A matched-pair analysis of laparoscopic versus open pancreaticoduodenectomy: oncological outcomes using Leeds Pathology Protocol

BACKGROUND： Laparoscopic pancreaticoduodenectomy（LPD）is a safe procedure. Oncological safety of LPD is still a matter for debate. This study aimed to compare the oncological outcomes,in terms of adequacy of resection and recurrence rate following LPD and open pancreaticoduodenectomy（OPD）.METHODS： Between November 2005 and April 2009, 12LPDs（9 ampullary and 3 distal common bile duct tumors）were performed. A cohort of 12 OPDs were matched for age,gender, body mass index（BMI） and American Society of Anesthesiologists（ASA） score and tumor site.RESULTS： Mean tumor size LPD vs OPD（19.8 vs 19.2 mm,P=0.870）. R0 resection was achieved in 9 LPD vs 8 OPD（P=1.000）. The mean number of metastatic lymph nodes and total number resected for LPD vs OPD were 1.1 vs 2.1（P=0.140）and 20.7 vs 18.5（P=0.534） respectively. Clavien complications grade I/II（5 vs 8）, III/IV（2 vs 6） and pancreatic leak（2 vs 1）were statistically not significant（LPD vs OPD）. The mean high dependency unit（HDU） stay was longer in OPD（3.7 vs 1.4 days,P〈0.001）. There were 2 recurrences each in LPD and OPD（logrank,P=0.983）. Overall mortality for LPD vs OPD was 3 vs 6（log-rank, P=0.283） and recurrence-related mortality was 2 vs 1.There was one death within 30 days in the OPD group secondary to severe sepsis and none in the LPD group.CONCLUSIONS： Compared to open procedure, LPD achieved a similar rate of R0 resection, lymph node harvest and longterm recurrence for tumors less than 2 cm. Though technically challenging, LPD is safe and does not compromise oncological outcome.

SAFETY MARGIN IN ANUS-SAVING RESECTION FOR LOW RECTAL CANCER

The length and method of measurement of the safety-margin below the rectal cancer, being of the utmost importance for its prognosis, is still under debate.The following study was designed and done for its solution.Light microscopic examination was done on 83 resected rectal cancer specimens to assess the extent of intramural invasion towards the anus.By use of a ruler,the distance between the lower tumour margin and the resection line or the dentate line was measured when the specimen was:l. freshly resected,2.after fixing in 10% formalin, and 3.after being mounted in sections. The measurements were compared. By the same method,the distance between the lower tumor margin and the intended resectyion line was measured immediately before resection.It was compared with the measurement immediately after the resection.In 83 rectal cancer specimens, the extent of intramural infiltration toward the anus was:≤0.5 cm in 75 cases (90.4%).≥l cm in 2 cases which showed highly malignant carcinomas.These 2 cases, however,should not have been indicated for anus-saving resection.In 46 fresh specimens,the tumor-resection line distances gave an average of 2.7 cm.After fixing in 10% formalin, they became shortened by 0.7 cm. And, mouting in sections further shortened them by another 0.5 cm,giving a total shortening of l.2 cm.The tumor-resection line distance in 7 of the 11 fresh specimens resected by the Dixon's operation was shortened,though never more than o.5 cm immediately the operation.In performin ganus-saving resection for the low rectal cancer, after full isolation the rectum and stretching it slightly,≥3 cm of the rectum distal to the lower tumor margin should be resected.A safety margin of more than 2.5 cm is necessary in the fresh specimen.If formalin fixed specimen is measured, the safety margin should be ≥2 cm.

Pathological unit and the octagonal en bloc resection of thoracic ossification ligamentum flavum

Objective To describe the pathological unit and octagonal en bloc resection for the treatment of ossification ligamentum flavum(OLF)in thoracic spine with spondylotic myelopathy.Methods Ninety-five patients from January 2002 to January