简介：AIM:ToevaluatetheimpactofadvancedageonoutcomeMETHODS:Twohundredsandelevenpatientsundergonehepatectomy,gastrectomyandpancreatoduodenectomyfromJanuary1998toSeptember2002wereanalyzedretrospectively.Clinicopathologicfeaturesandoperativeoutcomeof83patientsaged65yearsormorewerecomparedwiththatin128youngerpatientsagedlessthan65years.RESULTS:Thenutritionalstate,suchaspre-operationlevelofserumalbuminandhemoglobinintheolderpatientswaspoorerthanthatintheyoungerpatients.Theolderpatientshadhighercomorbiditiesthantheyoungerpatients(48.2%vs15.6%).Nosignificantdifferencewasobservedinpedoperativemortality,andcomplicationratebetweentheolderandyoungerpatients(2.4%vs1.6%and22.9%vs20.3%,respectively).Multivariateanalysisdemonstratedthatpancreatoduodenectomy,hepatectomywithresectionofmorethan2segmentsandcomorbiditieswereindependentpredictorsofpostoperativecomplication,whereasagewasnot(P=0.3172).CONCLUSION:Itissafeforpatientsaged65yearsormoretoundergohepatic,pancreaticandgastricresectionifgreatcareistakenduringperioperativeperiod.

简介：Sleevegastrectomy(SG)isarestrictivebariatricsurgerytechniquethatwasfirstusedaspartofrestrictivehorizontalgastrectomyintheoriginalScopinarotypebiliopancreaticdiversion.Itsgoodresultsasasingletechniquehaveledtoariseinitsuse,anditiscurrentlythesecondmostperformedtechniqueworldwide.SGachievesclearlybetterresultsthanotherrestrictivetechniquesandiscomparableinsomeaspectstotheRoux-en-Ygastricbypass,thecurrentgoldstandardinbariatricsurgery.Thesebenefitshavebeenassociatedwithdifferentpathophysiologicmechanismsunrelatedtoweightlosssuchasincreasedgastricemptyingandintestinaltransit,andactivationofhormonalmechanismssuchasincreasedGLP-1hormoneanddecreasedghrelin.TheaimofthisreviewwastohighlightthesalientaspectsofSGregardingitshistoricalevolution,pathophysiologicmechanisms,mainresults,clinicalapplicationsandperioperativecomplications.

简介：AIM:Toinvestigatetheefficacyofneoadjuvantchemoradiotherapy(NACRT)forresectabilityoflocallyadvancedgastriccancer(LAGC).METHODS:BetweenNovember2007andJanuary2014,29patientswithLAGC(clinicallyT3withdistalesophagusinvasion/T4orbulkyregionalnodemetastasis)thatweretreatedwithNACRTfollowedbyD2gastrectomywereincludedinthisstudy.ResectabilitywasevaluatedwithradiologicandendoscopicexamsbeforeandafterNACRT.Usingthreedimensionalconformalradiotherapy,patientsreceived45Gy,withadailydoseof1.8Gy.Theentiretumorextentandtheregionalmetastaticlymphnodeswereincludedinthegrosstumorvolume.PatientspresentingwitharesectabletumorafterNACRTreceivedatotalorsubtotalgastrectomywithD2dissection.ThepathologictumorresponsewasevaluatedusingJapaneseGastricCancerAssociationhistologicevaluationcriteria.PostoperativemorbiditywasevaluatedusingtheNationalCancerInstitute-CommonTerminologyCriteriaforAdverseEventsversion4.0.Overallsurvival(OS)andprogression-freesurvival(PFS)rateswereestimatedusingaKaplan-Meieranalysisandcomparedusingthelog-ranktest.RESULTS:Allpatientswereassessedasunresectablecases.Twenty-fourpatients(24/29;82.8%)showedLAGConpositronemissiontomography-computedtomography(CT)andcontrast-enhancedCT,whereasfourpatients(4/29;13.8%)withvagueinvasionorabutmenttoanadjacentorganunderwentdiagnosticlaparoscopy.Onepatient(1/29;3.4%),initiallyassessedasaresectablecase,underwentan'openandclosure'afterthetumorwasfoundtobeunresectable.Abutmenttoanadjacentorgan(34.5%)wasthemostcommonreasonforNACRT.TheclinicalresponserateonemonthafterNACRTwas44.8%.AfterNACRT,69%(20/29)ofpatientshadaresectabletumor.Ofthe20patientswitharesectabletumor,18patients(62.1%)underwentaD2gastrectomy.TheR0resectionratewas94.4%andtwopatients(2/18;11.1%)showedacompleteresponse.Themedianfollow-updurationwas13.5mo.Theone-yearOSandPFS