Vascular resection in pancreatic adenocarcinoma with portal or superior mesenteric vein invasion

AIM:To evaluate long-term survival after the Whipple operation with superior mesenteric vein/portal vein resection(SMV/PVR)in relation to resection length.METHODS:We evaluated 118 patients who underwent the Whipple operation for pancreatic adenocarcinoma at our Department of Hepatobiliary Pancreatic Surgery between 2005 and 2010.Fifty-eight of these patients were diagnosed with microscopic PV/SMV invasion by frozen-section examination and underwent SMV/PVR.In 28 patients,the length of SMV/PVR was≤3 cm.In the other 30 patients,the length of SMV/PVR was>3cm.Clinical and survival data were analyzed.RESULTS:SMV/PVR was performed successfully in 58patients.There was a significant difference between the two groups(SMV/PVR≤3 cm and SMV/PVR>3 cm)in terms of the mean survival time(18 mo vs 11 mo)and the overall 1-and 3-year survival rates(67.9%and14.3%vs 41.3%and 5.7%,P<0.02).However,there was no significant difference in age(64 years vs 58years,P=0.06),operative time(435 min vs 477 min,P=0.063),blood loss(300 mL vs 383 mL,P=0.071)and transfusion volume(85.7 mL vs 166.7 mL,P=0.084)between the two groups.CONCLUSION:Patients who underwent the Whipple operation with SMV/PVR≤3 cm had better long-term survival than those with>3 cm resection.

Surgical treatment of malignant biliary papillomatosis invading adjacent organs: A case report

BACKGROUND Biliary papillomatosis(BP) is a rare disease characterized by multiple papillary adenomas in the intrahepatic and extrahepatic biliary tree and has a high risk of malignant transformation. Early diagnosis and treatment for BP are challenges, as it spreads along the biliary tract. A radical resection with an adequate resection margin is advocated in patients with malignant BP.CASE SUMMARY We report a case of BP with malignant transformation in a 52-year-old female patient who presented with emaciation, severe malnutrition, and a T-tube for biliary drainage that was placed for almost 2 years at the time she visited us. The enhanced magnetic resonance imaging of the upper abdomen revealed a neoplasm with a diameter of 15 cm located in the gallbladder area surrounding the common bile duct where a drainage tube was placed. It was the first case with malignant BP involving multiple organs and the abdominal wall and receiving a radical resection. Plastic surgeons helped close the incision by transferring the rectus muscle and external oblique muscle flap. A diagnosis of papillary carcinoma with diffuse malignant papillomatosis of the biliary duct was given.The postoperative course was uneventful and she was asymptomatic and in good physical condition at 35 mo postoperatively with appropriate chemotherapy.CONCLUSION Aggressive surgical treatment with appropriate chemotherapy is advocated for patients with malignant BP even if multiple organ invasion is present.

Prospective randomized comparison of transumbilical two-port laparoscopic and conventional laparoscopic varicocele ligation

We have established a novel method named transumbilical two-port laparoscopic varicocele ligation （TTLVL） for varicocele, which is still needed to evaluate. In this study, 90 patients with left idiopathic symptomatic varicoceles of grades Ⅱ-Ⅲ according to the Dubin grading system were randomly assigned to TTLVL （n = 45） and conventional laparoscopic varicocele ligation （CLVL） （n = 45）. The demographic, intraoperative, postoperative, and follow-up data were recorded and compared between the two groups. All the procedures in the two groups were completed successfully with no intraoperative complications and no conversions to open surgery. No significant difference was found in the operative time, resuming ambulation, bowel recovery, postoperative hospital stay, and postoperative resolution of scrotal pain between the two groups （P 〉 0.05）. However, the postoperative mean visual analog pain scale scores for TTLVL group were all less at 24 h, 48 h, 72 h, and 7 days postoperatively compared to CLVL （P= 0.001, 0.010, 0.006, and 0.027, respectively）. The mean patient scar assessment questionnaire score in postoperative month 3 was 29.7 for TTLVL group compared with 32.1 for CLVL group （P 〈 0.001）. There was no testicular atrophy observed in both groups during the follow-up period. The study shows that TTLVL is a safe, feasible, and effective minimally invasive surgical alternative to CLVL for the treatment of varicocele. Compared with CLVL, TTLVL may decrease postoperative pain and improve the cosmetic outcomes.