As to the surgical technique, the perigastric
technique was applied to the first 82 patients, and the pars flaccida technique was applied to the other 92 patients (3,4).
Computed tomography of the abdomen showed cirrhosis with perigastric
, perisplenic, and splenorenal shunt, but otherwise no masses, ascites, or signs of hepatocellular carcinoma (HCC).
The pathology report described: a tumor with solid architecture, entirely invading the muscularis propria and extending into the perigastric
adipose tissue without infiltration of the serosa; infiltration of the small intestine at the anastomosis site.
There was no retroperitoneal involvement and no perigastric
Contrast enhanced computed tomography (CECT) of abdomen and chest showed circumferential mural thickening of antrum and pyloric canal extending along lesser curvature of stomach into gastroesophageal junction and lower 1/3rd of esophagus with irregular enhancing walls, mild perigastric
stranding, few enlarged perilesional lymph nodes.
vascular anatomy can be a challenging issue during surgery [6-8].
Eventually, five (2%) severe adverse events, including two perigastric
inflammatory fluid collections (adjacent to the fundus) that resolved with percutaneous drainage and antibiotics, one self-limited extra-gastric hemorrhage that required blood transfusion, one pulmonary embolism 72 h after the procedure, and one pneumoperitoneum and pneumothorax requiring chest tube placement, occurred.
nodes < 3 cm from the primary lesion were graded as N1, and enlarged distant (>3 cm) paragastric nodes and the nodes along the main arteries supplying the stomach were assessed as representative of N2.
organ": a replacement name for the "hepatopancreas" of Decapoda.
and paraaortic lymph nodes are involved first through lymphatic spread, whereas liver metastases develop via the portal venous system by hematogenous spread .
While CT global accuracy on the N parameter reaches about 90% at staging, adopting a double size cutoff (5 mm for perigastric
nodes and 8 mm for extraperigastric nodes), at present, there are no established criteria with high accuracy for defining lymph node response to NAC, such as a cutoff size or rate of size reduction; therefore, given the complexity of the issue, further studies are needed in this field, probably differentiating among different tumour histotypes .
The present study has some limitations as follows: EUS elastography and SR were used to evaluate different types of pathology in malignant nodes (e.g., mediastinal, pancreatic, perigastric
, paraaortic, etc.) and benign nodes, which may cause divergence in the results due to different tissue heterogeneity.