SESSION 6. Progrès en chirurgie et endoscopie des cancers digestifs. Modérateur : Dr. François QUENET

Size: px
Start display at page:

Download "SESSION 6. Progrès en chirurgie et endoscopie des cancers digestifs. Modérateur : Dr. François QUENET"

Transcription

1 SESSION 6 Progrès en chirurgie et endoscopie des cancers digestifs Modérateur : Dr. François QUENET

2 La chirurgie robotique Pr. Philippe ROUANET

3 La Chirurgie Robotique en cancérologie digestive Philippe Rouanet

4

5

6

7 Chirurgie Robotique Contrôle «Intuitif» des instruments Contrôle de la Camera Vision 3D HD Instrumentation «EndoWrist» Ergonomie pour le chirurgien

8

9 Depuis Robotic Surgery 5999 Robotic oncologic surgery 446 Robotic digestive surgery 206

10 Robot assistance in liver surgery: a real advantage over a fully laparoscopic approach? Results of a comparative bi-institutional analysis. Troisi R & al. Int J Med Robot 2013 LAPR (Laparoscopic liver resection) vs ROBR (Robot assisted Liver Surgery) LAPR ROBR N Hépatectomie majeure 17% 0 Chirurgie segmentaire 34% 55% Lésions réséquées 1,57 1,97 Conversion 7,6% 20% Saignement 174 ml 330 ml

11 Major early complications following open, laparoscopic and robotic gastrectomy Kim KM & al. BJS 2012 Open Laparoscopic Robotic p n LNH 40* 37 40* <0,001 T1/4 (%) 48 / / 5 77 / 6 <0,001 R0 (%) 99,3 99,8 99,3 0,2 Hosp Stay 10,2 7,8* 7,5* <0,001 Temps Op <0,001 Morbidity 10,7 9,4 10,1 0,494 Leak (%) 1,1 2,1 2,3 0,017 Abscess 3,3 2,0 1,4 0,013 Reoperation 1 1 1,6 0,483 Mortality 0,5 0,3 0,5 1

12

13 Cancer Control. 2013

14 Outcomes After Minimally Invasive Esophagectomy Review of Over 1000 Patients Luketich & al. Ann Surg 2012 MIE Neck McKeown MIE Chest Ivor-Lewis

15 The rise in minimally invasive esophagectomy publications in United States National Library of Medicine service, PubMed. Luketich & al. Ann Surg 2012

16 Notre démarche 2006 : Corum Montpellier Farid Gharagozloo, M.D. Washington Institute of Thoracic and Cardiovascular Surgery George Washington University 37 LS Robot avec anastomose intra thoracique 2012: University Medical Center Utrecht Robot-assisted minimally invasive thoraco-laparoscopic esophagectomy versus open transthoracic esophagectomy for resectable esophageal cancer, a randomized controlled trial (ROBOT trial) van der Sluis et al. Trials 2012, 13:230

17

18

19 Technical aspects and early results of robotic esophagectomy with chest anastomosis. Cerfolio RJ & al. J Thorac Cardiovasc Surg patients R0 100% LNH 18 BL 40 ml Anastomoses IT - 6 mécaniques morbidité 80% - 16 manuelles morbidité 0%

20

21

22 Robot-assisted laparoscopic surgery of the colon and rectum. Antoniou sa & al. Surg Endosc nonrandomized studies : 1012 patients 13 ileocaecal resections 220 Right colectomies Right C Left C AR APR Total C 190 Left Colectomies 440 Anterior resection 149 APR 11 Total colectomies 60% RC

23 Randomized clinical trial of robot-assisted versus standard laparoscopic right colectomy. Park JS & al. Br J Surg NCT patients : 35/35 Similar Hosp stay - Complications - post op pain blood loss - resection margin - LNH Conversion (0) Duration of surgery R > L (195/130 ; p:<0.0001) Hospital cost R > L (12.235$ / $ ; p:0.013) CCl: Robotic-assisted laparoscopic right colectomy was feasible but provided no benefit to justify the greater cost

24 Robotic versus laparoscopic anterior resection of Sigmoid colon cancer: comparative study of long-term oncologic outcomes. Lim DR & al. Surg Endosc sigmoid colon K: 34 R 146 L Operative technique: Anterior resection Operative time 252 / 217 p: Post op complications 10.3% / 5.9% p:0.28 OS3 92% / 93% p:0.723 CONCLUSION: In this study, R-AR showed safety and feasibility in terms of perioperative clinical and long-term oncologic outcomes. However, the advanced technologies of R-AR did not translate into better long-term oncologic outcomes compared with L-AR

25 Robotic Rectal Cancer

26 Effect of the plane of surgery achieved on local recurrence in patients with operable rectal cancer: a prospective study using data from the MRC CR07 and NCIC-CTG CO16 randomised clinical trial. P Quirke & al. Lancet 2009

27 RTME et Chirurgie conservatrice auteur type n durée Perte sang Spinoglio 2008 Choi 2009 Leong Pigazzi 2010 Zimmern 2010 Koh 2010 Baek 2010 Conv % Morbidité % DMS Nbre N Full % 14% ½ Full* 1 dock Full ISR Full hybrid % % % % % 41% % hybrid % 22% full % % Hybrid % 31% *: laparoscopic rectal section & anastomosis R1 %

28 KR: Robot vs Laparoscopie R L type Rob/ Lap durée Perte sang Conv % Morbidité % DMS Nbre N R1 % Bianchi Full R 75% Park 2010 Hyb % 7.3% Baek 2011 Hyb Patel Hyb * * Kwak Full R *

29 Meta-analysis of robotic and laparoscopic surgery for treatment of rectal cancer. Lin S & al. World J Gastroenterol études : 268 RTME / 393 LTME DS: Taux de conversion NS: Temps op / Saignement / Reprise transit / Hospit Complications / Nbre GGl / DM / CRM

30 The impact of robotic surgery for mid and low rectal cancer: a case-matched analysis of a 3-arm comparison - open, laparoscopic, and robotic surgery. Kang J & al. Ann Surg 2013 OS LS RS p n Op time <0.001 CS 89% 95% NS 99% 0.01 Conv - 1.8% 0.6% 0.62 NOTES - 4% 22% <0.01 ileostomy 32% 27% 22% 0.40 EBL <0.001 CRM+ 10.3% NS 6.7% % 0.09 LN harvested Fist 3.4% 11% 7.3% 0.04 Hosp lenght <0.001 NS

31 Cancer du rectum Notre pratique: OS LS TEM Robotic

32

33 Robotic and laparoscopic total mesorectal excision for conservative rectal surgery: a consecutive monocentric series of 120 patients. RTME n=60 LTME n= 60 p Age median (range) 62 (34 82) 60 (35 85) BMI median 25.8 ( ) 23.8 ( ) Gender M F 40 (66.7%) 20 (33.3%) 42 (70.0%) 18 (30.0%) ASA score (33.3%) 30 (50.0%) 9 (15.0%) 1 (1.7%) 18 (30.0%) 32 (53.3%) 10 (16.7%) 0 (0.0%) Tumor location Upper 11 Mid 6-10 Lower 5 8 (13.3%) 26 (43.3%) 26 (43.3%) 13 (21.7%) 21 (35.0%) 26 (43.3%) Pre op RCT 47 (78.3%) 39 (65.0%) 0.105

34 Robotic and laparoscopic total mesorectal excision for conservative rectal surgery: a consecutive monocentric series of 120 patients. RTME LTME p n=60 n= 60 Type of operation ULCRA PCAA DCAA LCAA 33(55.0%) 11 (18.3%) 8 (13.3%) 8 (13.3%) 30 (50.0%) 19 (31.7%) 11 (18.3%) 0 (0.0%) ISR Complete Partial Mucosectomie None 1 (1.7%) 25 (41.7%) 1 (1.7) 33 (55.0%) 0 (0.0%) 29 (48,4%) 0 (0.0%) 31 (51.7%) TAEP 1 (1.7%) 10 (16.7%) Median operation time (range) 274 min ( ) 228 min ( ) Diverting ileostomy 44 (73.3%) 35 (58.3%) Median EBL (range) 200 ml (0 1100) 100 ml (0 1700) Conversion 2 (3.2 %) 3 (4.8%) 0.661

35 Robotic and laparoscopic total mesorectal excision for conservative rectal surgery: a consecutive monocentric series of 120 patients. RTME (n=60) LTME (n=60) p Median DRM mm (range) 15.0 ( ) 10.0 ( ) Positive CRM 1 3 (6.4%) 4 (9.3%) Median HLN (range) 15 (1 71) 19 (3 68) Median POS (range) 12 (6 27) 11 (6 60) Severe Morbidity Fistula Colic necroses Occlusion Anastomotic abscess Other 17 (28.3%) 3 (5%) 4 (6%) 7 (11%) 1 (1.6%) 2 (3.2%) 12 (20.0%) 4 (6%) 0 (0%) 6 (10%) 2 (3.2%) 0 (0%) Early postop surgery 2 (3.3%) 4 (6.7%) Mortality 3 (5.0 %) 4 (6.8 %) (Log-rank test) Median follow-up 8 [ ] 19.9 [ ] Months (95% IC)

36 Robotic and laparoscopic total mesorectal excision for conservative rectal surgery: a consecutive monocentric series of 120 patients. Minutes Learning Curve First 30 patients patients Minutes

37 Randomized Trial on Robotic Assisted Resection for Rectal Cancer: ROLARR Robotic versus Laparoscopic Resection for Rectal cancer International, Multicentre, Prospective, Randomised controlled trial Total or hybrid procedure 400 patients / end date? Primary outcome: rate of conversion

38 Robot et chirurgie du KR? Dans la «course» entre Laparoscopie et Robotique, il n y a pas de vainqueur pour les cas «faciles» Aujourd hui, le Robot apporte un plus pour les cas difficiles: Homme gros à bassin étroit porteur de tumeur moyenne et basse, surtout antérieure. Mais demain,.?

39 Impact of Robotic Surgery on Sexual and Urinary Functions After Fully Robotic Nerve-Sparing Total Mesorectal Excision for Rectal Cancer. Luca F & al. Ann Surg /08 4/10 ; 74 RTME ; Prospective evaluation Urinary functions Sexual functions Results Urinary: Incontinence, at 1year, unchanged for both sexes Sexual function and General sexual satisfaction decreased 1 month after the surgery comparable at 1 year to those measured before surgery CONCLUSIONS: RTME allows for preservation of urinary and sexual functions. This is probably due to the superior movements of the wristed instruments that facilitate fine dissection, coupled with a stable and magnified view that helps in recognizing the inferior hypogastric plexus.

40

41 Robotic cancer surgery M. H. Sodergren and A. Darzi Institute of Global Health Innovation, Imperial College London. BJS 2013 Robotics is unlikely to displace the human element in the art of surgery, but, with adequate funding, resource allocation and market competition, robotic assistance will likely complement human surgical skills and significantly improve cancer surgery outcomes in the future.

42 Cœlio-chirurgie des cancers œsogastriques Pr. Christophe MARIETTE

43 Service de chirurgie digestive CHRU - Lille

44 Open resections involve significant risk of morbidity and death Purported advantages of MIO Reduced blood loss Reduced morbidity Reduced respiratory complications Less pain Shorter hospital stay Earlier functionnal recovery

45 Minimally invasive oesophagectomy techniques for oesophageal cancer WITH Thoracoscopic Approach Thoracoscopic AND Laparoscopic oesophagectomy with Cervical Anastomosis Thoracoscopic AND Laparoscopic oesophagectomy with Intra- Thoracic Anastomosis Thoracic oesophageal mobilisation with Open Laparotomy and Cervical Anastomosis MIO MIO Hybrid WITHOUT Thoracoscopic Approach Laparoscopic Gastric Mobilisation with Open Thoracotomy and Intra-Thoracic Anastomosis Total Laparoscopic Transhiatal Oesophagectomy Hybrid MIO

46 Mostly single institution case series Few studies report on comparisons with historical/concurrent/matched controls Various surgical techniques used Differences between Eastern and Western countries Differences according to the study period (Learning Curve)

47 Prospective Database Open surgery 64 Hybrid MIO 44 (Thoracoscopy / Laparotomy) Totally MIO 30 Survival curve comparing open (mean survival months ) and MIO (hybrid plus total MIO) (mean survival months) (p=0.501, n=137) World Journal of Surgery (2011) 35:

48 Oncological results... Decreased LOS Postoperative complications reduced significantly World Journal of Surgery (2011) 35:

49 University Hospital Vienna Case controlled pair matched study 31 consecutive patients undergoing MIO (laparoscopy and thoracoscopy) 31 consecutive open oesophagectomies

50

51 Retrospective Study Evaluation of outcomes in 1011 consecutive elective MIO Comparison of modified McKeown MIO to modified Ivor Lewis MIO Study period from with progression to Ivor Lewis MIO and intrathoracic stapled anastomosis in 2005

52

53

54 Less respiratory morbidity Review 31 Articles All of Level III evidence Single centre cohort and comparative studies Shorter Hospital Stay Lower 30 Day Mortality

55 TOTALLY MIO vs. Open Oesophagectomy

56 HYBRID MIO vs. Open Oesophagectomy

57 Comparison open vs. MIO Multi-centre RCT MIO 56 patients Open Resection 59pts Oesophageal Tumours including Siewert type I MIO Performed By - Thoracoscopy / Laparoscopy and cervical incision Open Resection - Right thoracotomy and intrathoracic anastomosis Primary Endpoints - Respiratory complications in first 2 weeks Secondary Endpoints - Operative / Postoperative / Oncological Data

58 Pulmonary infection defined clinical manifestation with confirmation on CXR or CT scan and positive culture

59 Positive results appear to validate MIO by thoracoscopy and laparoscopy... However... Many non-studies variables strongly affect the primary endpoint of TIME trial (malnutrition, smoking habits, pulmonary co-morbidity, performance status)... and small sample? non-equivalent repartition of these variables One lung ventilation only applicable to one group A longitudinal assessment of QoL No multivariate analysis to test independent effect of MIO on post-op course Pneumonia rate in open surgery group is high (34%) may be related to a high vocal cord paralysis rate (14%) in open group (2% in MIO group) Mariette C Lancet 2012

60 372 Ivor-Lewis procedures for cancer 140 consecutive laparoscopy HMIO Randomly matched for: 140 open resections Open group ASA score, age, gender, denutrition, tumoural location and stage, histological subtype, neoadjuvant CRT, epidural analgesia

61 Briez N, Mariette C et al BJS in press

62 HMIO Independent protective factor against major pulmonary complications

63 HMIO -> independent protective factor against major pulmonary complications Laparoscopic gastric mobilisation in OC could be a promising approach Easy, little learning curve Reproducible Do not compromise carcinologic resection significantly pulmonary complications = main source of morbidity after oesophagectomy Briez et al BJS 2012

64 Comparison open vs. MIO Multi-centre RCT Oesophageal Tumours Including Siewert I Surgical Procedure - Thoracotomy plus Laparoscopy Primary Endpoints - Major 30 day morbidity Secondary Endpoints - 30 day morbidity, mortality, pulmonary morbidity - DFS, OS, QOL, Medico-economic

65 Formidable technical challenge Increased complexity brings a higher potential for error Is it sufficiently safe to be offered selectively to patients with early disease? Concerns regarding gastric conduit vascularity and oncological resection Is the middle ground a hybrid procedure? Mariette C Recent Results Cancer Res 2012

66 Morbidité significative donc licite d évaluer place MIG Nombreuses publications qualité hétérogène Méta-analyse ayant inclus essais randomisés et études comparatives de qualité Vinuela F Ann Surg 2012

67 Vinuela F Ann Surg 2012

68 Vinuela F Ann Surg 2012

69 Vinuela F Ann Surg 2012

70 Vinuela F Ann Surg 2012

71 Vinuela F Ann Surg 2012

72 Vinuela F Ann Surg 2012

73 Laparoscopie pour cancer gastrique distal tx complications globales et médicales, durée d hospi, pertes sanguines Pas sur mortalité et complications majeures Moins de gg analysés Peu de données de survie Questions en suspend Sécurité oncologique? Learning curve En Occident? Faisabilité pour gastrectomie totale?

74 Faisabilité technique démontrée Centres entraînés Bénéfices à ce jour non majeurs Peu de données oncologiques à long terme Reproductibilité??? Résultats d essais randomisés à venir Certainement l avenir pour certains patients

75 Endoscopie interventionnelle Dr. Marc GIOVANNINI

76 CFOD, 5-7 SEPTEMBRE 2013

77 DEVELOPPEMENTS RECENTS DISSECTION SOUS-MUQUEUSE RADIOFREQUENCE OESOPHAGIENNE ECHO-ENDOSCOPIE THERAPEUTIQUE DRAINAGE BILIAIRE GUIDE PAR EE ABLATION TUMORALE GUIDEE PAR EE

78 ?

79 90-95% SM % IE

80 HD ENDOSCOPY

81 ESD Mark the lesion Local Injection Marginal Incision SM Dissection Dyeing Sprayer Marking Local Injection Injection Needle Marginal Incision Electro Surgical Knife Submucosal Dissection Hemostasis Marginal Incision, SM Dissection Post ESD for prevention of complication Hemostasis Device

82

83

84

85

86 ESD> EMR pour les cancers superficiels de l estomac (Gotoda, 2007) ESD>EMR pour les cancers superficiels de l oesophage ( Ishihara et al : GIE,2008) Taux de résection curative: 97% vs 71% Pas de différence en terme de complication EMR= lesion <15 mm, ESD=lesion>15 mm ESD>EMR pour les cancers superficiels du colon et rectum (Saito et al, Surg Endosc 2010) 145 CRT traités par ESD vs 228 traités par EMR Taux de récidive de 2% pour l ESD vs 14% pour l EMR (p<0.001) Taux de Perforation =6.2% pour ESD vs 1% pour EMR

87 ENDOSCOPIE TRADITIONNELLE A ECHOUE OU EST IMPOSSIBLE COLLECTIONS PANCREATIQUES ABCES PELVIENS DRAINAGE BILIAIRE DRAINAGE DU WIRSUNG ANASTOMOSE CHOLECYSTO- DUODENALE CHIRURGIE

88 10 F 8 F 6 F 19 G

89

90 QUELLE ALTERNATIVE SI ECHEC DE LA CPRE OU EN CAS DE MODIFICATION ANATOMIQUE? GASTRECTOMIE DPC RESECTION DE LA VBP ET ANASTOMOSE HEPATICO-JEJUNALE CHIRURGIE OU DRAINAGE PERCUTANE RADIOLOGIQUE

91

92

93

94

95

96

97

98 COMPLICATION RATE : 31% 4 DEATHS ( 1 Bile leakage, 1 perforation, 2 bleedings) Extra-Hepatic Intra-Hepatic p value Success 75/89 (84.3%) 132/146 (90.4%) 0.15 Complications 29/89 (32.6%) 52/146 (35.6%) 0.64 Perforation 1/89 (1.1%) 11/146 (7.5%) 0.03 Bile leakage 13/89 (14.6%) 14/146 (9.6%) 0.24 Cholangitis 4/89 (4.5%) 7/146 (4.8%) 0.92 Bleeding 8/89 (9.0%) 18/146 (12.3%) 0.42 Pain 1/89 (1.1%) 4/146 (2.7%) 0.41 Stent Obstruction 2/89 (2.3%) 0/146 (0%) 0.07

99

100

101 AETIOLOGIES K PANCREAS CCK META HILAIRE 8 NO FAILURE OF STENT INSERTION

102 YOUNG FEMALE OF 38 YEARS OLD WITH A LIVER MET OF OVARIAN CANCER STILL ALIVE AFTER 4 YEARS WITH 2 HEPATICO- GASTROSTOMIE AND 3 OTHER METALLIC STENTS IN THE RIGHT LOBE THIS KIND OF DRAINAGE WAS IMPOSSIBLE 10 YEAR AGO!!!!!

103 ENDOSCOPIE THERAPEUTIQUE OFFRE AUJOURD HUI UNE ALTERNATIVE A LA CHIRURGIE MAIS NECESSITE UNE SELECTION TRES PRECISE DES PATIENTS T SUPERFICIELLE DU TUBE DIGESTIF m3 ŒSOPHAGE-ESTOMAC Sm1 COLON-RECTUM ECHOENDOSCOPIE INTERVENTIONNELLE PERMET DES DRAINAGES BILIAIRES COMPLEXES

104

Bridging Techniques. What s between EMR and Traditional Surgery? Elisabeth C. McLemore, MD, FACS, FASCRS

Bridging Techniques. What s between EMR and Traditional Surgery? Elisabeth C. McLemore, MD, FACS, FASCRS Bridging Techniques What s between EMR and Traditional Surgery? Elisabeth C. McLemore, MD, FACS, FASCRS Associate Professor of Surgery Assistant Program Director, General Surgery Residency Disclosures

More information

Facing a Hysterectomy? If you ve been diagnosed with early stage gynecologic cancer, learn about minimally invasive da Vinci Surgery

Facing a Hysterectomy? If you ve been diagnosed with early stage gynecologic cancer, learn about minimally invasive da Vinci Surgery Facing a Hysterectomy? If you ve been diagnosed with early stage gynecologic cancer, learn about minimally invasive da Vinci Surgery The Condition: Early Stage Gynecologic Cancer A variety of gynecologic

More information

ESD for colorectal lesions I am in favour. Alessandro Repici, MD Digestive Endoscopy Unit IRCCS Istituto Clinico Humanitas Milano, Italy

ESD for colorectal lesions I am in favour. Alessandro Repici, MD Digestive Endoscopy Unit IRCCS Istituto Clinico Humanitas Milano, Italy ESD for colorectal lesions I am in favour Alessandro Repici, MD Digestive Endoscopy Unit IRCCS Istituto Clinico Humanitas Milano, Italy Surgery for early colonic lesions 51 pts referred for lap colectomy

More information

How to treat early gastric cancer. Surgery

How to treat early gastric cancer. Surgery How to treat early gastric cancer Surgery Mark I. van Berge Henegouwen Department of Surgery, AMC, Amsterdam Director upper GI surgical unit Academic Medical Center Upper GI surgery at AMC 100 oesophagectomies

More information

Facing Pancreatic Surgery? Learn about minimally invasive da Vinci Surgery

Facing Pancreatic Surgery? Learn about minimally invasive da Vinci Surgery Facing Pancreatic Surgery? Learn about minimally invasive da Vinci Surgery The Condition: Pancreatitis/Pancreatic Cancer The pancreas is an organ that produces enzymes and hormones to help your body digest

More information

Basic Laparoscopy and Lap. Suturing and Stapling course Course Contents

Basic Laparoscopy and Lap. Suturing and Stapling course Course Contents Online Courses on Laparoscopic GI Surgery for GISurgery.info Lap Skills course Harshad Soni 1. Basic Laparoscopy and Lap. Suturing and Stapling course H. Soni 2. Laparoscopic UGI Surgery Course J Mistry

More information

The Royal Marsden. Surgery for Gastric and GE Junction Cancer: primary palliative where and when? William Allum

The Royal Marsden. Surgery for Gastric and GE Junction Cancer: primary palliative where and when? William Allum The Royal Marsden Surgery for Gastric and GE Junction Cancer: primary palliative where and when? William Allum Any surgeon can cure Surgeon - dependent No surgeon can cure EMR D2 GASTRECTOMY H N SN. WEDGE

More information

Robotic Radical Prostatectomy: What s s the Advantage? Matthew T. Gettman, M.D. Associate Professor Department of Urology

Robotic Radical Prostatectomy: What s s the Advantage? Matthew T. Gettman, M.D. Associate Professor Department of Urology Robotic Radical Prostatectomy: What s s the Advantage? Matthew T. Gettman, M.D. Associate Professor Department of Urology Prostate Cancer Epidemiology: 2009 Estimated new cases: 230,000 Estimated deaths:

More information

Evidence tabel Lokaal palliatieve behandelingen

Evidence tabel Lokaal palliatieve behandelingen Auteurs, jaartal Mate van bewijs Studie type Follow-up Populatie (incl. steekproef-grootte) Patienten kenmerken Interventie Controle Resultaten Conclusie Opmerkingen, commentaar Hartgrink, 2002 The Netherlands

More information

Clinical Practice Assessment Robotic surgery

Clinical Practice Assessment Robotic surgery Clinical Practice Assessment Robotic surgery Background: Surgery is by nature invasive. Efforts have been made over time to reduce complications and the trauma inherently associated with surgery through

More information

9/26/14. Joel E. Rand, MPAS, PA-C DMU Luncheon May 1, 2014

9/26/14. Joel E. Rand, MPAS, PA-C DMU Luncheon May 1, 2014 Joel E. Rand, MPAS, PA-C DMU Luncheon May 1, 2014 No financial relationship or commercial interest in any of the technologies discussed Not supporting any non-fda off label uses of any product or service

More information

Endoscopic Resection for Barrett s Esophagus and Early Cancer 2014 Masters of Minimally Invasive Surgery

Endoscopic Resection for Barrett s Esophagus and Early Cancer 2014 Masters of Minimally Invasive Surgery Endoscopic Resection for Barrett s Esophagus and Early Cancer 2014 Masters of Minimally Invasive Surgery Matthew Hartwig, M.D. Duke Cancer Institute Case Presentation: Patient ER 51 y/o man with schizophrenia

More information

Cancer of the Cardia/GE Junction: Surgical Options

Cancer of the Cardia/GE Junction: Surgical Options Cancer of the Cardia/GE Junction: Surgical Options Michael A Smith, MD Associate Chief Thoracic Surgery Center for Thoracic Disease St Joseph s Hospital and Medical Center Phoenix, AZ Michael Smith, MD

More information

PANCREATIC AND PERIAMPULLARY TUMORS: PANCREATICODUODENECTOMY. Dr. Shailesh V. Shrikhande

PANCREATIC AND PERIAMPULLARY TUMORS: PANCREATICODUODENECTOMY. Dr. Shailesh V. Shrikhande PANCREATIC AND PERIAMPULLARY TUMORS: PANCREATICODUODENECTOMY Dr. Shailesh V. Shrikhande Associate Professor & Consultant Surgeon GI and HPB Surgical Oncology Tata Memorial Hospital, Mumbai INDIA HELICAL

More information

Surgery for oesophageal cancer

Surgery for oesophageal cancer Surgery for oesophageal cancer This information is an extract from the booklet Understanding oesophageal cancer (cancer of the gullet). You may find the full booklet helpful. We can send you a free copy

More information

Endoscopic Therapy for Early Esophageal Cancer: EMR and ESD

Endoscopic Therapy for Early Esophageal Cancer: EMR and ESD Endoscopic Therapy for Early Esophageal Cancer: EMR and ESD AATS Toronto April 26, 2014 Lorenzo Ferri MD PhD David S. Mulder Chair in Surgery Associate Professor of Surgery and Oncology Disclosures Olympus

More information

Cancer Surgery Volume Study: ICD-9 and CPT Codes

Cancer Surgery Volume Study: ICD-9 and CPT Codes This paper contains the ICD-9 diagnostic and procedure codes and the CPT procedure codes used by researchers for a project of the California HealthCare Foundation (CHCF) and the California Office of Statewide

More information

Facing a Hysterectomy? If you ve been diagnosed with early stage gynecologic cancer, learn about minimally invasive da Vinci Surgery

Facing a Hysterectomy? If you ve been diagnosed with early stage gynecologic cancer, learn about minimally invasive da Vinci Surgery Facing a Hysterectomy? If you ve been diagnosed with early stage gynecologic cancer, learn about minimally invasive da Vinci Surgery The Condition: Early Stage Gynecologic Cancer A variety of gynecologic

More information

Facing Prostate Cancer Surgery? Learn about minimally invasive da Vinci Surgery

Facing Prostate Cancer Surgery? Learn about minimally invasive da Vinci Surgery Facing Prostate Cancer Surgery? Learn about minimally invasive da Vinci Surgery The Condition: Prostate Cancer Your prostate is a walnut-sized gland that is part of the male reproductive system. The prostate

More information

Endoscopic therapy for obesity and complications of bariatric surgery

Endoscopic therapy for obesity and complications of bariatric surgery Endoscopic therapy for obesity and complications of bariatric surgery Jacques Devière, MD, PhD Erasme University Hospital Brussels Belgium jacques.deviere@erasme.ulb.ac.be Obesity Affects 300 millions

More information

INTERVENTIONAL PROCEDURES PROGRAMME

INTERVENTIONAL PROCEDURES PROGRAMME NATIONAL INSTITUTE FOR CLINICAL EXCELLENCE INTERVENTIONAL PROCEDURES PROGRAMME Interventional procedure overview of radical laparoscopic hysterectomy for early stage cervical cancer Introduction This overview

More information

Endoscopy and infection: Prevention of infection during endoscopy Treatment of infection by endoscopy. M. Arvanitakis SRBG June 2009

Endoscopy and infection: Prevention of infection during endoscopy Treatment of infection by endoscopy. M. Arvanitakis SRBG June 2009 Endoscopy and infection: Prevention of infection during endoscopy Treatment of infection by endoscopy M. Arvanitakis SRBG June 2009 Outline Antibiotic prophylaxis during endoscopy Upper GI endoscopy Lower

More information

Bowel Preparation for Colon Resection. Eric Klein, M.D. SUNY Downstate Department of Surgery

Bowel Preparation for Colon Resection. Eric Klein, M.D. SUNY Downstate Department of Surgery Bowel Preparation for Colon Resection Eric Klein, M.D. SUNY Downstate Department of Surgery Historical Perspective During World War II, failure to treat penetrating colon injuries with diversion could

More information

The Need for Accurate Lung Cancer Staging

The Need for Accurate Lung Cancer Staging The Need for Accurate Lung Cancer Staging Peter Baik, DO Thoracic Surgery Cancer Treatment Centers of America Oklahoma Osteopathic Association 115th Annual Convention Financial Disclosures: None 2 Objectives

More information

Considering Endometriosis Surgery? Learn about minimally invasive da Vinci Surgery

Considering Endometriosis Surgery? Learn about minimally invasive da Vinci Surgery Considering Endometriosis Surgery? Learn about minimally invasive da Vinci Surgery The Condition: Endometriosis Endometriosis is a condition in which the tissue that lines your uterus (the endometrium)

More information

The lungs What is lung cancer? How common is it? Risks & symptoms Diagnosis & treatment options

The lungs What is lung cancer? How common is it? Risks & symptoms Diagnosis & treatment options Why We re Here The lungs What is lung cancer? How common is it? Risks & symptoms Diagnosis & treatment options What Are Lungs? What Do They Do? 1 Located in the chest Allow you to breathe Provide oxygen

More information

Considering Bariatric Surgery? Learn about minimally invasive da Vinci Surgery

Considering Bariatric Surgery? Learn about minimally invasive da Vinci Surgery Considering Bariatric Surgery? Learn about minimally invasive da Vinci Surgery The Condition: Obesity Obesity is defined as having a body mass index (BMI) of 30 or greater. Obesity is a serious medical

More information

Endoscopic Management of Strictures and Leaks. Prepared by Aurora D. Pryor, MD Presented by Dana Portenier, MD Duke University Medical Center

Endoscopic Management of Strictures and Leaks. Prepared by Aurora D. Pryor, MD Presented by Dana Portenier, MD Duke University Medical Center Endoscopic Management of Strictures and Leaks Prepared by Aurora D. Pryor, MD Presented by Dana Portenier, MD Duke University Medical Center What can go wrong? Bleeding (2%) Sleeve too big Angulated Too

More information

Stadards in Abdominoperineal Resection

Stadards in Abdominoperineal Resection Stadards in Abdominoperineal Resection Manuel Francisco T. Roxas, MD, FPCS, FPSCRS, FACS Clinical Associate Professor, University of the Philippines Chief, Section of Colorectal Surgery, Department of

More information

Adiuwantowe i neoadiuwantowe leczenie chorych na zaawansowanego raka żołądka

Adiuwantowe i neoadiuwantowe leczenie chorych na zaawansowanego raka żołądka Adiuwantowe i neoadiuwantowe leczenie chorych na zaawansowanego raka żołądka Neoadiuvant and adiuvant therapy for advanced gastric cancer Franco Roviello, IT Neoadjuvant and adjuvant therapy for advanced

More information

GENERAL SUMMARY AND DISCUSSION

GENERAL SUMMARY AND DISCUSSION GENERAL SUMMARY AND DISCUSSION In the last 30 years, abdominal surgery has progressed from the standard open approach to less invasive techniques such as laparoscopy and natural orifice translumenal endoscopic

More information

Understanding Laparoscopic Colorectal Surgery

Understanding Laparoscopic Colorectal Surgery Understanding Laparoscopic Colorectal Surgery University Colon & Rectal Surgery A Problem with Your Colon Your doctor has told you that you have a colon problem. Now you ve learned that surgery is needed

More information

TITLE: Minimal Access Lobectomy for Lung Cancer Patients: A Review of the Clinical and Cost-Effectiveness

TITLE: Minimal Access Lobectomy for Lung Cancer Patients: A Review of the Clinical and Cost-Effectiveness TITLE: Minimal Access Lobectomy for Lung Cancer Patients: A Review of the Clinical and Cost-Effectiveness DATE: 02 February 2009 CONTEXT AND POLICY ISSUES: In Canada, lung cancer is the most common type

More information

Thomas A. Kollmorgen, M.D. Oregon Urology Institute

Thomas A. Kollmorgen, M.D. Oregon Urology Institute Thomas A. Kollmorgen, M.D. Oregon Urology Institute None 240,000 new diagnosis per year, and an estimated 28,100 deaths (2012) 2 nd leading cause of death from cancer in U.S.A. Approximately 1 in 6 men

More information

restricted to certain centers and certain patients, preferably in some sort of experimental trial format.

restricted to certain centers and certain patients, preferably in some sort of experimental trial format. Managing Pancreatic Cancer, Part 4: Pancreatic Cancer Surgery, Complications, & the Importance of Surgical Volume Dr. Matthew Katz, Surgeon, MD Anderson Cancer Center, Houston, TX I m going to talk a little

More information

PET/CT Imaging in Lung Cancer

PET/CT Imaging in Lung Cancer PET/CT Imaging in Lung Cancer Mylene T. Truong, MD Mylene T. Truong M.D. Objectives To discuss the role of PET/CT in the staging of lung cancer To review the recommendations from American Society of Clinical

More information

Acute Abdominal Pain following Bariatric Surgery. Disclosure. Objectives 8/17/2015. I have nothing to disclose

Acute Abdominal Pain following Bariatric Surgery. Disclosure. Objectives 8/17/2015. I have nothing to disclose Acute Abdominal Pain following Bariatric Surgery Kathy J. Morris, DNP, APRN, FNP C, FAANP University of Nebraska Medical Center College of Nursing Disclosure I have nothing to disclose Objectives Pathophysiology

More information

SBRT (Elekta), 45 Gy in fractions of 3 Gy 3x/week for 5 weeks (N=22) vs.

SBRT (Elekta), 45 Gy in fractions of 3 Gy 3x/week for 5 weeks (N=22) vs. Uitgangsvraag 6: Wat is de plaats van stereotactische radiotherapiebehandeling (SBRT) bij HCC patiënten? Primaire studies I Study ID II Method III Patient characteristics IV Intervention(s) V Results primary

More information

Resection of Lung Cancer Invading the Mediastinum

Resection of Lung Cancer Invading the Mediastinum Resection of Lung Cancer Invading the Mediastinum Philippe G. Dartevelle MARIE-LANNELONGUE HOSPITAL GUSTAVE ROUSSY INSTITUTE INSTITUTE OF THORACIC ONCOLOGY PARIS SUD UNIVERSITY Mediastinal Invasion Superior

More information

Laparoscopic One Anastomosis Gastric Bypass (LOAGB) How I do it

Laparoscopic One Anastomosis Gastric Bypass (LOAGB) How I do it CENTER OF EXCELLENCE FOR THE STUDY AND OBESITY TREATMENT Laparoscopic One Anastomosis Gastric Bypass (LOAGB) How I do it Concepts and Results in a series of 11-years experience with 2,200 patients Miguel-A.

More information

Robotic Assisted Surgery

Robotic Assisted Surgery WA Health Technology Assessment Robotic Assisted Surgery Health Technology Assessment Program UPDATED FINAL EVIDENCE REPORT May 3, 2012 Health Technology Assessment Program (HTA) Washington State Health

More information

Neoadjuvant radiotherapy: Necessary for treatment of rectal cancer. Shannon Acker April 4, 2011

Neoadjuvant radiotherapy: Necessary for treatment of rectal cancer. Shannon Acker April 4, 2011 Neoadjuvant radiotherapy: Necessary for treatment of rectal cancer Shannon Acker April 4, 2011 Rectal Cancer 40,870 new cases in the US in 2009 49,920 deaths from colorectal cancer Second leading cause

More information

Evolution of Barrett s esophagus

Evolution of Barrett s esophagus Endoscopic Treatment and Surveillance of Esophageal Cancer: GI Perspective Charles J. Lightdale, MD Columbia University New York, NY Evolution of Barrett s esophagus Squamous esophagus Chronic inflammation

More information

Preoperative drainage is always indicated in malignant CBD strictures PRO. Horst Neuhaus Evangelisches Krankenhaus Düsseldorf, Germany

Preoperative drainage is always indicated in malignant CBD strictures PRO. Horst Neuhaus Evangelisches Krankenhaus Düsseldorf, Germany Preoperative drainage is always indicated in malignant CBD strictures PRO Horst Neuhaus Evangelisches Krankenhaus Düsseldorf, Germany Background Jaundice is associated with high perioperative morbidity

More information

Facing Lung Cancer? Learn why da Vinci Surgery may be your best treatment option for lung cancer.

Facing Lung Cancer? Learn why da Vinci Surgery may be your best treatment option for lung cancer. Facing Lung Cancer? Learn why da Vinci Surgery may be your best treatment option for lung cancer. The Condition: Lung Cancer The lung is the organ that moves oxygen through your body. You have two lungs

More information

Management of Peritoneal Metastases (PM) from colorectal cancers: New Perspectives. Dominique ELIAS

Management of Peritoneal Metastases (PM) from colorectal cancers: New Perspectives. Dominique ELIAS Management of Peritoneal Metastases (PM) from colorectal cancers: New Perspectives Dominique ELIAS Declaration of interest BOARDS Congress and teaching 0 Merck 0 Ipsen Novartis Sanofi Trials The peritoneum

More information

Surgical Mitral Valve Repair The Gold Standard. A. Marc Gillinov, M.D.

Surgical Mitral Valve Repair The Gold Standard. A. Marc Gillinov, M.D. Surgical Mitral Valve Repair The Gold Standard A. Marc Gillinov, M.D. Disclosures Speaker/consultant Edwards Lifesciences Onyx Lifesciences Research support St. Jude Medical Medtronic A Common Case A Common

More information

Benign Esophageal Perforations: Better Keep a Surgeon in the Toolkit

Benign Esophageal Perforations: Better Keep a Surgeon in the Toolkit Benign Esophageal Perforations: Better Keep a Surgeon in the Toolkit Bryan F. Meyers MD MPH Patrick and Joy Williamson Professor of Surgery Background Esophageal perforation is a difficult problem to characterize,

More information

Laparoscopic Repair of Incisional Hernia. Maria B. ALBUJA-CRUZ, MD University of Colorado Department of Surgery-Grand Rounds

Laparoscopic Repair of Incisional Hernia. Maria B. ALBUJA-CRUZ, MD University of Colorado Department of Surgery-Grand Rounds Laparoscopic Repair of Incisional Hernia Maria B. ALBUJA-CRUZ, MD University of Colorado Department of Surgery-Grand Rounds Overview Definition Advantages of Laparoscopic Repair Disadvantages of Open Repair

More information

National Bowel Cancer Audit Report 2008 Public and Executive Summary

National Bowel Cancer Audit Report 2008 Public and Executive Summary National Bowel Cancer Audit Report 2008 Public and Executive Summary Prepared in association with: Healthcare Quality Improvement Partnership HQIP Association of Coloproctology of Great Britain and Ireland

More information

Sleeve gastrectomy or gastric bypass as revisional bariatric procedures: retrospective evaluation of outcomes. Abstract Background Methods:

Sleeve gastrectomy or gastric bypass as revisional bariatric procedures: retrospective evaluation of outcomes. Abstract Background Methods: Sleeve gastrectomy or gastric bypass as revisional bariatric procedures: retrospective evaluation of outcomes. Mousa Khoursheed, Ibtisam Al-Bader, Ali Mouzannar, Abdulla Al-Haddad, Ali Sayed, Ali Mohammad,

More information

Results of Surgery in a New Lung Institute in South Texas Focused on the Treatment of Lung Cancer

Results of Surgery in a New Lung Institute in South Texas Focused on the Treatment of Lung Cancer Results of Surgery in a New Lung Institute in South Texas Focused on the Treatment of Lung Cancer Lung cancer accounts for 13% of all cancer diagnoses and is the leading cause of cancer death in both males

More information

Richard M Peterson, MD MPH FACS Chief UT Medicine Center for Bariatric and Metabolic Surgery Director Christus Weight Loss Institute Assistant

Richard M Peterson, MD MPH FACS Chief UT Medicine Center for Bariatric and Metabolic Surgery Director Christus Weight Loss Institute Assistant Richard M Peterson, MD MPH FACS Chief UT Medicine Center for Bariatric and Metabolic Surgery Director Christus Weight Loss Institute Assistant Professor of Surgery UTHSCSA None Laparoscopic adjustable

More information

Summa Health System. A Woman s Guide to Hysterectomy

Summa Health System. A Woman s Guide to Hysterectomy Summa Health System A Woman s Guide to Hysterectomy Hysterectomy A hysterectomy is a surgical procedure to remove a woman s uterus (womb). The uterus is the organ which shelters and nourishes a baby during

More information

Mesothelioma. Malignant Pleural Mesothelioma

Mesothelioma. Malignant Pleural Mesothelioma Mesothelioma William G. Richards, PhD Brigham and Women s Hospital Malignant Pleural Mesothelioma 2,000-3,000 cases per year (USA) Increasing incidence Asbestos (50-80%, decreasing) 30-40 year latency

More information

The Link Between Obesity and Diabetes The Rapid Evolution and Positive Results of Bariatric Surgery

The Link Between Obesity and Diabetes The Rapid Evolution and Positive Results of Bariatric Surgery The Link Between Obesity and Diabetes The Rapid Evolution and Positive Results of Bariatric Surgery Michael E. Farkouh, MD, MSc Peter Munk Chair in Multinational Clinical Trials Director, Heart and Stroke

More information

Overview of Bariatric Surgery

Overview of Bariatric Surgery Overview of Bariatric Surgery To better understand how weight loss surgery works, it is helpful to know how the normal digestive process works. As food moves along the digestive tract, special digestive

More information

L Lang-Lazdunski, A Bille, S Marshall, R Lal, D Landau, J Spicer

L Lang-Lazdunski, A Bille, S Marshall, R Lal, D Landau, J Spicer Pleurectomy/decortication, hyperthermic pleural lavage with povidone-iodine and systemic chemotherapy in malignant pleural mesothelioma. A 10-year experience. L Lang-Lazdunski, A Bille, S Marshall, R Lal,

More information

THE SURGICAL TREATMENT OF ESOPHAGEAL CANCER. INDICATIONS, COMPARATIVE ANALYSIS OF SURGICAL TECHNIQUES.

THE SURGICAL TREATMENT OF ESOPHAGEAL CANCER. INDICATIONS, COMPARATIVE ANALYSIS OF SURGICAL TECHNIQUES. UNIVERSITY OF MEDICINE AND PHARMACY OF CRAIOVA FACULTY OF MEDICINE THE SURGICAL TREATMENT OF ESOPHAGEAL CANCER. INDICATIONS, COMPARATIVE ANALYSIS OF SURGICAL TECHNIQUES. Scientific coordinator : Prof.

More information

Weight loss surgery more than just a gastric band

Weight loss surgery more than just a gastric band Weight loss surgery more than just a gastric band Presented by Ms Beth Murgatroyd Honorary Bariatric Nurse Practitioner Mr Ameet G Patel Consultant Surgeon Director of Bariatric Surgery at King s College

More information

A Gynecologic Cancer Intergroup (GCIG) Trial led by the NCIC CTG. GCIG Trial Designation: The SHAPE Trial NCIC CTG Protocol Number: CX.

A Gynecologic Cancer Intergroup (GCIG) Trial led by the NCIC CTG. GCIG Trial Designation: The SHAPE Trial NCIC CTG Protocol Number: CX. A RANDOMIZED TRIAL COMPARING RADICAL HYSTERECTOMY AND PELVIC NODE DISSECTION VS SIMPLE HYSTERECTOMY AND PELVIC NODE DISSECTION IN PATIENTS WITH LOW RISK EARLY STAGE CERVICAL CANCER A Gynecologic Cancer

More information

Rehabilitation and Lung Cancer Resection. Roberto Benzo MD MS Mindful Breathing Laboratory Division of Pulmonary & CCM Mayo Clinic

Rehabilitation and Lung Cancer Resection. Roberto Benzo MD MS Mindful Breathing Laboratory Division of Pulmonary & CCM Mayo Clinic Rehabilitation and Lung Cancer Resection Roberto Benzo MD MS Mindful Breathing Laboratory Division of Pulmonary & CCM Mayo Clinic Disclosure Funded by the National Cancer Institute NIH for Preoperative

More information

The prostate and kidney cancer specialists. Robot-assisted surgery for prostate and kidney cancer

The prostate and kidney cancer specialists. Robot-assisted surgery for prostate and kidney cancer The prostate and kidney cancer specialists Robot-assisted surgery for prostate and kidney cancer ROBOT-ASSISTED SURGERY AT HARLEY STREET UROLOGY Mr Marc Laniado, Consultant Urologist Robot-assisted prostatectomy,

More information

Types of Bariatric Procedures. Tejal Brahmbhatt, MD General Surgery Teaching Conference April 18, 2012

Types of Bariatric Procedures. Tejal Brahmbhatt, MD General Surgery Teaching Conference April 18, 2012 Types of Bariatric Procedures Tejal Brahmbhatt, MD General Surgery Teaching Conference April 18, 2012 A Brief History of Bariatric Surgery First seen in pts with short bowel syndrome weight loss First

More information

Facing a Hernia Repair? Learn about minimally invasive da Vinci Surgery

Facing a Hernia Repair? Learn about minimally invasive da Vinci Surgery Facing a Hernia Repair? Learn about minimally invasive da Vinci Surgery The Condition: Hernia A hernia happens when part of an internal organ or tissue bulges through a hole or weak area in the belly wall

More information

The outcome of rectal cancer after early salvage surgery following transanal endoscopic microsurgery seems promising

The outcome of rectal cancer after early salvage surgery following transanal endoscopic microsurgery seems promising The outcome of rectal cancer after early salvage surgery following transanal endoscopic microsurgery seems promising Katarina Levic, Orhan Bulut, Peter Hesselfeldt & Steffen Bülow ABSTRACT INTRODUCTION:

More information

da Vinci Prostatectomy Information Guide (Robotically-Assisted Radical Prostatectomy)

da Vinci Prostatectomy Information Guide (Robotically-Assisted Radical Prostatectomy) da Vinci Prostatectomy Information Guide (Robotically-Assisted Radical Prostatectomy) Prostate Cancer Overview Prostate cancer is a disease in which malignant (cancer) cells form in the tissues of the

More information

INSTEAD at 5-year follow-up shifts the expectations for endovascular treatment

INSTEAD at 5-year follow-up shifts the expectations for endovascular treatment INSTEAD at 5-year follow-up shifts the expectations for endovascular treatment Christoph A. Nienaber, MD, FACC University Heart Center Rostock Department of Medicine I - Cardiology christoph.nienaber@med.uni-rostock.de

More information

Considering Surgery for Fibroids? Learn about minimally invasive da Vinci Surgery

Considering Surgery for Fibroids? Learn about minimally invasive da Vinci Surgery Considering Surgery for Fibroids? Learn about minimally invasive da Vinci Surgery The Condition: Uterine Fibroid (Fibroid Tumor) A uterine fibroid is a benign (non-cancerous) tumor that grows in the uterine

More information

How TARGIT Intra-operative Radiotherapy can help Older Patients with Breast cancer

How TARGIT Intra-operative Radiotherapy can help Older Patients with Breast cancer How TARGIT Intra-operative Radiotherapy can help Older Patients with Breast cancer Jeffrey S Tobias, Jayant S Vaidya, Frederik Wenz and Michael Baum, University College Hospital, London, UK - on behalf

More information

Learning Luncheon 7: Endoscopic Mucosal Resection: When, Where and How?

Learning Luncheon 7: Endoscopic Mucosal Resection: When, Where and How? Endoscopic Mucosal Resection (EMR): When, Where, and Charles J. Lightdale, MD Columbia University New York, NY Endoscopic Mucosal Resection (EMR) EMR developed for removal of sessile or flat neoplasms

More information

SURGICAL PREAMBLE SPECIFIC ELEMENTS SURGICAL SERVICES WHICH ARE NOT LISTED AS A "Z" CODE

SURGICAL PREAMBLE SPECIFIC ELEMENTS SURGICAL SERVICES WHICH ARE NOT LISTED AS A Z CODE Surgical PreambleApril 1, 2015 PREAMBLE SPECIFIC ELEMENTS In addition to the common elements, all surgical services include the following specific elements. A. Supervising the preparation of and/or preparing

More information

da Vinci Prostatectomy (Robotically Assisted Radical Prostatectomy)

da Vinci Prostatectomy (Robotically Assisted Radical Prostatectomy) Peninsula Urology Center, Inc. Dieter Bruno, M.D, F.A.C.S Chris Threat, M.D. 3351 El Camino. Real, Suite 101 Atherton, CA 94027 (650) 306-1016 dbrunomd@pucenter.com http://www.pucenter.com/ da Vinci Prostatectomy

More information

CANCER OF THE OESOPHAGUS

CANCER OF THE OESOPHAGUS CANCER OF THE OESOPHAGUS What is the oesophagus (gullet) The oesophagus is a muscular tube that connects the mouth to the stomach. It descends behind the trachea (windpipe) against the backbone. It propels

More information

A Practical Guide to Advances in Staging and Treatment of NSCLC

A Practical Guide to Advances in Staging and Treatment of NSCLC A Practical Guide to Advances in Staging and Treatment of NSCLC Robert J. Korst, M.D. Director, Thoracic Surgery Medical Director, The Blumenthal Cancer Center The Valley Hospital Objectives Revised staging

More information

Accelerated hemithoracic radiation followed by extrapleural pneumonectomy for malignant pleural mesothelioma

Accelerated hemithoracic radiation followed by extrapleural pneumonectomy for malignant pleural mesothelioma Accelerated hemithoracic radiation followed by extrapleural pneumonectomy for malignant pleural mesothelioma Marc de Perrot, Ronald Feld, Natasha B Leighl, Andrew Hope, Thomas K Waddell, Shaf Keshavjee,

More information

Neoadjuvant therapy are we doing it right? Short course and chemoradiation

Neoadjuvant therapy are we doing it right? Short course and chemoradiation Neoadjuvant therapy are we doing it right? Short course and chemoradiation Rob Glynne-Jones Mount Vernon Cancer Centre Relevant Endpoints in rectal cancer Local recurrence Disease-free survival Overall

More information

Use of stents in esophageal cancer" Hans Gerdes, M.D. Director, GI Endoscopy Unit Memorial Sloan-Kettering Cancer Center

Use of stents in esophageal cancer Hans Gerdes, M.D. Director, GI Endoscopy Unit Memorial Sloan-Kettering Cancer Center Use of stents in esophageal cancer" Hans Gerdes, M.D. Director, GI Endoscopy Unit Memorial Sloan-Kettering Cancer Center Features of esophageal cancer Esophageal cancer is an abnormal growth that arises

More information

Endoscopic gastric pouch plication - a novel endoluminal incision free approach to revisional bariatric surgery

Endoscopic gastric pouch plication - a novel endoluminal incision free approach to revisional bariatric surgery Endoscopic gastric pouch plication - a novel endoluminal incision free approach to revisional bariatric surgery Authors: Chiranjiv S Virk, I Michael Leitman and Elliot R Goodman. Location: Beth Israel

More information

Sur les nouveaux médicaments et les perspectives qu ils offrent (traitement à la carte et survie longue)

Sur les nouveaux médicaments et les perspectives qu ils offrent (traitement à la carte et survie longue) Sur les nouveaux médicaments et les perspectives qu ils offrent (traitement à la carte et survie longue) Professeur Jean Trédaniel Unité de cancérologie thoracique Hôpital Saint-Louis Comparison of Four

More information

Management of Liver Cancer: In the Era of Liver Transplantation

Management of Liver Cancer: In the Era of Liver Transplantation Management of Liver Cancer: In the Era of Liver Transplantation Marwan S. Abouljoud, M.D., F.A.C.S. Benson Ford Chair Transplant and Hepatobiliary Surgery Director, Henry Ford Transplant Institute I have

More information

Surgical & Nutritional Complications of Bariatric Surgery: What Every GI Doc Needs to Know Brian R. Smith, MD, FACS Associate Clinical Professor of

Surgical & Nutritional Complications of Bariatric Surgery: What Every GI Doc Needs to Know Brian R. Smith, MD, FACS Associate Clinical Professor of Surgical & Nutritional Complications of Bariatric Surgery: What Every GI Doc Needs to Know Brian R. Smith, MD, FACS Associate Clinical Professor of Surgery & Associate Residency Program Director UC Irvine

More information

Informed Consent for Laparoscopic Vertical Sleeve Gastrectomy. Patient Name

Informed Consent for Laparoscopic Vertical Sleeve Gastrectomy. Patient Name Informed Consent for Laparoscopic Vertical Sleeve Gastrectomy Patient Name Please read this form carefully and ask about anything you may not understand. I consent to have a laparoscopic Vertical Sleeve

More information

Management of Chest Tubes and Air Leaks after Lung Resection

Management of Chest Tubes and Air Leaks after Lung Resection Management of Chest Tubes and Air Leaks after Lung Resection Emily Kluck PA-C The Johns Hopkins Hospital Baltimore, MD AATS 2014, Toronto, CAN April 2014 Management of Chest Tubes 1 Overview Review the

More information

Emerging Concepts in Bariatric Surgery

Emerging Concepts in Bariatric Surgery Emerging Concepts in Bariatric Surgery C Y N T H I A L. L O N G, M D, F A C S S I N A I H O S P I T A L O F B A L T I M O R E D E P A R T M E N T O F S U R G E R Y D I V I S I O N O F M I N I M A L L Y

More information

RESEARCH ARTICLE. Abstract. Introduction. Materials and Methods

RESEARCH ARTICLE. Abstract. Introduction. Materials and Methods DOI:http://dx.doi.org/10.7314/APJCP.2015.16.13.5483 Perioperative and Oncologic Outcomes with Laparotomy, and Laparoscopic, and Robotic Surgery for Endometrial Cancer RESEARCH ARTICLE Comparison of Perioperative

More information

The Whipple Procedure. Sally Hodges, Ph.D.(c) Given the length and difficulty of the procedure, regardless of the diagnosis, certain

The Whipple Procedure. Sally Hodges, Ph.D.(c) Given the length and difficulty of the procedure, regardless of the diagnosis, certain The Whipple Procedure Sally Hodges, Ph.D.(c) Preoperative procedures Given the length and difficulty of the procedure, regardless of the diagnosis, certain assurances must occur prior to offering a patient

More information

Bariatric i Surgery: Optimalizing Outcome Results. Dr. B. Dillemans AZ Sint-Jan AV Brugge-Oostende BARIATRIC SURGERY

Bariatric i Surgery: Optimalizing Outcome Results. Dr. B. Dillemans AZ Sint-Jan AV Brugge-Oostende BARIATRIC SURGERY Bariatric i Surgery: Optimalizing i Outcome Results Dr. B. Dillemans AZ Sint-Jan AV Brugge-Oostende THE OBESE PATIENT : A CHALLENGE FOR ANAESTHESIA, Ostend,14/11/09 BARIATRIC SURGERY 50 s : First Reported

More information

COMMISSIONING. for ULTRA-RADICAL SURGERY ADVANCED OVARIAN CANCER

COMMISSIONING. for ULTRA-RADICAL SURGERY ADVANCED OVARIAN CANCER COMMISSIONING for ULTRA-RADICAL SURGERY in ADVANCED OVARIAN CANCER WHY THIS MUST HAPPEN PERSPECTIVE COMMISSIONING FOR WHO, FOR WHAT? Biological Basis Surgical Basis International and national standards

More information

Keywords: advanced stage ovarian cancer, tertiary cytoreduction, debulking surgery

Keywords: advanced stage ovarian cancer, tertiary cytoreduction, debulking surgery CASE PRESENTATION ROJSP 2016, Vol. I (issue 1): E 45-53. Extended upper abdominal resections as part of debulking surgery at the time of tertiary cytoreduction for relapsed ovarian cancer a case report

More information

Considering a Hysterectomy?

Considering a Hysterectomy? Considering a Hysterectomy? Learn more about virtually scarless surgery using da Vinci Single-Site technology { {Symptoms & Conditions: Chronic Pain, Heavy Bleeding, Fibroids, Endometriosis, Pelvic Prolapse

More information

Roux-en-y gastric bypass - clinical perspectives

Roux-en-y gastric bypass - clinical perspectives Roux-en-y gastric bypass - clinical perspectives Tom Mala Consultant surgeon Department of Gastroenterologic Surgery Oslo University Hospital Bariatric surgery weight loss Sjøstrøm L, JAMA 2012 Five-year

More information

Technical Aspects of Bariatric Surgical Procedures. Robert O. Carpenter, MD, MPH, FACS Department of Surgery Scott & White Memorial Hospital

Technical Aspects of Bariatric Surgical Procedures. Robert O. Carpenter, MD, MPH, FACS Department of Surgery Scott & White Memorial Hospital Technical Aspects of Bariatric Surgical Procedures Robert O. Carpenter, MD, MPH, FACS Department of Surgery Scott & White Memorial Hospital Disclosures Allergan, Inc. (Past) Faculty Member Educational

More information

Surgical Treatment of Obesity: A Surgeon s View

Surgical Treatment of Obesity: A Surgeon s View Surgical Treatment of Obesity: A Surgeon s View Jenny J. Choi, MD Director of Bariatrics Associate Director of Clinical Affairs Assistant Professor of Surgery Albert Einstein School of Medicine Montefiore

More information

Principles of Radiation Therapy A Bapsi Chakravarthy, MD Associate e P rofessor Professor Radiation Oncology

Principles of Radiation Therapy A Bapsi Chakravarthy, MD Associate e P rofessor Professor Radiation Oncology Principles of Radiation Therapy A Bapsi Chakravarthy, MD Associate Professor Radiation Oncology Disclosure Information I have no financial relationships to disclose relevant to the conten of this presentation.

More information

PATIENT CONSENT TO PROCEDURE - ROUX-EN-Y GASTRIC BYPASS

PATIENT CONSENT TO PROCEDURE - ROUX-EN-Y GASTRIC BYPASS As a patient you must be adequately informed about your condition and the recommended surgical procedure. Please read this document carefully and ask about anything you do not understand. Please initial

More information

Data Management, Audit and Outcomes

Data Management, Audit and Outcomes Data Management, Audit and Outcomes Providing Accurate Outcomes and Activity Data The Trust has in place robust mechanisms for capturing and reporting on all oesophago-gastric cancer surgery activity and

More information

A PATIENT S GUIDE TO ABLATION THERAPY

A PATIENT S GUIDE TO ABLATION THERAPY A PATIENT S GUIDE TO ABLATION THERAPY THE DIVISION OF VASCULAR/INTERVENTIONAL RADIOLOGY THE ROBERT WOOD JOHNSON UNIVERSITY HOSPITAL Treatment options for patients with cancer continue to expand, providing

More information

Dept. of Medical Imaging University of Ottawa

Dept. of Medical Imaging University of Ottawa ED Visits Related to Bariatric Surgery: Review of Normal Post-Surgical Anatomy as Well as Complications Dept. of Medical Imaging University of Ottawa Disclosures Background Roux-en-Y Gastric Bypass Surgery

More information

Alternatives to Surgical Resection for Early Stage Lung Cancer

Alternatives to Surgical Resection for Early Stage Lung Cancer Alternatives to Surgical Resection for Early Stage Lung Cancer Neil A. Christie MD University of Pittsburgh Medical Center Department of Thoracic Surgery Allied Health Personnel Symposium AATS 2014 Conflicts

More information