Abdominal Lymph Node Dissection Research Articles

Rare presentation of recurrent ovarian carcinoma with secondary Budd–Chiari syndrome: a case report

BackgroundBudd–Chiari syndrome (BCS) is a rare condition, usually associated with hematological disorders such as thrombotic diathesis and hypercoagulability. Serum CA-125 level is an established tumor marker of ovarian malignancy; however, cases of primary BCS may also show raised CA-125 levels. BCS in a case of ovarian carcinoma is usually primary in nature due to hypercoagulable state, and raised CA-125 levels with tender hepatomegaly in a treated case of ovarian carcinoma usually imply metastatic recurrence in the liver. However, our case demonstrates an atypical secondary cause of BCS in such a patient caused by extrinsic compression of IVC due to recurrent disease.Case presentationWe report an unusual case of a 69-year-old female who presented with nausea and abdominal pain. She had a 7-year-old history of endometrioid carcinoma of the right ovary for which she underwent total abdominal hysterectomy, bilateral salpingo-oophorectomy, omentectomy and pelvic lymph node dissection along with adjuvant chemotherapy. Currently, she had right hypochondrium tenderness, deranged liver function tests (LFT) and raised CA-125 levels, which raised suspicion of hepatic metastasis. However, CECT abdomen revealed peripheral mottled enhancement of liver with multifocal extrahepatic tumor deposits, one of them causing compression of inferior vena cava (IVC) implying a diagnosis of secondary Budd–Chiari syndrome.ConclusionsIn a background of treated ovarian malignancy with raised CA-125 levels and deranged LFT, primary suspicion is of hepatic tumor recurrence. However, in our case, radiological investigation revealed diagnosis of secondary Budd–Chiari syndrome due to perihepatic metastatic recurrence with the absence of frank intrahepatic lesions.

Surgical treatment of localised pelvic lymphocyst infection after radiotherapy for endometrial cancer

Endometrial cancer is mainly treated clinically by surgery, supplemented by postoperative radiotherapy. Pelvic and abdominal lymph node dissection is usually an important part of surgery, and one of the most common postoperative complications is lymph node cysts. Infection of cysts is very rare in clinical practice and can be cured mainly by anti-infection and puncture drainage. However, in this case, the patient was found to have a pelvic abscess due to radiating pain in the left lower limb, and the infection of the local lymphocyst was found to have formed a pelvic abscess, and laparoscopic open drainage was performed after puncture drainage with no improvement in symptoms. The patient recovered after surgery.

Subtotal esophagectomy and concurrent reconstruction with free jejunal flap for primary esophageal cancer after pancreatoduodenectomy.

Pancreatoduodenectomy and subtotal esophagectomy are widely considered the most invasive and difficult surgical procedures in gastrointestinal surgery. Subtotal esophagectomy after pancreatoduodenectomy is expected to be extremely difficult due to complicated anatomical changes, and selecting an appropriate intestinal reconstruction method will also be a difficult task. Therefore, perhaps because the method is considered impossible, there have been few reports of subtotal esophagectomy after pancreatoduodenectomy. A 73-year-old man with a history of pancreatoduodenectomy was diagnosed with superficial thoracic esophageal squamous cell carcinoma. Definitive chemoradiation therapy was recommended at another hospital; however, he visited our department to undergo surgery. We performed the robot-assisted thoracoscopic subtotal esophagectomy. There were some difficulties with the reconstruction: the gastric tube could not be used, the reconstruction was long, and the organs reconstructed in the previous surgery had to be preserved. However, the concurrent reconstruction was achieved with the help of a free jejunal flap and vascular reconstruction. All reconstructions from the previous surgery, including the remnant stomach, were preserved via regional abdominal lymph node dissection. After reconstruction, intravenous indocyanine green showed that circulation in the reconstructed intestines was preserved. On postoperative day 1, no recurrent nerve paralysis was observed during laryngoscopy. The patient could start oral intake smoothly 2weeks after surgery and did not exhibit any postoperative complications related to the reconstruction. The patient was transferred to another hospital on postoperative day 21. Owing to the free jejunal flap interposition method, we safely performed one stage subtotal esophagectomy and concurrent reconstruction, preservation of the remnant stomach, and pancreaticobiliary reconstruction in patients with a history of pancreatoduodenectomy. We believe that this method is acceptable and useful for patients undergoing complicated reconstruction.

Laparoscopic versus open abdominal lymph node dissection for esophageal squamous cell carcinoma: a propensity score matching analysis.

To compare the short- and long-term outcomes of laparoscopic and open abdominal lymph node dissection using propensity score matching (PSM) analysis. The subjects of this retrospective analysis were 459 patients who underwent curative resection for esophageal squamous cell carcinoma (ESCC) between May, 2005 and December, 2019, at our hospital. Patients were divided into two groups: the Laparoscopic (Lap group) and the Open (Open group). Post-PSM, 139 patients from each group were selected for the analysis to compare the short- and long-term outcomes between the groups. The Lap group experienced fewer Clavien-Dindo (CD) Grade ≥ 2 complications (28.1% vs. 40.3%, P = 0.04) and lower rates of abdominal surgical site infections (SSI) (2.9% vs. 7.9%, P = 0.02) than the Open group. The number of lymph nodes harvested was similar in the Lap and Open groups (14.8 ± 7.5 vs. 15.7 ± 8.6, P = 0.34). There was no significant difference in 3-year overall survival rates (81.2% vs. 69.5%, P = 0.12) or relapse-free survival rates (61.1% vs. 58.2%, P = 0.54) between the groups. Laparoscopic abdominal lymph node dissection for ESCC can be performed safely and appears to be beneficial.

Chinese expert consensus on celiac lymphadenectomy during open/minimally invasive esophagectomy (2023 edition)

Surgical resection remains the cornerstone of the multidisciplinary treatment for patient with localized esophageal cancer. Lymphadenectomy is a pivotal step of radical esophagectomy, which is advanced technique required. Although the consensus on mediastinal lymph node dissection in the radical esophagectomy had been published in China, no agreement or consensus are available on the abdominal lymph node dissection. Based on the latest guidelines or consensuses, available clinical evidence, and agreements from Chinese expert panel of abdominal lymph node dissection in the radical esophagectomy, Chinese Society of Esophageal Cancer, China Anti-cancer Association organized experts to discuss and write this consensus. The expert consensus focuses on the key points of and makes recommendations for surgical approach, extent of lymphadenectomy, quality control and complication management for abdominal lymph node dissection in the radical esophagectomy in China. Applying a standard and efficient abdominal lymph node dissection in the radical surgical resection for patient with esophageal cancer is important and indispensable.

Malignant germ cell tumor of fallopian tube with rhabdomyosarcoma: a case report and literature review

BackgroundMixed germ cell tumors originating from the fallopian tubes are rarely reported, and high-grade rhabdomyosarcoma with differentiated components is even less common. The non-specific clinical manifestations of this tumor are prone to misdiagnosis, and there is still controversy over the treatment plan for this rare differentiated type, and there are limited reports on the prognosis of related diseases.Case presentationHere, we report a 34-year-old woman who presented to our hospital with abdominal pain for two weeks and aggravated for two days. After completing relevant examinations, she underwent transabdominal resection of large tubal masses on the left side of the tube + pelvic lymph node dissection + abdominal paraaortic lymph node dissection + right ovarian cyst excision + greater omentectomy + multipoint peritoneal biopsy. hematoxylin–eosin (H&E) and immunohistochemical (IHC) staining were performed on the surgically resected specimens to further determine the type and nature of the tumor, and 3 cycles of Bleomycin + Etoposide + Cisplatonum (BEP) chemotherapy and 1 cycle of EP(Etoposide + Cisplatonum) chemotherapy were given after surgery.ConclusionUp to now, regular follow-up of the patient's tumor markers and imaging showed no abnormalities, the general condition is good, and the tumor free survival time has reached 24 months.

281. TOTAL LAPAROSCOPIC VERSUS OPEN GASTRIC PULL-UP FOLLOWING MINIMALLY INVASIVE THORACOSCOPIC ESOPHAGECTOMY FOR ESOPHAGEAL CANCER

Abstract Backgroud The use of minimally invasive esophagectomy (MIE) as a treatment for patients with esophageal cancer has recently become more common worldwide. However, the laparoscopic approach for reconstruction and abdominal lymph node dissection has not fully investigated. The aim of the present study was to evaluate the technical feasibility of alimentary tract reconstruction with laparoscopically assisted gastric pull-up compared with open laparotomy gastric pull-up following minimally invasive thoracoscopic esophagectomy. Methods 63 esophageal cancer patients who underwent minimally invasive thoracoscopic esophagectomy between 2011 and 2020 were included in the present study. For reconstruction, 25 patients underwent open laparotomy gastric pull-up (OLG) while 38 patients underwent laparoscopically assisted gastric pull-up (LAG). We compared the outcomes between the two groups. Results No significant difference was observed in physical and tumor status between the two groups. The mean operative time was significantly longer in LAG group (549 vs 621 min, p = 0.010) and blood loss was significantly lower in LAG (561 vs 134 mL, p < 0.001). The mean number of harvested lymph nodes (47.2 vs 46.2, p = 0.840) were similar. The postoperative course showed lower incidences of overall complications (64% vs 32%, p = 0.011). No difference was observed in each complication between the two groups. Conclusions The findings suggest that laparoscopically assisted gastric pull-up is feasible and more effective in preventing postoperative complications.

Application of single-port laparoscopic retrograde gastric mobilization during McKeown esophagectomy for esophageal cancer.

As a novel alternative to the conventional minimally invasive esophagectomy (MIE) to treat esophageal cancer, single-port laparoscopic retrograde three-step gastric mobilization (SLRM) for esophageal reconstruction during MIE to treat esophageal cancer was attempted in our department. The aim of the present study was to explore the preliminary clinical outcomes and feasibility of this innovative surgery. From March 2020 to November 2021, patients undergoing SLRM combined with four-port thoracoscopic McKeown esophagectomy for their esophageal cancers were reviewed. Gastric mobilization with abdominal lymph node dissection was performed through SLRM. The clinical characteristics and short-term outcomes were analyzed retrospectively. A total of 120 patients underwent R0 resection without conversion to open surgery. The mean times needed for the thoracic part, abdominal part, and total operation were 43 ± 6 min, 60 ± 18 min, and 230 ± 20 min, respectively. The numbers of mediastinal and abdominal lymph nodes harvested were 13.2 ± 2.7 and 10.2 ± 2.5, respectively. Postoperative pneumonia was encountered in 10 (8.3%) patients. Anastomotic leakage occurred in 3 (2.5%) cases. Temporary vocal cord paralysis was reported in 20 (16.6%) cases. The mean length of hospital stay was 8.5 ± 4.6 days. The SLRM is a technically feasible and safe treatment for patients with esophageal cancer. It can be considered an alternative method for patients, especially for the ones with obesity and gastric distension.

Utility of single-port laparoscopic retrograde gastric mobilization during McKeown esophagectomy for esophageal cancer: a 2-year experience with 120 cases in a single institution

As a novel alternative to the conventional minimally invasive esophagectomy (MIE), more minimally invasive single-port laparoscopic retrograde 3-step gastric mobilization (SLRM) for esophageal reconstruction during MIE to treat esophageal cancer was attempted by our department. This study explored the preliminary clinical outcomes and feasibility of this innovative surgery. The data of 120 patients who had undergone SLRM combined with 4-port thoracoscopic McKeown esophagectomy for their esophageal cancers from March 2020 to November 2021 were reviewed. Gastric mobilization with abdominal lymph node dissection was performed via SLRM. The clinical characteristics and short-term outcomes were retrospectively analyzed. The data of operating time, blood loss, harvested lymph nodes, postoperative hospital stay and complications are presented as the mean and standard deviation. A total of 120 patients underwent R0 resection without conversion to open surgery. The mean times for the thoracic procedure, abdominal procedure, and total operation were 43±6, 60±18, and 195±20 min, respectively. The numbers of mediastinal and abdominal lymph nodes harvested were 13.2±2.7, and 10.2±2.5, respectively. Postoperative pneumonia occurred in 10 patients (8.3%). Anastomotic leakage occurred in 3 patients (2.5%). Temporary vocal cord paralysis was reported in 20 patients (16.6%). The mean length of hospital stay was 8.5±4.6 days. SLRM is a technically feasible and safe treatment for patients with esophageal cancer. It can be considered an alternative method for patients, especially those with obesity and gastric distension.

251. COMPARISON OF LAPAROSCOPIC SURGERIES WITH OR WITHOUT HAND-ASSISTED PROCEDURE IN THE ABDOMINAL PHASE OF THORACOSCOPIC ESOPHAGECTOMY IN THE PRONE POSITION

Abstract Laparoscopic surgery is less invasive than open surgery in the abdominal phase of thoracoscopic esophagectomy in the prone position (TEP). Laparoscopic surgery (LAP) and hand-assisted laparoscopic surgery (HALS) for mobilization of the stomach and abdominal lymph node dissection have been standard procedures. We aimed to compare the safety and feasibility of those procedures in patients undergone TEP. We evaluated 69 patients who underwent TEP and received gastric conduit reconstruction for esophageal cancer. The LAP group consisted of 42 patients, whereas the HALS group consisted of 27 patients. Surgical outcomes and postoperative complications (Clavien-Dindo classification, grade II or higher) were evaluated between the two groups. No significant differences were found in age, sex, clinical T stage, clinical N status, and neoadjuvant chemotherapy status between the two groups. According to surgical outcomes, there were no significant differences in overall operation time and reconstruction route. Abdominal operation time was significantly shorter in HALS group than in LAP group (LAP: 157 min (73–238), HALS: 96 min (35–157), P < 0.0001). No significant differences were observed in anastomotic leakage, recurrent laryngeal nerve palsy, pneumonia, and postoperative stay (LAP vs HALS: 19.0% vs 25.9%, P = 0.558; 2.4% vs 3.7%, P = 1.000; 16.7% vs 29.6%, P = 0.240; 31 days (16–83) vs 36 days (16–97), P = 0.301). There were no significant differences in postoperative complications between the two groups. HALS is a feasible procedure with short abdominal operative time for patients with esophageal cancer.

Preferential HER2 Expression in Lymphovascular Invasion of a Uterine Carcinosarcoma, a Case Report

Abstract Introduction/Objective Uterine carcinosarcoma (UCS) is a rare, highly aggressive cancer accounting for <5% of reported uterine cancer cases. Commonly, myometrial invasion and lymphovascular invasion (LVI) are found at diagnosis, and recurrence rates of >40% are seen after therapy accounting for poor prognosis and high rate (16%) of death. Histologically, it is composed of both carcinoma and sarcoma components. HER2-targeted therapy without adjunctive chemotherapy for the treatment of UCS has generally not shown beneficial clinical responses, but a more recent phase II clinical trial revealed that the addition of Trastuzumab, a HER2-targeted monoclonal antibody, to carboplatin-paclitaxel chemotherapy showed an increase in progression free survival. Methods/Case Report Immunohistochemical (IHC) staining for HER2 was performed on histologic sections of UCS, areas of LVI, and lymph node metastasis (LNM). Confirmatory HER2 fluorescent in situ hybridization (FISH) studies were performed on the primary UCS and the LVI portion. A 67-year-old female presented with postmenopausal uterine bleeding. CT showed an enlarged uterus, widened endometrial canal, and enlarged lymph nodes. Initial endometrial biopsy showed UCS. Exploratory laparotomy with total abdominal hysterectomy, bilateral salpingo-ophorectomy, omentectomy, and lymph node dissection was performed with pathology confirming UCS with 86% myometrial invasion and LVI. Results (if a Case Study enter NA) NA Conclusion HER2 expression in this patient was solely seen in foci of LVI and within LNM. This finding suggests inclusion of histologic sections with LVI and LNM when evaluating for the presence of HER2 expression in uterine carcinosarcoma with reflex FISH testing when indicated may be helpful to provide additional treatment opportunities for patients. Further studies need to be performed to determine if this finding in generalizable to carcinosarcoma and endometrial serous carcinoma samples.

Systemic Sequential Therapy of CisGem, Tislelizumab, and Lenvatinib for Advanced Intrahepatic Cholangiocarcinoma Conversion Therapy.

Intrahepatic cholangiocarcinoma (CCA), always diagnosed at an advanced stage in recent years, is of high aggression and poor prognosis. There is no standard treatment beyond first-line chemotherapy and no molecular-targeted agents or immune checkpoint inhibitors approved for advanced intrahepatic CCA. Hence, we firstly report an original therapeutic strategy for a 60-year-old patient diagnosed with intrahepatic CCA categorized as Stage IIIB (T3N1M0) by the American Joint Committee on Cancer staging system. After histopathological examination and next-generation sequencing, the patient was treated with four courses of novel systemic sequential therapy (intravenous gemcitabine 1,000 mg/m2 and cisplatin 25 mg/m2 on days 1 and 8; oral lenvatinib 8 mg/day from days 1 to 21; intravenous tislelizumab 200 mg on day 15). Then, the patient achieved partial response and was operated on right hemihepatectomy, cholecystectomy, and abdominal lymph node dissection. Without any perioperative complications, the patient was discharged from our hospital in perfect condition. Thereafter, the patient continued to use this new regimen 1 month after surgery for adjuvant therapy and was confirmed without recurrence when we followed up. In a word, we found an effective therapeutic regimen for preoperative advanced intrahepatic CCA conversion therapy, which may become a new approach in cancer treatment in the future.

Clinical application and analysis of single-port laparoscopic and thoracoscopic McKeown esophagectomy for esophageal cancer

Objective: To explore the application value of single-port laparoscopic and thoracoscopic McKeown esophagectomy for esophageal cancer. Methods: A retrospective study was conducted to collect clinical data of 34 patients with esophageal cancer who were admitted to the Department of Thoracic Surgery, the First Affiliated Hospital of Fujian Medical University, from August to November 2020. All of them, 24 males and 10 females aged from 43 to 75 with an average of (62±4) years, underwent single-port laparoscopic and thoracoscopic McKeown esophagectomy.In the thoracic part, esophageal separation and mediastinal lymph node dissection were performed with conventional 4-ports thoracoscopy in the left lateral-prone position. In the abdominal part, gastric separation and lymph node dissection were accomplished with single-port laparoscopic retrograde three-step gastric separation: firstly, the lesser omentum was dissociated, the left liver lobe was suspended with purse-string needle and thread, after that the left gastric blood vessel and lymph node was dissected; secondly, the esophageal hiatus was separated, and the gastric cardia was cut off; finally, the spleen and stomach ligaments were dissociated to complete these steps. The operation time,volume of intraoperative blood loss, time for out-of-bed activities, time of postoperative drainage tube removal,volume of thoracic drainage fluid, short-term postoperative commplications,the postoperative pathological diagnoses, the time of their discharge from hospital and results of follow-up were observed. Results: All patients underwent successfully single-port laparoscopic and thoracoscopic esophagectomy without any conversion to open surgery; the operative time of the patients was 194-285 (240±21)min, including 53-105(60±13)min for the thoracic part and 40-73(49±7)min for the abdominal part. The volume of intraoperative blood loss was 15-110(60±20) ml. The numbers of mediastinal lymph node dissected and abdominal lymph nodes harvested were 10-25(13±3), 6-16(9±3)respectively. The 34 patients resumed out-of-bed activities on the 2nd to 3rd day after the operation. The thoracic closed drainage tube and left cervical drainage were removed 2 days after the operation. The thoracic Abel drainage tube was removed 5 days after the operation. The total volume of postoperative thoracic drainage fluid was 100-500(300±100)ml. No obvious sign of anastomotic leakage, anastomotic stenosis, chylothorax or gastric emptying disorder was found after the operation. Eight cases were complicated with temporal hoarseness, and 4 patients with pneumonia which was cured by antibiotics. The mean postoperative hospital stay was 8 days(6, 8), and patients were discharged after they could take a routine semi-liquid diet. The postoperative pathological diagnoses of all patients were squamous cell carcinoma, and the postoperative pathological stage was T1-3N0-1M0. Thirty-four patients were followed up for 60 (40, 75) days after the operation. During the follow-up period, no complication or death occurred. In addition, neither recurrence nor metastasis was observed. Conclusion: Single-port laparoscopic and thoracoscopic McKeown esophagectomy for esophageal carcinoma is safe and feasible, with good short-term efficacy. Therefore we consider it an alternative minimally invasive surgery for esophageal cancer.

Independent Risk Factors of Postoperative Lymphatic Leakage in Patients with Gynecological Malignant Tumor: A Single-Center Retrospective Study

BackgroundWe aimed this investigation to screen and analyze the risk factors of postoperative lymphatic leakage of gynecological malignant tumors that contribute to the treatment of the diseases.Material/MethodsAccording to the occurrence of lymphatic leakage after an operation, 655 patients with pelvic lymph node and/or abdominal para-aortic lymph node dissection for gynecological malignant tumor were retrospectively analyzed and divided into a case group and a control group. Univariate and multivariate logistic regression analysis were used to screen the effective independent risk factors and establish a clinical prediction model. The differentiation and calibration of the clinical prediction model were evaluated, and we performed internal and external validation of the model with 207 cases.ResultsThe surgeons, the number of removed lymph nodes, the field and range of lymph nodes to be removed, the method of drainage, and postoperative infection are the independent risk factors of lymphatic leakage after lymph node dissection for gynecological malignant tumors. The area under the ROC curve of the clinical prediction model was 0.839 (P<0.001), the calibration Hosmer-Lemeshow test shows χ2=4.381, P=0.821. Through 10-fold cross-validation, the average correct rate of the prediction model was 0.899, the area under the ROC curve of the external verification group was 0.741, and the calibration Hosmer-Lemeshow test showed χ2=12.728, P=0.122.ConclusionsThe new logistic prediction model showed a good degree of differentiation and calibration in both the modeling and verification groups, and it can be used for early warning of the occurrence of lymphatic leakage after lymph node dissection.

Endometrial Cancer in 40 Years Old or Younger: A Single Center Experience

Purpose: The purpose of this study was to identify prognostic factors associated with the successful outcome of endometrial cancer (EC) in women aged ≤40 years. Methods: This was a retrospective cohort study. The medical records of all women aged ≤ 40 years with EC diagnosed on endometrial curettage between 1995 and 2020 were reviewed. Patients who underwent hysterectomy and whose final histopathological evaluation was made in our hospital, or who were evaluated by the members of the tumor board and followed up in our hospital, were included in the study. Results: Median follow-up was 79 months (range 9-192). 42 of 44 patients underwent surgical intervention. 33,4%(n: 14) underwent total abdominal hysterectomy (TAH), bilateral salpingo-oophorectomy (BSO), and pelvic paraaortic lymph node dissection (PPLND). 61.9% (n:26) underwent TAH BSO, and PLND. In one patient (2,4 %) only TAH and in the other patient (2,4%) TAH BSO was performed. Medical treatment was administered to 2 patients who desired to preserve their fertility and had grade 1 endometrioid adenocarcinoma without any evidence of myometrial invasion and a comprehensive evaluation showed no evidence of extra-uterine disease. 26 (59,1%) patients had grade 1, 15(34,1%) had grade 2, and 3(6,8%) had grade 3 adenocarcinoma. CA 125 ≥35 IU/ml was statistically associated with lymph node metastasis (p=0,004), ˃ 50% myometrial invasion (p=0,044), and advanced-stage disease (p=0,048). Conclusions: CA 125 ≥35 IU/ml was statistically associated with lymph node metastasis, deep myometrial invasion, and advanced-stage disease in EC patients ≤ 40 years of age.

Complete remission of advanced low-grade endometrial stromal sarcoma after aromatase inhibitor therapy: a case report

BackgroundLow-grade endometrial stromal sarcoma is a rare neoplastic growth in the uterine cavity, representing less than 1% of uterine tumors. Such tumors usually affect premenopausal and perimenopausal women, with a mean age of 46 years. Treatment generally starts with surgical resection of the tumor, followed by chemotherapy, radiotherapy, or hormonal therapy.Case presentationIn the current report, we again present a case of low-grade endometrial stromal sarcoma in a 51-year-old Mediterranean woman presenting with abdominopelvic pain. Computed tomography scan revealed a primary uterine tumor measuring 17 × 9 × 9 cm metastasizing to the lungs, bladder, and ureteral orifice, along with lymphovascular involvement. The patient underwent total abdominal hysterectomy, omentectomy, and lymph node dissection. Estrogen deprivation was accomplished by bilateral salpingo-oophorectomy. Lifelong hormonal therapy consisting of letrozole 2.5 mg per day was prescribed, which demonstrated remarkable efficacy, resulting in a partial remission of lung metastasis within 8 months after surgery. Full remission was observed after 18 months of hormonal therapy, with no recurrence. Another scan was performed after 2.5 years, revealing complete remission with no recurrence.ConclusionWe again report a case of complete remission of low-grade endometrial stromal sarcoma after surgical removal of the tumor along with first-line hormonal therapy without the use of chemotherapy or radiotherapy, emphasizing the role of hormonal therapy in the treatment of such tumors.

Verification of oncological local control for hand-assisted laparoscopic abdominal lymph node dissection in esophageal cancer surgery: a propensity score-matched analysis.

In esophageal cancer, long-term outcomes of minimally invasive surgery using endoscopic surgery are currently being verified. However, most trials have compared thoracic procedures; few studies have focused on the abdominal procedures, which are important for lymph node dissection in radical esophageal cancer surgery. Hand-assisted laparoscopic surgery (HALS) is a simple and minimally invasive procedure. Although HALS superiority in short-term outcomes has been reported, its oncological safety in esophageal cancer remains unclear. Therefore, we retrospectively evaluated oncological safety of HALS compared with that of conventional open laparotomy (OL) in radical surgery for thoracic and abdominal esophageal cancer. We retrospectively analyzed the postoperative survival in 142 patients who underwent radical esophageal cancer surgery at our hospital between May 2012 and May 2017, with and without propensity score matching (PSM) between groups. Before PSM, OL (n = 65) and HALS (n = 77) groups differed significantly in overall survival (OS) (3-year OS rate: 74.2% and 87.3%, respectively; log-rank p = 0.040). Additionally, clinical abdominal lymph node metastasis (cALNM) independently predicted OS (p = 0.031). After PSM, the OL and HALS groups did not differ significantly in OS (3-year OS rate: 80.5% and 89.8%, respectively; log-rank p = 0.716). There was no statistically significant difference in abdominal-specific recurrence-free survival between the OL and HALS group before and after PSM. HALS may be a well-accepted procedure for radical esophagectomy in esophageal cancer, with oncological safety, including local control specific to the abdomen, comparable to that of the conventional OL.

Robotic-assisted single-incision gastric mobilization for minimally invasive oesophagectomy for oesophageal cancer: preliminary results.

OBJECTIVESWith the gradual acceptance of robotic-assisted surgery to treat oesophageal cancer and the application of a single-port approach in several abdominal procedures, we adopted a single-port technique in robotic-assisted minimally invasive oesophagectomy during the abdominal phase for gastric mobilization and abdominal lymph node dissection.METHODSRobotic-assisted oesophagectomy and mediastinal lymph node dissection in the chest were followed by robotic-assisted gastric mobilization and conduit creation with abdominal lymph node dissection, which were performed via a periumbilicus single incision. The oesophagogastrostomy was accomplished either in the chest (Ivor Lewis procedure) or neck (McKeown procedure) depending on the status of the proximal resection margin.RESULTSThe procedure was successfully performed on 11 patients with oesophageal cancer from January 2017 to December 2018 in our institute. No surgical or in-hospital deaths occurred, though we had one case each of anastomotic leakage, pneumonia and hiatal hernia (9%).CONCLUSIONSRobotic single-incision gastric mobilization for minimally invasive oesophagectomy for treating oesophageal cancer seems feasible. Its value in terms of perioperative outcome and long-term survival results awaits future evaluation.

Prognostic factors of radical resection on patients with intrahepatic cholangiocarcinoma and impact of abdominal lymph node dissection on prognosis

Objective To study factors affecting prognosis of patients with intrahepatic cholangiocarcinoma (ICC), focusing on the correlation between extent of lymph node dissection and prognosis of patients with ICC. Methods The clinical data of ICC patients who underwent radical resection at the Hepatobiliary and Pancreatic Surgery of Affiliated Cancer Hospital of Zhengzhou University from October 2013 to October 2017 were retrospectively analyzed. According to the extent of lymph node dissection, the patients were divided into the non-dissected lymph node group, the routine dissection lymph node group and the extended lymph node dissection group. The prognoses of the three groups were compared. The Cox stepwise regression model was used to analyze the independent risk factors for prognosis of patients with ICC. Results The 178 patients included 109 males and 69 females. Their ages ranged from 30 to 81 years (average 59 years). There were 80 patients in the non-dissected group, 34 patients in the routine lymph node dissection group, and 64 patients in the extended lymph node dissection group. The overall survival rates of the 178 patients at 3 years after liver resection was 29.2%(52/178), overall median survival 25.8 months. The 3-year survival rates of the non-dissected group, routine dissection group, and extended dissection group were 10.0%(8/80), 52.9%(18/34), 40.6%(26/64), respectively. The differences among the three groups were significant (P 0.05). There was a significant difference in survival rates between the non-dissected group and the extended lymph node dissection group (P<0.05). Univariate analysis showed that CA19-9, tumor diameter, portal tumor thrombus, and lymph node dissection were related to prognosis of patients with ICC (P<0.05). Multivariate analysis showed CA19-9, tumor diameter, and extent of lymph nodes clearance were related to patient survival (P<0.05). Conclusions CA19-9, tumor diameter, and extent of lymph node dissection were independent risk factors of survival in patients with ICC. For patients with ICC who undergo surgical resection, conventional laparoscopic lymph node dissection can achieve good results, and there is no need to extend lymph node dissection. Key words: Cholangiocarcinoma; Lymph node excision; Prognosis analysis

Mixed adenoneuroendocrine carcinoma of the liver: A rare case report.

A 55-year-old woman presented with chest and back pain of unknown cause. Contrast-enhanced computed tomography revealed two low-density tumors, sized 4.6 and 4.4 cm, in the hepatic caudate and left inner lobes, respectively. There are multiple enlarged lymph nodes around the abdominal aorta, hepatogastric ligament and gastrosplenic ligament. At the same time, there were multiple enlarged lymph nodes between the portal vein and the vena cava. Upper gastrointestinal endoscopy revealed chronic non-atrophic gastritis and esophagitis (grade B). Endoscopic examination of the lower digestive tract revealed polyps of the colon, diagnosed as tubular adenomas following biopsy and histopathological examination. The patient underwent left three hepatic resection (including left inner lobe, left outer lobe and right anterior lobe resection), abdominal lymph node dissection, right liver tumor radiofrequency ablation, hepatic caudate lobe resection, intestinal adhesion release, vena cava formation, portal vein repair and hilar cholangioplasty. The pathological examination of the resected specimens revealed intrahepatic bile duct carcinoma and hepatic parenchymal neuroendocrine tumor (NET). In addition, liver solid portions consisted of tumor cells with characteristic salt-and-pepper nuclei. Immunohistochemical examination revealed expression of the neuroendocrine marker synaptophysin in this solid component, confirming the diagnosis of NET. Furthermore, the MIB-1 proliferation index of the NET was higher compared with that of the adenocarcinoma, and lymph node invasion by the NET component was detected, indicating a neuroendocrine carcinoma (NEC, or NET G3). The diagnosis of mixed adenoneuroendocrine carcinoma of the liver was confirmed based on the World Health Organization 2010 criteria. Taking into consideration the patient's poor general condition, only symptomatic supportive treatment was administered postoperatively, without chemotherapy. Contrast-enhanced computed tomography at 45 days postoperatively revealed disease progression, with metastases in the liver stump, abdominal lymph nodes, spine and pelvis. The patient remained on symptomatic supportive treatment and succumbed to disease progression 3 months after surgery.