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Leakage is a serious and potentially fatal complication of gastrectomy for gastric cancer. However, comprehensive reports regarding leakage after gastrectomy remain limited. We aimed to evaluate the incidence and treatment outcomes of leakage after gastrectomy for cancer. We reviewed the prospectively collected data of 14,075 Patients who underwent gastrectomy for gastric cancer between 2005 and 2017. Outcomes included incidence, risk factors of leakage, and leakage treatment outcomes. The median day of leakage detection was postoperative day 7 (range 1–29days). The overall leakage incidence was 1.51% (213/14,075), and the most frequent location was the oesophagojejunostomy (2.07%). Leakage after total gastrectomy was more frequent with minimally invasive surgery (open:1.64%, laparoscopic:3.56%, robotic:5.83%; P < 0.001). Leakage incidence was higher in the surgeon's initial 100 cases than in later cases (2.4 vs. 1.3%; P < 0.001), especially with minimally invasive surgery. Early leakage (within 4 days of surgery) occurred more often after minimally invasive surgery (open:12.7%, laparoscopic:35.4%, robotic:29.0%; P = 0.006). The success rate for initial treatment of leakage was 70.4% (150/213). Surgery after initial treatment failure demonstrated a higher success rate for early leakage than for late leakage (80.0 vs. 22.2%). Among 213 patients who experienced leakage, fifteen patients (7.0%) died, and leakage-related mortality accounted for 38.5% (15/39) of all surgery-related mortality after gastrectomy. Leakage after gastric cancer surgery is associated with high mortality. Improved surgeon experience using minimally invasive techniques is required to reduce the risk of leakage. Surgery is an effective treatment for early leakage, although further studies are needed to establish the most appropriate treatment strategies. [Display omitted] • A retrospective review of 14,075 patients who underwent gastrectomy for gastric cancer revealed 1.5% leakage rate. •Leakage rate was significantly higher in a surgeon's initial 100 cases than in later cases, especially for minimally invasive surgery. •Technical proficiency and greater experience with minimally invasive surgery may be necessary to reduce the risk of leakage, which was associated with high mortality. [ABSTRACT FROM AUTHOR]

Objective: The purpose of our study was to evaluate interobserver variability between the radiologist and emergency physician in detecting blunt liver trauma by conventional and contrast-enhanced ultrasound (US) (CEUS). Methods: We created 20 sites of blunt liver trauma in rabbits and performed conventional US and CEUS on the animals. A radiologist and an emergency physician independently evaluated the degree of liver trauma. Using contrast-enhanced computed tomography as a reference standard, the diagnostic performance of US and CEUS was calculated. Interobserver variability between radiologist and emergency physician was compared before and after contrast enhancement of US. Results: Overall sensitivity and specificity for detecting liver trauma on conventional US, regardless of the degree of trauma, were 61.1% and 100% for the radiologist and 50% and 100% for the emergency physician. On CEUS, the sensitivity and specificity were 94.4% and 100% for both the radiologist and emergency physician. The interobserver agreement between emergency physician and radiologist increased from 0.867 to 0.955 after contrast enhancement on US. Conclusions: Contrast-enhanced US may permit a more accurate diagnosis for liver trauma than conventional US by both the radiologist and emergency physician. Contrast-enhanced US may also reduce interobserver variability for this diagnosis. [ABSTRACT FROM AUTHOR]

Rationale and Objectives: To characterize an iodized oil emulsion for computed tomography (CT) imaging of experimental hepatic tumors in rat models. Materials and Methods: For characterizing the agents in normal rats, three rats were intravenously infused and imaged with clinical CT up to 1 week. Iopamidol solution was also used as controls (n = 3). For evaluating the feasibility of diagnosis of hepatic tumors, 12 rats were injected with C6 glial tumor cells into the liver 11, 9, 7, and 5 days before CT (n = 3 per day). After CT imaging, gross and histopathologic correlation of liver tumors with CT images were performed. Results: CT numbers of aorta and inferior vena cava (IVC) increased immediately after injection of the emulsion and remained above 200 Hounsfield units for 1 hour (maximum: 295.67 ± 27.65 in aorta and 347.07 ± 10.58 in IVC). The mean attenuation in liver and spleen was relatively stable between 30 and 180 minutes (maximum: 188.84 ± 18.70 in liver and 210.97 ± 15.83 in spleen). All 20 tumors later confirmed by pathology were detected as hypodense lesions on CT (sensitivity: 100%; range, 2.0–16.4 mm). The mean enhancement ratios of liver at all time points were significantly higher than those of tumors (P < .05). Conclusion: The hepatic enhancement achieved by the iodized oil emulsion is reticuloendothelial system–specific with the property of blood pool enhancement and longer lasting than that achievable with the current water soluble agents. Thus, this agent may offer significant advantages for diagnosis of hepatic metastases. [Copyright &y& Elsevier]