BACKGROUND The management of polyps involving the appendiceal orifice(AO)presents notable challenges.Endoscopic resection is frequently hindered by operational complexities,a heightened risk of incomplete removal,and ...BACKGROUND The management of polyps involving the appendiceal orifice(AO)presents notable challenges.Endoscopic resection is frequently hindered by operational complexities,a heightened risk of incomplete removal,and an elevated risk of procedural complications,including appendicitis.Conversely,surgical resection may entail unnecessary excision of intestinal segments,leading to potential morbidity.CASE SUMMARY Here,we reported two patients who presented with polyps deeply situated within the AO,with indistinct boundaries making it challenging to ensure completeness using traditional endoscopic resection.To overcome these challenges,we em-ployed combined endo-laparoscopic surgery(CELS),achieving curative resection without postoperative complications.CONCLUSION The application of CELS in managing polyps involving the AO is emerging as a safe and effective treatment modality.展开更多
AIM: To evaluate the long-term results of radiofrequency ablation (RFA) compared to left lateral sectionectomy (LLS) in patients with Child-Pugh class A disease for the treatment of single and small hepatocellular car...AIM: To evaluate the long-term results of radiofrequency ablation (RFA) compared to left lateral sectionectomy (LLS) in patients with Child-Pugh class A disease for the treatment of single and small hepatocellular carcinoma (HCC) in the left lateral segments.展开更多
AIM: To compare the effectiveness of unilateral recession-resection(R&R) and bilateral/unilateral recession(BLR/ULR) for treatment of basic type of intermittent exotropia [IX(T)].METHODS: A comprehensive literatur...AIM: To compare the effectiveness of unilateral recession-resection(R&R) and bilateral/unilateral recession(BLR/ULR) for treatment of basic type of intermittent exotropia [IX(T)].METHODS: A comprehensive literature search was performed using PubMed, EMBASE, and the Cochrane Library, to identify randomized controlled trials and comparative studies regarding the effectiveness of R&R and BLR/ULR for IX(T). Based on which, a Meta-analysis was then performed in terms of long-term success rate, overcorrection rate, and recurrence rate.RESULTS: Nine studies in total satisfy the specified eligibility criteria. BLR is at disadvantage to R&R at a short-term follow-up [<2 y, OR 0.56(0.33-0.94) for success rate; OR 2.11(1.17, 3.81) for undercorrection rate]. However, BLR achieved a higher success rate [OR 2.49(1.61, 3.86)] and a lower undercorrection rate [OR 0.40(0.23, 0.71)], compared to that of R&R at a long-term followup(>2 y). There is no significant difference was found in overcorrection rate, regardless of the length of follow-up time [OR 0.85(0.41, 1.75)]. In the treatment for small-angle IX(T), the final outcome was significantly different between the groups, demonstrating a more successful alignment [OR 0.37(0.18, 0.74)] and a lower undercorrection [OR 3.50(1.28, 7.26)] in the R&R group than in the ULR group. While for moderate-angle IX(T)(20 PD-25 PD), the effectiveness of R&R and ULR is quite equivalent with similar success rate [OR 1.08(0.65, 1.79)] and undercorrection rate [OR 0.89(0.54, 1.48)]. CONCLUSION: As regard to the effect of BLR and R&R, R&R shows an advantage over BLR at short term. But, BLR is more effective in the long term for the basic typeIX(T) in children. R&R surgery should be a better choice for the treatment of small-angle IX(T) of ≤20 PD than ULR. However, both of ULR and R&R are recommended for moderate-angle IX(T) from 20 PD to 25 PD.展开更多
Rectal cancer constitutes a major public health issue.Total mesorectal excision has remained the gold standard treatment for mid and low rectal tumors since its introduction in the late 1980s.Removal of all lymph node...Rectal cancer constitutes a major public health issue.Total mesorectal excision has remained the gold standard treatment for mid and low rectal tumors since its introduction in the late 1980s.Removal of all lymph nodes located in the mesorectum has indeed improved pathological and oncological outcomes.However,when cancer spreads to the lateral lymph nodes(located along the iliac and obturator arteries)Western and Japanese practices differ.Where the Western guidelines consider this condition as an advanced form of the disease and use neoadjuvant radiochemotherapy liberally,the Japanese guidelines define it as a local disease and proceed to lateral lymph node dissection with or without neoadjuvant treatment.Herein,we review the current literature regarding both therapeutic strategies,with the aim of contributing to potential improvements in treatment and outcome for patients with low and mid rectal cancer.展开更多
Due to the advent of the screening programs for colorectal cancer and the era of quality assurance colonoscopy the number the polyps that can be considered difficult,including large(>20 mm)laterally spreading tumor...Due to the advent of the screening programs for colorectal cancer and the era of quality assurance colonoscopy the number the polyps that can be considered difficult,including large(>20 mm)laterally spreading tumors(LSTs),has increased in the last decade.All LSTs should be assessed carefully,looking for suspicious areas of submucosal invasion(SMI),such as nodules or depressed areas,describing the morphology according to the Paris classification,the pit pattern,and vascular pattern.The simplest,most appropriate and safest endoscopic treatment with curative intent should be selected.For LST-granular homogeneous type,piecemeal endoscopic mucosal resection should be the first option due to its biological low risk of SMI.LST-nongranular pseudodepressed type has an increased risk of SMI,and en bloc resection should be mandatory.Underwater endoscopic mucosal resection is useful in situations where submucosal injection alters the operative field,e.g.,for the resection of scar lesions,with no lifting,adjacent tattoo,incomplete resection attempts,lesions into a colonic diverticulum,in ileocecal valve and lesions with intra-appendicular involvement.Endoscopic full thickness resection is very useful for the treatment of difficult to resect lesions of less than 20 up to 25 mm.Among the indications,we highlight the treatment of polyps with suspected malignancy because the acquired tissue allows an exact histologic risk stratification to assign patients individually to the best treatment and avoid surgery for low-risk lesions.Endoscopic submucosal dissection is the only endoscopic procedure that allows completes en bloc resection regardless of the size of the lesion.It should therefore be indicated in the treatment of lesions with risk of SMI.展开更多
In low rectal cancer surgery,the section of rectum destal to the lower tumor maigin is relaxed and lengthened after fully isolation of the organ. This would facilitate the adoption of anus saving operation.Before and ...In low rectal cancer surgery,the section of rectum destal to the lower tumor maigin is relaxed and lengthened after fully isolation of the organ. This would facilitate the adoption of anus saving operation.Before and after fully isolation of the rectum in low ratal cancer surgery, the distance between the lower tumor margin and the anorectal line was measured by the same rectuscope introduced through the anus.The two results were compared .The average lengthening was less than 1 cm if the lower tumor marginanorectal line distance was 5 cm.It was 1─2 cm if the lower tumor margin-anorectal distance was 6 cm.It was more than 2 cm if the distance was 7─9 cm.The loosening and lengthening of the rectal canal was related to the presence of lymphnode metastasis and the skill of the operator.The lengthening was also influenced by the body build of the patient,involvement of the rectal circumference and the Dukes stage. Modified Park's operation,trans abdominosacral resection with anastormosis of rectum,and anterior resection on transpubic approach are indicated for those in whom the lower tumor margin-anorectal line distance was 5 cm The rectectomy-anastomosis in the abdominal cavity(Dixon's operation)is indicated for those in whom the lower tumor margin-anorectal line was 6 cm.If manual anastomosis is difficult,stapling device may be used. The anus saving resection is easy if the distance was 7─9 cm.展开更多
基金Supported by the National High-Level Hospital Clinical Research Funding,No.2022-PUMCH-B-024 and No.2022-PUMCH-A-020Undergraduate Teaching Reform and Innovation Project,No.2022zlgc0108.
文摘BACKGROUND The management of polyps involving the appendiceal orifice(AO)presents notable challenges.Endoscopic resection is frequently hindered by operational complexities,a heightened risk of incomplete removal,and an elevated risk of procedural complications,including appendicitis.Conversely,surgical resection may entail unnecessary excision of intestinal segments,leading to potential morbidity.CASE SUMMARY Here,we reported two patients who presented with polyps deeply situated within the AO,with indistinct boundaries making it challenging to ensure completeness using traditional endoscopic resection.To overcome these challenges,we em-ployed combined endo-laparoscopic surgery(CELS),achieving curative resection without postoperative complications.CONCLUSION The application of CELS in managing polyps involving the AO is emerging as a safe and effective treatment modality.
文摘AIM: To evaluate the long-term results of radiofrequency ablation (RFA) compared to left lateral sectionectomy (LLS) in patients with Child-Pugh class A disease for the treatment of single and small hepatocellular carcinoma (HCC) in the left lateral segments.
基金Supported by Young Medical Talents Foundation of Jiangsu Province(No.QNRC2016080)
文摘AIM: To compare the effectiveness of unilateral recession-resection(R&R) and bilateral/unilateral recession(BLR/ULR) for treatment of basic type of intermittent exotropia [IX(T)].METHODS: A comprehensive literature search was performed using PubMed, EMBASE, and the Cochrane Library, to identify randomized controlled trials and comparative studies regarding the effectiveness of R&R and BLR/ULR for IX(T). Based on which, a Meta-analysis was then performed in terms of long-term success rate, overcorrection rate, and recurrence rate.RESULTS: Nine studies in total satisfy the specified eligibility criteria. BLR is at disadvantage to R&R at a short-term follow-up [<2 y, OR 0.56(0.33-0.94) for success rate; OR 2.11(1.17, 3.81) for undercorrection rate]. However, BLR achieved a higher success rate [OR 2.49(1.61, 3.86)] and a lower undercorrection rate [OR 0.40(0.23, 0.71)], compared to that of R&R at a long-term followup(>2 y). There is no significant difference was found in overcorrection rate, regardless of the length of follow-up time [OR 0.85(0.41, 1.75)]. In the treatment for small-angle IX(T), the final outcome was significantly different between the groups, demonstrating a more successful alignment [OR 0.37(0.18, 0.74)] and a lower undercorrection [OR 3.50(1.28, 7.26)] in the R&R group than in the ULR group. While for moderate-angle IX(T)(20 PD-25 PD), the effectiveness of R&R and ULR is quite equivalent with similar success rate [OR 1.08(0.65, 1.79)] and undercorrection rate [OR 0.89(0.54, 1.48)]. CONCLUSION: As regard to the effect of BLR and R&R, R&R shows an advantage over BLR at short term. But, BLR is more effective in the long term for the basic typeIX(T) in children. R&R surgery should be a better choice for the treatment of small-angle IX(T) of ≤20 PD than ULR. However, both of ULR and R&R are recommended for moderate-angle IX(T) from 20 PD to 25 PD.
文摘Rectal cancer constitutes a major public health issue.Total mesorectal excision has remained the gold standard treatment for mid and low rectal tumors since its introduction in the late 1980s.Removal of all lymph nodes located in the mesorectum has indeed improved pathological and oncological outcomes.However,when cancer spreads to the lateral lymph nodes(located along the iliac and obturator arteries)Western and Japanese practices differ.Where the Western guidelines consider this condition as an advanced form of the disease and use neoadjuvant radiochemotherapy liberally,the Japanese guidelines define it as a local disease and proceed to lateral lymph node dissection with or without neoadjuvant treatment.Herein,we review the current literature regarding both therapeutic strategies,with the aim of contributing to potential improvements in treatment and outcome for patients with low and mid rectal cancer.
文摘Due to the advent of the screening programs for colorectal cancer and the era of quality assurance colonoscopy the number the polyps that can be considered difficult,including large(>20 mm)laterally spreading tumors(LSTs),has increased in the last decade.All LSTs should be assessed carefully,looking for suspicious areas of submucosal invasion(SMI),such as nodules or depressed areas,describing the morphology according to the Paris classification,the pit pattern,and vascular pattern.The simplest,most appropriate and safest endoscopic treatment with curative intent should be selected.For LST-granular homogeneous type,piecemeal endoscopic mucosal resection should be the first option due to its biological low risk of SMI.LST-nongranular pseudodepressed type has an increased risk of SMI,and en bloc resection should be mandatory.Underwater endoscopic mucosal resection is useful in situations where submucosal injection alters the operative field,e.g.,for the resection of scar lesions,with no lifting,adjacent tattoo,incomplete resection attempts,lesions into a colonic diverticulum,in ileocecal valve and lesions with intra-appendicular involvement.Endoscopic full thickness resection is very useful for the treatment of difficult to resect lesions of less than 20 up to 25 mm.Among the indications,we highlight the treatment of polyps with suspected malignancy because the acquired tissue allows an exact histologic risk stratification to assign patients individually to the best treatment and avoid surgery for low-risk lesions.Endoscopic submucosal dissection is the only endoscopic procedure that allows completes en bloc resection regardless of the size of the lesion.It should therefore be indicated in the treatment of lesions with risk of SMI.
文摘In low rectal cancer surgery,the section of rectum destal to the lower tumor maigin is relaxed and lengthened after fully isolation of the organ. This would facilitate the adoption of anus saving operation.Before and after fully isolation of the rectum in low ratal cancer surgery, the distance between the lower tumor margin and the anorectal line was measured by the same rectuscope introduced through the anus.The two results were compared .The average lengthening was less than 1 cm if the lower tumor marginanorectal line distance was 5 cm.It was 1─2 cm if the lower tumor margin-anorectal distance was 6 cm.It was more than 2 cm if the distance was 7─9 cm.The loosening and lengthening of the rectal canal was related to the presence of lymphnode metastasis and the skill of the operator.The lengthening was also influenced by the body build of the patient,involvement of the rectal circumference and the Dukes stage. Modified Park's operation,trans abdominosacral resection with anastormosis of rectum,and anterior resection on transpubic approach are indicated for those in whom the lower tumor margin-anorectal line distance was 5 cm The rectectomy-anastomosis in the abdominal cavity(Dixon's operation)is indicated for those in whom the lower tumor margin-anorectal line was 6 cm.If manual anastomosis is difficult,stapling device may be used. The anus saving resection is easy if the distance was 7─9 cm.
