CA : A Cancer Journal for Clinicians

Retrospective study: The diagnostic accuracy of conventional forceps biopsy of gastric epithelial compared to endoscopic submucosal dissection (STROBE compliant).

Statistical Analysis with Missing Data

Delayed gastric emptying (DGE) after pancreatic surgery: A suggested definition by the International Study Group of Pancreatic Surgery (ISGPS)

This is the fourth updated Enhanced Recovery After Surgery (ERAS®) Society guideline presenting a consensus for optimal perioperative care in colorectal surgery and providing graded recommendations for each ERAS item within the ERAS® protocol. A wide database search on English literature publications was performed. Studies on each item within the protocol were selected with particular attention paid to meta-analyses, randomised controlled trials and large prospective cohorts and examined, reviewed and graded according to Grading of Recommendations, Assessment, Development and Evaluation (GRADE) system. All recommendations on ERAS® protocol items are based on best available evidence; good-quality trials; meta-analyses of good-quality trials; or large cohort studies. The level of evidence for the use of each item is presented accordingly. The evidence base and recommendation for items within the multimodal perioperative care pathway are presented by the ERAS® Society in this comprehensive consensus review.

/pdf/guidelines-for-perioperative-care-in-elective-colonic-1wl593eui2.pdf

Guidelines for perioperative care in elective colonic surgery: Enhanced recovery after surgery (ERAS®) society recommendations

Electrical Stimulation Therapy (EST) of the Lower Esophageal Sphincter (LES) for Refractory Gerd and Two Year Results of an International Multicenter Trial

Background Anastomotic leakage is one of the most severe complications in patients undergoing esophagectomy with gastric tube reconstruction. Transection of the left gastric and gastro-epiploic artery and vein results in compromised perfusion which is seen as the major contributing factor for anastomotic dehiscence. The main objective of this prospective, observational, in-vivo pilot study is to microscopically evaluate gastric tube perfusion with Sidestream Darkfield Microscopy (SDF). Methods Intra-operative microscopic images of gastric-microcirculation were obtained with SDF directly after reconstruction in 22 patients. Quantitative perfusion related parameters were: velocity, Microvascular Flow Index(MFI), Total Vessel Density(TVD), Perfusion Vessel Density(PVD), Proportion of Perfused Vessels(PPV) and De Backer Score(DBS). Dedicated software was used to assess parameters predictive for compromised perfusion. Results SDF was feasible to accurately visualize and evaluate microcirculation in all patients. Velocity(μm/sec) was significantly decreased towards the fundus (p = 0.001). MFI, PVD and PVD were decreased distal of the watershed – between the right and left gastro-epiploic artery and vein – and in the fundus, compared to the base of the gastric tube(p = 0.0002). No differences in TVD and DBS were observed; because of vessel-dilation in the fundus-area. This suggests that venous congestion results in comprised inflow of oxygen rich blood and therefore in plays an role in the development of ischaemia. Conclusion We present quantitative perfusion imaging with SDF of the gastric tube. Velocity, MFI, TVD and PPV are accurate parameters to observe perfusion decrease. Also, venous congestion is visible in the fundus, suggesting an important role in the development of ischaemia. These parameters could allow early risk stratification, and, potentially, can accomplish a reduction in anastomotic leakage.

Quantitative change of perfusion in gastric tube reconstruction by sidestream dark field microscopy (SDF) after esophagectomy, a prospective in-vivo cohort study

Background: Keeping adequate tissue perfusion during high-risk abdominal surgery is of utmost importance to decrease postoperative complications. The objective was to investigate the alteration in mean systemic filling pressure (MSFP), venous return (VR) and sublingual microcirculation during pneumoperitoneum and steep reverse-Trendelenburg position during thoracolaparoscopic esophagectomy. Methods: This is a single-center prospective observational study in operating room at a university hospital. Eleven consecutive patients undergoing minimally invasive esophagectomy. Intraoperative hemodynamic and sublingual microcirculatory variables were simultaneously measured within 5 minutes at the following time points: T1, baseline supine position before the start of surgery; T2, pneumoperitoneum in supine position; T3, steep reverse-Trendelenburg position after the pneumoperitoneum. The cardiac output (CO) was obtained with continuous pulse contour waveform-derived measurements, and the MSFP was estimated with the analogue method. Results: The pneumoperitoneum and reverse-Trendelenburg caused an increase in stroke volume variation (SVV), MSFP and central venous pressure (CVP), and a decrease in the microcirculatory perfusion index (MFI, 2. Using a CVP ≥23 mmHg to detect MFI ≤2 results in a sensitivity of 61.54% and a specificity of 100%.
 Conclusions: A high CVP is related to poor microcirculatory flow perfusion even if the macrocirculation has been maintained during pneumoperitoneum.

/pdf/effect-of-pneumoperitoneum-and-steep-reverse-trendelenburg-1p1w1p7g4q.pdf

Effect of pneumoperitoneum and steep reverse-Trendelenburg position on mean systemic filling pressure, venous return, and microcirculation during esophagectomy

Improved clinical and survival outcomes after esophagectomy for cancer over 25 years.

/pdf/preoperative-functional-status-is-not-associated-with-5m83osgo9y.pdf

Mark I. van Berge Henegouwen

Papers

Electrical Stimulation Therapy (EST) of the Lower Esophageal Sphincter (LES) for Refractory Gerd and Two Year Results of an International Multicenter Trial

Quantitative change of perfusion in gastric tube reconstruction by sidestream dark field microscopy (SDF) after esophagectomy, a prospective in-vivo cohort study

Effect of pneumoperitoneum and steep reverse-Trendelenburg position on mean systemic filling pressure, venous return, and microcirculation during esophagectomy

Improved clinical and survival outcomes after esophagectomy for cancer over 25 years.

Preoperative functional status is not associated with postoperative surgical complications in low risk patients undergoing esophagectomy