Left colonic metastasis from primary hepatocellular carcinoma: A case report

BACKGROUND Hepatocellular carcinoma(HCC)accounts for 5-6%of all human cancers.Considering the extrahepatic metastasis,the main organs involved are lymphnodes,lung,bone and adrenal gland.Usually colon metastasis is very rare,especially on the left sided colon.CASE SUMMARY We report a case of a 70 years-old man hepatitis B carrier with HCC treated four times with trans-arterial chemoembolization,presented to our surgical department complaining of gastrointestinal bleeding.A colonoscopy revealed a mass of 4 cm of the sigmoid colon with signs of bleeding.The computed tomography showed a mass originated from the sigmoid colon of 3.5 cm,and the presence of HCC in segment VI and VII,without portal vein thrombosis.Due to the large size of the mass and the active bleeding,the patient underwent a left colectomy.The postoperative period was uneventful,and the patient was discharged in fifth post-operative day.Histological examination revealed that the neoplasm was characterized by a diffuse proliferation of epithelial cells with an hepatoid differentiation.So,the presence of a history of HCC of the liver and the histopathological features supported the diagnosis of metastasis from the liver.CONCLUSION Although rare,colon metastasis from an HCC can be left-sided and can present with acute bleeding.

Robotic vs laparoscopic right colectomy—the burden of age and comorbidity in perioperative outcomes: An observational study

BACKGROUND Several studies have shown the safety,feasibility and oncologic adequacy of robotic right hemicolectomy(RRH).Laparoscopic right hemicolectomy(LRH)is considered technically challenging.Robotic surgery has been introduced to overcome this technical limitation,but it is related to high costs.To maximize the benefits of such surgery,only selected patients are candidates for this technique.In addition,due to progressive aging of the population,an increasing number of minimally invasive procedures are performed on elderly patients with severe comorbidities,who are usually more prone to post-operative complications.AIM To investigate the outcomes of RRH vs LRH with regard to age and comorbidities.METHODS We retrospectively analyzed 123 minimally invasive procedures(68 LRHs vs 55 RRHs)for right colon cancer or endoscopically unresectable adenoma performed in our Center from January 2014 until September 2019.The surgical procedures were performed according to standardized techniques.The primary clinical outcome of the study was the length of hospital stay(LOS)measured in days.Secondary outcomes were time to first flatus(TFF)and time to first stool evacuation.The robotic technique was considered the exposure and the laparoscopic technique was considered the control.Routine demographic variables were obtained,including age at time of surgery and gender.Body mass index and American Society of Anesthesiologists physical status were registered.The age-adjusted Charlson Comorbidity Index(ACCI)was calculated;the tumornode-metastasis system,intra-operative variables and post-operative complications were recorded.Post-operative follow-up was 180 d.RESULTS LOS,TFF,and time to first stool were significantly shorter in the robotic group:Median 6[interquartile range(IQR)5-8]vs 7(IQR 6-10.5)d,P=0.028;median 2(IQR 1-3)vs 3(IQR 2-4)d,P<0.001;median 4(IQR 3-5)vs 5(IQR 4-6.5)d,P=0.005,respectively.Following multivariable analysis,the robotic technique was confirmed to be predictive of significantly shorter hospitalization and faster restoration of bowel function;in addition the dichotomous variables of age over75 years and ACCI more than 7 were significant predictors of hospital stay.No outcomes were significantly associated with Clavien-Dindo grading.Sub-group analysis demonstrated that patients aged over 75 years had a longer LOS(median6-IQR 5-8-vs 7-IQR 6-12-d,P=0.013)and later TFF(median 2-IQR 1-3-vs 3-IQR 2-4-d,P=0.008),while patients with ACCI more than 7 were only associated with a prolonged hospital stay(median 7-IQR 5-8-vs 7-IQR 6-14.5-d,P=0.036).CONCLUSION RRH is related to shorter LOS when compared with the laparoscopic approach,but older age and several comorbidities tend to reduce its benefits.

Artificial intelligence as a future in cancer surgery

Artificial intelligence(AI)is defined as the theory and development of computer systems able to perform tasks normally requiring human intelligence,such as visual perception,speech recognition,and decision-making.Machine learning and deep learning(DL)are subfields of AI that are able to learn from experience in order to complete tasks.AI and its subfields,in particular DL,have been applied in numerous fields of medicine,especially in the cure of cancer.Computer vision(CV)system has improved diagnostic accuracy both in histopathology analyses and radiology.In surgery,CV has been used to design navigation system and robotic-assisted surgical tools that increased the safety and efficiency of oncological surgery by minimizing human error.By learning the basis of AI,surgeons can take part in this revolution to optimize surgical care of oncologic disease.

Robotic surgery in colon cancer: current evidence and future perspectives – narrative review

In the last 10 years,surgery has been developing towards minimal invasiveness;therefore,robotic surgery represents the consequent evolution of laparoscopic surgery.Worldwide,surgeons’performances have been upgraded by the ergonomic developments of robotic systems,leading to several benefits for patients.The introduction into the market of the new Da Vinci Xi system has made it possible to perform all types of surgery on the colon,an in selected cases,to combine interventions in other organs or viscera at the same time.Optimization of the suprapubic surgical approach may shorten the length of hospital stay for patients who undergo robotic colonic resection.From this perspective,single-port robotic colectomy,has reduced the number of robotic ports needed,allowing a better anesthetic outcome and faster recovery.The introduction on the market of new surgical robotic systems from multiple manufacturers is bound to change the landscape of robotic surgery and yield high-quality surgical outcomes.