenital heart defects. Quality-of-life metrics and clinical outcomes in children undergoing either the right axillary approach or median sternotomy were compared. Methods: Patients undergoing either approach for the same defects between 2018 and 2020 were included. Demographic details, operative data, and outcomes were compared between both groups. An abbreviated quality of life questionnaire based on the Infant/Toddler/Child Health Questionnaires focused on the patient’s global health, physical activity, and pain/discomfort was administered to all parents/guardians within two post-operative years. Results: Eighty-seven infants and children underwent surgical repair (right axillary thoracotomy, n = 54; sternotomy, n = 33) during the study period. There were no mortalities in either group. The right axillary thoracotomy group experienced significantly decreased red blood cell transfusion, intubation, intensive care, and hospital durations, and earlier chest tube removal. Up to 1 month, parents’ perception of their child’s degree and frequency of post-operative pain was significantly less after the right axillary thoracotomy approach. No difference was found in the patient’s global health or physical activity limitations beyond a month between the two groups. Conclusions: With the mini right axillary approach, surrogates of faster clinical recovery and hospital discharge were noted, with a significantly less perceived degree and frequency of post-operative pain initially, but without the quality of life differences at last follow-up. While providing obvious cosmetic advantages, the minimally invasive right axillary thoracotomy approach for the surgical repair of certain congenital heart lesions is a safe alternative to median sternotomy.

Nordic retirement contracts and the economic situation of widows

2006 ◽  
Vol 21 (3) ◽  
pp. 383-418 ◽  
Author(s):  
BEATRICE MORING
Keyword(s):  
Quality Of Life ◽  
Eighteenth Century ◽  
Economic Status ◽  
Economic Situation ◽  
Standard Of Living ◽  
The Family ◽  
Early Eighteenth Century ◽  
The Right

The aim of this article is to explore the economic status and the quality of life of widows in the Nordic past, based on the evidence contained in retirement contracts. Analysis of these contracts also shows the ways in which, and when, land and the authority invested in the headship of the household were transferred between generations in the Nordic countryside. After the early eighteenth century, retirement contracts became more detailed but these should be viewed not as a sign of tension between the retirees and their successors but as a family insurance strategy designed to protect the interests of younger siblings of the heir and his or her old parents, particularly if there was a danger of the property being acquired by a non-relative. Both the retirement contracts made by couples and those made by a widow alone generally guaranteed them an adequate standard of living in retirement. Widows were assured of an adequately heated room of their own, more generous provision of food than was available to many families, clothing and the right to continue to work, for example at spinning and milking, but to be excused heavy labour. However, when the land was to be retained by the family, in many cases there was no intention of establishing a separate household.

Support for People with Dementia

2009 ◽  
Vol 2 (4) ◽  
pp. 245-249
Author(s):  
Neil Hunt
Keyword(s):  
Quality Of Life ◽  
Early Intervention ◽  
Support Services ◽  
Daily Life ◽  
Terminal Condition ◽  
People With Dementia ◽  
The Right

Dementia is a progressive and eventually terminal condition, but with early intervention and the right support, people with dementia can continue to enjoy a good quality of life for many years. Living with dementia can be challenging both for those affected and their families as it can affect all aspects of daily life. It is vital that people with dementia and their carers are signposted to the support services that can help them take control of their condition and help them remain active and independent.

scholarly journals Euthanasia and suicide: a medical and social discourse

2021 ◽  
Vol 25 (1) ◽  
pp. 107-112
Author(s):  
V. N. Ostapenko ◽  
I. V. Lantukh ◽  
A. P. Lantukh
Keyword(s):  
Quality Of Life ◽  
Assisted Suicide ◽  
Human Life ◽  
Modern Science ◽  
Physician Assisted Suicide ◽  
Adequate Quality ◽  
The Subject ◽  
Strong Explosion ◽  
The Right

Annotation. The problem of suicide and euthanasia has been particularly updated with the spread of the COVID-19 pandemic, which caused a strong explosion of suicide, because medicine was not ready for it, and the man was too weak in front of its pressure. The article considers the issue of euthanasia and suicide based on philosophical messages from the position of a doctor, which today goes beyond medicine and medical ethics and becomes one of the important aspects of society. Medicine has achieved success in the continuation of human life, but it is unable to ensure the quality of life of those who are forced to continue it. In these circumstances, the admission of suicide or euthanasia pursues the refusal of the subject to achieve an adequate quality of life; an end to suffering for those who find their lives unacceptable. The reasoning that banned suicide: no one should harm or destroy the basic virtues of human nature; deliberate suicide is an attempt to harm a person or destroy human life; no one should kill himself. The criterion may be that suicide should not take place when it is committed at the request of the subject when he devalues his own life. According to supporters of euthanasia, in the conditions of the progress of modern science, many come to the erroneous opinion that medicine can have total control over human life and death. But people have the right to determine the end of their lives while using the achievements of medicine, as well as the right to demand an extension of life with the help of the same medicine. They believe that in the era of a civilized state, the right to die with medical help should be as natural as the right to receive medical care. At the same time, the patient cannot demand death as a solution to the problem, even if all means of relieving him from suffering have been exhausted. In defense of his claims, he turns to the principle of beneficence. The task of medicine is to alleviate the suffering of the patient. But if physician-assisted suicide and active euthanasia become part of health care, theoretical and practical medicine will be deprived of advances in palliative and supportive therapies. Lack of adequate palliative care is a medical, ethical, psychological, and social problem that needs to be addressed before resorting to such radical methods as legalizing euthanasia.

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