Effect of Robotic Inferior Mesenteric Artery Ligation Level on Low Anterior Resection Syndrome in Rectum Cancer

Background: Life expectancy of patients with rectal cancer is increasing day by day with innovative treatments. Low anterior resection syndrome (LARS), which disrupts the comfort of life in these patients, has become a serious problem. We aimed to evaluate the effect of high ligation (HL) and low ligation (LL) techniques on LARS in rectal cancer surgery performed with the robotic method. Materials and Methods: The data of patients diagnosed with mid-distal rectal cancer between 2016 and 2021 who underwent robotic low anterior resection by the same team in the same center with neoadjuvant chemoradiotherapy were retrospectively evaluated. Patients were divided into two groups as those who underwent HL and LL procedures. Preoperative, 8 weeks after neoadjuvant treatment, 3 and 12 months after ileostomy closure were evaluated. Results: A total of 84 patients (41 HL, 43 LL) were included in the study. There was no statistically significant difference between the demographic characteristics and pathology data of the patients. Although there was a decrease in LARS scores after neoadjuvant treatment, there was a statistically significant difference between the two groups at 3 and 12 months after ileostomy closure (P: .001, P: .015). Conclusions: In patients who underwent robotic low anterior resection, there is a statistically significant difference in the LARS score in the first 1 year with the LL technique compared with that of the HL technique, and the LL technique has superiority in reducing the development of LARS between the two oncologically indistinguishable methods.

Impact of titanium-prepared platelet-rich fibrin in type 1 fascia graft tympanoplasty on graft survival and hearing outcomes

Background

Type 1 fascia graft tympanoplasty (T1FGT) is the mainstay surgical approach for the treatment of tympanic membrane perforations. The most widely used graft material is temporal muscle fascia, and graft take rates are reported differently. The methods to enhance graft take are still being investigated. Aim: The aim of our study was to investigate the effect of titanium-prepared platelet-rich fibrin (T-PRF) on graft take and hearing outcomes in T1FGT.

Materials and Methods

Fifty-seven ears eligible for T1FGT were involved in the study and prospectively evaluated. T-PRF was applied with T1FGT in 27 ears. Thirty ears in the other group underwent only T1FGT. The patients underwent an otomicroscopic and audiometric examination in preoperative and postoperative 2nd week, 1st month, and 6th month. Both groups were evaluated in terms of hearing levels, infection, and graft take rates.

Results

Two patients in the T1FGT + T-PRF group and seven patients in the T1FGT group had postoperative perforation (graft take rate: 92.6% versus 76.7%). The graft take rate was found to be increased in the T-PRF group although the difference was not statistically significant. In the T1FGT group, the percentage of infection was higher than in the T1FGT + T-PRF group. When the preoperative and postoperative 6th-month audiometry was compared, a statistically significant hearing gain was obtained for both groups.

Conclusion

In the treatment of tympanic membrane perforations, T-PRF applied over the fascia graft was shown to increase graft take rates and decrease the probability of infection. Further studies with larger samples are needed to demonstrate the effects of PRF.

Ectopic bone formation in thyroid gland: report of sixteen cases and comprehensive literature review

OBJECTIVE

This study aimed to analyze the outcomes of patients with ectopic bone formation (EBF) diagnosed in thyroidectomy specimen.

PATIENTS AND METHODS

We retrospectively analyzed the data of 16 patients who underwent thyroidectomy between February 2009 and June 2018 and whose pathology examination diagnosed EBF.

RESULTS

Fourteen patients underwent bilateral total thyroidectomy (BTT), one patient required BTT with central lymph node dissection, and one patient was subjected to BTT with functional lymph node dissection. On histopathological examination, left lobe EBF was diagnosed in four patients; left lobe EBF with bilateral papillary thyroid carcinoma (PTC) in two; left lobe EBF with left lobe PTC in one; left lobe EBF with left follicular adenoma in one; left lobe EBF with right lobe papillary thyroid microcarcinoma in one; bilateral EBF in one; right lobe EBF with extramedullary hematopoiesis in one; right lobe EBF in three; right lobe EBF with right lobe medullary thyroid carcinoma in one, and right lobe EBF with bilateral lymphocytic thyroiditis in one. One of the five patients who underwent bone marrow biopsy was diagnosed with myeloproliferative dysplasia, and another with polycythemia vera. Three patients were treated medically for anemia because no other pathological findings could be observed.

CONCLUSIONS

There is a lack of literature data about the clinical significance of EBF in the thyroid gland in cases with no concomitant hematological diseases. People who have been diagnosed with EBF in the thyroid gland should be checked for hematological diseases.

Can the surgeon prolong the remaining life of the patient in pancreaticoduodenectomy surgery? or Is the surgeon helpless?

BACKGROUND

We aimed to evaluate the effects of R0 and R1 resections after pancreatic surgery.

METHODS

Data of 130 patients were evaluated. Re-resection was performed in patients who were found to have R1 resection after frozen section (FS). Overall survival (OS), disease free survival (DFS) among patients with R1 resection in paraffin section (PS) (n:28, Group1) and patients who underwent re-resection after FS and achieved the R0 resection goal in PS (n:16, Group 2) (DFS), local recurrence and systemic metastasis results were compared.

RESULTS

Tumor diameter, differentiation, age and complications were found to negatively affect OS. It was observed that DFS increased (p:0.02) and local recurrence rates decreased (p:0.037) in group 2 compared but there was no difference between the two groups in terms of OS (p:0.420) and systemic metastasis (p:0.467).

CONCLUSIONS

R0 resection obtained by surgical margin resection of the neck in pancreatic head adenocarcinomas decreases local recurrence and increases the duration of DFS. However, it has no effect on preventing OS and systemic metastasis.

Pancreatic extragastrointestinal stromal tumor: A case report and comprehensive literature review

AIM: To provide an overview of the literature on pancreatic extragastrointestinal stromal tumors (EGISTs).

METHODS: We report a case of pancreatic EGIST and review published studies on pancreatic EGIST accessed via the PubMed, MEDLINE, Google Scholar, and Google databases. The keywords used were “pancreas and GIST”, “pancreas and extra GIST”, “pancreas and gastrointestinal stromal tumor”, and “pancreas and extragastrointestinal stromal tumor”. Literature reviews and/or duplicate studies were excluded. The search included articles published in the English language between January 1, 2000 and May 15, 2014.

RESULTS: From our literature survey, 30 manuscripts on pancreatic EGISTs were considered, of which 27 met the search criteria and three were excluded. The studies involved 30 patients (15 men, 15 women) with a mean age of 55.3 ± 14.3 years (range 30-84 years). The mean age of the male patients was 50.8 ± 13.7 years (range 30-84 years); that of the female patients was 59.9 ± 13.3 years (range 38-81 years). Tumor dimensions were obtained for 28 cases (mean 114.4 ± 78.6 mm; range 20-350 mm). Tumors were diagnosed incidentally in 23.3% of patients; abdominal discomfort and weight loss were the major complaints in symptomatic patients. Risk of aggressive behavior according to Fletcher criteria was determined in 25 of 30 patients (68%: high risk, 28%: intermediate risk, 4%: low risk). Histopathological examination revealed the presence of spindle cells in 96.1% of cases; CD117 and CD34 were present immunohistochemically in 96.6% and 84% of patients, respectively. The most common surgical procedures were distal pancreatectomy with splenectomy (n = 9) and pancreaticoduodenectomy (n = 7). The total follow-up period for the 28 patients ranged from 3-66 mo, during which locoregional or distant metastases were diagnosed in six patients and two patients died.

CONCLUSION: Studies on EGISTs have only been published in the last decade. The lack of studies with large patient cohorts and long-term follow-up limits evidence-based commentary. In theory, each case should be assessed individually and further genetic and immunohistochemical studies are needed.