Abstract Laparoscopy assisted distal gastrectomy (LADG) was first reported in 1994. Since then, it has gradually gained maturity. This procedure is less invasive than conventional open gastrectomy, and the oncologic outcomes are comparable. Recently, single-incision la- paroscopic surgery (SILS) has been developed, which seems to be less invasive than conventional laparoscopic surgery. However, SILS technique is characterized by a limited working area, crowding and crossing of instruments which make it difficult to be applied for oncologic gas- trectomy. In a trial to overcome SILS difficulties, the au- thors report their initial clinical experience of LADG with D1 lymphadenectomy using a novel 3-ports technique. Twenty-one patients have been enrolled for 3-ports la- paroscopic gastrectomy. The patient’s demographic and perioperative data have been collected prospectively. The mean operative time in the first ten cases was 170 min and for the last eleven cases was 140 min (P = 0.01). The mean estimated blood loss was 65 ml. There was no use for additional ports or conversion to open surgery. There were no intra-operative major complications. The mean time for hospital stay was 9 days. One case of pneumonia and one death were the postoperative complications. The mean number of retrieved lymph nodes was 21 and all the cases had free surgical margin. Three-ports LADG with D1 lymphadenectomy could be a safe and oncologically fea- sible procedure; however, a prospective randomized controlled trial comparing three ports LADG with con- ventional multi-ports LADG is required. It is a step towards three-port total laparoscopic distal gastrectomy.

Abstract Laparoscopy assisted distal gastrectomy (LADG) was first reported in 1994. Since then, it has gradually gained maturity. This procedure is less invasive than conventional open gastrectomy, and the oncologic outcomes are comparable. Recently, single-incision la- paroscopic surgery (SILS) has been developed, which seems to be less invasive than conventional laparoscopic surgery. However, SILS technique is characterized by a limited working area, crowding and crossing of instruments which make it difficult to be applied for oncologic gas- trectomy. In a trial to overcome SILS difficulties, the au- thors report their initial clinical experience of LADG with D1 lymphadenectomy using a novel 3-ports technique. Twenty-one patients have been enrolled for 3-ports la- paroscopic gastrectomy. The patient’s demographic and perioperative data have been collected prospectively. The mean operative time in the first ten cases was 170 min and for the last eleven cases was 140 min (P = 0.01). The mean estimated blood loss was 65 ml. There was no use for additional ports or conversion to open surgery. There were no intra-operative major complications. The mean time for hospital stay was 9 days. One case of pneumonia and one death were the postoperative complications. The mean number of retrieved lymph nodes was 21 and all the cases had free surgical margin. Three-ports LADG with D1 lymphadenectomy could be a safe and oncologically fea- sible procedure; however, a prospective randomized controlled trial comparing three ports LADG with con- ventional multi-ports LADG is required. It is a step towards three-port total laparoscopic distal gastrectomy.

Abstract Laparoscopy assisted distal gastrectomy (LADG) was first reported in 1994. Since then, it has gradually gained maturity. This procedure is less invasive than conventional open gastrectomy, and the oncologic outcomes are comparable. Recently, single-incision la- paroscopic surgery (SILS) has been developed, which seems to be less invasive than conventional laparoscopic surgery. However, SILS technique is characterized by a limited working area, crowding and crossing of instruments which make it difficult to be applied for oncologic gas- trectomy. In a trial to overcome SILS difficulties, the au- thors report their initial clinical experience of LADG with D1 lymphadenectomy using a novel 3-ports technique. Twenty-one patients have been enrolled for 3-ports la- paroscopic gastrectomy. The patient’s demographic and perioperative data have been collected prospectively. The mean operative time in the first ten cases was 170 min and for the last eleven cases was 140 min (P = 0.01). The mean estimated blood loss was 65 ml. There was no use for additional ports or conversion to open surgery. There were no intra-operative major complications. The mean time for hospital stay was 9 days. One case of pneumonia and one death were the postoperative complications. The mean number of retrieved lymph nodes was 21 and all the cases had free surgical margin. Three-ports LADG with D1 lymphadenectomy could be a safe and oncologically fea- sible procedure; however, a prospective randomized controlled trial comparing three ports LADG with con- ventional multi-ports LADG is required. It is a step towards three-port total laparoscopic distal gastrectomy.

Background: Laparoscopic colectomy has been shown to have significant short- and long-term benefits compared to open approach. The incorporation of laparoscopy in developing countries is challenging, due to the high costs of equipment and lack of expertise. The aim of this study was to evaluate the safety and feasibility of laparoscopic colorectal surgery for cancer that could be performed in developing countries under different circumstances in developed countries. Methods: Thirty-seven patients (23 males and 14 females) with colorectal cancer with a median age of 46 years (39–72) have been enrolled for laparoscopic colo-rectal surgery in a tertiary center in Egypt (South Egypt Cancer Institute) with the trend of reuse of some disposable laparoscopic instruments. Results: The median operative time was 130 min (95–195 min). The median estimated blood loss was 70 ml (30–90 ml). No major intra-operative complications have been encountered. Two cases (5.5%) have been converted because of local advancement (one case) and bleeding with unavailability of vessel sealing device at that time (one case). The median time for passing flatus after surgery was 36 h (12–72 h). The median hospital stay was 4.8 days (4–7 days). The peri-operative period passed without events. Pathologic outcome revealed that the median number of retrieved lymph nodes was 14 (range 9–23 lymph node) and all cases had free surgical margin. Conclusion: Laparoscopic colorectal surgery for cancer in developing countries could be safe and feasible. Safe reuse of disposable expensive parts of some laparoscopic instruments could help in propagation of this technique in developing countries.

Background: Laparoscopic colectomy has been shown to have significant short- and long-term benefits compared to open approach. The incorporation of laparoscopy in developing countries is challenging, due to the high costs of equipment and lack of expertise. The aim of this study was to evaluate the safety and feasibility of laparoscopic colorectal surgery for cancer that could be performed in developing countries under different circumstances in developed countries. Methods: Thirty-seven patients (23 males and 14 females) with colorectal cancer with a median age of 46 years (39–72) have been enrolled for laparoscopic colo-rectal surgery in a tertiary center in Egypt (South Egypt Cancer Institute) with the trend of reuse of some disposable laparoscopic instruments. Results: The median operative time was 130 min (95–195 min). The median estimated blood loss was 70 ml (30–90 ml). No major intra-operative complications have been encountered. Two cases (5.5%) have been converted because of local advancement (one case) and bleeding with unavailability of vessel sealing device at that time (one case). The median time for passing flatus after surgery was 36 h (12–72 h). The median hospital stay was 4.8 days (4–7 days). The peri-operative period passed without events. Pathologic outcome revealed that the median number of retrieved lymph nodes was 14 (range 9–23 lymph node) and all cases had free surgical margin. Conclusion: Laparoscopic colorectal surgery for cancer in developing countries could be safe and feasible. Safe reuse of disposable expensive parts of some laparoscopic instruments could help in propagation of this technique in developing countries.

Background: Laparoscopic colectomy has been shown to have significant short- and long-term benefits compared to open approach. The incorporation of laparoscopy in developing countries is challenging, due to the high costs of equipment and lack of expertise. The aim of this study was to evaluate the safety and feasibility of laparoscopic colorectal surgery for cancer that could be performed in developing countries under different circumstances in developed countries. Methods: Thirty-seven patients (23 males and 14 females) with colorectal cancer with a median age of 46 years (39–72) have been enrolled for laparoscopic colo-rectal surgery in a tertiary center in Egypt (South Egypt Cancer Institute) with the trend of reuse of some disposable laparoscopic instruments. Results: The median operative time was 130 min (95–195 min). The median estimated blood loss was 70 ml (30–90 ml). No major intra-operative complications have been encountered. Two cases (5.5%) have been converted because of local advancement (one case) and bleeding with unavailability of vessel sealing device at that time (one case). The median time for passing flatus after surgery was 36 h (12–72 h). The median hospital stay was 4.8 days (4–7 days). The peri-operative period passed without events. Pathologic outcome revealed that the median number of retrieved lymph nodes was 14 (range 9–23 lymph node) and all cases had free surgical margin. Conclusion: Laparoscopic colorectal surgery for cancer in developing countries could be safe and feasible. Safe reuse of disposable expensive parts of some laparoscopic instruments could help in propagation of this technique in developing countries.

Background: Despite improved preoperative diagnostics, incidental postoperative detection of differentiated thyroid cancer in the final histology is still common. In most of these cases, completion thyroidectomy is recommended by national and international guidelines, although secondary surgery is associated with an increased operative risk. The optimal timing of completion thyroidectomy is still controversial. Patients and Methods: The patients admitted to surgical oncology department, SECI, with diagnosis of differentiated thyroid cancer; during the period from January 2008 to December 2015; were rewired for age, sex, type of 1st operation, histopathological result, type of 2nd operation and time interval between the 2 operation, complication of 2nd operation and morbidity. 118 patients underwent completion thyroidectomy; those patients were divided according to timing of completion operation into 3 groups: Group A is from one week to 3 months and include 64 patients; Group B is from 3 - 6 months and include 30 patients; Group C is more than 6 months and include 24 patients. Clinical complications and oncologic outcomes were analyzed. The mean follow-up was 80 ± 10 months. Result: we record 118 patients under completion thyroidectomy. Ages range from 79 to 13 years. Papillary thyroid cancer were 96 and follicular thyroid cancer were 22. The overall rates of transient and persistent postoperative hypocalcemia were 19.5% and 4.2%, respectively. The rates of persistent hypocalcemia were found in group A and B but not in group C. Transient or persistent vocal cord paresis was observed in 9 (7.6%) and 3 patients (2.5%). The incidence of persistent vocal cord paresis (VCP) was significantly higher in groups A and B than in group C. There was no significant difference regarding survival among the 3 groups; however recurrence is higher in group A. Conclusion: Considering perioperative morbidity and oncologic outcomes, completion thyroidectomy should be performed at least 3 to 6 months after primary surgery.

Background: Despite improved preoperative diagnostics, incidental postoperative detection of differentiated thyroid cancer in the final histology is still common. In most of these cases, completion thyroidectomy is recommended by national and international guidelines, although secondary surgery is associated with an increased operative risk. The optimal timing of completion thyroidectomy is still controversial. Patients and Methods: The patients admitted to surgical oncology department, SECI, with diagnosis of differentiated thyroid cancer; during the period from January 2008 to December 2015; were rewired for age, sex, type of 1st operation, histopathological result, type of 2nd operation and time interval between the 2 operation, complication of 2nd operation and morbidity. 118 patients underwent completion thyroidectomy; those patients were divided according to timing of completion operation into 3 groups: Group A is from one week to 3 months and include 64 patients; Group B is from 3 - 6 months and include 30 patients; Group C is more than 6 months and include 24 patients. Clinical complications and oncologic outcomes were analyzed. The mean follow-up was 80 ± 10 months. Result: we record 118 patients under completion thyroidectomy. Ages range from 79 to 13 years. Papillary thyroid cancer were 96 and follicular thyroid cancer were 22. The overall rates of transient and persistent postoperative hypocalcemia were 19.5% and 4.2%, respectively. The rates of persistent hypocalcemia were found in group A and B but not in group C. Transient or persistent vocal cord paresis was observed in 9 (7.6%) and 3 patients (2.5%). The incidence of persistent vocal cord paresis (VCP) was significantly higher in groups A and B than in group C. There was no significant difference regarding survival among the 3 groups; however recurrence is higher in group A. Conclusion: Considering perioperative morbidity and oncologic outcomes, completion thyroidectomy should be performed at least 3 to 6 months after primary surgery.

Background: Despite improved preoperative diagnostics, incidental postoperative detection of differentiated thyroid cancer in the final histology is still common. In most of these cases, completion thyroidectomy is recommended by national and international guidelines, although secondary surgery is associated with an increased operative risk. The optimal timing of completion thyroidectomy is still controversial. Patients and Methods: The patients admitted to surgical oncology department, SECI, with diagnosis of differentiated thyroid cancer; during the period from January 2008 to December 2015; were rewired for age, sex, type of 1st operation, histopathological result, type of 2nd operation and time interval between the 2 operation, complication of 2nd operation and morbidity. 118 patients underwent completion thyroidectomy; those patients were divided according to timing of completion operation into 3 groups: Group A is from one week to 3 months and include 64 patients; Group B is from 3 - 6 months and include 30 patients; Group C is more than 6 months and include 24 patients. Clinical complications and oncologic outcomes were analyzed. The mean follow-up was 80 ± 10 months. Result: we record 118 patients under completion thyroidectomy. Ages range from 79 to 13 years. Papillary thyroid cancer were 96 and follicular thyroid cancer were 22. The overall rates of transient and persistent postoperative hypocalcemia were 19.5% and 4.2%, respectively. The rates of persistent hypocalcemia were found in group A and B but not in group C. Transient or persistent vocal cord paresis was observed in 9 (7.6%) and 3 patients (2.5%). The incidence of persistent vocal cord paresis (VCP) was significantly higher in groups A and B than in group C. There was no significant difference regarding survival among the 3 groups; however recurrence is higher in group A. Conclusion: Considering perioperative morbidity and oncologic outcomes, completion thyroidectomy should be performed at least 3 to 6 months after primary surgery.

Objectives: Aim of our work is to study the effect of early enteral feeding through either nasoentral or feeding jejunostomy tube post esophagectomy on patients recovery and hospital stay. Background: Postoperative nutrition is a well known aspect of care in recent years and has been shown to decrease the incidence of complications and hospital stay. Enteral nutrition has been shown to be superior to parenteral nutrition as it is more physiological, safer, cheaper and early enteral nutrition has been clearly confirmed to reduce postoperative morbidity. Methods: This is randomized combined retrospective and prospective study that is conducted in surgical oncology department, South Egypt cancer institute, Assiut University; from October 2012 to October 2016. Patients in this study were divided into two groups: group 1 includes patients with feeding jejunostomy and group 2 is patients with nasoenteral tube. Results: 25 Patients included in this study (19 males & 6 females). All cases were primarily diagnosed as esophageal cancer, middle and lower 1/3 esophagus or proximal gastric carcinoma infiltrating cardia by clinical data associated with abdominal sonar and/or C.T scan and upper endoscopy with biopsy. There was no significant difference in catheter related complications (P value 0.238). There was no operative mortality. Conclusion: Early postoperative enteral nutrition was feasible and safe for patients undergoing esophagectomy. There is no significant difference between NE and FJ. Enteral nutrition either through nasoenteral or feeding jejunostomy is an effective method for postoperative nutritional support in this type of major surgery.