Background
The incidence of gastric cancer is decreasing in Australia, yet it remains a common cause of cancer-related mortality. Surgical resection remains the cornerstone of curative treatment. ...High-volume specialized units have reported superior perioperative and oncological outcomes. The role of D2 lymphadenectomy has been controversial as a result of concerns over increased morbidity. Our aim is to report the perioperative and oncological outcomes of curative gastric resection from a specialist Australian upper GI unit.
Methods
Data from a prospectively maintained database were reviewed for all patients undergoing curative resection for gastric adenocarcinoma from a single unit during a 12-year period. Perioperative and long-term outcomes were compiled.
Results
There were 255 curative gastric resections during 12 years. An R0 resection was performed in 96 % with a perioperative mortality rate of 1.6 %. A D2 dissection was performed in 85 % of cases in the past 6 years, with no increase in perioperative morbidity or mortality detected. The 5-year overall survival was 53 %.
Conclusion
Our results demonstrate that both short- and long-term outcomes of surgical resection in gastric cancer patients, comparable to international high-volume centers, can be achieved in an Australian upper GI unit. A D2 lymph node dissection can be performed safely without any increase in perioperative risk in a specialist unit that has the necessary training but also the perioperative support structures to manage these complex patients.
In patients with operable esophageal cancer, there is evidence supporting the use of preoperative chemotherapy or preoperative chemoradiation. The addition of radiotherapy to chemotherapy seems more ...relevant for the more locally advanced cancers. There is a need to examine in trials more modern chemotherapy combinations with and without concurrent radiation and for research into assessing methods for predicting outcomes from neoadjuvant therapy as part of the paradigm of therapy for this disease.
“Thinking Love: Heidegger and Arendt” explores the problematic nature of romantic love as it developed between Martin Heidegger and Hannah Arendt, whom Heidegger later called “the passion of his ...life.” I suggest that three different ways of understanding love can be found at work in Heidegger and Arendt’s relationship, namely, the perfectionist, the unconditional, and the ontological models of love. Explaining these different ways of thinking romantic love, this paper shows how the distinctive problems of the perfectionist and unconditional models played out in Heidegger and Arendt’s relationship and how that relationship eventually gave rise to the third, ontological understanding of love. This ontological vision of love combines some of the strengths of the perfectionist and unconditional views while avoiding their worst problems, and so emerges as perhaps the most important philosophical lesson about romantic love to be drawn from studying the lifelong love affair between two of the twentieth century’s greatest thinkers.
The idea inspiring the eco-phenomenological movement is that phenomenology can help remedy our environmental crisis by uprooting and replacing environmentally-destructive ethical and metaphysical ...presuppositions inherited from modern philosophy. Eco-phenomenology's critiques of subject/object dualism and the fact/value divide are sketched and its positive alternatives examined. Two competing approaches are discerned within the eco-phenomenological movement: Nietzscheans and Husserlians propose a naturalistic ethical realism in which good and bad are ultimately matters of fact, and values should be grounded in these proto-ethical facts; Heideggerians and Levinasians articulate a transcendental ethical realism according to which we discover what really matters when we are appropriately open to the environment, but what we thereby discover is a transcendental source of meaning that cannot be reduced to facts, values, or entities of any kind. These two species of ethical realism generate different kinds of ethical perfectionism: naturalistic ethical realism yields an eco-centric perfectionism which stresses the flourishing of life in general; transcendental ethical realism leads to a more 'humanistic' perfectionism which emphasizes the cultivation of distinctive traits of Dasein. Both approaches are examined, and the Heideggerian strand of the humanistic approach defended, since it approaches the best elements of the eco-centric view while avoiding its problematic ontological assumptions and anti-humanistic implications.
Abstract
Definitive chemoradiotherapy (dCRT) for oesophageal cancer is recommended in selected patients who are unfit for surgery, or where doctor and/or patient prefers to surgery. Salvage ...oesophagectomy after dCRT is reportedly a morbid procedure compared to oesophagectomy following neoadjuvant chemoradiotherapy (nCRT). If indications for dCRT expand, there will be a larger pool of patients requiring salvage oesophagectomy. We aimed to assess the post-operative clinical outcomes of patients who had dCRT compared with nCRT in our unit.
Data were obtained from a prospectively maintained database of patients receiving curative treatment for oesophageal cancer from January 2010 until February 2022. Patients receiving a salvage oesophagectomy after dCRT were compared to those receiving nCRT and planned oesophagectomy. An comparison of differences in group characteristics, post-operative outcomes and survival rates was made. Analysis was completed using t-test, chi-square, log rank and Kaplan–Meier methods.
216 patients had dCRT with 24 undergoing salvage oesophagectomy. 228 had nCRT followed by surgery. The salvage group had more SCC (47% versus 16%; p = 0.002), higher blood loss (434 versus 280 mL; p = 0.033) and more surgeon-rated technical problems (e.g. pleural adhesions or mediastinal fibrosis) (30% versus 11%; p = 0.010). Operative times were not significantly different (357 versus 330 minutes; p = 0.232). There was a trend towards higher complications in the dCRT group (83 versus 63%; p = 0.057). Operative mortality was 0% in both groups. As expected the median survival was worse in the dCRT group (26 versus 66 months; p = 0.040).
Patients selected to dCRT who require and are fit for salvage oesophagectomy have worse outcomes compared with those who have nCRT. However, this subgroup still have a modest potential for cancer survival. Our dataset adds to the existing literature and will help to counsel patients being considered for salvage oesophagectomy. The possible future increase in number of patients being offered dCRT makes improving the understanding of peri-operative and cancer-specific outcomes after salvage oesophagectomy a priority.
We report the case of an 80-year-old male with stage three kidney disease, who survived a primary aorto-enteric fistula (AEF) in the setting of chronic Q fever after presenting with melena and ...syncope. His initial surgical treatment included endovascular aortic repair. Type 2 endoleak was present post-operatively. Six months later, he was diagnosed with a secondary AEF after syncope and large volume hematemesis. He was definitively treated with an open explant of his stent, repair of the duodenum and bilateral axillofemoral bypass. Two years later, he remains active and independent on life-long antibiotics.
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