Laparoscopic spleen-preserving total pancreatectomy for the treatment of low-grade malignant pancreatic tumors:Two case reports and review of literature

BACKGROUND Function-preserving pancreatectomy can improve the long-term quality of life of patients with benign or low-grade malignant tumors,such as intraductal papillary mucinous neoplasms(IPMNs)and mucinous cystic neoplasms.However,there is limited literature on laparoscopic spleen-preserving total pancreatectomy(LSpTP)due to technical difficulties.CASE SUMMARY Patient 1 was a 51-year-old male diagnosed with IPMN based on preoperative imaging,showing solid nodules in the pancreatic head and diffuse dilation of the main pancreatic duct with atrophy of the distal pancreas.We performed L-SpTP with preservation of the splenic vessels,and the postoperative pathology report revealed IPMN with invasive carcinoma.Patient 2 was a 60-year-old male with multiple cystic lesions in the pancreatic head and body.L-SpTP was performed,and intraoperatively,the splenic vein was injured and required ligation.Postoperative pathology revealed a mucinous cystic tumor of the pancreas with low-grade dysplasia.Both patients were discharged on postoperative day 7,and there were no major complications during the perioperative period.CONCLUSION We believe that L-SpTP is a safe and feasible treatment for low-grade malignant pancreatic tumors,but more case studies are needed to evaluate its safety,efficacy,and long-term outcomes.

Clinicopathological Evaluation of Ovarian Juvenile Granulosa Cell Tumor: Is Fertility-Sparing Surgery Safe?

Objective:To retrospectively investigate the clinicopathological characteristics of ovarian juvenile granulosa cell tumors(JGCTs)and to evaluate the safety of fertility-sparing surgery.Methods:In this study,surgically treated patients with JGCTs diagnosed between January 2004 and October 2018 in our center were identified.Clinicopathological data,survival outcomes,and recurrence rates were examined in these patients.Results:A total of 8 patients were included.All patients were premenarchal girls or young women(age range,9-32 years).Irregular vaginal bleeding was the most common presenting symptom.Of them,seven patients were classified with Stage I JGCTs,and they underwent fertility-sparing surgery.One patient who had Stage IIIC JGCT and had completed childbearing underwent complete surgery.Seven patients received adjuvant chemotherapy.The median follow-up duration in the total cohort was 64 months(range,2-117 months).The overall survival rate in the fertility-sparing group was 100%,whereas the patient with Stage IIIC JGCT died 1 month after the treatment.Conclusions:Fertility-sparing surgery might not show a negative impact on oncologic outcomes.Fertility sparing could be considered a modified option for patients with Stage I JGCTs.However,due to the limited number of patients,the conclusion must be interpreted with caution,and larger or multicenter studies are needed before conclusions can be drawn.

Surgical incision in complete video-assisted mitral valve replacement

Background Prosthetic mitral valve replacement is a common surgical treatment of mitral valve disease.Complete video-assisted mitral valve replacement represents the contemporary minimally invasive cardiac surgery in valve disease surgical therapy. In the field of minimally invasive cardiac surgery, the success of the operation is largely depending on surgical incision, it also reflects the surgeon’s technique level. Method From February 2010 to February 2013, 80 cases of cardiac patients with mitral valve pathological changes in our department who had received surgical treatment of complete video-assisted mitral valve replacement were recruited, they were divided into two groups according to the surgical incision： midclavicular group（M group,n = 50） and parasternal group（P group, n = 30）. The clinical data were recorded including： cardiopulmonary bypass time, aortic clamping time, volume of thoracic drainage after operation, ICU tracheal intubation time,postoperative days of hospital stay and time for observing the postoperative complications. The comparison between two groups was performed using t-test analysis. Result Both M Group and P Group had favorable surgical view, there were no emergency situation of redo median sternotomy during initial operative period or intraoperative death, no pericardial tamponade, no infection, and no other serious postoperative complications.Whereas, there were 2 cases of redo operation for stanch bleeding in M Group and 1 case of perivalvular leakage in P Group. Nevertheless, 3 months later, the result of reexamine showed that the perivalvular leakage had vanished. The clinical data was shown as follow（M Group vs. P Group）： cardiopulmonary bypass time（90.2 ± 28.7 vs. 87.3 ± 24.5 min, P 〉 0.05）, aortic clamping time（65.2 ± 17.4 vs. 68.6 ± 21.9 min, P 〉 0.05）,1st day volume of thoracic drainage after operation 1（75.8 ± 35.6 vs. 53.2 ± 25.6 mL, P 〉 0.05）, ICU tracheal intubation time（9.6 ± 3.4 vs. 8.4 ± 4.5 hours, P 〉 0.05）, postoperative days of hospital stay（7.3 ± 2.2 vs. 6.9± 3.2 days, P 〉 0.05）. T-test analysis of the data of each groups showed that there were no significant statistically difference. Conclusions Appropriate surgical incisions guarantee a favorable surgical view and the success of the whole process during intraoperative period. In both midclavicular and parasternal approaches, the complete video-assisted mitral valve replacement is able to be accomplished safely and successfully. Due to the current development level of thoracoscopic instruments and equipment, the surgical incision and approach for video-assisted mitral valve replacement are diversified. As a result, diversified surgical incisions can be customized according to the variegated pathological changes of cardiac patients.