BACKGROUND Schwannomas are rare peripheral neural myelin sheath tumors that originate from Schwann cells.Of the different types of schwannomas,pelvic sciatic nerve schwannoma is extremely rare.Definite preoperative di...BACKGROUND Schwannomas are rare peripheral neural myelin sheath tumors that originate from Schwann cells.Of the different types of schwannomas,pelvic sciatic nerve schwannoma is extremely rare.Definite preoperative diagnosis of pelvic schwannomas is difficult,and surgical resection is the gold standard for its definite diagnosis and treatment.CASE SUMMARY We present a case of pelvic schwannoma arising from the sciatic nerve that was detected in a 40-year-old man who underwent computed tomography for intermittent right lower back pain caused exclusively by a right ureteral calculus.Subsequently,successful transperitoneal laparoscopic surgery was performed for the intact removal of the stone and en bloc resection of the schwannoma.The total operative time was 125 min,and the estimated blood loss was inconspicuous.The surgical procedure was uneventful.The patient was discharged on postoperative day 5 with the simultaneous removal of the urinary catheter.However,the patient presented with motor and sensory disorders of the right lower limb,caused by partial damage to the right sciatic nerve.No tumor recurrence was observed at the postoperative appointment.CONCLUSION Histopathological examination of the specimen confirmed the diagnosis of a schwannoma.Thus,laparoscopic surgery is safe and feasible for concomitant extirpation of pelvic schwannomas and other pelvic and abdominal diseases that require surgical treatment.展开更多
BACKGROUND Colorectal cancer is the third most common cancer and the second highest cause of cancer-related mortality worldwide.About 5%-10%of patients are diagnosed with locally advanced rectal cancer(LARC)on present...BACKGROUND Colorectal cancer is the third most common cancer and the second highest cause of cancer-related mortality worldwide.About 5%-10%of patients are diagnosed with locally advanced rectal cancer(LARC)on presentation.For LARC invading into other structures(i.e.T4b),multivisceral resection(MVR)and/or pelvic ex-enteration(PE)remains the only potential curative surgical treatment.MVR and/or PE is a major and complex surgery with high post-operative morbidity.Minimally invasive surgery(MIS)has been shown to improve short-term post-operative outcomes in other gastrointestinal malignancies,but there is little evi-dence on its use in MVR,especially so for robotic MVR.This is a single-center retrospective cohort study from 1st January 2015 to 31st March 2023.Inclusion criteria were patients diagnosed with cT4b rectal cancer and underwent MVR,or stage 4 disease with resectable systemic metastases.Pa-tients who underwent curative MVR for locally recurrent rectal cancer,or me-tachronous rectal cancer were also included.Exclusion criteria were patients with systemic metastases with non-resectable disease.All patients planned for elective surgery were enrolled into the standard enhanced recovery after surgery pathway with standard peri-operative management for colorectal surgery.Complex sur-gery was defined based on technical difficulty of surgery(i.e.total PE,bladder-sparing prostatectomy,pelvic lymph node dissection or need for flap creation).Our primary outcomes were the margin status,and complication rates.Cate-gorical values were described as percentages and analysed by the chi-square test.Continuous variables were expressed as median(range)and analysed by Mann-Whitney U test.Cumulative overall survival(OS)and recurrence-free survival(RFS)were analysed using Kaplan-Meier estimates with life table analysis.Log-rank test was performed to determine statistical significance between cumulative estimates.Statistical significance was defined as P<0.05.Meier estimates with life table analysis.Log-rank test was performed to determine statistical significance between cumulative estimates.Statistical significance was defined as P<0.05.RESULTS A total of 46 patients were included in this study[open MVR(oMVR):12(26.1%),miMVR:36(73.9%)].Patients’American Society of Anesthesiologists score,body mass index and co-morbidities were comparable between oMVR and miMVR.There is an increasing trend towards robotic MVR from 2015 to 2023.MiMVR was associated with lower estimated blood loss(EBL)(median 450 vs 1200 mL,P=0.008),major morbidity(14.7%vs 50.0%,P=0.014),post-operative intra-abdominal collections(11.8%vs 50.0%,P=0.006),post-operative ileus(32.4%vs 66.7%,P=0.04)and surgical site infection(11.8%vs 50.0%,P=0.006)compared with oMVR.Length of stay was also shorter for miMVR compared with oMVR(median 10 vs 30 d,P=0.001).Oncological outcomes-R0 resection,recurrence,OS and RFS were comparable between miMVR and oMVR.There was no 30-d mortality.More patients underwent robotic compared with laparoscopic MVR for complex cases(robotic 57.1%vs laparoscopic 7.7%,P=0.004).The operating time was longer for robotic compared with laparoscopic MVR[robotic:602(400-900)min,laparoscopic:Median 455(275-675)min,P<0.001].Incidence of R0 resection was similar(laparoscopic:84.6%vs robotic:76.2%,P=0.555).Overall complication rates,major morbidity rates and 30-d readmission rates were similar between la-paroscopic and robotic MVR.Interestingly,3-year OS(robotic 83.1%vs 58.6%,P=0.008)and RFS(robotic 72.9%vs 34.3%,P=0.002)was superior for robotic compared with laparoscopic MVR.CONCLUSION MiMVR had lower post-operative complications compared to oMVR.Robotic MVR was also safe,with acceptable post-operative complication rates.Prospective studies should be conducted to compare short-term and long-term outcomes between robotic vs laparoscopic MVR.展开更多
BACKGROUND Low-grade appendiceal mucinous neoplasm(LAMN)is extremely rare and easily misdiagnosed before surgery.CASE SUMMARY We report the treatment of an asymptomatic case of LAMN diagnosed by magnetic resonance ima...BACKGROUND Low-grade appendiceal mucinous neoplasm(LAMN)is extremely rare and easily misdiagnosed before surgery.CASE SUMMARY We report the treatment of an asymptomatic case of LAMN diagnosed by magnetic resonance imaging(MRI)and surgical findings.A 70-year-old woman presented with an adnexal mass found by physical examination in July 2020.Gynecologic ultrasonography revealed a cystic mass in the right adnexa,and computed tomography showed a cystic mass in the pelvic cavity.All tumor markers were normal.A further MRI examination suggested mucinous neoplasm in the right pelvic cavity,excluding the possibility of adnexal cyst.Laparoscopic exploration found a huge cystic mass of about 10 cm×7 cm that originated from the apex of the appendix,with spontaneous rupture.LAMN was confirmed by pathological examination.As of May 2021,no disease recurrence occurred after an open appendectomy.CONCLUSION This case indicates that we should pay more attention to female patients who are clinically diagnosed with an adnexal mass at admission,.The physical examination should be done carefully,and the laboratory and imaging examination results should be comprehensively analyzed to avoid misdiagnosis and to ensure prompt diagnosis and treatment,and to improve prognosis.MRI may be a better option for the diagnosis of appendiceal mucinous neoplasm.展开更多
BACKGROUND Appendiceal tumors are rare lesions that may not be easily differentiated from primary ovarian lesions preoperatively,despite the use of advanced diagnostic methods by experienced clinicians.CASE SUMMARY A ...BACKGROUND Appendiceal tumors are rare lesions that may not be easily differentiated from primary ovarian lesions preoperatively,despite the use of advanced diagnostic methods by experienced clinicians.CASE SUMMARY A 59-year-old G2P2 woman,with chronic pelvic pain,underwent a pelvic ultrasound that revealed an adnexal mass measuring 58 mm×34 mm×36 mm,with irregular borders,heterogeneous echogenicity,no color Doppler vascularization and without acoustic shadowing.Normal ovarian tissue was visualized in contact with the lesion,and it was impossible to separate the lesion from the ovary by applying pressure with the ultrasound probe.Ascites,peritoneal metastases or other alterations were not observed.With the international ovarian tumor analysis ADNEX model,the lesion was classified as a malignant tumor(the risk of malignancy was 27.1%,corresponding to Ovarian-Adnexal Reporting Data System category 4).Magnetic resonance imaging confirmed the presence of a right adnexal mass,apparently an ovarian tumor measuring 65 mm×35 mm,without signs of invasive or metastatic disease.During explorative laparotomy,normal morphology of the internal reproductive organs was noted.A solid mobile lesion involved the entire appendix.Appendectomy was performed.Inspection of the abdominal cavity revealed no signs of malignant dissemination.Histopathologically,the appendiceal lesion corresponded to a completely resected low-grade mucinous appendiceal neoplasm(LAMN).CONCLUSION The appropriate treatment and team of specialists who should provide health care to patients with seemingly adnexal lesions depend on the nature(benign vs malignant)and origin(gynecological vs nongynecological)of the lesion.Radiologists,gynecologists and other pelvic surgeons should be familiar with the imaging signs of LAMN whose clinical presentation is silent or nonspecific.The assistance of a consultant specializing in intestinal tumors is important support that gynecological surgeons can receive during the operation to offer the patient with intestinal pathology an optimal intervention.展开更多
Ewing sarcoma is the second most common primary bone tumor seen in children and adolescents,typically presenting between 10 and 20 years of age.Extraosseous sarcomas of the Ewing family in adults are rare.We report a ...Ewing sarcoma is the second most common primary bone tumor seen in children and adolescents,typically presenting between 10 and 20 years of age.Extraosseous sarcomas of the Ewing family in adults are rare.We report a manifestation of this tumor entity in the periprostatic tissue of a 33-year-old male and discuss our treatment approach.Transrectal biopsy is a feasible and simple diagnostic tool for unclear pelvic masses.Multi-modal therapy and central registries are needed to gain knowledge of rare pelvic tumors like Ewing sarcoma.展开更多
Colorectal cancer accounts for 10%of diagnosed cancers globally and often presents as advanced disease,necessitating aggressive treatment.With both younger and healthier elderly patients being diagnosed,as well as pot...Colorectal cancer accounts for 10%of diagnosed cancers globally and often presents as advanced disease,necessitating aggressive treatment.With both younger and healthier elderly patients being diagnosed,as well as potentially the need for salvage therapy post total neoadjuvant treatment,surgical options for cure include pelvic exenteration.Whilst typically performed via an open approach,there has been an increased utilisation of minimally invasive techniques including robotic surgery.Offering smaller in-cisions,reduced postoperative pain,and quicker recovery time than open surgery,robotic techniques have demonstrated lower blood loss,shorter hospital stays,and reduced morbidity.Moreover,the er-gonomic design of robotic systems provides surgeons with comfort during long procedures and increased precision.It also offers an increased opportunity for organ preservation and reconstruction whilst maintaining adequate oncological outcomes.As robotic technology continues to evolve and combines with artificial intelligence,it is poised to play an even more significant role in the management of complex colorectal cancer cases,improving survival and long-term outcomes.展开更多
文摘BACKGROUND Schwannomas are rare peripheral neural myelin sheath tumors that originate from Schwann cells.Of the different types of schwannomas,pelvic sciatic nerve schwannoma is extremely rare.Definite preoperative diagnosis of pelvic schwannomas is difficult,and surgical resection is the gold standard for its definite diagnosis and treatment.CASE SUMMARY We present a case of pelvic schwannoma arising from the sciatic nerve that was detected in a 40-year-old man who underwent computed tomography for intermittent right lower back pain caused exclusively by a right ureteral calculus.Subsequently,successful transperitoneal laparoscopic surgery was performed for the intact removal of the stone and en bloc resection of the schwannoma.The total operative time was 125 min,and the estimated blood loss was inconspicuous.The surgical procedure was uneventful.The patient was discharged on postoperative day 5 with the simultaneous removal of the urinary catheter.However,the patient presented with motor and sensory disorders of the right lower limb,caused by partial damage to the right sciatic nerve.No tumor recurrence was observed at the postoperative appointment.CONCLUSION Histopathological examination of the specimen confirmed the diagnosis of a schwannoma.Thus,laparoscopic surgery is safe and feasible for concomitant extirpation of pelvic schwannomas and other pelvic and abdominal diseases that require surgical treatment.
基金Informed consent was obtained from patients included(No.SDB-2023-0069-TTSH-01).
文摘BACKGROUND Colorectal cancer is the third most common cancer and the second highest cause of cancer-related mortality worldwide.About 5%-10%of patients are diagnosed with locally advanced rectal cancer(LARC)on presentation.For LARC invading into other structures(i.e.T4b),multivisceral resection(MVR)and/or pelvic ex-enteration(PE)remains the only potential curative surgical treatment.MVR and/or PE is a major and complex surgery with high post-operative morbidity.Minimally invasive surgery(MIS)has been shown to improve short-term post-operative outcomes in other gastrointestinal malignancies,but there is little evi-dence on its use in MVR,especially so for robotic MVR.This is a single-center retrospective cohort study from 1st January 2015 to 31st March 2023.Inclusion criteria were patients diagnosed with cT4b rectal cancer and underwent MVR,or stage 4 disease with resectable systemic metastases.Pa-tients who underwent curative MVR for locally recurrent rectal cancer,or me-tachronous rectal cancer were also included.Exclusion criteria were patients with systemic metastases with non-resectable disease.All patients planned for elective surgery were enrolled into the standard enhanced recovery after surgery pathway with standard peri-operative management for colorectal surgery.Complex sur-gery was defined based on technical difficulty of surgery(i.e.total PE,bladder-sparing prostatectomy,pelvic lymph node dissection or need for flap creation).Our primary outcomes were the margin status,and complication rates.Cate-gorical values were described as percentages and analysed by the chi-square test.Continuous variables were expressed as median(range)and analysed by Mann-Whitney U test.Cumulative overall survival(OS)and recurrence-free survival(RFS)were analysed using Kaplan-Meier estimates with life table analysis.Log-rank test was performed to determine statistical significance between cumulative estimates.Statistical significance was defined as P<0.05.Meier estimates with life table analysis.Log-rank test was performed to determine statistical significance between cumulative estimates.Statistical significance was defined as P<0.05.RESULTS A total of 46 patients were included in this study[open MVR(oMVR):12(26.1%),miMVR:36(73.9%)].Patients’American Society of Anesthesiologists score,body mass index and co-morbidities were comparable between oMVR and miMVR.There is an increasing trend towards robotic MVR from 2015 to 2023.MiMVR was associated with lower estimated blood loss(EBL)(median 450 vs 1200 mL,P=0.008),major morbidity(14.7%vs 50.0%,P=0.014),post-operative intra-abdominal collections(11.8%vs 50.0%,P=0.006),post-operative ileus(32.4%vs 66.7%,P=0.04)and surgical site infection(11.8%vs 50.0%,P=0.006)compared with oMVR.Length of stay was also shorter for miMVR compared with oMVR(median 10 vs 30 d,P=0.001).Oncological outcomes-R0 resection,recurrence,OS and RFS were comparable between miMVR and oMVR.There was no 30-d mortality.More patients underwent robotic compared with laparoscopic MVR for complex cases(robotic 57.1%vs laparoscopic 7.7%,P=0.004).The operating time was longer for robotic compared with laparoscopic MVR[robotic:602(400-900)min,laparoscopic:Median 455(275-675)min,P<0.001].Incidence of R0 resection was similar(laparoscopic:84.6%vs robotic:76.2%,P=0.555).Overall complication rates,major morbidity rates and 30-d readmission rates were similar between la-paroscopic and robotic MVR.Interestingly,3-year OS(robotic 83.1%vs 58.6%,P=0.008)and RFS(robotic 72.9%vs 34.3%,P=0.002)was superior for robotic compared with laparoscopic MVR.CONCLUSION MiMVR had lower post-operative complications compared to oMVR.Robotic MVR was also safe,with acceptable post-operative complication rates.Prospective studies should be conducted to compare short-term and long-term outcomes between robotic vs laparoscopic MVR.
文摘BACKGROUND Low-grade appendiceal mucinous neoplasm(LAMN)is extremely rare and easily misdiagnosed before surgery.CASE SUMMARY We report the treatment of an asymptomatic case of LAMN diagnosed by magnetic resonance imaging(MRI)and surgical findings.A 70-year-old woman presented with an adnexal mass found by physical examination in July 2020.Gynecologic ultrasonography revealed a cystic mass in the right adnexa,and computed tomography showed a cystic mass in the pelvic cavity.All tumor markers were normal.A further MRI examination suggested mucinous neoplasm in the right pelvic cavity,excluding the possibility of adnexal cyst.Laparoscopic exploration found a huge cystic mass of about 10 cm×7 cm that originated from the apex of the appendix,with spontaneous rupture.LAMN was confirmed by pathological examination.As of May 2021,no disease recurrence occurred after an open appendectomy.CONCLUSION This case indicates that we should pay more attention to female patients who are clinically diagnosed with an adnexal mass at admission,.The physical examination should be done carefully,and the laboratory and imaging examination results should be comprehensively analyzed to avoid misdiagnosis and to ensure prompt diagnosis and treatment,and to improve prognosis.MRI may be a better option for the diagnosis of appendiceal mucinous neoplasm.
文摘BACKGROUND Appendiceal tumors are rare lesions that may not be easily differentiated from primary ovarian lesions preoperatively,despite the use of advanced diagnostic methods by experienced clinicians.CASE SUMMARY A 59-year-old G2P2 woman,with chronic pelvic pain,underwent a pelvic ultrasound that revealed an adnexal mass measuring 58 mm×34 mm×36 mm,with irregular borders,heterogeneous echogenicity,no color Doppler vascularization and without acoustic shadowing.Normal ovarian tissue was visualized in contact with the lesion,and it was impossible to separate the lesion from the ovary by applying pressure with the ultrasound probe.Ascites,peritoneal metastases or other alterations were not observed.With the international ovarian tumor analysis ADNEX model,the lesion was classified as a malignant tumor(the risk of malignancy was 27.1%,corresponding to Ovarian-Adnexal Reporting Data System category 4).Magnetic resonance imaging confirmed the presence of a right adnexal mass,apparently an ovarian tumor measuring 65 mm×35 mm,without signs of invasive or metastatic disease.During explorative laparotomy,normal morphology of the internal reproductive organs was noted.A solid mobile lesion involved the entire appendix.Appendectomy was performed.Inspection of the abdominal cavity revealed no signs of malignant dissemination.Histopathologically,the appendiceal lesion corresponded to a completely resected low-grade mucinous appendiceal neoplasm(LAMN).CONCLUSION The appropriate treatment and team of specialists who should provide health care to patients with seemingly adnexal lesions depend on the nature(benign vs malignant)and origin(gynecological vs nongynecological)of the lesion.Radiologists,gynecologists and other pelvic surgeons should be familiar with the imaging signs of LAMN whose clinical presentation is silent or nonspecific.The assistance of a consultant specializing in intestinal tumors is important support that gynecological surgeons can receive during the operation to offer the patient with intestinal pathology an optimal intervention.
文摘Ewing sarcoma is the second most common primary bone tumor seen in children and adolescents,typically presenting between 10 and 20 years of age.Extraosseous sarcomas of the Ewing family in adults are rare.We report a manifestation of this tumor entity in the periprostatic tissue of a 33-year-old male and discuss our treatment approach.Transrectal biopsy is a feasible and simple diagnostic tool for unclear pelvic masses.Multi-modal therapy and central registries are needed to gain knowledge of rare pelvic tumors like Ewing sarcoma.
文摘Colorectal cancer accounts for 10%of diagnosed cancers globally and often presents as advanced disease,necessitating aggressive treatment.With both younger and healthier elderly patients being diagnosed,as well as potentially the need for salvage therapy post total neoadjuvant treatment,surgical options for cure include pelvic exenteration.Whilst typically performed via an open approach,there has been an increased utilisation of minimally invasive techniques including robotic surgery.Offering smaller in-cisions,reduced postoperative pain,and quicker recovery time than open surgery,robotic techniques have demonstrated lower blood loss,shorter hospital stays,and reduced morbidity.Moreover,the er-gonomic design of robotic systems provides surgeons with comfort during long procedures and increased precision.It also offers an increased opportunity for organ preservation and reconstruction whilst maintaining adequate oncological outcomes.As robotic technology continues to evolve and combines with artificial intelligence,it is poised to play an even more significant role in the management of complex colorectal cancer cases,improving survival and long-term outcomes.
