Conservative Surgery Group Research Articles

Fertility-Sparing Surgery Should Be the Standard Treatment in Patients with Malignant Ovarian Germ Cell Tumors

To validate the oncological safety of fertility preservation in malignant ovarian germ cell tumors (MOGCTs) and to define the significance of maximal cytoreduction in early stage MOGCTs. Sixty-nine patients with stage I and II MOGCTs who underwent surgical treatment were included in the study. Fertility-sparing surgery is defined as conservative surgery and hysterectomy and contralateral salpingo-oophorectomy were defined as definitive surgery. Both surgical approaches involved lymphadenectomy and omentectomy. Most patients received platinum-based combinations for adjuvant therapy. Survival outcomes of the conservative surgery group were compared with the definitive surgery group. Median age of the study group was 21 years (range: 12-40 years). Median tumor size measured 150 mm (range, 20-300 mm). Surgery type (conservative surgery vs. definitive surgery) and lymphadenectomy (performed vs. not performed) were insignificant for the recurrence (p = 0.758, p = 0.271). However, surgical outcome (maximal vs. optimal and suboptimal) and type of tumor (dysgerminoma vs. nondysgerminoma) determined the recurrence (p = 0.001, p = 0.021). Fertility-conserving approach is safe in early stage MOGCTs. However, maximal cytoreduction should be achieved in this group of patients, without conceding fertility-conserving approach. On the other hand, development of chemotherapy options with less gonadotoxic effects, but equal or stronger efficiency in comparison with platinum-based chemotherapy, will certainly facilitate management of this patient group.

Serous and Mucinous Borderline Ovarian Tumours: Evaluation of Clinical Outcome and Risk Factors for Recurrence

Objective: Borderline Ovarian Tumors (BOTs) have a good prognosis; however, a few BOT patients experience the relapse of disease, either borderline or malignant. The aims of this study were to analyze the risk factors of relapse. Methods: This is a retrospective study of 31 patients with confirmed BOTs treated in the Salah Azaiez Oncologic institute between 2005 and 2015. Results: 31 cases were identified; median age was 43 years. Most of the patients 27 (87%) demonstrated stage IA. 8 patients had laparoscopic surgery and they were all treated conservatively. Between 23 patients, which had laparotomy, only two cases underwent conservative surgery and the remaining patients had radical surgery. Five patients had recurrences (16.13%). The relapse was occurred meanly 62.38 months after the primary surgery. Among the 5 recurrent cases, one cancerous transformation and 4 borderline recurrences were detected. 3 recurrences of 8 Laparoscopic surgery group and 2 recurrent cases of 23 laparotomic surgery groups were observed but the statistic result of the relation between laparoscopic approach and higher recurrence rate was not significant (P=0.093). 3 recurrences of 10 conservative surgery group and 2 recurrent cases of 21 radical surgery groups were observed. However, it did not show significant difference (P=0.175). Mean age of disease-recurrence group was 42.8 years whereas the one of non-recurrent group was 46.5 years (P=0.65), age was not risk factor of disease recurrence. Conclusion: Even if age, conservative treatment and laparoscopic technique does not reach the statistic significance as a risk factors for recurrence, we can have a definite conclusion. It is necessary to perform more randomized controlled trials to confirm such an assumption.

Subfascial endoscopic perforator surgery in treating varicose ulcer after great saphenous vein stripping

Objective To evaluate the feasibility and efficacy of subfascial endoscopic perforator surgery in treating varicose ulcer after great saphenous vein stripping. Methods Between July 2008 and July 2013, 152 limbs of venous ulceration after great saphenous vein stripping were divided into two groups(conservative therapy and subfascial endoscopic perforator surgery therapy) and followed up at least for 2 years, respectively compared symptoms and signs improvement, ulcer healing time, ulcer healing and ulcer recurrence rate after healing for 6, 12, 24 months. Results No patient underwent the surgery occured pulmonary embolism or death, 2 limbs appeared hematoma. Conservative and subfascial endoscopic perforator surgery group′s symptoms and signs improvement rates were 81.9%(59/72) and 86.3%(69/80)(not significant, P=0.528), while the ulcer healing time, ulcer healing and ulcer recurrence rate respectively were 65.3%(47/72) and 78.8%(63/80), (73±15.7) d and (41±12.6) d, 34.0%(16/47) and 14.3%(9/63) (significantly different, P<0.05). According to the three time-points′ (6, 12, 24 months) follow-up, the non-recurrence rate were 89.4%(42/47) and 96.8%(61/63), P=0.135; 72.3%(34/47) and 92.1%(58/63), P=0.006; 66.0%(31/47) and 85.7%(54/63), P=0.014. Conclusions Subfascial endoscopic perforator surgery is a reliable, safe and minimally invasive surgery, and has a long-term effect in treating varicose ulcer after great saphenous vein stripping. Key words: Venous insufficiency; Surgical procedures, minimally invasive; Varicose ulcer

Surgical outcomes of post chemoradiotherapy unresectable locally advanced rectal cancers improve with interim chemotherapy, is FOLFIRINOX better than CAPOX?

Role of chemotherapy in patients who continue to have unresectable disease after pre-operative chemo-radiotherapy (CRT) remains largely unaddressed. Patients with LA rectal cancer from January 2013 to June 2015 were evaluated. Post-CRT, patients, who were deemed unresectable, were considered for further interim chemotherapy (i-CT). Seventy six patients (15%) with median age of 38.5 years received i-CT after CRT. About 61.8% patients receiving i-CT managed to undergo a definitive surgery and the extent of surgery was reduced in 48.7% patients. With the median follow up of 19 months, the estimated 2-year event free survival (EFS) of 48% and OS was 56%. The estimated 2-year OS was 81% in mucinous tumors whereas it was 44.4% in signet ring pathology (P=0.045). The 2-year OS of 86% for whom surgery was done vs. 38% (2-year OS) in whom surgery was not done (P=0.011). Survival was better in conservative surgery group vs. total pelvic exenteration (TPE) vs. no surgery (2-year OS: 84% vs. 59.1% vs. 38%; P=0.033). In the CAPE-OX group, 71.4% (14/23) underwent surgery whereas 75.9% (29/47) in the 5-FU plus irinotecan plus oxaliplatin (FOLFIRINOX) group with EFS (P=0.570) and OS (P=0.120). In conservative surgery group, OS was better in FOLFIRINOX (2-year OS: 95.7%) vs. capecitabine plus oxaliplatin (CAPOX) (2-year OS: 70%) (P=0.012). i-CT can lead to improved resection rates, improved survivals and downstaging with acceptable toxicity. FOLFIRINOX appears to better over CAPOX, specifically in whom conservative surgery is feasible.

The clinical application of enhanced recovery after surgery on pharyngeal surgery in children

Objective To evaluate the effect of enhanced recovery after surgery(ERAS) on pharyngeal surgery in children. Methods Sixty childrens aged 6-12 y, scheduled for pharyngeal surgery, were randomly divided into two groups(n=30): group ERAS and conservative treatment surgery group(group CTS). Optimization measures by evidence based medicine for preoperative education, anesthetic management and postoperative analgesia were administered in group ERAS. Meanwhile, group CTS received conventional perioperative care. The hemodynamic index, sedation-agitation scale, and VAS scale were monitored during awaken from anesthesia and 2, 8, 24 h postoperatively. Rescue analgesia and postoperative complications were recorded 24 h after surgery. Hospital stays were also observed. Results There were no significant differences in hemodynamic index and operative time between the those two groups. Group ERAS was associated with a significantly lower sedation-agitation scale[(2.41±0.50), (2.48±0.67), (2.39±0.81), (2.33±0.51)], VAS scale [(3.3±0.5),(3.2±0.5),(3.0±0.6),(2.6±0.9)] and shorter hospital stay [(5.5±0.8) d] compared with group CTS[(3.54±1.01),(3.63±0.92), (3.42±0.32),(3.38±0.20)],[(5.3±0.4), (4.9±0.3), (4.8±0.4), (3.9±0.5)],[(7.1±0.5) d]. Group ERAS(30%) also received less rescue analgesia than group CTS(50%). Incidence rate of postoperative nausea and vomiting was lower in group ERAS(33.3%) than group CTS(66.7%). Conclusions ERAS is feasible and effective for pharyngeal surgery in children, with improvements of postoperative rehabilitation, postoperative pain, hospital stay and patients' satisfaction. Key words: Pediatric anesthesia; Pharyngeal surgery; Enhanced recovery after surgery

Borderline ovarian tumors: clinical characteristics, management, and outcomes - a multicenter study.

BackgroundThe optimal surgical management and staging of borderline ovarian tumors (BOTs) are controversial. Institutions have different surgical approaches for the treatment of BOTs. Here, we performed a retrospective review of clinical characteristics, surgical management and surgical outcomes, and sought to identify variables affecting disease-free survival (DFS) and overall survival (OS) in patients with BOTs.MethodsA retrospective review of ten gynecological oncology department databases in Turkey was conducted to identify patients diagnosed with BOTs. The effects of type of surgery, age, stage, surgical staging, complete versus incomplete staging, and adjuvant chemotherapy were examined on DFS and OS.ResultsIn total, 733 patients with BOTs were included in the analysis. Most of the staged cases were in stage IA (70.4 %). In total, 345 patients underwent conservative surgeries. Recurrence rates were similar between the conservative and radical surgery groups (10.5 % vs. 8.7 %). Furthermore we did not find any difference between DFS (HR = 0.96; 95 % confidence interval, CI = 0.7–1.2; p = 0.576) or OS (HR = 0.9; 95 % CI = 0.8–1.1; p = 0.328) between patients who underwent conservative versus radical surgeries. There was also no difference in DFS (HR = 0.74; 95 % CI = 0.8–1.1; p = 0.080) or OS (HR = 0.8; 95 % CI = 0.7–1.0; p = 0.091) between complete, incomplete, and unstaged patients. Furthermore, receiving adjuvant chemotherapy (CT) for tumor stage ≥ IC was not an independent prognostic factor for DFS or OS.ConclusionsPatients undergoing conservative surgery did not show higher recurrence rates; furthermore, survival time was not shortened. Detailed surgical staging, including lymph node sampling or dissection, appendectomy, and hysterectomy, were not beneficial in the surgical management oF BOTs.

Strategies for the Optimal Individualized Surgical Management of Craniofacial Fibrous Dysplasia.

The surgical management of craniofacial fibrous dysplasia is controversial. The purpose of this study was to report the surgical outcomes of individualized management of craniofacial fibrous dysplasia of a single institution. Data from patients (n = 20) with craniofacial fibrous dysplasia, who were surgically treated between 2007 and 2014, were analyzed. Surgical approach (radical or conservative surgery) was individualized according to age, craniofacial anatomical site (zones I to IV of Chen and Noordhoff), functional issues, aesthetic impairment, patients/parents' preferences, and surgical team experience. The surgical outcomes (radical surgery group versus conservative surgery group) were compared based on the age at the time of the procedure, the length of hospital stay, reoperation, recurrence and complication rates, and the Whitaker grading system. Significant (all P < 0.05) differences were observed in patients with craniofacial fibrous dysplasia who were treated with radical excision (65%) compared with those treated with limited reduction burring (35%), according to age (19.22 years versus 12.57 years), the length of hospital stay (3.56 days versus 1.29 days), recurrence (15% versus 71%), and number of subsequent procedures (1 intervention versus 2.4 interventions), respectively. The radical surgery group presented a significantly (P < 0.05) lower initial Whitaker outcome score than the conservative surgery group (1.89 and 2.57, respectively). Similar (all P > 0.05) final Whitaker outcome scores (1.56 versus 1.71) and surgical complication rates (11% versus 14%) were recorded between the treatment groups. Based on clinical experience and surgical outcomes presented in this study, the surgical approach of craniofacial fibrous dysplasia should be tailored to individual patient's needs.

Outcome of Fertility after Radical Conservative Surgery in Grade III-IV Endometriosis Lesions: A Retrospective Analysis

Purpose: Researching reproductive outcome after laparoscopic radical resection of grade III and IV endometrial lesions. Methods and Materials: A retrospective analysis of 54 women was carried out. The patients underwent laparoscopic radical resection in the Gynecology Department of a secondary health care center between January 2009 and December 2013. Diagnostic investigation, with histological confirmation of moderate to severe endometriosis, preceded surgical intervention in a multidisciplinary setting. Thirty seven of the 54 patients had an active desire for pregnancy. The outcome measure was the number of pregnancies in the subgroup of 37 women with an active desire for pregnancy. Results: Within the subgroup of 37 patients, 28 women became pregnant within the study period. Twelve patients became pregnant spontaneously and 16 had medically assisted pregnancies. Within the medically assisted group, 4 patients conceived after Intra-Uterine Insemination (IUI) and 12 after In- Vitro Fertilization (IVF). The pregnancy rate was 76%, a result similar to findings of earlier studies. Conclusion: The results of this retrospective analysis suggest that extensive laparoscopic surgery for moderate to severe endometriosis has a beneficial effect on fertility in both spontaneous and medically assisted pregnancies.

Analysis of loco-regional and distant recurrences in breast cancer after conservative surgery.

BackgroundA number of patients treated conservatively for breast cancer will develop loco-regional and distant recurrences. Our aim was to determine how their occurrence may be linked to the evolution of the disease.MethodsWe analyzed 238 women treated by conservative breast surgery and breast irradiation in a single institution. We evaluated the prognostic factors associated with loco-regional and distant recurrences and the prognostic value of local and regional recurrences on systemic progression.ResultsAfter a median follow-up of 5 year (range 1–10), 16 (6.72 %) patients in the breast conservative surgery (BCS) groups had loco-regional recurrence. For distant recurrence, 10 (4.2 %) patients had experienced distant recurrence. Lympho-vascular invasion (HR 2.55; 95 % CI, 076 to 8.49) and an extensive intraductal component (HR, 2.22; 95 % CI, 0.69 to 7.15) and nodal status are risk factors for loco-regional recurrence (LRR) after breast conservative therapy (BCT). Tumor size, nodal status, high histologic grade, and breast cancer diagnosed at a young age (≤35 years) are correlated with higher distant recurrence rates after BCT.ConclusionsRisk factors for LRR after BCS include lympho-vascular invasion, extensive inraductal component, and high nodal status, where as risk factors for distant recurrence include tumor size, nodal status, high histologic grade, and breast cancer diagnosed at a young age (≤35 years).

MP91-15 LEYDIG CELL ULTRASOUND FEATURES: A USEFUL TOOL FOR A PROPER PREOPERATIVE COUNSELLING

INTRODUCTION AND OBJECTIVES: The aim of this study is to clarify Leydig Cell Tumor (LCT) ultrasound features to distinguish them in the characterization of both benign and malignant intratesticular lesions. Normally, testicular neoplasms, either malignant or benign, demonstrate an alteration in the normal homogenous testicular ultrasound outcome, besides this there are no typical and described features to drive preoperative surgical approach. METHODS: From January 2007 to July 2014 we reviewed the scrotal ultrasound images of all patients diagnosed with Leydig cell Tumor and treated with conservative surgery (group A). We considered only patients that were first diagnosed at one of the participating centers. We create a random homogenous control group of patients (B), in term of age and presentation, different from the group A just for the definitive malignant histology. All the images were collected and we analyzed ultrasound features of the lesions classified in terms of length, US lesion homogeneity, shape, presence of hypervascularization. The collected data were analysed by an online regression (Student’s t-test, chi-square test, and logistic regression analysis). RESULTS: From January 2007 to July 2014, 35 patients with Leydig cell tumor underwent conservative surgery at our centers. A random group B of 35 patients was also considered. Patient mean age was 35,11 years (range 28 to 45) for the first group and 33,89 years for the second one (range 22 to 41). Patients presented either with a palpable testicular nodule (12 patients group A, 34.28% 29 patients 82,86% group B) or a nodule diagnosed by ultrasound (23 patients group A, 65.72% 6 patients 17.14% group B). Mean ultrasound size was 0.96 cm and 1.57 cm for the two groups respectively (range 0.25 to 1.8 cm and 0.8 to 3 cm). Both groups had hypervascularization of the lesions with no significant differences. Patients presenting with LCT (group A) had an homogenous ultrasound intralesional aspect and the shape is defined with an elliptic or spheroid mold while patients from group B had dis-homogenous intralesional aspect and non-defined margins (p>0.05). CONCLUSIONS: Ultrasound is a sensitive and accurate technique for the evaluation of testicular abnormalities, and is widely accepted as the first-line imaging technique for many common and uncommon testicular diseases. Ultrasound is effectively the sole scrotal imaging technique that a patient will undergo prior to surgery, but does not provide histological diagnosis. Although most focal lesions will be malignant and require an orchiectomy, recognition of the benign entity may be challenging. In a small lesion mainly not palpable the presence of a well-defined shape with an homogenous intralesional ultrasound aspect do correlate with a LCT.

A Single-Institution Retrospective Study of Jugular Foramen Schwannoma Management: Radical Resection Versus Subtotal Intracranial Resection Through a Retrosigmoid Suboccipital Approach Followed by Radiosurgery

Despite advances in skull base surgery, achieving effective surgical management of jugular foramen schwannomas (JFSs) that avoids postoperative cranial nerve (CN) deficits remains a challenge. Subtotal resection followed by radiosurgery (rather than radical resection) is increasingly being viewed as a better treatment strategy. Here, an institutional database was retrospectively analyzed for outcomes after surgical treatment of JFSs to evaluate the optimal strategy for managing JFSs. Twenty-two patients with JFSs were operated on by either radical resection (n= 13) or conservative resection plus radiosurgery (n= 9). These 2 different groups were compared in terms of early (≤4 weeks after surgery) and late postoperative functional outcome and oncologic control. No deaths occurred in either group, but there were 3 surgery-related complications in the radical resection group. Postoperative CN deficits and additional procedures related to CN morbidity were generally higher in the radical resection group, but the differences were not statistically significant. The conservative surgery group showed a statistically significant improvement in the level of dysphagia and dysphagia-related functional state in the late postoperative period. There was 1 case of recurrence after radical resection over a mean follow-up period of 73 months. All tumors in the conservative surgery group were controlled over a mean period of 34 months. Our results suggest that conservative resection of JFSs via a familiar intracranial approach plus radiosurgery may be an effective surgical alternative for improving functional outcome with adequate oncologic control.

Surgical Procedure Choice for Removing Hepatic Cysts of Echinococcus granulosus in Children.

Aim This study aims to evaluate the effectiveness of radical and conservative surgical procedures for removal of hydatid cysts in the liver of children. Methods A total of 112 pediatric patients had surgical treatment of hepatic cystic echinococcosis (CE) between January 2002 and December 2012 at the First Affiliated Hospital of Xinjiang Medical University were retrospectively evaluated. The patients were divided into two groups receiving either radical (n = 26) or conservative surgery (CS) (n = 86). Patient age, gender, symptoms, preoperative radiologic investigations, type of cyst, involvement of other organs, surgical procedure performed, postoperative complications, and mean hospital stay after surgery were recorded. Results The mean surgical procedure time for radical surgery (RS) was significantly longer than CS (126.4 ± 37 vs. 90.4 ± 22.9 minutes, p < 0.001], and the days for hospitalization showed no difference (11.0 ± 2.1 vs. 11.5 ± 3.1 days, p > 0.05]. Seven patients in the CS group had 20-300 mL of bile drainage 2-4 days post-operation and two patients developed a postoperative cavitary abscess; five patients in the RS group and one patient in the CS group developed a hydrothorax on the fifth day postoperatively. Follow-up of all patients showed that the majority had recovered well except for 3 cases who developed recurrences due to cysts ruptured accidently before surgery. There were no recurrences or biliary complications in the RS group. Conclusion CS is an effective method for liver CE cyst removal and RS is suitable for hepatic cysts in less risk position in pediatric patients.

Clinical outcomes and toxicity after exclusive versus postoperative radiotherapy in supraglottic cancer: new solutions for old problems? The case of stage III and IV disease.

To compare toxicity, survival and laryngeal preservation rate after radiotherapy alone (RR), radiotherapy after supraglottic horizontal laryngectomy (SHLR) and radiotherapy after total laryngectomy (TLR) for advanced supraglottic laryngeal cancer. From 1984 to 2012, 532 patients (pts) were treated in our Department: 273 were potentially fit for conservative surgery (Group I) and 259 were not amenable to partial surgery (Group II). A younger age (p = 0.005), a better performance status (p < 0.001), the absence of comorbidities (p < 0.001) and the absence of nodal involvement (p = 0.006) favorably impacted on overall survival. More high-grade mucositis (p = 0.009), mild dysphagia (p < 0.001) and mild xerostomia (p < 0.001) were found in RR group; surgical patients had more edema of neck (p = 0.009) and skin toxicity (p = 0.008). Group I No differences in local, nodal and distant recurrences and in number of rescue laryngectomies were observed. The disease characteristics (T, N and stage) but not the treatment modality impacted on disease-free survival (DFS). Group II There was an higher number of local (p = 0.013) and nodal (p = 0.022) recurrences after RR. DFS (p = 0.01) was longer after TLR. No differences in DFS between TLR patients and RR patients who underwent radio-chemotherapy were found. In Group I, RR results in a local-regional control and organ preservation comparable to surgical treatments, with only slight increase of late mild xerostomia and dysphagia. In Group II RR was less effective than TLR, with a significantly worse DFS. The use of concurrent radical radio-chemotherapy seems to provide comparable loco-regional control to TLR.

Assessment of spontaneous hemopneumothorax: Indications for surgery.

Although spontaneous hemopneumothorax is rare, emergency surgery may be necessary if massive bleeding is present. We examined therapeutic strategies and outcomes as well as background factors in 16 patients with spontaneous hemopneumothorax treated at our hospital between April 2002 and August 2013. Emergency surgery was performed in 3 patients, all of whom were hemodynamically unstable. Elective surgery was performed in 7 patients, all of whom showed continuous bleeding from a pleural cavity drain. The surgery consisted of intrapleural hematoma removal, hemostasis, and bullectomy; 3-port thoracoscopy was used in all of the surgical cases. Six patients, none of whom showed continuous bleeding, recovered with conservative therapy. Comparing the conservative therapy and surgery groups revealed the mean continuous bleeding volume and total blood loss to be significantly greater in the latter, but no significant difference was noted between the two groups in terms of the initial bleeding volume following tube thoracostomy. None of the cases required a blood transfusion. Spontaneous hemopneumothorax is not necessarily an indication for surgery, and even when the initial volume of blood drained through the chest tube is large, some patients can still be treated conservatively with careful monitoring of vital signs and continuous bleeding volumes. However, it is important not to miss the optimal timing of surgery in order to avoid administering unnecessary blood transfusions to young patients.

Influence of Gynaecologic Adnexal Surgeries on Subsequent Ovarian Function and In Vitro Fertilization Treatment Outcome

Objective To investigate the correlation between gynaecologic adnexal surgery history and pregnancy outcome of in vitro fertilization (IVF) treatment. Methods A total of 810 women who were proceeded 810 IVF treatment cycles from October 2009 to March 2011 were recruited to this retrospective study, based on whether they had history of gynaecologic adnexal surgeries or not. Among 810 women, 587 women had no gynaecologic adnexal surgeries (group A), 223 women had gynaecologic adnexal surgeries (group B). Additionally, the group B was further divided into 4 subgroups based on their different gynaecologic adnexal surgery histories, such as tubal conservative surgery (group Ba1), unilateral salpingectomy (group Ba2), ovarian cyst ablation (group Bb1) and unilateral adnexal resection (group Bb2). The basal levels of FSH, antral follicle count (AFC), clinical pregnancy rate (CPR), embryos implantation rates (IR) and live birth rates (LBR) were compared. Results The levels of FSH and AFC were significantly different between groups A and B, respectively. Therefore, CPR, IR and LBR were significantly lower (P Conclusion The previous history of gynaecologic adnexal surgeries may affect the subsequent ovarian function and also IVF outcomes. As for different operation methods, between tubal conservation surgery and unilateral salpingectomy, the IVF outcomes were not significantly different. The same result we found in different ovarian operation groups.

Is radical surgery feasible in liver hydatid cysts in contact with the inferior vena cava?

Cysts in contact with the inferior vena cava (IVC) represent a challenge for hepato-pancreatico-biliary surgeons. Although the literature on the topic is scarce, the most widely accepted approach is conservative surgery. Partial cyst resection is recommended, because radical resection is considered a high-risk procedure. This was a retrospective study over the period January 2007-December 2012. We operated on 103 patients with liver hydatidosis. A total of 32 patients (31 %) had a liver cyst in contact with the IVC. We proposed a cyst classification based on location of the cyst and length of contact and degrees of involvement of the IVC. Median size of the contacting cyst measured by computed tomography (CT) was 12 cm. On CT, median length of contact with the IVC was 37 mm. The median degree of involvement was 90°. Radical surgery was performed in 20 patients (62.5 %). No IVC resection was done. Morbidity rate was 28 %, and mortality was 3 %. In follow-up (median 27 months), no relapses or problems related to IVC flow were detected. Postoperative stay and transfusion rate were higher in the conservative surgery group, but these patients presented fewer complications. There was no relationship between circumferential grades and length of contact with the IVC and the type of surgery performed. Liver hydatid cysts in contact with the IVC are large cysts usually located in the right liver. They do not normally cause clinical symptoms related to IVC contact. Radical surgery is feasible, and was performed in 60 % of our series, but it is technically demanding. We propose a classification of cysts in contact with the IVC.

Fast-Track Surgery in Intestinal Deep Infiltrating Endometriosis

Study ObjectiveTo evaluate the length of hospital stay (LOS) and the readmission rate in patients undergoing laparoscopic surgery to treat intestinal deep infiltrating endometriosis (DIE) with application of the concepts of fast-track surgery. DesignRetrospective study of women undergoing laparoscopic treatment of intestinal DIE (Canadian Task Force classification II-3). SettingTertiary referral private hospital. InterventionsWe evaluated 161 women who underwent laparoscopic surgery between January 2010 and April 2013 for complete treatment of intestinal DIE, via either conservative surgery (rectal shaving, mucosal skinning, or anterior disk resection) or radical surgery (segmental bowel resection). After surgery, all specimens were sent for pathologic examination to confirm the presence of endometriosis. Measurements and Main ResultsPatients were divided into 2 groups according to type of surgery (conservative [n = 102] or radical [n = 59]), and LOS and readmission rate were measured in both groups. Median LOS was shorter in the conservative group compared with the segmental bowel resection group (19 vs 28 hours; p < .001). Ninety-two patients (90.2%) in the conservative surgery group were discharged to home on the first postoperative day, compared with only 38 patients (64.4%) in the segmental bowel resection group. Overall, the readmission rate was low (3.1%): 6.8% in the segmental bowel resection group and 1% in the conservative group (p = .04; odds ratio, 7.34; 95% confidence interval, 0.8–67.3); however, the need for repeat operation was similar in both groups (3.4% vs 1%; p = .28; odds ratio, 3.54; 95% confidence interval, 0.31–39.95). ConclusionImplementation of fast-track concepts in the laparoscopic treatment of intestinal DIE resulted in a short LOS and low readmission rate in both the segmental bowel resection and conservative surgery groups.

Effect of surgical staging on 539 patients with borderline ovarian tumors: A Turkish Gynecologic Oncology Group study

ObjectiveThe objectives of this study were to examine demographic and clinicopathologic characteristics and to determine the effects of primary surgery, surgical staging and the extensiveness of staging. MethodsIn a retrospective Turkish multicenter study, 539 patients, from 14 institutions, with borderline ovarian tumors were investigated. Some of the demographic, clinical and surgical characteristics of the cases were evaluated. The effects of type of surgery, surgical staging; complete or incomplete staging on survival rates were calculated by using Kaplan–Meier method. ResultsThe median age at diagnosis was 40years (range 15–84) and 71.1% of patients were premenopausal. The most common histologic types were serous and mucinous. Majority of the staged cases were in Stage IA (73.5%). 242 patients underwent conservative surgery. Recurrence rates were significantly higher in conservative surgery group (8.3% vs. 3%). Of all patients in this study, 294 (54.5%) have undergone surgical staging procedures. Of the patients who underwent surgical staging, 228 (77.6%) had comprehensive staging including lymphadenectomy. Appendectomy was performed on 204 (37.8%) of the patients. The median follow-up time was 36months (range 1–120months). Five-year survival rate was 100% and median survival time was 120months. Surgical staging, lymph node sampling or dissection and appendectomy didn't cause any difference on survival. ConclusionComprehensive surgical staging, lymph node sampling or dissection and appendectomy are not beneficial in borderline ovarian tumors surgical management.

Is a bowel resection necessary for deep endometriosis with rectovaginal or colorectal involvement?

BackgroundThe purpose of this paper is to report the long-term results of surgery without bowel resection in patients suffering from deep infiltrating endometriosis with rectovaginal or colorectal involvement.MethodsThis retrospective observational study identified 42 patients suffering with deep infiltrating endometriosis who underwent surgery. Conservative surgery was performed in 23 women (only one of them with bowel resection), and 19 women underwent a hysterectomy and bilateral salpingo-oophorectomy (HBSO). In the conservative surgery group, a later HBSO was performed in eight patients as a second operation. Pregnancies, recurrences, reoperations, use of hormone replacement therapy, and outcomes during long-term follow-up were analyzed.ResultsThe average follow-up duration was 7 ± 5.7 years in conservative surgery cases. Only one patient was treated with sigmoid bowel resection in 1997 and had complications. In this conservative surgery group, 13 patients (56%) received medical treatment after surgery, 10 patients wanted to get pregnant (of whom seven [70%] were successful), and eight patients underwent a subsequent HBSO because of recurrent symptoms and/or endometrioma. Therefore, HBSO was performed in 27 patients, of whom 14 (51.8%) used hormone replacement therapy for 5.6 ± 3.6 years. No recurrences or complications were observed in patients after HBSO with or without hormone replacement therapy.ConclusionGood clinical results can be obtained by performing only conservative surgery and/or HBSO without bowel resection, an alternative that could reduce the number of colorectal resections that are performed very frequently nowadays. After HBSO, patients may use hormone replacement therapy for several years with total satisfaction and well-being.

Duodenal Gastrointestinal Stromal Tumors (GISTs): Arguments for Conservative Surgery

IntroductionGastrointestinal stromal tumors (GISTs) of the duodenum are rare. We sought to evaluate the postoperative courses and long-term outcomes of conservative surgery (CS) versus pancreaticoduodenectomy (PD) for patients with non-metastatic duodenal GISTs. MethodsSeventeen patients underwent surgery for duodenal GISTs between January 2000 and January 2012; 11 patients underwent CS (CS group), and six patients underwent a PD (PD group). ResultsMortality was similar between the two groups. Patients in the PD group had longer operative times, more tumors located on the pancreatic side of the duodenum, higher rates of post-operative complications including postoperative pancreatic fistulas, and a longer hospital stay, when compared with patients of CS group. All tumors were resected with clear surgical margins (R0 resection). The median disease-free survival times were not different. ConclusionCS was safe and provided similar oncologic outcomes as PD. CS should be the procedure of choice in patients with GIST that does not involve the pancreatic side of the duodenum.