Feasibility and nutritional impact of laparoscopic assisted tailored subtotal gastrectomy for middle-third gastric cancer

BACKGROUND Laparoscopic assisted total gastrectomy(LaTG)is associated with reduced nutritional status,and the procedure is not easily carried out without extensive expertise.A small remnant stomach after near-total gastrectomy confers no significant nutritional benefits over total gastrectomy.In this study,we developed a modified laparoscopic subtotal gastrectomy procedure,termed laparoscopicassisted tailored subtotal gastrectomy(LaTSG).AIM To evaluate the feasibility and nutritional impact of LaTSG compared to those of LaTG in patients with advanced middle-third gastric cancer(GC).METHODS We retrospectively analyzed surgical and oncological outcomes and postoperative nutritional status in 92 consecutive patients with middle-third GC who underwent radical laparoscopic gastrectomy at Department of Pancreatic Stomach Surgery,National Cancer Center/Cancer Hospital,Chinese Academy of Medical Sciences,and Peking Union Medical College between 2013 and 2017.Of these 92 patients,47 underwent LaTSG(LaTSG group),and the remaining underwent LaTG(LaTG group).RESULTS Operation time(210±49.8 min vs 208±50.0 min,P>0.05)and intraoperative blood loss(152.3±166.1 mL vs 188.9±167.8 mL,P>0.05)were similar between the groups.The incidence of postoperative morbidities was lower in the LaTSG group than in the LaTG group(4.2%vs 17.8%,P<0.05).Postoperatively,nutritional indices did not significantly differ,until postoperative 12 mo.Albumin,prealbumin,total protein,hemoglobin levels,and red blood cell counts were significantly higher in the LaTSG group than in the LaTG group(P<0.05).No significant differences in Fe or C-reaction protein levels were found between the two groups.Endoscopic examination demonstrated that reflux oesophagitis was more common in the LaTG group(0%vs 11.1%,P<0.05).Kaplan–Meier analysis showed a significant improvement in the overall survival(OS)and disease free survival(DFS)in the LaTSG group.Multivariate analysis showed that LaTSG was an independent prognostic factor for OS(P=0.048)but not for DFS(P=0.054).Subgroup analysis showed that compared to LaTG,LaTSG improved the survival of patients with stage III cancers,but not for other stages.CONCLUSION For advanced GC involving the middle third stomach,LaTSG can be a good option with reduced morbidity and favorable nutritional status and oncological outcomes.

Robotically assisted removal of pelvic splenosis fifty-six years after splenectomy: A case report

BACKGROUND‘Splenosis’is defined as the autotransplantation of splenic tissue following trauma or surgery,usually in the form of intraperitoneal nodules.The proliferation of imaging techniques has resulted in increased unexpected discoveries of splenosis nodules,and achieving a differential diagnosis can be challenging.Nuclear medicine studies have been playing an increasingly important role in this process,but the clinical significance of asymptomatic nodules remains uncertain.CASE SUMMARY We present a case of pelvic splenosis in a 73-year-old man diagnosed 56 years after a splenectomy during a computed tomography(CT)follow-up for B-cell lymphoma,presenting intense contrast enhancement of an 18 mm nodule in the right recto-vesical space.18F-fluorodeoxyglucose demonstrated weak metabolic activity.Since histological diagnosis was deemed necessary,the nodule was easily removed with robotically assisted laparoscopy,together with another 6 mm left a paracolic lesion.The latter was previously undiagnosed but retrospectively visible on the CT scan.CONCLUSION In a patient requiring differential diagnosis of splenosis nodules from lymphomarecurrence, the robotic approach provided a safe en bloc removal with shorthospitalization. The Da Vinci Xi robot was particularly helpful because its opticscan be introduced from all ports, facilitating visualization and lysis of multipleintra-abdominal adhesions.

Comparison of the Efficacy and Safety of Different Surgical Strategies for Patients with Type Ⅱ Cesarean Scar Pregnancy

Objective:To compare the efficacy and safety of four surgical strategies currently used for the management of deep implantation cesarean scar pregnancy(CSP-Ⅱ).Methods:This was a retrospective clinical cohort study,and,in total,131 women diagnosed with CSP-Ⅱ and primarily treated in our hospital were recruited.Women treated using laparoscopy assisted by operative hysteroscopy(LAOH;Group A,n=25),uterine artery embolization(UAE)followed by LAOH(Group B,n=21),ultrasound-guided dilatation and curettage(D&C;Group C,n=24),and UAE followed by D&C(Group D,n=61)were evaluated.Univariate and multiple logistic analyses were performed to identify the risk factors.Results:No statistically significant difference was found in patient age,gestational age,size of lesion,and pretreatment serumβ-human chorionic gonadotropins(β-hCG)level.Operation time was longer(P<0.001)and the success rate was higher(P=0.01)in both Group A and Group B than in Group C and Group D.When the cohort was further analyzed regarding patients with myometrial thickness≤3 mm(n=75,defined as CSP-IIb),a lower rate of perioperative complications(P=0.036)and a higher success rate(P<0.001)remained in Group A(n=15)and Group B(n=15)but not in Group C(n=11)or Group D(n=34).In multiple logistic regression analysis,the risk factors related to lower treatment efficacy for patients with CSP-Ⅱ were thinner myometrial thickness of cesarean scar(CS)(≤3 mm)(odds ratio[OR]=5.470,P=0.062),number of cesarean sections(a2)(OR=8.877,P=0.013),mass protruding into the bladder or abdominal cavity(OR=25.507,P<0.001),and direct D&C modality(OR=38.247,P=0.010).Conclusions:Compared with D&C±UAE,LAOH±UAE showed a higher success rate for patients with CSP-Ⅱ,especially when the zygote was more deeply implanted with a myometrial thickness of CS≤3 mm.CSP-Ⅱ treatment should be individualized on the basis of many risk factors.