Low rectal cancer is traditionally treated by abdominoperineal resection. In recent years, several new techniques for the treatment of very low rectal cancer patients aiming to preserve the gastrointestinal continuity...Low rectal cancer is traditionally treated by abdominoperineal resection. In recent years, several new techniques for the treatment of very low rectal cancer patients aiming to preserve the gastrointestinal continuity and to improve both the oncological as well as the functional outcomes, have been emerged. Literature suggest that when the intersphincteric resection is applied in T1-3 tumors located within 30-35 mm from the anal verge, is technically feasible, safe, with equal oncological outcomes compared to conventional surgery and acceptable quality of life. The Anterior Perineal Plan E for Ultra-low Anterior Resection technique, is not disrupting the sphincters, but carries a high complication rate, while the reports on the oncological and functional outcomes are limited. Transanal Endoscopic Micro Surgery(TEM) and Trans Anal Minimally Invasive Surgery(TAMIS) should represent the treatment of choice for T1 rectal tumors, with specific criteria according to the NCCN guidelines and favorable pathologic features. Alternatively to the standard conventional surgery, neoadjuvant chemo-radiotherapy followed by TEM or TAMIS seems promising for tumors of a local stage T1sm2-3 or T2. Transanal Total Mesorectal Excision should be performed only when a board approved protocol is available by colorectal surgeons with extensive experience in minimally invasive and transanal endoscopic surgery.展开更多
BACKGROUND The perivascular epithelioid cell tumour(PEComa)family of tumours mainly includes renal and hepatic angiomyolipomas,pulmonary lymphangioleiomyomatosis and clear cell“sugar”tumour of the lung.Several uncom...BACKGROUND The perivascular epithelioid cell tumour(PEComa)family of tumours mainly includes renal and hepatic angiomyolipomas,pulmonary lymphangioleiomyomatosis and clear cell“sugar”tumour of the lung.Several uncommon tumours with similar morphological and immunophenotypical characteristics arising at a variety of sites(abdominal cavity,digestive tract,retroperitoneum,skin,soft tissue and bones)are also included in the PEComa family and are referred to as PEComas not otherwise specified.CASE SUMMARY We present a 37-year-old female patient who underwent resection of an 8.5 cm×8 cm×4 cm retroperitoneal tumour,which eventually was diagnosed as PEComa of uncertain biological behaviour.Three years after the operation,the patient remains without any evidence of recurrence.A search was performed in the Medline and EMBASE databases for articles published between 1996 and 2018,and we identified 31 articles related to retroperitoneal and perinephric PEComas.We focused on sex,age,maximum dimension,histological and immunohistochemical characteristics of the tumour,follow-up and long-term outcome.Thirty-four retroperitoneal(including the present one)and ten perinephric PEComas were identified,carrying a malignant potential rate of 44%and 60%,respectively.Nearly half of the potentially malignant PEComas presented with or developed metastases during the course of the disease.CONCLUSION Retroperitoneal PEComas are not as indolent as they are supposed to be.Radical surgical resection constitutes the treatment of choice for localized disease,while mammalian target of the rapamycin(mTOR)inhibitors constitute the most promising therapy for disseminated disease.The role of mTOR inhibitors as adjuvant or neoadjuvant therapies needs to be evaluated in the future.展开更多
AIM:To evaluate routine modified D2 lymphadenectomy in gastric cancer,based on immunohistochemically detected skip micrometastases in levelⅡlymph nodes. METHODS:Among 95 gastric cancer patients who were routinely sub...AIM:To evaluate routine modified D2 lymphadenectomy in gastric cancer,based on immunohistochemically detected skip micrometastases in levelⅡlymph nodes. METHODS:Among 95 gastric cancer patients who were routinely submitted to curative modified D2 lymphadenectomy,from January 2004 to December 2008,32 were classified as pN0.All levelⅠlymph nodes of these 32 patients were submitted to immunohistochemistry for micrometastases detection. Patients in whom micrometastases were detected in the levelⅠlymph node stations(n=4)were excluded from further analysis.The levelⅡlymph nodes of the remaining 28 patients were studied immunohistochemically for micrometastases detection and constitute the material of the present study. RESULTS:Skip micrometastases in the levelⅡlymph nodes were detected in 14%(4 out of 28)of the patients. The incidence was further increased to 17%(4 out of24)in the subgroup of T1-2 gastric cancer patients.All micrometastases were detected in the No.7 lymph node station.Thus,the disease was upstaged from stageⅠA toⅠB in one patient and from stageⅠB toⅡin three patients. CONCLUSION:In gastric cancer,true R0 resection may not be achieved without modified D2 lymphadenectomy. Until D2+/D3 lymphadenectomy becomes standard, modified D2 lymphadenectomy should be performed routinely.展开更多
BACKGROUND： Liver resection is currently the most efficient curative approach for a wide variety of liver tumors. The application of modern techniques and new surgical devices has improved operative outcomes. Radiofr...BACKGROUND： Liver resection is currently the most efficient curative approach for a wide variety of liver tumors. The application of modern techniques and new surgical devices has improved operative outcomes. Radiofrequency ablation is used more often for liver parenchymal transection. This study aimed to assess the efficacy and safety of radiofrequency ablation-assisted liver resection.METHODS： A retrospective study of 145 consecutive patients who underwent radiofrequency ablation-assisted liver resection was performed. Intraoperative blood loss, need for transfusion or intraoperative Pringle maneuver, the duration of liver parenchymal transection, perioperative complications, and postoperative morbidity and mortality were all evaluated.RESULTS： Fifty minor and ninety-five major liver resections were performed. The mean intraoperative blood loss was 251 m L, with a transfusion rate of 11.7%. The Pringle maneuver was necessary in 12 patients（8.3%）. The mean duration for parenchymal transection was 51.75 minutes. There were 47 patients（32.4%） with postoperative complications. There is no mortality within 30 days after surgery. CONCLUSIONS： Radiofrequency ablation-assisted liver resection permits both major and minor liver resections with minimal blood loss and without occlusion of hepatic inflow. Furthermore it decreases the need for blood transfusion and reduces morbidity and mortality.展开更多
New insights emerged last decade that enriched our knowledge regarding the biological behavior of appendiceal neuroendocrine tumors(NETs),which range from totally benign tumors less than 1cm to goblet cell carcinomas ...New insights emerged last decade that enriched our knowledge regarding the biological behavior of appendiceal neuroendocrine tumors(NETs),which range from totally benign tumors less than 1cm to goblet cell carcinomas which behave similarly to colorectal adenocarcinoma.The clinical implication of that knowledge reflected to surgical strategies which also vary from simple appendicectomy to radical abdominal procedures based on specific clinical and histological characteristics.Since the diagnosis is usually established post-appendicectomy,current recommendations focus on the early detection of:(1)the subgroup of patients who require further therapy;(2)the recurrence based on the chromogranin a plasma levels;and(3)other malignancies which are commonly developed in patients with appendiceal NETs.展开更多
Complete mesocolic excision(CME) for the treatment of colon cancer was first introduced in the West in 2008. The first aim of this procedure is to remove the afflicted colon and its accessory lymphovascular supply by ...Complete mesocolic excision(CME) for the treatment of colon cancer was first introduced in the West in 2008. The first aim of this procedure is to remove the afflicted colon and its accessory lymphovascular supply by resecting the colon and mesocolon in an intact envelope of visceral peritoneum, which holds potentiallyinvolved lymph nodes. The second component of CME is a central vascular tie to remove completely all lymph nodes in the central(vertical) direction. In its original iteration, CME was performed via laparotomy, although many centers preferentially perform laparoscopic surgery, with its associated benefits and similar oncolo-gical outcomes, as the standard treatment for colonic cancer. Here, we present the surgical techniques for CME in open and laparoscopic surgery, as well as the surgical, pathological and oncological outcomes of the procedure that are available to date. Because there are no randomized control trials comparing CME to "standard" colon surgery, the principles underlying CME seem anatomical and logical, and the results published from the Far East, reporting an 80% 5-year survival rate for Stage III cancer, should guide us.展开更多
The 7th TNM classification clearly states that micro-metastases detected by morphological techniques(HE stain and immunohistochemistry) should always be reported and calculated in the staging of the disease(pN1mi or M...The 7th TNM classification clearly states that micro-metastases detected by morphological techniques(HE stain and immunohistochemistry) should always be reported and calculated in the staging of the disease(pN1mi or M1),while patients in whom micrometas-tases are detected by non-morphological techniques(e.g.,ow cytometry,reverse-transcriptase polymerase chain reaction) should still be classif ied as N0 or M0.In gastric cancer patients,micrometastases have been de-tected in lymph nodes,the peritoneal cavity and bone marrow.However,the clinical implications and/or their prognostic signif icance are still a matter of debate.Cur-rent literature suggests that lymph node micrometasta-ses should be encountered for the loco-regional staging of the disease,while skip lymph node micrometastases should also be encountered in the total number of infiltrated lymph nodes.Peritoneal fluid cytology ex-amination should be obligatorily performed in pT3 or pT4 tumors.A positive cytology classif ies gastric cancer patients as stage Ⅳ.Although a curative resection is not precluded,these patients face an overall dismal prognosis.Whether patients with a positive cytology should be treated similarly to patients with macroscopic peritoneal recurrence should be evaluated further.Gas-tric cancer cells are detected with high incidence in the bone marrow.However,the published results make comparison of data between groups almost impossible due to severe methodological problems.If these meth-odological problems are overcome in the future,specif ic target therapies may be designed for specif ic groups of patients.展开更多
Lymphatic complications leading to retention,accumulation or drainage of peritoneal fluid are frequently encountered following extended or superextended lymphadenectomy for gastric cancer.1 The vast majority of these ...Lymphatic complications leading to retention,accumulation or drainage of peritoneal fluid are frequently encountered following extended or superextended lymphadenectomy for gastric cancer.1 The vast majority of these drainages usually subsides spontaneously, but in some instances they can persist for long period of time causing significant morbidity.However, the classification,展开更多
Angiomyolipoma （AML） is a tumour of uncertain .histogenesis originally believed to be a hamartomatous lesion, but recently recognized as a usually benign clonal mesenchymal neoplasm. Along with lymphagiomyomatosis ...Angiomyolipoma （AML） is a tumour of uncertain .histogenesis originally believed to be a hamartomatous lesion, but recently recognized as a usually benign clonal mesenchymal neoplasm. Along with lymphagiomyomatosis （LAM）, clear cell ＂sugar＂ turnout （CCST） and clear cell myelomelanocytic tumour （CCMMT）, AML was classified in the so called perivascular epithelioid cell （PEComa） neoplasm family.展开更多
文摘Low rectal cancer is traditionally treated by abdominoperineal resection. In recent years, several new techniques for the treatment of very low rectal cancer patients aiming to preserve the gastrointestinal continuity and to improve both the oncological as well as the functional outcomes, have been emerged. Literature suggest that when the intersphincteric resection is applied in T1-3 tumors located within 30-35 mm from the anal verge, is technically feasible, safe, with equal oncological outcomes compared to conventional surgery and acceptable quality of life. The Anterior Perineal Plan E for Ultra-low Anterior Resection technique, is not disrupting the sphincters, but carries a high complication rate, while the reports on the oncological and functional outcomes are limited. Transanal Endoscopic Micro Surgery(TEM) and Trans Anal Minimally Invasive Surgery(TAMIS) should represent the treatment of choice for T1 rectal tumors, with specific criteria according to the NCCN guidelines and favorable pathologic features. Alternatively to the standard conventional surgery, neoadjuvant chemo-radiotherapy followed by TEM or TAMIS seems promising for tumors of a local stage T1sm2-3 or T2. Transanal Total Mesorectal Excision should be performed only when a board approved protocol is available by colorectal surgeons with extensive experience in minimally invasive and transanal endoscopic surgery.
文摘BACKGROUND The perivascular epithelioid cell tumour(PEComa)family of tumours mainly includes renal and hepatic angiomyolipomas,pulmonary lymphangioleiomyomatosis and clear cell“sugar”tumour of the lung.Several uncommon tumours with similar morphological and immunophenotypical characteristics arising at a variety of sites(abdominal cavity,digestive tract,retroperitoneum,skin,soft tissue and bones)are also included in the PEComa family and are referred to as PEComas not otherwise specified.CASE SUMMARY We present a 37-year-old female patient who underwent resection of an 8.5 cm×8 cm×4 cm retroperitoneal tumour,which eventually was diagnosed as PEComa of uncertain biological behaviour.Three years after the operation,the patient remains without any evidence of recurrence.A search was performed in the Medline and EMBASE databases for articles published between 1996 and 2018,and we identified 31 articles related to retroperitoneal and perinephric PEComas.We focused on sex,age,maximum dimension,histological and immunohistochemical characteristics of the tumour,follow-up and long-term outcome.Thirty-four retroperitoneal(including the present one)and ten perinephric PEComas were identified,carrying a malignant potential rate of 44%and 60%,respectively.Nearly half of the potentially malignant PEComas presented with or developed metastases during the course of the disease.CONCLUSION Retroperitoneal PEComas are not as indolent as they are supposed to be.Radical surgical resection constitutes the treatment of choice for localized disease,while mammalian target of the rapamycin(mTOR)inhibitors constitute the most promising therapy for disseminated disease.The role of mTOR inhibitors as adjuvant or neoadjuvant therapies needs to be evaluated in the future.
文摘AIM:To evaluate routine modified D2 lymphadenectomy in gastric cancer,based on immunohistochemically detected skip micrometastases in levelⅡlymph nodes. METHODS:Among 95 gastric cancer patients who were routinely submitted to curative modified D2 lymphadenectomy,from January 2004 to December 2008,32 were classified as pN0.All levelⅠlymph nodes of these 32 patients were submitted to immunohistochemistry for micrometastases detection. Patients in whom micrometastases were detected in the levelⅠlymph node stations(n=4)were excluded from further analysis.The levelⅡlymph nodes of the remaining 28 patients were studied immunohistochemically for micrometastases detection and constitute the material of the present study. RESULTS:Skip micrometastases in the levelⅡlymph nodes were detected in 14%(4 out of 28)of the patients. The incidence was further increased to 17%(4 out of24)in the subgroup of T1-2 gastric cancer patients.All micrometastases were detected in the No.7 lymph node station.Thus,the disease was upstaged from stageⅠA toⅠB in one patient and from stageⅠB toⅡin three patients. CONCLUSION:In gastric cancer,true R0 resection may not be achieved without modified D2 lymphadenectomy. Until D2+/D3 lymphadenectomy becomes standard, modified D2 lymphadenectomy should be performed routinely.
文摘BACKGROUND： Liver resection is currently the most efficient curative approach for a wide variety of liver tumors. The application of modern techniques and new surgical devices has improved operative outcomes. Radiofrequency ablation is used more often for liver parenchymal transection. This study aimed to assess the efficacy and safety of radiofrequency ablation-assisted liver resection.METHODS： A retrospective study of 145 consecutive patients who underwent radiofrequency ablation-assisted liver resection was performed. Intraoperative blood loss, need for transfusion or intraoperative Pringle maneuver, the duration of liver parenchymal transection, perioperative complications, and postoperative morbidity and mortality were all evaluated.RESULTS： Fifty minor and ninety-five major liver resections were performed. The mean intraoperative blood loss was 251 m L, with a transfusion rate of 11.7%. The Pringle maneuver was necessary in 12 patients（8.3%）. The mean duration for parenchymal transection was 51.75 minutes. There were 47 patients（32.4%） with postoperative complications. There is no mortality within 30 days after surgery. CONCLUSIONS： Radiofrequency ablation-assisted liver resection permits both major and minor liver resections with minimal blood loss and without occlusion of hepatic inflow. Furthermore it decreases the need for blood transfusion and reduces morbidity and mortality.
文摘New insights emerged last decade that enriched our knowledge regarding the biological behavior of appendiceal neuroendocrine tumors(NETs),which range from totally benign tumors less than 1cm to goblet cell carcinomas which behave similarly to colorectal adenocarcinoma.The clinical implication of that knowledge reflected to surgical strategies which also vary from simple appendicectomy to radical abdominal procedures based on specific clinical and histological characteristics.Since the diagnosis is usually established post-appendicectomy,current recommendations focus on the early detection of:(1)the subgroup of patients who require further therapy;(2)the recurrence based on the chromogranin a plasma levels;and(3)other malignancies which are commonly developed in patients with appendiceal NETs.
文摘Complete mesocolic excision(CME) for the treatment of colon cancer was first introduced in the West in 2008. The first aim of this procedure is to remove the afflicted colon and its accessory lymphovascular supply by resecting the colon and mesocolon in an intact envelope of visceral peritoneum, which holds potentiallyinvolved lymph nodes. The second component of CME is a central vascular tie to remove completely all lymph nodes in the central(vertical) direction. In its original iteration, CME was performed via laparotomy, although many centers preferentially perform laparoscopic surgery, with its associated benefits and similar oncolo-gical outcomes, as the standard treatment for colonic cancer. Here, we present the surgical techniques for CME in open and laparoscopic surgery, as well as the surgical, pathological and oncological outcomes of the procedure that are available to date. Because there are no randomized control trials comparing CME to "standard" colon surgery, the principles underlying CME seem anatomical and logical, and the results published from the Far East, reporting an 80% 5-year survival rate for Stage III cancer, should guide us.
文摘The 7th TNM classification clearly states that micro-metastases detected by morphological techniques(HE stain and immunohistochemistry) should always be reported and calculated in the staging of the disease(pN1mi or M1),while patients in whom micrometas-tases are detected by non-morphological techniques(e.g.,ow cytometry,reverse-transcriptase polymerase chain reaction) should still be classif ied as N0 or M0.In gastric cancer patients,micrometastases have been de-tected in lymph nodes,the peritoneal cavity and bone marrow.However,the clinical implications and/or their prognostic signif icance are still a matter of debate.Cur-rent literature suggests that lymph node micrometasta-ses should be encountered for the loco-regional staging of the disease,while skip lymph node micrometastases should also be encountered in the total number of infiltrated lymph nodes.Peritoneal fluid cytology ex-amination should be obligatorily performed in pT3 or pT4 tumors.A positive cytology classif ies gastric cancer patients as stage Ⅳ.Although a curative resection is not precluded,these patients face an overall dismal prognosis.Whether patients with a positive cytology should be treated similarly to patients with macroscopic peritoneal recurrence should be evaluated further.Gas-tric cancer cells are detected with high incidence in the bone marrow.However,the published results make comparison of data between groups almost impossible due to severe methodological problems.If these meth-odological problems are overcome in the future,specif ic target therapies may be designed for specif ic groups of patients.
文摘Lymphatic complications leading to retention,accumulation or drainage of peritoneal fluid are frequently encountered following extended or superextended lymphadenectomy for gastric cancer.1 The vast majority of these drainages usually subsides spontaneously, but in some instances they can persist for long period of time causing significant morbidity.However, the classification,
文摘Angiomyolipoma （AML） is a tumour of uncertain .histogenesis originally believed to be a hamartomatous lesion, but recently recognized as a usually benign clonal mesenchymal neoplasm. Along with lymphagiomyomatosis （LAM）, clear cell ＂sugar＂ turnout （CCST） and clear cell myelomelanocytic tumour （CCMMT）, AML was classified in the so called perivascular epithelioid cell （PEComa） neoplasm family.
