Technique Note for Staged Resection of Giant Invasive High-Cervical Schwannoma and Reconstruction of C2—C4 with 3D Printing Technique

A schwannoma is a relatively common benign spinal cord tumour;however,giant schwannomas with extensive cervical vertebral erosion are rare,and the treatment strategy,especially the reconstruction of the upper cervical vertebra,remains a challenge for spine surgeons.Here,we present a rare case of giant invasive high-cervical schwannoma with extensive erosion of the C2—C4 vertebral bodies and tumour-encased left vertebral artery.The surgical strategy and the reconstruction of C2—C4 with 3D printing techniques were discussed and performed.A 32-year-old man presented to our department with complaints of gait disturbance and weakness in both upper and lower extremities.His limb muscle strength was grade 2 or 3/5,and he exhibited severe bladder and bowel dysfunction on admission.X-ray and computed tomography of the cervical spine showed an extremely large erosive lesion at the C2—C4 vertebral bodies and lateral masses.Magnetic resonance imaging of the cervical spine showed a large soft-tissue mass on the left aspect of the C2—C5 vertebra and in the spinal canal at the C3—C4 level.A staged schwannoma resection,instrumented fixation,and reconstruction of C2—C4 with 3D metal printing technique were performed.The patient achieved good postoperative outcomes and returned to normal daily life with no recurrence of schwannoma during follow-up for four and a half years.The 3D-printed implant achieved solid fusion with the remaining cervical spine.We performed staged resection of the giant invasive high-cervical schwannoma and reconstructed the erosive C2—C4 vertebra with the assistance of a 3D printing technique.3D printing technology has facilitated the design and manufacture of customised implants for complex surgical procedures.

Minimum invasive associating liver partition and portal vein ligation for staged hepatectomy

Associating liver partition and portal vein ligation for staged hepatectomy(ALPPS)has gained interest,as the potential alternative to portal vein embolisation for inducing future liver remnant hypertrophy in patients at risk of post-hepatectomy liver failure but is associated with high morbidity and mortality.As a result,several variant ALPPS have been reported to reduce ALPPS related morbidity and mortality.ALPPS is able to induce more extensive hypertrophy in a shorter time-period than portal vein embolisation.Minimally-invasive surgery,which has known benefits with regards to morbidity and mortality,has also been applied to ALPPS,with promising results regarding safety and feasibility and patient outcomes.Evidence suggests that both laparoscopic and robot-assisted ALPPS present technically feasible and safe options for patients.Minimally-invasive ALPPS offers a clear benefit to patients,including reduction of fibrous adhesions,shorter length of hospital stay,and lower morbidity.However,the technical difficulty of the procedure still limits its wide application,even to experienced hepato-pancreato-biliary centres.

Pathological response to neoadjuvant therapy with chemotherapy vs chemoradiotherapy in stage III NSCLC-contribution of IASLC recommendations

BACKGROUND Neoadjuvant treatment(NT)with chemotherapy(Ch)is a standard option for resectable stage III(N2)NSCLC.Several studies have suggested benefits with the addition of radiotherapy(RT)to NT Ch.The International Association for the Study of Lung Cancer(IASLC)published recommendations for the pathological response(PHR)of NSCLC resection specimens after NT.AIM To contribute to the IASLC recommendations showing our results of PHR to NT Ch vs NT chemoradiotherapy(ChRT).METHODS We analyzed 67 consecutive patients with resectable stage III NSCLC with positive mediastinal nodes treated with surgery after NT Ch or NT ChRT between 2013 and 2020.After NT,all patients were evaluated for radiological response(RR)according to Response Evaluation Criteria in Solid Tumours criteria and evaluated for surgery by a specialized group of thoracic surgeons.All histological samples were examined by the same two pathologists.PHR was evaluated by the percentage of viable cells in the tumor and the resected lymph nodes.RESULTS Forty patients underwent NT ChRT and 27 NT Ch.Fifty-six(83.6%)patients underwent surgery(35 ChRT and 21 Ch).The median time from ChRT to surgery was 6 wk(3-19)and 8 wk(3-21)for Ch patients.We observed significant differences in RR,with disease progression in 2.5%and 14.8%of patients with ChRT and Ch,respectively,and partial response in 62.5%ChRT vs 29.6%Ch(P=0.025).In PHR we observed≤10%viable cells in the tumor in 19(54.4%)and 2 cases(9.5%),and in the resected lymph nodes(RLN)30(85.7%)and 7(33.3%)in ChRT and Ch,respectively(P=0.001).Downstaging was greater in the ChRT compared to the Ch group(80%vs 33.3%;P=0.002).In the univariate analysis,NT ChRT had a significant impact on partial RR[odds ratio(OR)12.5;95%confidence interval(CI):1.21-128.61;P=0.034],a decreased risk of persistence of cancer cells in the tumor and RLN and an 87.5%increased probability for achieving downstaging(OR 8;95%CI:2.34-27.32;P=0.001).CONCLUSION We found significant benefits in RR and PHR by adding RT to Ch as NT.A longer follow-up is necessary to assess the impact on clinical outcomes.

SIMULTANEOUS RESECTION OF A STAGE-Ⅲ PRIMARY SQUAMOUS CARCINOMA OF LUNG AND A CARCINOID OF CARDIA A CASE REPORT

Multiplc primary carcinona (MPC),disease with two or more ncoplasms,occurs in a patient simultancously of consecutively It is reported that