Complete resection of the hepatic veins: The role of right inferior vein

To the editor:In the recent years liver surgery has been dramatically improved because of technical and technological innovations,perioperative and intraoperative intensive care,better knowledge of liver physiology and early recognition and treatment of postoperative complications.Last but not least,liver anatomy,though not

Endoscopic mucosal resection with double band ligation versus endoscopic submucosal dissection for small rectal neuroendocrine tumors

BACKGROUND Endoscopic resection remains an effective method for the treatment of small rectal neuroendocrine tumors(NETs)(≤10 mm).Moreover,endoscopic mucosal resection(EMR)with double band ligation(EMR-dB),a simplified modification of EMR with band ligation,is an alternative strategy to remove small rectal NETs.AIM To evaluate the feasibility and safety of EMR-dB for the treatment of small rectal NETs(≤10 mm).METHODS A total of 50 patients with small rectal NETs,without regional lymph node enlargement or distant metastasis confirmed by endoscopic ultrasound,computerized tomography scan,or magnetic resonance imaging,were enrolled in the study from March 2021 to June 2022.These patients were randomly assigned into the EMR-dB(n=25)group or endoscopic submucosal dissection(ESD)group(n=25).The characteristics of the patients and tumors,procedure time,devices cost,complete resection rate,complications,and recurrence outcomes were analyzed.RESULTS There were 25 patients(13 males,12 females;age range 28-68 years old)in the EMR-dB group,and the ESD group contained 25 patients(15 males,10 females;age range 25-70 years old).Both groups had similar lesion sizes(EMR-dB 4.53±1.02 mm,ESD 5.140±1.74 mm;P=0.141)and resected lesion sizes(1.32±0.52 cm vs 1.58±0.84 cm;P=0.269).Furthermore,the histological complete resection and en bloc resection rates were achieved in all patients(100%for each).In addition,there was no significant difference in the complication rate between the two groups.However,the procedure time was significantly shorter and the devices cost was significantly lower in the EMRdB group.Besides,there was no recurrence in both groups during the follow-up period.CONCLUSION The procedure time of EMR-dB was shorter compared with ESD,and both approaches showed a similar curative effect.Taken together,EMR-dB was a feasible and safe option for the treatment of small rectal NETs.

Preservation of left colic artery in laparoscopic colorectal operation: The benefit challenge

BACKGROUND During laparoscopic resection for colorectal cancer,there is controversy regarding whether the left colic artery(LCA)should be preserved at its origin.AIM To investigate the prognostic significance of preservation of the LCA in colorectal cancer surgery.METHODS Patients were divided into two groups.The high ligation(H-L)technique(refers to ligation performed 1 cm from the beginning of the inferior mesenteric artery)group consisted of 46 patients,and the low ligation(L-L)technique(refers to ligation performed below the initiation of the LCA)group consisted of 148 patients.Operative time,blood loss,lymph nodes with tumor invasion,postoperative complications and recovery time,recurrence rate,and 5-year survival rate were compared between the two groups.RESULTS The average number of lymph nodes detected in postoperative pathological specimens was 17.4/person in the H-L group and 15.9/person in the L-L group.There were 20 patients(43%)with positive lymph nodes(lymph node metastasis)in the H-L group and 60 patients(41%)in the L-L group.No statistical differences were found between the groups.Complications occurred in 12 cases(26%)in the H-L group and in 26 cases(18%)in the L-L group.The incidences of postoperative anastomotic complications and functional urinary complications were significantly lower in the L-L group.The 5-year survival rates in H-L and L-L groups were 81.7%and 81.6%,respectively,and relapse-free survival rates were 74.3%and 77.1%,respectively.The two groups were similar statistically.CONCLUSION Complete mesenteric resection combined with lymph node dissection around the inferior mesenteric artery root while preserving the LCA is a beneficial surgical approach during laparoscopic resection for colorectal cancer.

Novel and safer endoscopic cholecystectomy using only a flexible endoscope via single port

AIM: To apply the laparoscopic and endoscopic cooperative surgery concept, we investigated whether endoscopic cholecystectomy could be performed more safely and rapidly via only 1 port or not.METHODS: Two dogs(11 and 13-mo-old female Beagle) were used in this study. Only 1 blunt port was created, and a flexible endoscope with a tip attachment was inserted between the fundus of gallbladder and liver. After local injection of saline to the gallbladder bed, resection of the gallbladder bed from the liver was performed. After complete resection of the gallbladder bed, the gallbladder was pulled up to resect its neck using the Ring-shaped thread technique. The neck of the gallbladder was cut using scissor forceps. Resected gallbladder was retrieved using endoscopic net forceps via a port. RESULTS: The operation times from general anesthetizing with sevoflurane to finishing the closure of the blunt port site were about 50 min and 60 min respectively. The resection times of gallbladder bed were about 15 min and 13 min respectively without liver injury and bleeding at all. Feed were given just after next day of operation, and they had a good appetite. Two dogs are in good health now and no complications for 1 mo after endoscopic cholecystectomy using only a flexible endoscope via one port.CONCLUSION: We are sure of great feasibility of endoscopic cholecystectomy via single port for human.

Multiple well-differentiated retroperitoneal liposarcomas with different patterns of appearance on computed tomography:A case report

BACKGROUND Primary retroperitoneal liposarcoma(PRPLS)is a rare soft tissue tumor with nonspecific clinical symptoms;it has different computed tomography(CT)image features according to pathological types.Some patients with a single tumor have been previously reported in the literature.We present an exceptional case of a PRPLS patient with multiple large tumors exhibiting different patterns of appearance on CT and confirmed as atypical lipomatous tumor/welldifferentiated liposarcoma by postoperative pathology.CASE SUMMARY A 64-year-old man presented with abdominal distension for 1 year.The patient was diagnosed with PRPLS based on physical examination,laparotomy,ultrasonography,CT scan,and surgery.Both of the tumors were completely resected through surgery and confirmed as atypical lipomatous tumor/welldifferentiated liposarcoma by postoperative pathology.The postoperative course was uneventful without recurrence or metastasis,as demonstrated by abdominalpelvic CT during an 18 mo follow-up.CONCLUSION Multiple large Well-differentiated liposarcomas with different patterns of appearance on CT image can occur simultaneously in the same patient,to which more attention should be paid to make an effective differential diagnosis.

Giant Cell Tumor of the Wrist: Rare Location of the Distal Ulna

Giant cell tumor of the wrist is a rare, benign and usually symptomatic condition. The discovery is sometimes made following a medical imaging examination or a painful symptomatology or more often a visible or palpable swelling with or without vascular and/or nerve compression. At an advanced stage, the X-ray is of paramount importance. The well codified complete surgical resection is part of the therapeutic arsenal. We present a clinical case report of a young woman with a giant cell tumor localized in the wrist in N’Djamena, Chad. This case concerns a 25-year-old patient who presented in July 2020 of a painful swelling lateral to her left wrist bone and whose X-ray radiography showed lysis of the cortical bone in the lower third of the ulna. After the operative resection of the tumor mass, the pathological examination of the operative specimen revealed the diagnosis of a giant cell tumor. A giant cell tumor is a benign condition, with a few symptoms and the location at the ulna is exceptional. Complete surgical resection is a viable treatment option.

Complete transurethral resection of bladder tumor before radical cystectomy is not a risk factor for organ-confined bladder cancer:A case-control study

Objectives:To investigate the role of complete transurethral resection of bladder tumor(TURBT)before radical cystectomy(RC)for organ-confined bladder cancer.Materials and methods:Data of patients who underwent RC in our center from January 2008 to December 2018 were retrospectively reviewed.Patients with>T2N0M0 disease and positive surgical margins and those who received neoadjuvant/adjuvant chemotherapy or radiotherapy were excluded.Complete TURBT was defined as no visible lesion under endoscopic examination after TURBT or in the bladder specimen after RC.Kaplan-Meier curves and log-rank tests assessed disease-free survival(DFS).Logistic and Cox regression analyses were performed to identify potential predictors.Results:A total of 236 patients were included in this review,including 207 males,with a median age of 61 years.The median tumor size was 3 cm,and a total of 94 patients had identified pathological T2 stage disease.Complete TURBT was correlated with tumor size(p=0.041),histological variants(p=0.026),and down-staging(p<0.001).Tumor size,grade,and histological variants were independent predictors of complete TURBT.During a median follow-up of 42.7 months,30 patients developed disease recurrence.Age and histological variants were independent predictors of DFS(p=0.022 and 0.032,respectively),whereas complete TURBT was not an independent predictor of DFS(p=0.156).Down-staging was not associated with survival outcome.Conclusions:Complete TURBT was correlated with an increased rate of down-staging before RC.It was not associated with better oncologic outcomes for patients with organ-confined bladder cancer.