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Crestani A, Merlot B, Goualard PH, Grigoriadis G, Chanavaz Lacheray I, Dennis T, Roman H. Bowel endometriosis: Surgical customization is demanding. Best Pract Res Clin Obstet Gynaecol 2024; 94:102495. [PMID: 38593673 DOI: 10.1016/j.bpobgyn.2024.102495] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2024] [Revised: 02/20/2024] [Accepted: 03/20/2024] [Indexed: 04/11/2024]
Abstract
Bowel endometriosis is the most common form of severe deep endometriosis. Surgery is an option in case of infertility and/or chronic pain or in the presence of a stenotic lesion. Clinical examination and preoperative imaging must provide an identity card of the lesion so that customized surgery can be proposed. The primary objective of this tailor-made surgery will always be to preserve the organ. The surgeon then has three options: shaving, discoid resection and segmental resection. The more extensive the resection, the greater the risk of severe short- and long-term complications. Surgery must therefore be adapted to the patient's specific situation and needs. Moreover, personalized care must extend beyond surgery. It must begin before the operation, preparing the patient for the operation like an athlete before a race, and continue afterwards by adapting the follow-up to the surgery performed.
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Affiliation(s)
- Adrien Crestani
- Institut Franco-Europeen Multidisciplinaire d'Endometriose (IFEMEndo), Endometriosis Centre, CliniqueTivoli-Ducos, 33000, Bordeaux, France.
| | - Benjamin Merlot
- Institut Franco-Europeen Multidisciplinaire d'Endometriose (IFEMEndo), Endometriosis Centre, CliniqueTivoli-Ducos, 33000, Bordeaux, France; Franco-European Multidisciplinary Endometriosis Institute (IFEMEndo), Middle East Clinic, Burjeel Medical City, Abu Dhabi, 7400, United Arab Emirates
| | - Paul-Henri Goualard
- Institut Franco-Europeen Multidisciplinaire d'Endometriose (IFEMEndo), Endometriosis Centre, CliniqueTivoli-Ducos, 33000, Bordeaux, France
| | | | - Isabelle Chanavaz Lacheray
- Institut Franco-Europeen Multidisciplinaire d'Endometriose (IFEMEndo), Endometriosis Centre, CliniqueTivoli-Ducos, 33000, Bordeaux, France
| | - Thomas Dennis
- Institut Franco-Europeen Multidisciplinaire d'Endometriose (IFEMEndo), Endometriosis Centre, CliniqueTivoli-Ducos, 33000, Bordeaux, France
| | - Horace Roman
- Institut Franco-Europeen Multidisciplinaire d'Endometriose (IFEMEndo), Endometriosis Centre, CliniqueTivoli-Ducos, 33000, Bordeaux, France; Franco-European Multidisciplinary Endometriosis Institute (IFEMEndo), Middle East Clinic, Burjeel Medical City, Abu Dhabi, 7400, United Arab Emirates; Department of Obstetrics and Gynecology, Aarhus University, 8000, Aarhus, Denmark
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Crestani A, Le Gac M, de Labrouhe É, Touboul C, Bendifallah S, Ferrier C, Dabi Y, Darai E. Outcomes of discoid excision and segmental resection for colorectal endometriosis: robotic versus conventional laparoscopy. J Robot Surg 2024; 18:87. [PMID: 38386205 DOI: 10.1007/s11701-024-01854-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Accepted: 01/28/2024] [Indexed: 02/23/2024]
Abstract
Surgery for deep endometriosis with colorectal involvement is an option after medical treatment failure. Over the past decade, robotic laparoscopy has emerged as an alternative to conventional laparoscopy. We aimed to evaluate surgical outcomes of robotic versus conventional laparoscopy for discoid excision and segmental resection. From 2019 to 2023, we conducted a retrospective cohort study of 152 consecutive patients with colorectal endometriosis who underwent robotic or conventional laparoscopy for discoid excision and colorectal resection. Ninety of the patients 152 underwent robotic surgery and 62 conventional laparoscopy. The mean total surgical room occupancy and operating times were longer in the robotic group: 270 ± 81 min vs 240 ± 79 min, p = 0.010, and 216 ± 78 min vs 190 ± 76, p = 0.027, respectively. The mean intraoperative blood loss, and the incidence of intra- and postoperative complications (according to Clavien-Dindo classification) were similar in the two groups. The mean hospital stay was greater after conventional laparoscopy (8 ± 5 vs 7 ± 4 days; p = 0.03), and the rate of persistent voiding dysfunction was higher in the conventional group (9/11, 25% vs 2/11, 5%; p = 0.01). A higher incidence of persistent voiding dysfunction was also observed after segmental resection by conventional laparoscopy (25% vs 4.8%, p = 0.01). Our results support the use of robotic surgery as an alternative to conventional laparoscopy for discoid excision and segmental resection for colorectal endometriosis.
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Affiliation(s)
- Adrien Crestani
- Franco-European Multidisciplinary Endometriosis Institute (IFEMEndo), Clinique Tivoli-Ducos, Bordeaux, France.
| | - Marjolaine Le Gac
- Department of Obstetrics and Reproductive Medicine, Sorbonne University, Hôpital Tenon, 4 rue de la Chine, Paris, France
| | - Éric de Labrouhe
- Department of Obstetrics and Reproductive Medicine, Sorbonne University, Hôpital Tenon, 4 rue de la Chine, Paris, France
| | - Cyril Touboul
- Department of Obstetrics and Reproductive Medicine, Sorbonne University, Hôpital Tenon, 4 rue de la Chine, Paris, France
- Clinical Research Group (GRC) Paris 6, Centre Expert Endométriose (C3E), Sorbonne University (GRC6 C3E SU), Paris, France
| | - Sofiane Bendifallah
- Department of Obstetrics and Reproductive Medicine, Sorbonne University, Hôpital Tenon, 4 rue de la Chine, Paris, France
- Clinical Research Group (GRC) Paris 6, Centre Expert Endométriose (C3E), Sorbonne University (GRC6 C3E SU), Paris, France
| | - Clément Ferrier
- Department of Obstetrics and Reproductive Medicine, Sorbonne University, Hôpital Tenon, 4 rue de la Chine, Paris, France
- Clinical Research Group (GRC) Paris 6, Centre Expert Endométriose (C3E), Sorbonne University (GRC6 C3E SU), Paris, France
| | - Yohann Dabi
- Department of Obstetrics and Reproductive Medicine, Sorbonne University, Hôpital Tenon, 4 rue de la Chine, Paris, France
- Clinical Research Group (GRC) Paris 6, Centre Expert Endométriose (C3E), Sorbonne University (GRC6 C3E SU), Paris, France
| | - Emile Darai
- Department of Obstetrics and Reproductive Medicine, Sorbonne University, Hôpital Tenon, 4 rue de la Chine, Paris, France
- Clinical Research Group (GRC) Paris 6, Centre Expert Endométriose (C3E), Sorbonne University (GRC6 C3E SU), Paris, France
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3
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Freund MR, Horesh N, Emile SH, Garoufalia Z, Gefen R, Wexner SD. Segmental and extended resections provide comparable survival for clinically node-negative splenic flexure cancer: a propensity score-matched analysis of the National Cancer Database. Tech Coloproctol 2023; 27:1073-1081. [PMID: 37071308 DOI: 10.1007/s10151-023-02796-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2022] [Accepted: 03/23/2023] [Indexed: 04/19/2023]
Abstract
PURPOSE There is an ongoing debate regarding the extent of resection for splenic flexure tumors (SFT). The purpose of this study was to compare segmental and extended resections in terms of overall survival (OS) and pathologic outcomes. METHODS Retrospective analysis of all patients surgically treated for SFT in the National Cancer Database (NCDB) for the period 2010-2019. Outcomes of segmental and extended resections were compared and a 1:1 propensity score matching was used to match for confounders. Primary outcome was OS. RESULTS In total 3498/668,852 (0.5%) patients with clinical stage I-III splenic flexure adenocarcinoma in the NCDB were included. Of these, 1533 (43.8%) underwent segmental resection while 1965 (56.1%) underwent extended resection. After matching, mean OS was similar between the groups (92 vs 91 months; p = 0.94). When survival was stratified by clinical N stage, an 8-month survival benefit was shown in the extended resection group for clinical N-positive status (86 vs 78); however, this difference did not achieve statistical significance (p = 0.078). Median number of harvested lymph nodes was significantly lower in the segmental resection group (16 vs 17; p < 0.001) and the percentage of patients with fewer than 12 harvested nodes was significantly higher (18.4% vs 11.6%; p < 0.001). Length of stay was significantly shorter in the segmental resection group (5 vs 6 days; p = 0.027). There were no significant differences between the groups in terms of 30-day readmission or 30- or 90-day mortality. CONCLUSIONS While segmental and extended resections were associated with similar OS for clinically node-negative SFT, there might be a survival benefit for extended resection in patients with clinical evidence of lymph node involvement.
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Affiliation(s)
- Michael R Freund
- Ellen Leifer Shulman and Steven Shulman Digestive Disease Center, Cleveland Clinic Florida, 2950 Cleveland Clinic Blvd., Weston, FL, 33331, USA
- Department of Surgery, Shaare Zedek Medical Center, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Nir Horesh
- Ellen Leifer Shulman and Steven Shulman Digestive Disease Center, Cleveland Clinic Florida, 2950 Cleveland Clinic Blvd., Weston, FL, 33331, USA
- Department of Surgery and transplantation, Sheba Medical Center, Ramat-Gan, Israel
| | - Sameh Hany Emile
- Ellen Leifer Shulman and Steven Shulman Digestive Disease Center, Cleveland Clinic Florida, 2950 Cleveland Clinic Blvd., Weston, FL, 33331, USA
- Colorectal Surgery Unit, Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | - Zoe Garoufalia
- Ellen Leifer Shulman and Steven Shulman Digestive Disease Center, Cleveland Clinic Florida, 2950 Cleveland Clinic Blvd., Weston, FL, 33331, USA
| | - Rachel Gefen
- Ellen Leifer Shulman and Steven Shulman Digestive Disease Center, Cleveland Clinic Florida, 2950 Cleveland Clinic Blvd., Weston, FL, 33331, USA
- Department of General Surgery, Faculty of Medicine, Hadassah Medical Organization, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Steven D Wexner
- Ellen Leifer Shulman and Steven Shulman Digestive Disease Center, Cleveland Clinic Florida, 2950 Cleveland Clinic Blvd., Weston, FL, 33331, USA.
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4
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Odongo CN, Godier-Furnemont A, Moro J, Oyania F. A case report of an asymptomatic necrotic Meckel's diverticulum in an inguinal hernia during elective surgery in a resource limited setting: Littre's hernia. Int J Surg Case Rep 2023; 105:108011. [PMID: 36963222 PMCID: PMC10060671 DOI: 10.1016/j.ijscr.2023.108011] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Revised: 03/02/2023] [Accepted: 03/16/2023] [Indexed: 03/26/2023] Open
Abstract
INTRODUCTION AND IMPORTANCE Although the common complications of Meckel's diverticulum (MD) are well known, that these congenital intestinal outpouchings may become involved as the content of abdominal hernia sacs is not well appreciated. MD is the most prevalent congenital abnormality of the gastrointestinal tract, but involvement in a hernia, known as Littre's hernia (LH), accounts for less than 1 % of MD cases. Incarcerated LH has been reported sporadically in the literature, with MD found in the sacs of paraumbilical, femoral, inguinal, and incisional hernias. PRESENTATION OF CASE We report a LH in a 3-year-old male child who was scheduled for elective herniotomy for a reducible left inguinal hernia. Intraoperatively we found the hernia sac contained a necrotic and perforated MD with viable associated bowel loop. The patient was successfully managed by diverticulectomy and primary repair through a trans-inguinal incision and herniotomy was performed. CLINICAL DISCUSSION LH is a rare presentation of MD, and preoperative diagnosis of LH is challenging. Even in the case of a strangulated MD, a patient may not present with the typical signs and symptoms associated with compromised viscous. Once identified, repair of Littre hernia consists of resection of the diverticulum, or segmental bowel resection if necessary, and herniotomy. CONCLUSION The finding of a perforated MD during elective hernia repair emphasizes the importance of awareness of unusual variants of inguinal hernia, and the necessity of identifying a MD given the risk of sequelae in the case of necrosis or perforation, if not repaired.
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Affiliation(s)
- Charles Newton Odongo
- Mbarara University of Science and Technology, Department of Surgery, Division of Pediatric Surgery, Uganda.
| | - Amandine Godier-Furnemont
- University of California, San Francisco, Department of Surgery, Center for Health Equity in Surgery and Anesthesia, San Francisco, CA, USA
| | - Joshua Moro
- Mbarara University of Science and Technology, Department of Surgery, Division of Pediatric Surgery, Uganda
| | - Felix Oyania
- Mbarara University of Science and Technology, Department of Surgery, Division of Pediatric Surgery, Uganda
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5
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Degiuli M, Ortenzi M, Tomatis M, Puca L, Cianflocca D, Rega D, Maroli A, Elmore U, Pecchini F, Milone M, La Mendola R, Soligo E, Deidda S, Spoletini D, Cassini D, Aprile A, Mineccia M, Nikaj H, Marchegiani F, Maiello F, Bombardini C, Zuolo M, Carlucci M, Ferraro L, Falato A, Biondi A, Persiani R, Marsanich P, Fusario D, Solaini L, Pollesel S, Rizzo G, Coco C, Di Leo A, Cavaliere D, Roviello F, Muratore A, D’Ugo D, Bianco F, Bianchi PP, De Nardi P, Rigamonti M, Anania G, Belluco C, Polastri R, Pucciarelli S, Gentilli S, Ferrero A, Scabini S, Baldazzi G, Carlini M, Restivo A, Testa S, Parini D, De Palma GD, Piccoli M, Rosati R, Spinelli A, Delrio P, Borghi F, Guerrieri M, Reddavid R. Minimally invasive vs. open segmental resection of the splenic flexure for cancer: a nationwide study of the Italian Society of Surgical Oncology-Colorectal Cancer Network (SICO-CNN). Surg Endosc 2023; 37:977-988. [PMID: 36085382 PMCID: PMC9944710 DOI: 10.1007/s00464-022-09547-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2022] [Accepted: 08/07/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND Evidence on the efficacy of minimally invasive (MI) segmental resection of splenic flexure cancer (SFC) is not available, mostly due to the rarity of this tumor. This study aimed to determine the survival outcomes of MI and open treatment, and to investigate whether MI is noninferior to open procedure regarding short-term outcomes. METHODS This nationwide retrospective cohort study included all consecutive SFC segmental resections performed in 30 referral centers between 2006 and 2016. The primary endpoint assessing efficacy was the overall survival (OS). The secondary endpoints included cancer-specific mortality (CSM), recurrence rate (RR), short-term clinical outcomes (a composite of Clavien-Dindo > 2 complications and 30-day mortality), and pathological outcomes (a composite of lymph nodes removed ≧12, and proximal and distal free resection margins length ≧ 5 cm). For these composites, a 6% noninferiority margin was chosen based on clinical relevance estimate. RESULTS A total of 606 patients underwent either an open (208, 34.3%) or a MI (398, 65.7%) SFC segmental resection. At univariable analysis, OS and CSM were improved in the MI group (log-rank test p = 0.004 and Gray's tests p = 0.004, respectively), while recurrences were comparable (Gray's tests p = 0.434). Cox multivariable analysis did not support that OS and CSM were better in the MI group (p = 0.109 and p = 0.163, respectively). Successful pathological outcome, observed in 53.2% of open and 58.3% of MI resections, supported noninferiority (difference 5.1%; 1-sided 95%CI - 4.7% to ∞). Successful short-term clinical outcome was documented in 93.3% of Open and 93.0% of MI procedures, and supported noninferiority as well (difference - 0.3%; 1-sided 95%CI - 5.0% to ∞). CONCLUSIONS Among patients with SFC, the minimally invasive approach met the criterion for noninferiority for postoperative complications and pathological outcomes, and was found to provide results of OS, CSM, and RR comparable to those of open resection.
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Affiliation(s)
- Maurizio Degiuli
- University of Turin, Department of Oncology, San Luigi University Hospital, Div of Surgical Oncology, Orbassano, Turin, Italy. .,Department of Oncology, Head Surgical Oncology and Digestive Surgery, University of Torino, San Luigi University Hospital, Regione Gonzole 10 Orbassano, 10043, Turin, Italy.
| | - Monica Ortenzi
- grid.411490.90000 0004 1759 6306Clinica Chirurgica Universita’ Politecnica delle Marche, Ospedali Riuniti, Ancona, Italy
| | - Mariano Tomatis
- grid.7605.40000 0001 2336 6580BSIT, Department of Oncology, University of Turin, Orbassano, Turin, Italy
| | - Lucia Puca
- grid.7605.40000 0001 2336 6580University of Turin, Department of Oncology, San Luigi University Hospital, Div of Surgical Oncology, Orbassano, Turin, Italy
| | - Desiree Cianflocca
- grid.413179.90000 0004 0486 1959Department of Surgery, S. Croce e Carle Hospital, Cuneo, Italy ,grid.432329.d0000 0004 1789 4477Department of General and Emergency Surgery, Azienda Ospedaliero Universitaria, Città della Salute e della Scienza, Turin, Italy
| | - Daniela Rega
- Colorectal Surgical Oncology, Abdominal Oncology Department, Fondazione Giovanni Pascale IRCCS, Naples, Italy
| | - Annalisa Maroli
- grid.417728.f0000 0004 1756 8807Colon and Rectal Surgery Division, Humanitas Clinical and Research Center, Via Alessandro Manzoni, 56, Rozzano, 20089 Milan, Italy
| | - Ugo Elmore
- grid.15496.3f0000 0001 0439 0892Division of Gastrointestinal Surgery, Vita Salute University, San Raffaele Hospital, 20132 Milan, Italy
| | - Francesca Pecchini
- grid.7548.e0000000121697570Unita’ Operativa di chirurgia generale, d’urgenza e nuove tecnologie, OCSAE, Azienda Ospedaliero Universitaria di Modena, Modena, Italy
| | - Marco Milone
- grid.4691.a0000 0001 0790 385XDepartment of Clinical Medicine and Surgery, Department of Gastroenterology, Endocrinology and Endoscopic Surgery, University of Naples “Federico II”, Naples, Italy
| | - Roberta La Mendola
- grid.415200.20000 0004 1760 6068General Surgery Unit, Santa Maria della Misericordia Hospital, Rovigo, Italy
| | - Erica Soligo
- grid.415230.10000 0004 1757 123XS.C. Chirurgia Generale, Ospedale S. Andrea, Vercelli, Italy
| | - Simona Deidda
- grid.7763.50000 0004 1755 3242Chirurgia Coloproctologica-AOU Cagliari, Dipartimento di Scienze Chirurgiche, Università di Cagliari, Cagliari, Italy
| | - Domenico Spoletini
- grid.416628.f0000 0004 1760 4441UOC Chirurgia Generale, Ospedale S. Eugenio, Piazzale dell’Umanesimo, 10, 00144 Rome, Italy
| | - Diletta Cassini
- Unità Operativa Complessa di Chirurgia Generale, P.O. SSG, ASST NORD MILANO, Milan, Italy
| | - Alessandra Aprile
- grid.410345.70000 0004 1756 7871Surgical Oncology Surgery, IRCCS Policlinico San Martino, Genoa, Italy
| | - Michela Mineccia
- grid.414700.60000 0004 0484 5983Department of General and Oncological Surgery, ”Umberto I” Mauriziano Hospital, Turin, Italy
| | - Herald Nikaj
- grid.412824.90000 0004 1756 8161SCDU Clinica Chirurgica, General Surgery Department, AOU “Maggiore Della Carità” Hospital, Novara, Italy
| | - Francesco Marchegiani
- grid.5608.b0000 0004 1757 3470Department of Surgical, Oncological, and Gastroenterological Sciences, University of Padua, Padua, Italy
| | - Fabio Maiello
- Department of Surgery, General Surgery Unit, Hospital of Biella, Biella, Italy
| | - Cristina Bombardini
- Department of Surgical Morphology and Experimental Medicine, AOU Ferrara, Ferrara, Italy
| | - Michele Zuolo
- General Surgery Division, “Valli del Noce” Hospital, Cles, Provincial Agency for Health Services (APSS), Trento, Italy
| | - Michele Carlucci
- grid.18887.3e0000000417581884Gastrointestinal Surgery, San Raffaele Hospital, 20132 Milan, Italy
| | - Luca Ferraro
- grid.4708.b0000 0004 1757 2822Division of General and Robotic Surgery, Dipartimento di Scienze della Salute, Università di Milano, 20142 Milan, Italy
| | - Armando Falato
- General Surgery Unit, San Leonardo Hospital, ASL-NA3sud, Castellammare di Stabbia, Naples, Italy
| | - Alberto Biondi
- grid.414603.4Fondazione Policlinico Gemelli, IRCCS, AREA di Chirurgia Addominale, Rome, Italy
| | - Roberto Persiani
- grid.414603.4Fondazione Policlinico Gemelli, IRCCS, AREA di Chirurgia Addominale, Rome, Italy
| | | | - Daniele Fusario
- grid.9024.f0000 0004 1757 4641UOC General and Oncological Surgery, University of Siena, Siena, Italy
| | - Leonardo Solaini
- grid.415079.e0000 0004 1759 989XGeneral and Oncologic Surgery, Morgagni-Pierantoni Hospital, Ausl Romagna, Forlì, Italy
| | - Sara Pollesel
- grid.414603.4Fondazione Policlinico Universitario A. Gemelli, IRCCS, Chirurgia Generale Presidio Columbus, Rome, Italy
| | - Gianluca Rizzo
- grid.414603.4Fondazione Policlinico Universitario A. Gemelli, IRCCS, Chirurgia Generale Presidio Columbus, Rome, Italy
| | - Claudio Coco
- grid.414603.4Fondazione Policlinico Universitario A. Gemelli, IRCCS, Chirurgia Generale Presidio Columbus, Rome, Italy
| | | | - Davide Cavaliere
- grid.414603.4Department of Surgical Oncology, CRO Aviano, National Cancer Institute, IRCCS, Aviano, Italy
| | - Franco Roviello
- grid.414603.4Fondazione Policlinico Universitario A. Gemelli, IRCCS, Chirurgia Generale Presidio Columbus, Rome, Italy
| | - Andrea Muratore
- Surgical Department, Edoardo Agnelli Hospital, Pinerolo, Italy
| | - Domenico D’Ugo
- grid.414603.4Fondazione Policlinico Gemelli, IRCCS, AREA di Chirurgia Addominale, Rome, Italy
| | - Francesco Bianco
- General Surgery Unit, San Leonardo Hospital, ASL-NA3sud, Castellammare di Stabbia, Naples, Italy
| | - Paolo Pietro Bianchi
- grid.4708.b0000 0004 1757 2822Division of General and Robotic Surgery, Dipartimento di Scienze della Salute, Università di Milano, 20142 Milan, Italy ,grid.415928.3Department of Surgery, Misericordia Hospital, Grosseto, Italy
| | - Paola De Nardi
- grid.4708.b0000 0004 1757 2822Division of General and Robotic Surgery, Dipartimento di Scienze della Salute, Università di Milano, 20142 Milan, Italy
| | - Marco Rigamonti
- General Surgery Division, “Valli del Noce” Hospital, Cles, Provincial Agency for Health Services (APSS), Trento, Italy
| | - Gabriele Anania
- Department of Surgical Morphology and Experimental Medicine, AOU Ferrara, Ferrara, Italy
| | - Claudio Belluco
- grid.414603.4Department of Surgical Oncology, CRO Aviano, National Cancer Institute, IRCCS, Aviano, Italy
| | - Roberto Polastri
- Department of Surgery, General Surgery Unit, Hospital of Biella, Biella, Italy
| | - Salvatore Pucciarelli
- grid.5608.b0000 0004 1757 3470Department of Surgical, Oncological, and Gastroenterological Sciences, University of Padua, Padua, Italy
| | - Sergio Gentilli
- grid.412824.90000 0004 1756 8161SCDU Clinica Chirurgica, General Surgery Department, AOU “Maggiore Della Carità” Hospital, Novara, Italy
| | - Alessandro Ferrero
- grid.414700.60000 0004 0484 5983Department of General and Oncological Surgery, ”Umberto I” Mauriziano Hospital, Turin, Italy
| | - Stefano Scabini
- grid.410345.70000 0004 1756 7871Surgical Oncology Surgery, IRCCS Policlinico San Martino, Genoa, Italy
| | - Gianandrea Baldazzi
- Unità Operativa Complessa di Chirurgia Generale, P.O. SSG, ASST NORD MILANO, Milan, Italy
| | - Massimo Carlini
- grid.416628.f0000 0004 1760 4441UOC Chirurgia Generale, Ospedale S. Eugenio, Piazzale dell’umanesimo, 10, 00144 Rome, Italy
| | - Angelo Restivo
- grid.7763.50000 0004 1755 3242Chirurgia Coloproctologica-AOU Cagliari, Dipartimento di Scienze Chirurgiche, Università di Cagliari, Cagliari, Italy
| | - Silvio Testa
- grid.415230.10000 0004 1757 123XS.C. Chirurgia Generale, Ospedale S. Andrea, Vercelli, Italy
| | - Dario Parini
- grid.415200.20000 0004 1760 6068General Surgery Unit, Santa Maria della Misericordia Hospital, Rovigo, Italy
| | - Giovanni Domenico De Palma
- grid.4691.a0000 0001 0790 385XDepartment of Clinical Medicine and Surgery, Department of Gastroenterology, Endocrinology and Endoscopic Surgery, University of Naples “Federico II”, Naples, Italy
| | - Micaela Piccoli
- grid.7548.e0000000121697570Unita’ Operativa di chirurgia generale, d’urgenza e nuove tecnologie, OCSAE, Azienda Ospedaliero Universitaria di Modena, Modena, Italy
| | - Riccardo Rosati
- grid.15496.3f0000 0001 0439 0892Division of Gastrointestinal Surgery, Vita Salute University, San Raffaele Hospital, 20132 Milan, Italy
| | - Antonino Spinelli
- grid.417728.f0000 0004 1756 8807Humanitas Clinical and Research Center, Via Alessandro Manzoni, 56 Rozzano, 20089 Milan, Italy ,grid.452490.eDepartment of Biomedical Science, Humanitas University, Pieve Emanuele, Milan, Italy
| | - Paolo Delrio
- Colorectal Surgical Oncology, Abdominal Oncology Department, Fondazione Giovanni Pascale IRCCS, Naples, Italy
| | - Felice Borghi
- grid.413179.90000 0004 0486 1959Department of Surgery, S. Croce e Carle Hospital, Cuneo, Italy ,grid.419555.90000 0004 1759 7675Oncological Surgery, Candiolo Cancer Institute-FPO-IRCCS, Candiolo, 10060 Torino, Italy
| | - Marco Guerrieri
- grid.411490.90000 0004 1759 6306Clinica Chirurgica Universita’ Politecnica delle Marche, Ospedali Riuniti, Ancona, Italy
| | - Rossella Reddavid
- grid.7605.40000 0001 2336 6580University of Turin, Department of Oncology, San Luigi University Hospital, Div of Surgical Oncology, Orbassano, Turin, Italy
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6
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Kumar VM, Chakravarthy A, Sathyanarayanan R, Raghu K, Reddy CD. Hybrid Ameloblastoma Arising from a Treated Odontogenic Keratocyst of the Mandible: A Case Report With Literature Review. Indian J Otolaryngol Head Neck Surg 2022; 74:6180-6188. [PMID: 36742540 PMCID: PMC9895636 DOI: 10.1007/s12070-021-02889-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Accepted: 09/22/2021] [Indexed: 02/07/2023] Open
Abstract
Odontogenic Keratocyst (OKC) is an odontogenic cyst of developmental origin arising from remnants of the dental lamina. Malignant or benign transformations though rare have been noticed from their epithelium. Ameloblastomatous transformation from an OKC is extremely rare with such lesions being referred to as combined/"hybrid" odontogenic lesions. In this article, we present an intriguing case of a 60-year-old male who was operated on for OKC of the anterior mandible 3 years before, who came back with a complaint of swelling over the same site. Incisional biopsy revealed the acanthomatous type of ameloblastoma for which segmental resection with immediate reconstruction using recon plate was done. Excision biopsy revealed a plexiform variant as well, thus exhibiting a hybrid pattern. Surgeons should be aware of this hybrid presentation of ameloblastoma arising from the epithelium of OKC as the acanthomatous subtype is known for its notorious genetic behavior leading to recurrence and aggressive nature of this tumor.
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Affiliation(s)
- V. Manoj Kumar
- Department of Oral and Maxillofacial Surgery, Indira Gandhi Institute of Dental Science, Sri Balaji Vidyapeeth University, Pillayyarkuppam, Pondicherry 607402 India
- Present Address: No. 50/52B Subhiksha Appartment, Kannagi Street, Anna Nedumpathai, Choolaimedu, Chennai, 600094 India
| | - Anirudh Chakravarthy
- Department of Oral and Maxillofacial Surgery, Indira Gandhi Institute of Dental Science, Sri Balaji Vidyapeeth University, Pillayyarkuppam, Pondicherry 607402 India
| | - R. Sathyanarayanan
- Department of Oral and Maxillofacial Surgery, Indira Gandhi Institute of Dental Science, Sri Balaji Vidyapeeth University, Pillayyarkuppam, Pondicherry 607402 India
| | - K. Raghu
- Department of Oral and Maxillofacial Surgery, Indira Gandhi Institute of Dental Science, Sri Balaji Vidyapeeth University, Pillayyarkuppam, Pondicherry 607402 India
| | - C. Deepika Reddy
- Department of Oral and Maxillofacial Surgery, Indira Gandhi Institute of Dental Science, Sri Balaji Vidyapeeth University, Pillayyarkuppam, Pondicherry 607402 India
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Zhang J, Wang Y, Yuan L, Wang W. Masticatory performance in patients undergoing free fibula flap for mandible reconstruction. BMC Oral Health 2022; 22:78. [PMID: 35300661 PMCID: PMC8932328 DOI: 10.1186/s12903-022-02114-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2021] [Accepted: 03/07/2022] [Indexed: 11/13/2022] Open
Abstract
Background To explore the masticatory performance in patients undergoing an osteo(cutaneous) free fibula (OFF) flap for mandible reconstruction by a prospective design. Methods A total of 56 patients who had undergone OFF flap reconstructions for mandibular reconstruction secondary to malignant (squamous cell carcinoma) or benign (ameloblastoma) tumor resection were prospectively enrolled. They were asked to complete the masticatory performance test by the weigh method and the chew domain of the University of Washington quality of life questionnaire (version 4) preoperatively and at 3, 6, and 12 months postoperatively. The pair nonparametric test was used to analyze the dynamic change of masticatory performance and subjective chew function. Results Fifty-one patients were included for analysis finally. The mean masticatory performance for patients with malignant tumors were 53.4% ± 10.3%, 36.4% ± 10.3%, 42.6% ± 9.6%, 52.8% ± 10.9%, and 53.1% ± 11.8% preoperatively, at 2 weeks, 3 months, 6 months, and 12 months postoperatively, respectively. Compared with the preoperative level, the masticatory performance had a significant reduction immediately after surgery (p < 0.001), followed by a return to the baseline level within three months. A similar trend was noted for those with benign tumors. The mean score of chew domain for patients with malignant tumors were 100 ± 0, 54.3 ± 32.9, 81.4 ± 24.5, and 92.9 ± 17.8 preoperatively, at 3 months, 6 months, and 12 months postoperatively, respectively. Compared with the preoperative level, the subjective chew function was greatly affected within the first three months (p < 0.001), and it gradually recovered to the baseline level in the following nine months. A similar trend was noted in patients with benign tumors. Conclusions The masticatory performance and subjective chew function was significantly affected after OFF flap reconstructions in the short term, but both recovered to the preoperative levels within 9–12 months.
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Affiliation(s)
- Jun Zhang
- Department of Oromaxillofacial-Head and Neck Surgery and Department of Oral and Maxillofacial Surgery, School and Hospital of Stomatology, Liaoning Provincial Key Laboratory of Oral Diseases, China Medical University, Shenyang, China.
| | - Yujing Wang
- Department of Oromaxillofacial-Head and Neck Surgery and Department of Oral and Maxillofacial Surgery, School and Hospital of Stomatology, Liaoning Provincial Key Laboratory of Oral Diseases, China Medical University, Shenyang, China
| | - Lulu Yuan
- Department of Oromaxillofacial-Head and Neck Surgery and Department of Oral and Maxillofacial Surgery, School and Hospital of Stomatology, Liaoning Provincial Key Laboratory of Oral Diseases, China Medical University, Shenyang, China
| | - Weiren Wang
- Department of Oromaxillofacial-Head and Neck Surgery and Department of Oral and Maxillofacial Surgery, School and Hospital of Stomatology, Liaoning Provincial Key Laboratory of Oral Diseases, China Medical University, Shenyang, China
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Pang AJ, Marinescu D, Morin N, Vasilevsky CA, Boutros M. Segmental resection of splenic flexure colon cancers provides an adequate lymph node harvest and is a safe operative approach - an analysis of the ACS-NSQIP database. Surg Endosc 2022; 36:5652-5659. [PMID: 34973078 PMCID: PMC9283142 DOI: 10.1007/s00464-021-08926-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Accepted: 11/22/2021] [Indexed: 12/02/2022]
Abstract
Introduction Fewer than 10% of colon cancers are found at the splenic flexure. A standard surgical approach to these cancers has not been defined. The goal of this study was to compare lymph node harvest and post-operative morbidity between segmental resection and formal left hemicolectomy for splenic flexure colon cancers. Method Patients diagnosed with a splenic flexure cancer were identified from the 2012–2018 ACS-NSQIP colectomy-targeted database. Patients were categorized based on type of surgical resection – left hemicolectomy with colorectal anastomosis or segmental colectomy with colocolonic anastomosis. Demographic, clinicopathologic, and post-operative outcomes were compared between groups. Factors independently associated with lymph node harvest, operative time, and post-operative morbidity were investigated by linear and binomial logistic regression models. Results A total of 3,049 patients underwent colectomy for a splenic flexure cancer. Of these, 83.6% had a segmental colectomy and 73% were performed by a minimally invasive approach. T- and N-stage did not differ between segmental and left hemicolectomy groups (p = 0.703 and p = 0.429, respectively). Inadequate nodal harvest (< 12 nodes) was infrequent and similar between the two procedures (7.4% vs. 9.1%, p = 0.13). Operative time was significantly shorter for segmental colectomy (213 ± 83.5 min vs. 193 ± 84.1 min, p < 0.0001) and major morbidity was similar between the two surgical techniques (8.4% vs. 8.9%, p = 0.75). After accounting for demographic, clinicopathologic, and operative factors, binomial logistic regression showed that type of procedure was not significantly associated with LN harvest (OR 0.80, 95%CI 0.54–1.17) or major morbidity (OR 1.17, 95%CI 0.36–3.81). However, on linear regression, segmental splenic flexure resection was associated with shorter operative time (estimate 20.29, 95%CI 12.61–27.97, p < 0.0001). Conclusion Splenic flexure resection for colon cancer is associated with an adequate lymph node harvest. Compared to a formal left hemicolectomy, a segmental resection also has a shorter operative time with equivalent post-operative morbidity.
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Affiliation(s)
- Allison J Pang
- Division of Colon and Rectal Surgery, Jewish General Hospital, McGill University, Montréal, QC, Canada.
| | - Daniel Marinescu
- Division of Colon and Rectal Surgery, Jewish General Hospital, McGill University, Montréal, QC, Canada
| | - Nancy Morin
- Division of Colon and Rectal Surgery, Jewish General Hospital, McGill University, Montréal, QC, Canada
| | - Carol-Ann Vasilevsky
- Division of Colon and Rectal Surgery, Jewish General Hospital, McGill University, Montréal, QC, Canada
| | - Marylise Boutros
- Division of Colon and Rectal Surgery, Jewish General Hospital, McGill University, Montréal, QC, Canada
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Portale G, Mazzeo A, Fiscon V. Gist of the 4th Portion of the Duodenum: Laparoscopic Resection with Pancreas Preservation. J Gastrointest Surg 2021; 25:3013-3014. [PMID: 34382156 DOI: 10.1007/s11605-021-05109-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Accepted: 07/14/2021] [Indexed: 01/31/2023]
Abstract
In this video, we present the laparoscopic technique of pancreas-preserving segmental resection for GISTs of the 4th portion of the duodenum. A 54-year-old male presented with a polypoid mass of about 3 cm in diameter with a large base, in the 4th portion of the duodenum, about 4 cm from the ampulla. Multiple endoscopic biopsies were taken, and all were negative for adenocarcinoma. CT scan of the abdomen confirmed that the mass, suggestive of GIST, was limited to the duodenum, a limited part intraluminal and the vast majority in the duodenal wall. A laparoscopic segmental resection with a 3D video system was accomplished. The operation lasted 160 min. Recovery was uneventful.
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Affiliation(s)
- Giuseppe Portale
- Department of General Surgery, ULSS 6 Euganea, Via Casa di Ricovero 40, 35013, Cittadella, Padova, Italy.
| | - Antonio Mazzeo
- Department of General Surgery, ULSS 6 Euganea, Via Casa di Ricovero 40, 35013, Cittadella, Padova, Italy
| | - Valentino Fiscon
- Department of General Surgery, ULSS 6 Euganea, Via Casa di Ricovero 40, 35013, Cittadella, Padova, Italy
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Zhao X, Lu H, Zhang Z. [Preliminary Study of CT Three-dimensional Reconstruction
Combined with Ground Glass Nodules of Natural Lung Collapse
in Thoracoscopic Pulmonary Segmental Resection]. Zhongguo Fei Ai Za Zhi 2021; 24:683-689. [PMID: 34696541 PMCID: PMC8560987 DOI: 10.3779/j.issn.1009-3419.2021.101.39] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Computed tomography (CT) three-dimensional reconstruction technology is increasingly used in preoperative planning of patients with ground glass nodule (GGN), but how to accurately locate the nodule and ensure the safe resection edge is still a difficult problem for clinicians. The purpose of this study was to investigate the accuracy, convenience and safety of CT three-dimensional reconstruction combined with intraoperative natural collapse localization in total thoracoscopic segmental pneumonectomy. METHODS A total of 45 patients with radiographic findings of pulmonary GGN admitted from July 2019 to December 2019 were selected as the study group. All patients received thin-slice CT scan and underwent preoperative three-dimensional reconstruction. After anesthesia, the small thoracic operation opening and the airway of the patients were quickly opened, and the lung was rapidly and naturally collapsed by pressure difference. GGN were positioned according to the natural marker line, and marked with 3-0 prolene line. After specimen removal, the distance between the GGN and the suture mark, the distance between the GGN and the incision margin were measured, and the incision margin was routinely examined. The general clinical data, pathological data and postoperative complications were counted and compared with 45 consecutive patients who were located with hookwire positioning needle in the same period. RESULTS The average localization time of non-invasive GGN with natural lung collapse during operation was 6.9 min, and the localization accuracy was 90.6%. There were 2 cases of extensive pleural adhesion and 1 case of emphysema. Postoperative pathology was confirmed as lung adenocarcinoma, and the examination of incision margin was negative. No GGNs were scanned again after surgery, and the precise resection rate of lung segment was 100.0%. CONCLUSIONS CT three-dimensional reconstruction combined with GGN localization of natural lung collapse during operation can shorten the time of searching for GGN during operation and guarantee the safety of the incision margin. It is a more economical and convenient localization method and makes pulmonary segment resection more accurate.
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Affiliation(s)
- Xiao Zhao
- Department of Thoracic Surgery, Weifang People's Hospital, Weifang 261000, China
| | - Hengxiao Lu
- Department of Thoracic Surgery, Weifang People's Hospital, Weifang 261000, China
| | - Zhenjiang Zhang
- Department of Thoracic Surgery, Weifang People's Hospital, Weifang 261000, China
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Kirschbaum A, Ivanovic A, Wiesmann T, Mirow N, Meyer C. Determination of initial airtightness after anatomical laser segmentectomy in an ex vivo model. Lasers Med Sci 2021; 37:815-820. [PMID: 33891211 PMCID: PMC8918094 DOI: 10.1007/s10103-021-03312-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Accepted: 03/30/2021] [Indexed: 11/12/2022]
Abstract
If a pulmonary pathology can be removed by anatomical segmentectomy, the need for lobectomy is obviated. The procedure is considered oncologically equivalent and saves healthy lung tissue. In every segmentectomy, lung parenchyma must be transected in the intersegmental plane. Using an ex vivo model based on porcine lung, three transection techniques (monopolar cutter + suture, stapler, and Nd:YAG laser) are to be compared with respect to their initial airtightness. At an inspiratory ventilation pressure of 25 mbar, all three preparations were airtight. Upon further increase in ventilation pressure up to 40 mbar, the laser group performed best in terms of airtightness. Since thanks to its use of a laser fibre, this technique is particularly suitable for minimally invasive surgery; it should be further evaluated clinically for this indication in the future.
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Affiliation(s)
- Andreas Kirschbaum
- Department of Visceral, Thoracic and Vascular Surgery, University Hospital Gießen and Marburg (UKGM), Marburg site, Baldingerstraße, D-35043, Marburg, Germany.
| | - Andrijana Ivanovic
- Department of Visceral, Thoracic and Vascular Surgery, University Hospital Gießen and Marburg (UKGM), Marburg site, Baldingerstraße, D-35043, Marburg, Germany
| | - Thomas Wiesmann
- Department of Anaesthesiology, University Hospital Gießen and Marburg (UKGM), Marburg site, Baldingerstraße, D-35043, Marburg, Germany
| | - Nikolas Mirow
- Department of Cardiac Surgery, University Hospital Gießen and Marburg (UKGM), Marburg site, Baldingerstraße, D-35043, Marburg, Germany
| | - Christian Meyer
- Department of Surgery, Asklepios Stadtklinik Bad Wildungen, Bad Wildungen, Germany
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Raimondo D, Maletta M, Borghese G, Mastronardi M, Arena A, Del Forno S, Salucci P, Giaquinto I, Casadio P, Seracchioli R. Indocyanine Green Fluorescence Angiography after Full-thickness Bowel Resection for Rectosigmoid Endometriosis-A Feasibility Study. J Minim Invasive Gynecol 2021; 28:1225-1230. [PMID: 33352315 DOI: 10.1016/j.jmig.2020.12.017] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Revised: 11/18/2020] [Accepted: 12/13/2020] [Indexed: 12/28/2022]
Abstract
STUDY OBJECTIVE To evaluate feasibility of near-infrared (NIR)-indocyanine green (ICG) imaging for bowel vascularization assessment after full-thickness bowel resection for rectosigmoid endometriosis (RSE). DESIGN This is a prospective, single-center, preliminary study on consecutive patients who were symptomatic submitted to discoid or segmental resection for RSE and NIR-ICG evaluation for vascular assessment of the anastomotic line from May 2018 to January 2020. SETTING Tertiary university hospital. PATIENTS Thirty-two women with RSE meeting eligibility criteria were included for study analysis. INTERVENTIONS NIR-ICG evaluation of anastomotic line vascularization after RSE removal. MEASUREMENTS AND MAIN RESULTS Fluorescence degree of the anastomotic line was assessed with a 0 to 2 Likert scale, as follows: 0 or "absent" (no fluorescence observed), 1 or "irregular" (not uniform distribution or weak fluorescence), and 2 or "regular" (uniform distribution of fluorescence and similar to the proximal colon). In all the patients included in the study (100%), NIR-ICG imaging allowed the evaluation of fluorescence degree of the anastomotic line. No adverse reaction related to ICG use was recorded. The protocol did not greatly lengthen operating time (median, 4 [range, 3-5] minutes). Excellent interoperator agreement was observed. Most of the patients (31 of 32, 96.9%) showed regular fluorescence on the anastomotic line; in 1 patient with irregular fluorescence at NIR-ICG after discoid excision, the anastomotic suture was reinforced through interrupted stitches. We had 1 case of anastomotic leakage after segmental resection with intraoperative good fluorescence at NIR-ICG evaluation. CONCLUSION NIR-ICG imaging for anastomotic perfusion assessment after discoid or segmental resection for RSE seems to be a feasible, safe, and reproducible method.
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Affiliation(s)
- Diego Raimondo
- Division of Gynaecology and Human Reproduction Physiopathology, Department of Medical and Surgical Sciences (DIMEC), IRCCS Azienda Ospedaliero-Universitaria di Bologna, S. Orsola Hospital, University of Bologna, Bologna, Italy (all authors)..
| | - Manuela Maletta
- Division of Gynaecology and Human Reproduction Physiopathology, Department of Medical and Surgical Sciences (DIMEC), IRCCS Azienda Ospedaliero-Universitaria di Bologna, S. Orsola Hospital, University of Bologna, Bologna, Italy (all authors)
| | - Giulia Borghese
- Division of Gynaecology and Human Reproduction Physiopathology, Department of Medical and Surgical Sciences (DIMEC), IRCCS Azienda Ospedaliero-Universitaria di Bologna, S. Orsola Hospital, University of Bologna, Bologna, Italy (all authors)
| | - Manuela Mastronardi
- Division of Gynaecology and Human Reproduction Physiopathology, Department of Medical and Surgical Sciences (DIMEC), IRCCS Azienda Ospedaliero-Universitaria di Bologna, S. Orsola Hospital, University of Bologna, Bologna, Italy (all authors)
| | - Alessandro Arena
- Division of Gynaecology and Human Reproduction Physiopathology, Department of Medical and Surgical Sciences (DIMEC), IRCCS Azienda Ospedaliero-Universitaria di Bologna, S. Orsola Hospital, University of Bologna, Bologna, Italy (all authors)
| | - Simona Del Forno
- Division of Gynaecology and Human Reproduction Physiopathology, Department of Medical and Surgical Sciences (DIMEC), IRCCS Azienda Ospedaliero-Universitaria di Bologna, S. Orsola Hospital, University of Bologna, Bologna, Italy (all authors)
| | - Paolo Salucci
- Division of Gynaecology and Human Reproduction Physiopathology, Department of Medical and Surgical Sciences (DIMEC), IRCCS Azienda Ospedaliero-Universitaria di Bologna, S. Orsola Hospital, University of Bologna, Bologna, Italy (all authors)
| | - Ilaria Giaquinto
- Division of Gynaecology and Human Reproduction Physiopathology, Department of Medical and Surgical Sciences (DIMEC), IRCCS Azienda Ospedaliero-Universitaria di Bologna, S. Orsola Hospital, University of Bologna, Bologna, Italy (all authors)
| | - Paolo Casadio
- Division of Gynaecology and Human Reproduction Physiopathology, Department of Medical and Surgical Sciences (DIMEC), IRCCS Azienda Ospedaliero-Universitaria di Bologna, S. Orsola Hospital, University of Bologna, Bologna, Italy (all authors)
| | - Renato Seracchioli
- Division of Gynaecology and Human Reproduction Physiopathology, Department of Medical and Surgical Sciences (DIMEC), IRCCS Azienda Ospedaliero-Universitaria di Bologna, S. Orsola Hospital, University of Bologna, Bologna, Italy (all authors)
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Bendifallah S, Puchar A, Vesale E, Moawad G, Daraï E, Roman H. Surgical Outcomes after Colorectal Surgery for Endometriosis: A Systematic Review and Meta-analysis. J Minim Invasive Gynecol 2020; 28:453-466. [PMID: 32841755 DOI: 10.1016/j.jmig.2020.08.015] [Citation(s) in RCA: 42] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Revised: 08/13/2020] [Accepted: 08/19/2020] [Indexed: 02/06/2023]
Abstract
OBJECTIVE To assess the impact of type of surgery for colorectal endometriosis-rectal shaving or discoid resection or segmental colorectal resection-on complications and surgical outcomes. DATA SOURCES We performed a systematic review of all English- and French-language full-text articles addressing the surgical management of colorectal endometriosis, and compared the postoperative complications according to surgical technique by meta-analysis. The PubMed, Clinical Trials.gov, Cochrane Library, and Web of Science databases were searched for relevant studies published before March 27, 2020. The search strategy used the following Medical Subject Headings terms: ("bowel endometriosis" or "colorectal endometriosis") AND ("surgery for endometriosis" or "conservative management" or "radical management" or "colorectal resection" or "shaving" or "full thickness resection" or "disc excision") AND ("treatment", "outcomes", "long term results" and "complications"). METHODS OF STUDY SELECTION Two authors conducted the literature search and independently screened abstracts for inclusion, with resolution of any difference by 3 other authors. Studies were included if data on surgical management (shaving, disc excision, and/or segmental resection) were provided and if postoperative outcomes were detailed with at least the number of complications. The risk of bias was assessed according to the Cochrane recommendations. TABULATION, INTEGRATION, AND RESULTS Of the 168 full-text articles assessed for eligibility, 60 were included in the qualitative synthesis. Seventeen of these were included in the meta-analysis on rectovaginal fistula, 10 on anastomotic leakage, 5 on anastomotic stenosis, and 9 on voiding dysfunction <30 days. The mean complication rate according to shaving, disc excision, and segmental resection were 2.2%, 9.7%, and 9.9%, respectively. Rectal shaving was less associated with rectovaginal fistula than disc excision (odds ratio [OR] = 0.19; 95% confidence interval [CI], 0.10-0.36; p <.001; I2 = 33%) and segmental colorectal resection (OR = 0.26; 95% CI, 0.15-0.44; p <.001; I2 = 0%). No difference was found in the occurrence of rectovaginal fistula between disc excision and segmental colorectal resection (OR = 1.07; 95% CI, 0.70-1.63; p = .76; I2 = 0%). Rectal shaving was less associated with leakage than disc excision (OR = 0.22; 95% CI, 0.06-0.73; p = .01; I2 = 86%). No difference was found in the occurrence of leakage between rectal shaving and segmental colorectal resection (OR = 0.32; 95% CI, 0.10-1.01; p = .05; I2 = 71%) or between disc excision and segmental colorectal resection (OR = 0.32; 95% CI, 0.30-1.58; p = .38; I2 = 0%). Disc excision was less associated with anastomotic stenosis than segmental resection (OR = 0.15; 95% CI, 0.05-0.48; p = .001; I2 = 59%). Disc excision was associated with more voiding dysfunction <30 days than rectal shaving (OR = 12.9; 95% CI, 1.40-119.34; p = .02; I2 = 0%). No difference was found in the occurrence of voiding dysfunction <30 days between segmental resection and rectal shaving (OR = 3.05; 95% CI, 0.55-16.87; p = .20; I2 = 0%) or between segmental colorectal and discoid resections (OR = 0.99; 95% CI, 0.54-1.85; p = .99; I2 = 71%). CONCLUSION Colorectal surgery for endometriosis exposes patients to a risk of severe complications such as rectovaginal fistula, anastomotic leakage, anastomotic stenosis, and voiding dysfunction. Rectal shaving seems to be less associated with postoperative complications than disc excision and segmental colorectal resection. However, this technique is not suitable for all patients with large bowel infiltration. Compared with segmental colorectal resection, disc excision has several advantages, including shorter operating time, shorter hospital stay, and lower risk of postoperative bowel stenosis.
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Affiliation(s)
- Sofiane Bendifallah
- Department of Gynaecology and Obstetrics, Tenon University Hospital, Assistance Publique des Hôpitaux de Paris (Drs. Bendifallah, Puchar, Vesale, and Daraï); UMRS-938 (Drs. Bendifallah and Daraï); Groupe de Recherche Clinique 6, Centre Expert En Endométriose (Drs. Bendifallah and Daraï), Sorbonne University, Paris
| | - Anne Puchar
- Department of Gynaecology and Obstetrics, Tenon University Hospital, Assistance Publique des Hôpitaux de Paris (Drs. Bendifallah, Puchar, Vesale, and Daraï)
| | - Elie Vesale
- Department of Gynaecology and Obstetrics, Tenon University Hospital, Assistance Publique des Hôpitaux de Paris (Drs. Bendifallah, Puchar, Vesale, and Daraï)
| | - Gaby Moawad
- Department of Obstetrics and Gynecology, George Washington University School of Medicine and Health Sciences, Washington, District of Columbia (Dr. Moawad)
| | - Emile Daraï
- Department of Gynaecology and Obstetrics, Tenon University Hospital, Assistance Publique des Hôpitaux de Paris (Drs. Bendifallah, Puchar, Vesale, and Daraï); UMRS-938 (Drs. Bendifallah and Daraï); Groupe de Recherche Clinique 6, Centre Expert En Endométriose (Drs. Bendifallah and Daraï), Sorbonne University, Paris
| | - Horace Roman
- Endometriosis Centre, Clinique Tivoli-Ducos, Bordeaux (Dr Roman), France; Department of Surgical Gynaecology, University Hospital of Aarhus, Aarhus, Denmark (Dr. Roman).
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Turco LC, Tortorella L, Tuscano A, Palumbo MA, Fagotti A, Uccella S, Fanfani F, Ferrandina G, Nicolotti N, Vargiu V, Lodoli C, Scaldaferri F, Scambia G, Cosentino F. Surgery-related complications and long-term functional morbidity after segmental colo-rectal resection for deep infiltrating endometriosis (ENDO-RESECT morb). Arch Gynecol Obstet 2020; 302:983-93. [PMID: 32676859 DOI: 10.1007/s00404-020-05694-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2020] [Accepted: 07/09/2020] [Indexed: 12/26/2022]
Abstract
PURPOSE Segmental resection has been generally associated with increased peri-operative risk of major complications. While major complications are widely acknowledged, minor complications, such as slight, to moderate infections, peripheral sensory disturbances, bladder voiding dysfunction, postoperative urinary obstruction, and sexual disorders are less reported. The aim of this study is to investigate the surgery-related complications and functional disorders, as well as to evaluate their persistence after long-term follow-up in women undergone segmental resection for deep infiltrating endometriosis. Special attention is given to evaluating impairments of bowel, bladder, and sexual function. METHODS All clinical data obtained from medical records of women who underwent segmental resection for intestinal endometriosis between October 2005, and November 2017, in Catholic University Institutions. Perioperative morbidity was classified by Extended Clavien-Dindo classification. Postoperative intestinal, voiding, and sexual morbidity was estimated by the compilation of specific questionnaires. RESULTS Fifty women were included in the study. Forty-three high colorectal resections (86%), 6 low resections (12%), and 1 ultra-low resection (2%) were performed, while in 3 cases (6%) multiple resections were needed. The overall complication rate was 44%. Nineteen women (38%) experienced early complications and 3 women (6%) late complications. Long-term functional postoperative complications were composed of intestinal in 30%, urinary in 50%, and sexual in 64% of the study population. Median follow-up was 55.5 months. CONCLUSIONS Segmental resection, when indicated, offers a radical and feasible approach for bowel deep infiltrating endometriosis, resulting in an improved general quality of life. The bowel and bladder complications appear to be acceptable and often reversible. Postoperative sexual dysfunctions, such as anorgasmia and insufficient vaginal lubrication, appear to persist over time. Surgeons and women have to be aware of the incidence of this kind of complications.
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Roh SJ, Hong YH, Kim BC, Chang HJ, Han KS, Hong CW, Sohn DK, Park SC, Lee DW, Kim B, Baek JY, Cha YJ, Choi MK, Oh JH. Analysis of metachronous colorectal neoplasms and survival following segmental or extended resection in patients with hereditary non-polyposis colorectal cancer. Int J Colorectal Dis 2020; 35:1273-1282. [PMID: 32347342 DOI: 10.1007/s00384-020-03583-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/04/2020] [Indexed: 02/04/2023]
Abstract
PURPOSE The high incidence of metachronous colorectal tumours in patients with hereditary non-polyposis colorectal cancer (HNPCC) encourages extended resection (ER); however, the optimal surgical approach remains unclear. We evaluated the incidences of metachronous colorectal neoplasms following curative colorectal cancer segmental resection (SR) vs ER in patients with HNPCC and investigated patients' oncologic outcomes according to surgical modality and mismatch repair status. METHODS We retrospectively investigated medical records of patients with HNPCC (per the Amsterdam II criteria) treated for primary colon cancer at our institution between 2001 and 2017. All patients underwent intensive endoscopic surveillance. RESULTS We included 87 patients (36 who underwent SR and 51 who underwent ER). The cumulative incidence of metachronous adenoma was higher in the SR group. One patient in the SR group (2.8%) and 3 in the ER group (5.9%) developed metachronous colon cancer; the difference was not significant (P = 0.693). Four patients in the SR group (11.1%) and 1 in the ER group (2.0%) developed distant recurrences; again, the difference was not significant (P = 0.155). Moreover, no significant differences were observed in the 5-year overall survival rates of patients in the SR and ER groups (88.2% vs 95.5%, P = 0.446); the same was true for 5-year disease-free survival rates (79.5% vs 91.0%, P = 0.147). CONCLUSION The incidence of metachronous cancer was not significantly different between the ER and SR groups; however, that of cumulative metachronous adenoma was higher in the SR group. Hence, intensive surveillance colonoscopy may be sufficient for patients with HNPCC after non-extensive colon resection.
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Affiliation(s)
- Seung Jae Roh
- Center for Colorectal Cancer, National Cancer Center, Research Institute and Hospital, 323, Ilsan-ro, Ilsandong-gu, Goyang-si, Gyeonggi-do, 10408, Republic of Korea
| | - Yoon Hwa Hong
- Center for Colorectal Cancer, National Cancer Center, Research Institute and Hospital, 323, Ilsan-ro, Ilsandong-gu, Goyang-si, Gyeonggi-do, 10408, Republic of Korea
| | - Byung Chang Kim
- Center for Colorectal Cancer, National Cancer Center, Research Institute and Hospital, 323, Ilsan-ro, Ilsandong-gu, Goyang-si, Gyeonggi-do, 10408, Republic of Korea.
| | - Hee Jin Chang
- Center for Colorectal Cancer, National Cancer Center, Research Institute and Hospital, 323, Ilsan-ro, Ilsandong-gu, Goyang-si, Gyeonggi-do, 10408, Republic of Korea
| | - Kyung Su Han
- Center for Colorectal Cancer, National Cancer Center, Research Institute and Hospital, 323, Ilsan-ro, Ilsandong-gu, Goyang-si, Gyeonggi-do, 10408, Republic of Korea
| | - Chang Won Hong
- Center for Colorectal Cancer, National Cancer Center, Research Institute and Hospital, 323, Ilsan-ro, Ilsandong-gu, Goyang-si, Gyeonggi-do, 10408, Republic of Korea
| | - Dae Kyung Sohn
- Center for Colorectal Cancer, National Cancer Center, Research Institute and Hospital, 323, Ilsan-ro, Ilsandong-gu, Goyang-si, Gyeonggi-do, 10408, Republic of Korea
| | - Sung Chan Park
- Center for Colorectal Cancer, National Cancer Center, Research Institute and Hospital, 323, Ilsan-ro, Ilsandong-gu, Goyang-si, Gyeonggi-do, 10408, Republic of Korea
| | - Dong Woon Lee
- Center for Colorectal Cancer, National Cancer Center, Research Institute and Hospital, 323, Ilsan-ro, Ilsandong-gu, Goyang-si, Gyeonggi-do, 10408, Republic of Korea
| | - Bun Kim
- Center for Colorectal Cancer, National Cancer Center, Research Institute and Hospital, 323, Ilsan-ro, Ilsandong-gu, Goyang-si, Gyeonggi-do, 10408, Republic of Korea
| | - Ji Yeon Baek
- Center for Colorectal Cancer, National Cancer Center, Research Institute and Hospital, 323, Ilsan-ro, Ilsandong-gu, Goyang-si, Gyeonggi-do, 10408, Republic of Korea
| | - Yong Jun Cha
- Center for Colorectal Cancer, National Cancer Center, Research Institute and Hospital, 323, Ilsan-ro, Ilsandong-gu, Goyang-si, Gyeonggi-do, 10408, Republic of Korea
| | - Moon Ki Choi
- Center for Colorectal Cancer, National Cancer Center, Research Institute and Hospital, 323, Ilsan-ro, Ilsandong-gu, Goyang-si, Gyeonggi-do, 10408, Republic of Korea
| | - Jae Hwan Oh
- Center for Colorectal Cancer, National Cancer Center, Research Institute and Hospital, 323, Ilsan-ro, Ilsandong-gu, Goyang-si, Gyeonggi-do, 10408, Republic of Korea
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Yan T, Wang K, Liu J, Zeng Y, Bie F, Wang G, Du J. Wedge resection is equal to segmental resection for pulmonary typical carcinoid patients at localized stage: a population-based analysis. PeerJ 2019; 7:e7519. [PMID: 31565553 PMCID: PMC6743473 DOI: 10.7717/peerj.7519] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2019] [Accepted: 07/19/2019] [Indexed: 11/20/2022] Open
Abstract
Background Medical institutions worldwide have not reached a consensus on what surgery is the most advisable for pulmonary typical carcinoid (TC) patients at the localized stage. This research focuses on exploring whether wedge resection or segmental resection is the superior option. Methods The demographic and clinical information of 1,887 TC patients diagnosed at the localized stage from 2004 to 2015 was collected from the Surveillance, Epidemiology, and End Results (SEER) Program. Patient prognosis was evaluated by KM curves. The chi-square test was used to examine the variation between different groups that would be eliminated by propensity score matching (PSM). Univariate and multivariate Cox proportional hazard model analyses were used to evaluate prognostic values of relative factors. Results The prognosis of TC was the most favorable for patients suffering from pulmonary squamous cell carcinoma (SCC), adenocarcinoma (ADC), and pulmonary carcinoids (PCs). The choice to have surgery, not the type of surgery chosen, was the most significant independent prognostic factor correlated with overall survival (OS) and lung cancer-special survival (LCSS). The prognostic result of the comparison between wedge resection and segmental resection was not statistically significant before or after PSM. In subgroup analysis, the inference still held.
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Affiliation(s)
- Tao Yan
- Institute of Oncology, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, China
| | - Kai Wang
- Institute of Oncology, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, China.,Department of Healthcare Respiratory, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, China
| | - Jichang Liu
- Institute of Oncology, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, China
| | - Yukai Zeng
- Institute of Oncology, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, China
| | - Fenglong Bie
- Institute of Oncology, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, China
| | - Guanghui Wang
- Institute of Oncology, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, China.,Department of Thoracic Surgery, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, China
| | - Jiajun Du
- Institute of Oncology, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, China.,Department of Thoracic Surgery, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, China
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Tsimogiannis KE, Karlbom U, Lundin E, Graf W. Long-term outcome after segmental colonic resection for slow transit constipation. Int J Colorectal Dis 2019; 34:1013-9. [PMID: 30937526 DOI: 10.1007/s00384-019-03283-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/19/2019] [Indexed: 02/04/2023]
Abstract
PURPOSE Colectomy with ileorectal anastomosis (IRA) is the most common surgical procedure for slow transit constipation (STC). A hemicolectomy has been suggested as an alternative to IRA with good short-term results. However, long-term results are unknown. The aim of this study was to evaluate the long-term results after hemicolectomy as a treatment for STC. METHODS Fifty patients with STC were selected for right- or left-sided hemicolectomy after evaluation with colonic scintigraphy from 1993 to 2008. Living patients (n = 43) received a bowel function questionnaire and a questionnaire about patient-reported outcome. RESULTS After a median follow-up of 19.8 years, 13 patients had undergone rescue surgery (n = 12) or used irrigation (n = 1) and were classified as failures. In all, 30 were evaluable for functional outcome and questionnaire data for 19 patients (due to 11 non-responding) could be analysed. Two reported deterioration after several years and were also classified as failures. Median stool frequency remained increased from 1 per week at baseline to 5 per week at long-term follow-up (p = 0.001). Preoperatively, all patients used laxatives, whereas 12 managed without laxatives at long-term follow-up (p = 0.002). There was some reduction in other constipation symptoms but not statically significant. In the patients' global assessment, 10 stated a very good result, seven a good result and two a poor result. CONCLUSIONS Hemicolectomy for STC increases stool frequency and reduces laxative use. Long-term success rate could range between 17/50 (34%) and 35/50 (70%) depending on outcome among non-responders.
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Badescu A, Roman H, Barsan I, Soldea V, Nastasia S, Aziz M, Puscasiu L, Stolnicu S. Patterns of Bowel Invisible Microscopic Endometriosis Reveal the Goal of Surgery: Removal of Visual Lesions Only. J Minim Invasive Gynecol 2017; 25:522-527.e9. [PMID: 29097234 DOI: 10.1016/j.jmig.2017.10.026] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2017] [Revised: 10/20/2017] [Accepted: 10/23/2017] [Indexed: 01/19/2023]
Abstract
STUDY OBJECTIVE To document the presence of bowel invisible microscopic endometriosis implants and their relationship with deep endometriosis macronodule infiltrating the bowel. DESIGN A series of consecutive patients with deep endometriosis infiltrating the rectum and/or sigmoid colon (Canadian Task Force classification II-2). SETTINGS A university referral center. PATIENTS Ten patients managed by colorectal resection. INTERVENTIONS A microscopic study of endometriotic foci of the bowel involving 3272 microsection slides was established using a unique method of step serial sections using combined transverse and longitudinal macrosection. Two-dimensional reconstruction based on slide scanning highlighted the presence and localization of the deep endometriosis macronodule in contrast with bowel invisible microscopic endometriosis microimplants. MEASUREMENTS AND MAIN RESULTS The distance separating the microimplants and the nodule and their histologic characteristics. The mean length of the colorectal specimens was 91 ± 19 mm. The maximum distance between the farthest microimplants was 7.2 cm. The maximum distance from the macroscopic nodule limit to the farthest microimplant was 31 mm. Bowel invisible microscopic endometriosis microimplants presented with similar features independently of the type of spread. They had an active appearance including stroma and glands, were sometimes decidualized, and were free of fibrosis. They were found on the distal/rectal limit of the specimen in 3 patients and on both limits (distal/rectal and proximal/sigmoid colon) in 1 patient. CONCLUSION Invisible microscopic endometriosis implants surround the bowel macroscopic endometriosis nodule at variable distances, suggesting that complete surgical microscopic removal may be a challenging goal. These results may help to reconsider the principles and feasibility of the surgical management of bowel endometriosis.
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Affiliation(s)
- Alexandra Badescu
- Department of Gynecology and Obstetrics, Rouen University Hospital, Rouen France; Department of Obstetrics and Gynecology, University of Medicine and Pharmacy, Targu Mures, Romania
| | - Horace Roman
- Department of Gynecology and Obstetrics, Rouen University Hospital, Rouen France; Research Group 4308 "Spermatogenesis and Gamete Quality," IHU Rouen Normandy, IFRMP23, Reproductive Biology Laboratory, Rouen University Hospital, Rouen France.
| | - Iulia Barsan
- Department of Pathology, University of Medicine and Pharmacy, Targu Mures, Romania
| | - Valentin Soldea
- Department of Pathology, University of Medicine and Pharmacy, Targu Mures, Romania; Department of Thoracic Surgery, Rouen University Hospital, Rouen France
| | - Serban Nastasia
- Department of Obstetrics and Gynecology, Cantacuzino Hospital, University of Medicine and Pharmacy Carol Davila, Bucharest, Romania
| | - Moutaz Aziz
- Department of Pathology, Rouen University Hospital, Rouen France
| | - Lucian Puscasiu
- Department of Obstetrics and Gynecology, University of Medicine and Pharmacy, Targu Mures, Romania
| | - Simona Stolnicu
- Department of Pathology, University of Medicine and Pharmacy, Targu Mures, Romania
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Gupta S, Kumar N. Jejunal diverticula with perforation in non steroidal anti inflammatory drug user: A case report. Int J Surg Case Rep 2017; 38:111-114. [PMID: 28756358 PMCID: PMC5537402 DOI: 10.1016/j.ijscr.2017.07.021] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2017] [Revised: 07/10/2017] [Accepted: 07/15/2017] [Indexed: 12/27/2022] Open
Abstract
Multiple diverticulosis of the jejunum constitutes an uncommon pathology of the small bowel. Jejunal diverticular perforation related to steroid/treatment has been reported only once previously. The current treatment of choice is prompt laparotomy with segmental intestinal resection and primary anastomosis.
Introduction Multiple diverticulosis of the jejunum constitutes an uncommon pathology of the small bowel. The disease is often asymptomatic and must be taken into consideration in cases of unexplained malabsorption, anemia, chronic abdominal pain and discomfort. Case presentaion We are thereby reporting a 50 yr patient on chronic NSAID ingestion presenting to us with acute abdomen. On exploration, there were multiple (14) jejunal diverticuli on both mesenteric and antimesentric border from 10 cm to 90 cm distal to duedenojejunal junction with a perforation in one of the diverticulum, 80 cm distal to the ligament of Treitz. We performed a resection of a 80-cm jejunal segment involving the multiple diverticula and an end to end jejunojejunostomy. Discussion Drug-induced jejunal perforation is known, but jejunal diverticular perforation related to steroid/treatment has been reported only once previously. Long-term NSAID therapy usually induces clinically silent enteropathy characterized by increased intestinal permeability and inflammation. Jejunal diverticulosis is a challenging disorder from a diagnostic perspective, with no truly reliable diagnostic tests. The current treatment of choice for perforated jejunal diverticula causing generalized peritonitis is prompt laparotomy with segmental intestinal resection and primary anastomosis. Conclusion Jejunal diverticula are rare lesions, and their perforation never features in the list of diagnoses for acute abdomen, especially in this part of the world. Further this unique case report opens the doors for further research to prove an assosiation between NSAID use and diverticular perforation which itself is a very rare entity.
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Affiliation(s)
- Shobhit Gupta
- R.G. Kar Medical College and Hospital, 1, Kshudiram Bose Sarani, Kolkata, West Bengal, 700004, India.
| | - Naveen Kumar
- PGIMER & DR. R.M.L. Hospital, New Delhi, 110001, India
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Cloyd JM, George E, Visser BC. Duodenal adenocarcinoma: Advances in diagnosis and surgical management. World J Gastrointest Surg 2016; 8:212-221. [PMID: 27022448 PMCID: PMC4807322 DOI: 10.4240/wjgs.v8.i3.212] [Citation(s) in RCA: 52] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2015] [Revised: 11/02/2015] [Accepted: 12/14/2015] [Indexed: 02/06/2023] Open
Abstract
Duodenal adenocarcinoma is a rare but aggressive malignancy. Given its rarity, previous studies have traditionally combined duodenal adenocarcinoma (DA) with either other periampullary cancers or small bowel adenocarcinomas, limiting the available data to guide treatment decisions. Nevertheless, management primarily involves complete surgical resection when technically feasible. Surgery may require pancreaticoduodenectomy or segmental duodenal resection; either are acceptable options as long as negative margins are achievable and an adequate lymphadenectomy can be performed. Adjuvant chemotherapy and radiation are important components of multi-modality treatment for patients at high risk of recurrence. Further research would benefit from multi-institutional trials that do not combine DA with other periampullary or small bowel malignancies. The purpose of this article is to perform a comprehensive review of DA with special focus on the surgical management and principles.
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Abstract
Antenatal diagnosis of lung lesion has become more accurate resulting in dilemma and controversies of its antenatal and postnatal management. Majority of antenatally diagnosed congenital lung lesions are asymptomatic in the neonatal age group. Large lung lesions cause respiratory compromise and inevitably require urgent investigations and surgery. The congenital lung lesion presenting with hydrops requires careful postnatal management of lung hypoplasia and persistent pulmonary hypertension. Preoperative stabilization with gentle ventilation with permissive hypercapnia and delayed surgery similar to congenital diaphragmatic hernia management has been shown to result in good outcome. The diagnostic investigations and surgical management of the asymptomatic lung lesions remain controversial. Postnatal management and outcome of congenital cystic lung lesions are discussed.
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Affiliation(s)
- Dakshesh H Parikh
- Department of Paediatric Surgery, Birmingham Children׳s Hospital NHS Foundation Trust, Steelhouse Lane, Birmingham B4 6NH, UK.
| | - Shree Vishna Rasiah
- Southern West Midlands Newborn Network and Birmingham Women's Health Care NHS Trust, Mindelsohn Way, Edgbaston Birmingham, B15 2TG UK
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Chen CJ, Chuang JP. Conservative Surgery for Right Colon Perforation Leads to Better Long-Term Outcomes in Children: A 21-year Experience. Pediatr Neonatol 2015; 56:159-64. [PMID: 25446523 DOI: 10.1016/j.pedneo.2014.09.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2014] [Revised: 08/14/2014] [Accepted: 09/07/2014] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE There is no consensus on standard treatment for right colon perforation in pediatric patients. We reviewed our cases over the past 21 years, comparing the effects of different operations to the long-term growth of patients. METHODS From February 1990 to October 2011, 29 patients of right colon perforation were enrolled in our analysis after excluding tumors, diverticulum, volvulus, and tuberculosis. Clinical information was collected from medical records, and analysis was done over 26 cases younger than 10 years at the time of the treatment. Surgical options included primary repair (D group, 12 cases), segmental resection (S group, 5 cases) and right hemicolectomy (H group, 9 cases). The length of postoperative stay, complications, and body weight growth in body weight percentile curve chart at last follow-up visit in each group were compared by analysis of variance. RESULTS Of the 26 patients who underwent the right colon perforation treatment, cecum perforation was found in 16 (62%), ascending colon perforation in six (23%), transverse colon perforation in three (12%), and combined ascending and transverse colon in one (4%). No mortality or anastomotic leakage occurred. The mean length of postoperative stay was shorter in the D group than in the S and H groups but without statistical significance (mean 10.9 days vs. 11.6 days and 17.9 days, respectively). Long-term body weight growth was significantly better in the D group (+26.3 ± 22.2 percentile) than the H group (-4.8 ± 8.0 percentile; p = 0.02). CONCLUSION For right colon perforation in children, simple closure following debridement has long-term benefits over more extensive resections.
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Affiliation(s)
- Chau-Jing Chen
- Section of Pediatric Surgery, Department of Surgery, National Cheng-Kung University Hospital, Tainan, Taiwan
| | - Jen-Pin Chuang
- Surgery Department, Sin-Hua Branch, Tainan Hospital, Ministry of Health and Welfare, Tainan, Taiwan; Institute of Clinical Medicine, National Cheng Kung University College of Medicine, Tainan, Taiwan.
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Shetty SK, Biddappa L. Recurrence of a giant peripheral osteoma of mandible. J Maxillofac Oral Surg 2015; 14:452-6. [PMID: 25848157 DOI: 10.1007/s12663-014-0674-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2014] [Accepted: 07/12/2014] [Indexed: 10/25/2022] Open
Abstract
Osteomas are rare benign tumours in the bone. We describe a case of giant osteoma involving the lingual side of the ramus and body of mandible that recurred 8 years after its surgical treatment at another hospital. Surgical resection with reconstruction is the treatment of choice for this lesion. The clinicopathological features of osteoma are discussed and Gardner's syndrome was excluded.
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Fukino N, Oida T, Mimatsu K, Kuboi Y, Kida K. Adenocarcinoma arising from heterotopic pancreas at the third portion of the duodenum. World J Gastroenterol 2015; 21:4082-4088. [PMID: 25852297 PMCID: PMC4385559 DOI: 10.3748/wjg.v21.i13.4082] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2014] [Revised: 11/18/2014] [Accepted: 01/08/2015] [Indexed: 02/06/2023] Open
Abstract
A 62-year-old Japanese man presented to our hospital with a history of weight loss of 6 kg in 4 mo. Imaging examinations revealed a tumor located on the third portion of the duodenum with stenosis. We suspected duodenal carcinoma and performed pancreas-preserving segmental duodenectomy. Adenocarcinoma arising from a heterotopic pancreas at the third portion of the duodenum was finally diagnosed by immunohistochemical staining. Malignant transformation in the duodenum arising from a heterotopic pancreas is extremely rare; to our knowledge, only 13 cases have been reported worldwide, including the present case. The most common location of malignancy is the proximal duodenum at the first and descending portion. Herein, we describe the first case of adenocarcinoma arising from a heterotopic pancreas, which was located in the third portion of the duodenum, with a review of the literature.
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Zhuo CH, Shi DB, Ying MG, Cheng YF, Wang YW, Zhang WM, Cai SJ, Li XX. Laparoscopic segmental colectomy for colonic lymphangiomas: A definitive, minimally invasive surgical option. World J Gastroenterol 2014; 20:8745-8750. [PMID: 25024636 PMCID: PMC4093731 DOI: 10.3748/wjg.v20.i26.8745] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2013] [Revised: 01/29/2014] [Accepted: 03/10/2014] [Indexed: 02/06/2023] Open
Abstract
Colonic lymphangioma is an unusual benign malformation. We herein describe two cases. A 36-year-old woman was admitted with one year of intermittent abdominal pain; colonoscopy, abdominopelvic computed tomography and endoscopic ultrasonography (EUS) revealed enlarged cystic masses at the ascending colon. In another 40-year-old man, colonoscopy and EUS revealed an asymptomatic lobulated cystic mass with four small sessile polyps at the sigmoid colon. Both patients underwent laparoscopic segmental colectomy. Both masses were histologically confirmed as cystic lymphangiomas, and the patients were discharged without complications. The management of colonic lymphangioma depends on the individual situation; close surveillance or endoscopic therapy may be appropriate for asymptomatic lesions smaller than 2.5 cm in diameter. Surgical intervention can be considered for larger lesions or in patients who develop complication risks. Laparoscopic segmental colon resection may be recommended to excise relatively large submucosal lesions because it is a definitive, minimally invasive intervention with a fast postoperative recovery.
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Bagrodia N, Cassel S, Liao J, Pitcher G, Shilyansky J. Segmental resection for the treatment of congenital pulmonary malformations. J Pediatr Surg 2014; 49:905-9. [PMID: 24888832 DOI: 10.1016/j.jpedsurg.2014.01.021] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2014] [Accepted: 01/27/2014] [Indexed: 10/25/2022]
Abstract
PURPOSE The purpose of this study was to compare clinical outcomes of segmental resection to lobectomy as increasing antenatal diagnosis of congenital pulmonary malformations has led to a shift in surgical management. METHODS A retrospective institutional review for patients undergoing surgical excision of congenital pulmonary malformations was performed. RESULTS Sixty-two patients with congenital pulmonary malformations were reviewed between 2001 and 2012. Forty-five were included for analysis. Malformations were subdivided into two groups, including congenital lobar emphysema (CLE) (n=11, 24%) and intrapulmonary (IP) lesions (n=34, 76%). Nineteen (56%) IP patients underwent segmental resection, and 15 (79%) were performed thoracoscopically without conversion to thoracotomy. None of these patients had recurrent disease. Lobectomy was performed in 11 (100%) CLE and 15 (44%) IP patients, and the majority were by thoracotomy. Median hospital stay was longer for the lobectomy group at 7days when compared to the segmentectomy group at 2days (p<0.001). There was not a difference in complication rate (21% vs. 19%, p=1.000) or in median number of chest tube days (2 vs. 3days, p=0.079) for segmentectomy versus lobectomy patients. CONCLUSIONS Segmental resections of congenital pulmonary malformations can be performed safely while conserving healthy lung tissue.
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Affiliation(s)
- Naina Bagrodia
- Department of Surgery, Division of Pediatric Surgery, University of Iowa Hospitals and Clinics, Iowa City, IA 52242, USA
| | - Shannon Cassel
- Department of Surgery, Division of Pediatric Surgery, University of Iowa Hospitals and Clinics, Iowa City, IA 52242, USA
| | - Junlin Liao
- Department of Surgery, Division of Pediatric Surgery, University of Iowa Hospitals and Clinics, Iowa City, IA 52242, USA
| | - Graeme Pitcher
- Department of Surgery, Division of Pediatric Surgery, University of Iowa Hospitals and Clinics, Iowa City, IA 52242, USA
| | - Joel Shilyansky
- Department of Surgery, Division of Pediatric Surgery, University of Iowa Hospitals and Clinics, Iowa City, IA 52242, USA.
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Ooi A, Feng J, Tan HK, Ong YS. Primary treatment of mandibular ameloblastoma with segmental resection and free fibula reconstruction: achieving satisfactory outcomes with low implant-prosthetic rehabilitation uptake. J Plast Reconstr Aesthet Surg 2014; 67:498-505. [PMID: 24508227 DOI: 10.1016/j.bjps.2014.01.005] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2013] [Revised: 12/25/2013] [Accepted: 01/03/2014] [Indexed: 11/18/2022]
Abstract
Ameloblastoma is a locally aggressive and disfiguring oral cavity tumour and surgical management is the mainstay of treatment. The ideal management of ameloblastoma should minimise recurrence, restore function and appearance and present minimal donor site morbidity. Conservative management is associated with minimal downtime but high recurrence rates. By contrast, segmental mandibulectomy with appropriate margins have much lower recurrence rates but presents the challenge of reconstruction. Osseointegrated (OI) implants and permanent dental prosthesis, while ideal, are not always available. We conducted a retrospective review on 30 consecutive patients at our centre with unicystic and multicystic ameloblastoma who were treated with segmental mandibular resection and free fibula flap reconstruction. Only three patients underwent OI implant insertion, with 40% of the patients not receiving any form of dental rehabilitation. We performed a functional and aesthetic outcome survey to determine patient satisfaction with this form of treatment. At an average follow-up of 5 years, there were no recurrences of tumour in our population. Of the 26 patients who responded to the survey, 96% of the patients reported that they were satisfied with their appearance, 88% reported an absolutely normal diet and 93% of the patients reported no problems with donor site function. Overall, we found that low uptake of dental rehabilitation did not adversely affect patient satisfaction and outcomes.
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Affiliation(s)
- Adrian Ooi
- Department of Plastic, Reconstructive and Aesthetic Surgery, Singapore General Hospital, Singapore.
| | - Jiajun Feng
- Department of Plastic, Reconstructive and Aesthetic Surgery, Singapore General Hospital, Singapore
| | - Hiang Khoon Tan
- Department of Surgical Oncology, National Cancer Centre, Singapore
| | - Yee Siang Ong
- Department of Plastic, Reconstructive and Aesthetic Surgery, Singapore General Hospital, Singapore
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Manuballa V, Amin M, Cappell MS. Clinical presentation and comparison of surgical outcome for segmental resection vs. Whipple's procedure for solid pseudopapillary tumor: Report of six new cases & literature review of 321 cases. Pancreatology 2013; 14:71-80. [PMID: 24555981 DOI: 10.1016/j.pan.2013.11.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2013] [Revised: 09/12/2013] [Accepted: 11/14/2013] [Indexed: 12/11/2022]
Abstract
AIM Report 6 new cases of solid-pseudopapillary-pancreatic-tumor, comprehensively review 321 cases reported in American literature, and compare outcomes for segmental resection vs.. Whipple's procedure. METHODS Cases of solid-pseudopapillary-tumor at William Beaumont Hospital, 1999-2011, identified by computerized analysis of pathology reports. Comprehensive review of all American cases identified by computerized literature review. Segmental resection includes open/laparoscopic central pancreatectomy and anatomic distal pancreatectomy, but excludes enucleation. RESULTS Six cases of solid-pseudopapillary-pancreatic-tumors (0.5% of all solid pancreatic lesions), occurred during 1999-2011 at the hospital. Mean age at diagnosis = 27.7 years. All 6 were female. All patients had abdominal pain. Mean symptom duration = 10.0 days. All patients had normal routine blood tests. Mean APACHE II score at diagnosis = 1.8. All six patients had single heterogeneous lesions, with cystic/solid components. All patients underwent surgery: segmental resection-4, Whipple's procedure-2. Tumors were uniformly diagnosed by surgically resected tissue. Mean tumor size = 5.7 cm. Mean postoperative length of stay = 4.0 days for segmental resection (N = 4) vs. 14.0 days for Whipple's procedure (N = 2). All 6 patients are alive and well to-date, without evident local recurrence or metastasis. In a literature review, 45 patients undergoing Whipple's procedure versus 34 patients undergoing segmental resection, had significantly longer mean postoperative hospitalization (16.4 vs. 4.3 days, p = 0.01), and had increased unadjusted mortality (20.2% vs. 2.2%, p = 0.018). However, this mortality difference became insignificant when adjusting for longer mean follow-up of Whipple's procedure patients (Kaplan-Meier-survival-curve, p = 0.75). CONCLUSIONS This work suggests segmental resection of these pancreatic tumors localized to the body/tail may have a better surgical outcome than Whipple's procedure for tumors localized to the pancreatic head. Further studies are necessary.
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Affiliation(s)
| | - Mitual Amin
- William Beaumont Hospital, Royal Oak, MI, USA; Oakland University-William Beaumont School of Medicine, Royal Oak, MI, USA
| | - Mitchell S Cappell
- William Beaumont Hospital, Royal Oak, MI, USA; Oakland University-William Beaumont School of Medicine, Royal Oak, MI, USA.
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Fascetti-Leon F, Gobbi D, Pavia SV, Aquino A, Ruggeri G, Gregori G, Lima M. Sparing-lung surgery for the treatment of congenital lung malformations. J Pediatr Surg 2013; 48:1476-80. [PMID: 23895957 DOI: 10.1016/j.jpedsurg.2013.02.098] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2012] [Revised: 01/16/2013] [Accepted: 02/20/2013] [Indexed: 11/28/2022]
Abstract
PURPOSE Congenital lung malformations (CLM) are traditionally treated by pulmonary lobectomy. The foremost indication for surgery is that these lesions predispose to respiratory tract infections and to malignancy. Owing to the improvement of prenatal diagnosis, most patients are operated in a timely manner and prophylactically. In this context, lung-sparing surgery (LS) has gained interest as a lung preservation strategy, especially for asymptomatic patients. In the present study, we evaluated both thoracoscopic and open lung-preserving resections as an alternative to lobectomy for CLM resection. METHODS We retrospectively reviewed all patients who underwent lung-sparing resection (segmentectomy and atypical resection) for CLM from 2001 to 2010. Data were collected regarding preoperative diagnostic workup, type of intervention, and follow up. RESULTS Fifty-four patients received LS for CLM during the study period. Twenty-six were approached thoracoscopically, with 18 cases requiring open conversion for a complete resection. There were six postoperative complications: three asymptomatic pneumothoraces that resolved without intervention, one tension pneumothorax that required replacement of a drainage catheter, and three instances of intra-operative bleeding requiring blood transfusion. Mean duration of follow-up was 65.2 months. Two patients experienced pneumonia during the follow-up period. A third patient had a cystic lung lesion on postoperative computed tomography (CT) which required a second-look surgery. CONCLUSIONS LS for CLM is a safe and effective means of lung parenchymal preservation in pediatric patients. Complication rates are comparable to that of traditional lobectomy. In our experience, this type of lung surgery does not carry a higher risk of residual disease and recurrence if accurately planned in selected patients, i.e., those with small asymptomatic lesions. The complication rate is acceptable and apparently not affected by preoperative symptoms. The thoracoscopic approach is recommended, although open conversion should be advocated to avoid too long operative times.
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Affiliation(s)
- Francesco Fascetti-Leon
- Department of Paediatric Surgery, Paediatric Surgery Unit, University of Bologna, Via Massarenti, 11, 40138, Bologna, Italy.
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Sista F, Santis GD, Giuliani A, Cecilia EM, Piccione F, Lancione L, Leardi S, Amicucci G. Adenocarcinoma of the third duodenal portion: Case report and review of literature. World J Gastrointest Surg 2012; 4:23-6. [PMID: 22347539 PMCID: PMC3277878 DOI: 10.4240/wjgs.v4.i1.23] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2011] [Revised: 11/13/2011] [Accepted: 11/20/2011] [Indexed: 02/06/2023] Open
Abstract
We focus on the diagnostic and therapeutic problems of duodenal adenocarcinoma, reporting a case and reviewing the literature. A 65-year old man with adenocarcinoma in the third duodenal portion was successfully treated with a segmental resection of the third part of the duodenum, avoiding a duodeno-cephalo-pancreatectomy. This tumor is very rare and frequently affects the III and IV duodenal portion. A precocious diagnosis and the exact localization of this neoplasia are crucial factors in order to decide the surgical strategy. Given a non-specificity of symptoms, endoscopy with biopsy is the diagnostic gold standard. Duodeno-cephalo-pancreatectomy (DCP) and segmental resection of the duodenum (SRD) are the two surgical options, with overlapping morbidity (27% vs 18%) and post operative mortality (3% vs 1%). The average incidence of postoperative long-term survival is 100%, 73.3% and 31.6% of cases after 1, 3 and 5 years from surgery, respectively. Long-term survival is made worse by two factors: the presence of metastatic lymph nodes and tumor localization in the proximal duodenum. The two surgical options are radical: DCP should be used only for proximal localizations while SRD should be chosen for distal localizations.
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Affiliation(s)
- Federico Sista
- Federico Sista, Giuseppe De Santis, Antonio Giuliani, Emanuela Marina Cecilia, Federica Piccione, Laura Lancione, Sergio Leardi, Gianfranco Amicucci, General Surgery, Department of Surgery, University of L'Aquila, 67100 L'Aquila, Italy
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Abstract
AIM: To compare survival between bile duct segmental resection (BDSR) and pancreaticoduodenectomy (PD) for treating distal bile duct cancers.
METHODS: Retrospective analysis was conducted for 45 patients in a BDSR group and for 149 patients in a PD group.
RESULTS: The T-stage (P < 0.001), lymph node invasion (P = 0.010) and tumor differentiation (P = 0.005) were significant prognostic factors in the BDSR group. The 3- and 5-year overall survival rates for the BDSR group and PD group were 51.7% and 36.6%, respectively and 46.0% and 38.1%, respectively (P = 0.099). The BDSR group and PD group did not show any significant difference in survival when this was adjusted for the TNM stage. The 3- and 5-year survival rates were: stage Ia [BDSR (100.0% and 100.0%) vs PD (76.9% and 68.4%) (P = 0.226)]; stage Ib [BDSR (55.8% and 32.6%) vs PD (59.3% and 59.3%) (P = 0.942)]; stage IIb [BDSR (19.2% and 19.2%) vs PD (31.9% and 14.2%) (P = 0.669)].
CONCLUSION: BDSR can be justified as an alternative radical operation for patients with middle bile duct in selected patients with no adjacent organ invasion and resection margin is negative.
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