Complete Resection Rate Research Articles

Evaluation of the Effect of Photodynamic Therapy on CAM-Grown Sarcomas.

Resection margin adequacy plays a critical role in the local control of sarcomas. Fluorescence-guided surgery has increased complete resection rates and local recurrence-free survival in several oncological disciplines. The purpose of this study was to determine whether sarcomas exhibit sufficient tumor fluorescence (photodynamic diagnosis (PDD)) after administration of 5-aminolevulinic acid (5-ALA) and whether photodynamic therapy (PDT) has an impact on tumor vitality in vivo. Sixteen primary cell cultures were derived from patient samples of 12 different sarcoma subtypes and transplanted onto the chorio-allantoic membrane (CAM) of chick embryos to generate 3-dimensional cell-derived xenografts (CDXs). After treatment with 5-ALA, the CDXs were incubated for another 4 h. Subsequently accumulated protoporphyrin IX (PPIX) was excited by blue light and the intensity of tumor fluorescence was analyzed. A subset of CDXs was exposed to red light and morphological changes of both CAMs and tumors were documented. Twenty-four hours after PDT, the tumors were excised and examined histologically. High rates of cell-derived engraftments on the CAM were achieved in all sarcoma subtypes and an intense PPIX fluorescence was observed. PDT of CDXs resulted in a disruption of tumor-feeding vessels and 52.4% of CDXs presented as regressive after PDT treatment, whereas control CDXs remained vital in all cases. Therefore, 5-ALA mediated PDD and PDT appear to be promising tools in defining sarcoma resection margins (PDD) and adjuvant treatment of the tumor bed (PDT).

Efficacy of Endoscopic Resection for Rectal Neuroendocrine Tumors Smaller than 15mm.

Local resection, including endoscopic resection, is recommended for rectal neuroendocrine tumors (NETs) < 15mm in patients without risk factors for metastasis, though the short- and long-term outcomes are unclear. This study investigates the efficacy of endoscopic resection for rectal NETs < 15mm. The short- and long-term outcomes of patients with rectal NETs < 15mm who underwent endoscopic resection and the outcomes of each endoscopic technique were analyzed. The tumors were stratified as < 10mm (small-size group, SSG) and 10-14mm (intermediate-size group, IMG). Overall, 139 lesions (SSG, n = 118; IMG, n = 21) were analyzed. All tumors were classified as G1 (n = 135) or G2 (n = 4) according to the 2019 World Health Organization grading criteria. The complete resection rate was not different between the groups (P = 0.151). Endoscopic submucosal dissection (ESD) and endoscopic submucosal resection with a ligation device (ESMR-L) achieved complete resection rates > 90% in the SSG. The ESMR-L procedure time (P < 0.001) and hospitalized period (P < 0.001) were significantly shorter than those of ESD. ESD achieved a complete resection rate of 80.0% in the IMG. The tumor size did not affect the overall survival or rate of lymph node/distant metastases. Endoscopic resection is a feasible and effective treatment for patients with rectal NETs < 15mm without the risk factors of metastasis. ESMR-L and ESD are optimal techniques for resecting tumors smaller than 10mm and 10-14mm, respectively.

Comparison of Modified Cap-Assisted Endoscopic Mucosal Resection and Endoscopic Submucosal Dissection in Treating Intraluminal Gastric Gastrointestinal Stromal Tumor (≤20 mm).

A modified cap-assisted endoscopic mucosal resection (mEMR-C), introduced in this study, was a novel variation of the standard EMR. We aimed to compare the outcomes of mEMR-C and endoscopic submucosal dissection (ESD) for the treatment of small (≤20 mm) intraluminal gastric gastrointestinal stromal tumors (gGISTs). This retrospective study included 43 patients who underwent mEMR-C and 156 patients who received ESD at Nanjing Drum Tower Hospital. Baseline characteristics, adverse events, and clinical outcomes were compared between the 2 groups. Univariate and multivariable analyses were conducted to adjust for confounders. After propensity score matching using sex, year, location, and tumor size, outcomes were compared with 41 patients in each group. A total of 199 patients underwent endoscopic resection and the en bloc resection rate was 100%. The complete resection rate was comparable in both groups ( P = 1.000). Approximately 9.5% of all patients had a positive margin. There was no significant difference in positive margin for patients undergoing mEMR-C or ESD (9.3% vs 9.6%, P = 1.000). No difference in adverse events in both groups ( P = 0.724). The mEMR-C was associated with shorter operation time and lower cost than the ESD. Recurrence was reported in 2 patients at 1 and 5 years after ESD during a median follow-up of 62 months. No metastasis and disease-related death were identified in both groups. Propensity score matching analysis revealed similar results. The mEMR-C was found to be the preferable technique for small (≤20 mm) intraluminal gGISTs with shorter operation time and lower cost as compared with ESD.

Efficacy of the specialized scissor-type knife for gastric endoscopic submucosal dissection: a propensity score matched retrospective study.

Background and study aims Prevention of bleeding and perforation during gastric endoscopic submucosal dissection (ESD) is important. Scissor-type knives can accurately grasp and incise the targeted tissue using electrosurgical currents, thereby eliminating unexpected incisions. The SB Knife GX, a scissor-type knife specialized for gastric ESD, was released in June 2016 in Japan. The aim of the present study was to evaluate the efficacy and safety of gastric ESD using the SB Knife GX. Patients and methods A total of 716 patients who underwent gastric ESD at Hiroshima University Hospital between July 2016 and December 2020 were retrospectively reviewed. From these, 671 patients underwent ESD using the IT Knife 2 (IT-2 group), while 45 underwent ESD using an SB Knife GX (SB-GX group). After propensity score matching, the procedure time, specimen size, en bloc and complete resection rates, and intraoperative bleeding, delayed bleeding, and perforation rates were evaluated. Results No significant differences were observed in mean procedure time (SB-GX group: 115 ± 165 min; IT-2 group: 95 ± 61 min; P = 0.82) and en bloc and complete resection rates between the two groups. Intraoperative bleeding rates were significantly lower in the SB-GX group than in the IT-2 group (18 % vs. 40 %; P = 0.01), and there were no differences in delayed bleeding (4 % vs. 4 %) or perforation (0 % vs. 4 %) between the two groups. Conclusions The SB Knife GX was proven to be useful for control of intraoperative bleeding during gastric ESD, although the procedure time tended to be longer.

Factors that contribute to the recurrence of mucinous ovarian cancer: Monocenter retrospective evaluation.

In this study, we aimed to put forth the factors that contribute to the recurrence of mucinous ovarian cancer. Forty-four mucinous ovarian cancer patients who have presented to our clinic between February 2006 and May 2018 took part in the study. In order to predict the factors that contribute to recurrence, the univariate and the multivariate logistic regressions were utilized. The Kaplan-Meier survival analysis was utilized for survival and the log-rank test was used for the discrepancies between the groups. In the analysis of the data, the Statistical Package for the Social Sciences 22 program was used. It was acknowledged to have statistical meaning when the P value in all the tests was lower than 0.05. Recurrence was detected in 20 out of 44 patients who participated in the study. The ages of the patients who did not experience recurrence were significantly lower ( P = 0.001). The patients were detected mostly in Stage 1 (36.4%). In the group of patients without recurrence, systemic lymphadenectomy (43.2%) was greater ( P = 0.019). Lymph node metastasis was three times higher in the group that experienced recurrence ( P = 0.047). When the two groups were compared, the platinum resistance was considerably greater in the group with recurrence ( P = 0.005). In terms of residual tumor, the rate of complete resection was (9%) better in the group that experienced recurrence compared to the group that did not experience recurrence, with a rate of 45.5%. While 12 patients who experienced recurrence died, 6 people died in the other group. From the factors that contribute to recurrence, in terms of residual tumor quantity, this was grouped as complete (R0) resection and optimal + suboptimal (R1 + R2) resection and the following were determined: odds ratio (OR) - 5.7 (95% confidence interval [CI]: 1.56-20.9) and P = 0.008 for R1 + R2. In univariate analysis, the OR was determined as 1.16 (95% CI: 1.06-1.27) for age. Possessing a Stage 2 and higher disease statistically contributed considerably to the recurrence compared to Stage 1 disease (OR: 6.33; 95% CI: 1.59-25.22; P = 0.009). Age was determined as an independent prognostic risk factor in the multivariate analysis (OR: 1.10 [95% CI: 1.04-1.25]), P = 0.018. Furthermore, the OR for the advanced-stage (Stage 2 or higher) patients in the multivariate analysis was determined as 7.88 (95% CI: 0.78-78.8) and was found to be statistically significant at limits ( P = 0.079). We have put forth that the genetic, biological, and clinical characteristics of mucinous ovarian cancers differ from that of other epithelial ovarian cancers, and that age, advanced stage, and residual tumor quantity are prognostic risk factors in terms of recurrence, and that age is an independent prognostic risk factor. Biological and clinical characteristics of mucinous ovarian cancers differ from those of other epithelial ovarian cancers, and we observed that the age, advanced stage, and the amount of residual tumor regarding recurrence are prognostic risk factors, while age was determined as an independent prognostic risk factor.

429 Intramedullary Spinal Arteriovenous Malformations—Definition of Two Distinct Subtypes

INTRODUCTION: Intramedullary spinal arteriovenous malformations (SpiAVM) are complex lesions. Due to their rarity, reports of their management and outcomes are limited. METHODS: Our neurovascular database was reviewed SpiAVMs between January 1986 and December 2021. Demographic, clinical, radiographic, and outcome data were obtained. Eccentric SpiAVMs were defined as those with a significant portion presenting through the pia mater into the subarachnoid space, with large vessels coursing outside the parenchyma. Concentric SpiAVMs were defined as those embedded within the spinal cord parenchyma, not presenting to pia mater, and well circumscribed. RESULTS: Fifty-nine patients (mean [SD] age, 34 [15] years; female sex, 34) were identified. Patients exhibited myelopathy (88%), including pain (51%), paresis (88%), sensory deficits (46%), and bowel and bladder dysfunction (46%). Twenty-seven patients (46%) presented with hemorrhage. Forty-nine percent of lesions were located in the cervical spine and 51% in the thoracic spine. Thirty-five lesions (59%) were previously embolized. Twenty-eight patients (51%) were classified as eccentric and 27 (49%) as concentric SpiAVMs. Postoperative outcomes were similar with no significant differences (improved, 8/18 [44%] vs. 9/17 [53%]; unchanged, 8/18 [44%] vs. 7/17 [41%]; worse, 2/18 [11%] vs. 1/17 [6%]). Retreatment rates were not significantly different between both subtypes (eccentric, 9/28 [32%]; concentric, 6/27 [22%]). Eccentric and concentric SpiAVMs were associated with similar rates of complete resection (eccentric, 14/26 [54%], concentric, 18/26 [69%]). Of 55 classifiable lesions, 4 (7%) were determined to have a mixed phenotype, harboring characteristics of eccentric and concentric SpiAVMs. CONCLUSIONS: Intramedullary AVMs may cause significant symptoms. The eccentric and concentric subtypes have different angioarchitecture and outcomes. While complete resection is usually the preferred surgical objective, eccentric SpiAVMs are amenable to the pial resection that may achieve angiographic obliteration without complete resection.

Near-Infrared Fluorescence Imaging of Pancreatic Cancer Using a Fluorescently Labelled Anti-CEA Nanobody Probe: A Preclinical Study

Molecular fluorescence-guided surgery using near-infrared light has the potential to improve the rate of complete resection of cancer. Typically, monoclonal antibodies are being used as targeting moieties, however smaller fragments, such as single-domain antibodies (i.e., Nanobodies®) improve tumor specificity and enable tracer injection on the same day as surgery. In this study, the feasibility of a carcinoembryonic antigen-targeting Nanobody (NbCEA5) conjugated to two zwitterionic dyes (ZW800-1 Forte [ZW800F] and ZW800-1) for visualization of pancreatic ductal adenocarcinoma (PDAC) was investigated. After site-specific conjugation of NbCEA5 to the zwitterionic dyes, binding specificity was evaluated on human PDAC cell lines with flow cytometry. A dose escalation study was performed for both NbCEA5-ZW800F and NbCEA5-ZW800-1 in mice with subcutaneously implanted pancreatic tumors. Fluorescence imaging was performed up to 24 h after intravenous injection. Furthermore, the optimal dose for NbCEA5-ZW800-1 was injected in mice with orthotopically implanted pancreatic tumors. A dose-escalation study showed superior mean fluorescence intensities for NbCEA5-ZW800-1 compared to NbCEA5-ZW800F. In the orthotopic tumor models, NbCEA5-ZW800-1 accumulated specifically in pancreatic tumors with a mean in vivo tumor-to-background ratio of 2.4 (SD = 0.23). This study demonstrated the feasibility and potential advantages of using a CEA-targeted Nanobody conjugated to ZW800-1 for intraoperative PDAC imaging.

Endoscopic mucosal resection with double band ligation versus endoscopic submucosal dissection for small rectal neuroendocrine tumors.

Endoscopic resection remains an effective method for the treatment of small rectal neuroendocrine tumors (NETs) (≤ 10 mm). Moreover, endoscopic mucosal resection (EMR) with double band ligation (EMR-dB), a simplified modification of EMR with band ligation, is an alternative strategy to remove small rectal NETs. To evaluate the feasibility and safety of EMR-dB for the treatment of small rectal NETs (≤ 10 mm). A total of 50 patients with small rectal NETs, without regional lymph node enlargement or distant metastasis confirmed by endoscopic ultrasound, computerized tomography scan, or magnetic resonance imaging, were enrolled in the study from March 2021 to June 2022. These patients were randomly assigned into the EMR-dB (n = 25) group or endoscopic submucosal dissection (ESD) group (n = 25). The characteristics of the patients and tumors, procedure time, devices cost, complete resection rate, complications, and recurrence outcomes were analyzed. There were 25 patients (13 males, 12 females; age range 28-68 years old) in the EMR-dB group, and the ESD group contained 25 patients (15 males, 10 females; age range 25-70 years old). Both groups had similar lesion sizes (EMR-dB 4.53 ± 1.02 mm, ESD 5.140 ± 1.74 mm; P = 0.141) and resected lesion sizes(1.32 ± 0.52 cm vs 1.58 ± 0.84 cm; P = 0.269). Furthermore, the histological complete resection and en bloc resection rates were achieved in all patients (100% for each). In addition, there was no significant difference in the complication rate between the two groups. However, the procedure time was significantly shorter and the devices cost was significantly lower in the EMR-dB group. Besides, there was no recurrence in both groups during the follow-up period. The procedure time of EMR-dB was shorter compared with ESD, and both approaches showed a similar curative effect. Taken together, EMR-dB was a feasible and safe option for the treatment of small rectal NETs.

Effects of traction methods in inexperienced endoscopists during colorectal endoscopic submucosal dissection

Background colorectal endoscopic submucosal dissection (ESD) remains a technical challenge, but traction devices show promise in making this procedure easier. However, the efficacy of traction techniques for colorectal ESD is still unknown for inexperienced endoscopists. Methods We selected 400 patients who underwent colorectal ESD performed by four inexperienced endoscopists. Each patient in the traction-assisted ESD (TA-ESD) group was matched to a patient in the conventional ESD (C-ESD) group according to propensity scores. Results One-to-one propensity score-matching analysis created 87 matched pairs. The self-completion rate in the TA-ESD group is significantly higher than that in the C-ESD group (100% [87/87] vs. 92% [80/87], p < 0.001). The median resection speed was significantly faster in the TA-ESD group than that in the C-ESD group (27 mm2/min [IQR, 19.5–47.3] vs.18 mm2/min [IQR, 13.5–33.8], p < 0.001) and the procedure time in the TA-ESD group was significantly shorter than that in the C-ESD group (33 min [IQR, 27–47] vs.53 min [IQR, 38–73], p < 0.001). However, the histologic complete resection rate was not significantly different between the TA-ESD and C-ESD groups (93.1% [6/87]) vs. 96.6% [3/87], p < 0.1888, respectively). The en bloc resection rate (96.6%) and perforation rate (4.6%) were equivalent between the TA-ESD group and the C-ESD group. Conclusion Traction techniques seem to improve resection speed and self-completion rate of colorectal ESD for inexperienced endoscopists.

Standard Endoscopic Mucosal Resection vs Precutting Endoscopic Mucosal Resection Using Novel Disk-Tip Snare for Colorectal Lesions.

SOUTEN (KANEKA Co., Tokyo, Japan) is a unique snare with a disk tip. We analyzed the efficacy of precutting endoscopic mucosal resection with SOUTEN (PEMR-S) for colorectal lesions. We retrospectively reviewed 57 lesions of 10-30mm treated with PEMR-S at our institution from 2017 to 2022. The indications were lesions that were difficult for standard EMR due to size, morphology, and poor elevation by injection. Various therapeutic results of PEMR-S such as en bloc resection, procedure time, and perioperative hemorrhage were analyzed, and the results of 20 lesions of 20-30mm with PEMR-S were compared to those of lesions with standard EMR (2012-2014) using propensity score matching. Additionally, the stability of the SOUTEN disk tip was analyzed in a laboratory experiment. The polyp size was 16.5 ± 4.2mm and the non-polypoid morphology rate was 80.7%. Histopathological diagnosis included 10 sessile-serrated lesions, 43 low-grade and high-grade dysplasias, and 4 T1 cancers. After matching, the en bloc resection and histopathological complete resection rates of lesions of 20-30mm between PEMR-S and standard EMR (90.0% vs. 58.1%, p = 0.03 and 70.0% vs. 45.0%, p = 0.11). The procedure time (min) was 14.8 ± 9.7 and 9.7 ± 8.3 (p < 0.01). The en bloc resection (%) and procedure time of expert/non-expert were 89.7/85.7 (p = 0.96) and 6.1 ± 2.2/18.5 ± 7.2 (p < 0.01). The perioperative bleeding and hemostasis success rates with SOUTEN were 43.9% and 96.0%. In the experiment, the SOUTEN disk tip was fixed stably compared to other EMR snares. PEMR-S achieved high en bloc resection of colorectal lesions of 20-30mm though it leaded to long procedure time.

PKCθ Regulates Pituitary Adenoma Bone Invasion by Activating Osteoclast in NF-κB/IL-1β-Dependent Manner

Pituitary adenoma (PA) bone invasion results in adverse outcomes, such as reduced rates of complete surgical resection and biochemical remission as well as increased recurrence rates, though few studies have been conducted. We collected clinical specimens of PAs for staining and statistical analysis. Evaluation of the ability of PA cells to induce monocyte-osteoclast differentiation by coculturing PA cells with RAW264.7 in vitro. An in vivo model of bone invasion was used to simulate the process of bone erosion and evaluate the effect of different interventions in alleviating bone invasion. We found an overactivation of osteoclasts in bone-invasive PAs and concomitant aggregation of inflammatory factors. Furthermore, activation of PKCθ in PAs was established as a central signaling promoting PA bone invasion through the PKCθ/NF-κB/IL-1β pathway. By inhibiting PKCθ and blocking IL1β, we were able to significantly reverse bone invasion in an in vivo study. Meanwhile, we also found that celastrol, as a natural product, can obviously reduce the secretion of IL-1β as well as alleviate the progression of bone invasion. By activating the PKCθ/NF-κB/IL-1β pathway, pituitary tumors are able to induce monocyte-osteoclast differentiation in a paracrine manner and promote bone invasion, which can be alleviated by celastrol.

Local Recurrence after Endoscopic Submucosal Dissection of Early Gastric Cancer

Endoscopic submucosal dissection (ESD) is considered the treatment of choice for early gastric cancer (EGC) with a negligible risk of lymph node metastasis. Locally recurrent lesions on artificial ulcer scars are difficult to manage. Predicting the risk of local recurrence after ESD is important to manage and prevent the event. We aimed to elucidate the risk factors associated with local recurrence after ESD of EGC. Between November 2008 and February 2016, consecutive patients (n = 641; mean age, 69.3 ± 9.5 years; men, 77.2%) with EGC who underwent ESD at a single tertiary referral hospital were retrospectively analyzed to evaluate the incidence and factors associated with local recurrence. Local recurrence was defined as the development of neoplastic lesions at or adjacent to the site of the post-ESD scar. En bloc and complete resection rates were 97.8% and 93.6%, respectively. The local recurrence rate after ESD was 3.1%. The mean follow-up period after ESD was 50.7 ± 32.5 months. One case of gastric cancer-related death (0.15%) was noted, wherein the patient had refused additive surgical resection after ESD for EGC with lymphatic and deep submucosal invasion. Lesion size ≥15 mm, incomplete histologic resection, undifferentiated adenocarcinoma, scar, and the absence of erythema of the surface were associated with a higher risk of local recurrence. Predicting local recurrence during regular endoscopic surveillance after ESD is important, especially in patients with a larger lesion size (≥15 mm), incomplete histologic resection, surface changes of scars, and no erythema of the surface.

Hysteroscopic myomectomy with the IBS® Intrauterine Bigatti Shaver: A Retrospective Comparative Analysis of the impact of rotational speed and aspiration flow rate

Myoma removal remains a challenge hysteroscopically including for the "IBS®" Intrauterine Bigatti Shaver technique. To evaluate whether the Intrauterine IBS® instrument settings and the myoma size and type are prognostic factors for the complete removal of submucous myomas using this technology. This study was conducted at the San Giuseppe University Teaching Hospital Milan, Italy; Ospedale Centrale di Bolzano - Azienda Ospedaliera del Sud Tirolo Bolzano, Italy (Group A) and the Sino European Life Expert Centre-Shanghai Jiao Tong University School of Medicine Affiliated Renji Hospital, Shanghai, China (Group B). In Group A: surgeries were performed between June 2009 and January 2018 on 107 women using an IBS device set to a rotational speed of 2,500 rpm and an aspiration flow rate of 250ml/min. In Group B: surgeries were performed between July 2019 and March 2021 on 84 women with the instrument setting to a rotational speed of 1,500 rpm and aspiration flow rate of 500 ml/min. Further subgroup analysis was performed based on fibroid size:<3 cm and 3-5 cm. Both Groups A and B were similar in terms of patient age, parity, symptoms, myoma type and size. Submucous myomas were classified according to the European Society for Gynaecological Endoscopy classification. All patients underwent a myomectomy with the IBS® under general anaesthesia. The conventional 22 Fr. Bipolar Resectoscope was used in cases requiring conversion to the resection technique. All surgeries were planned, performed and followed by the same surgeon in both institutions. Complete resection rates, total operation time, resection time and used fluid volume. Complete resection with the IBS® Shaver was seen in 93/107 (86.91%) in Group A versus 83/84 (98.8 %) in Group B (P=0.0021). Five patients (5.8%) in Subgroup A1 (<3 cm) and nine patients (42.9%) in Subgroup A2 (3cm~5cm) could not be finished with the IBS (P<0.001, RR=2.439), while in Group B only one case (8.3%) in Subgroup B2 (3cm~5cm) underwent a conversion to bipolar resectoscope (Group A: 14/107=13.08% vs. Group B: 1/84=1.19%, P=0.0024). For <3cm myomas (subgroup A1 versus B1) there was a statistically significant difference in terms of resection time (7.75±6.363 vs. 17.28±12.19, P<0.001), operation time (17.81 ± 8.18 vs. 28.19 ±17.614, P<0.001) and total amount of fluid used (3365.63 ± 2212.319 ml vs. 5800.00 ± 8422.878 ml, P<0.05) in favour of Subgroup B1. For larger myomas, a statistical difference was only observed for the total operative time (51.00±14.298 min vs. 30.50±12.122 min, P=0.003). For hysteroscopic myomectomy using the IBS®, 1,500rpm rotational speed and 500ml/min aspiration flow rate are recommended as these settings result in more complete resections compared to the conventional settings. In addition, these settings are associated with a reduction in total operating time. Reducing the rotational speed rate from 2500 rpm to 1500 rpm and increasing the aspiration flow rate from 250 ml/min to 500 ml/min improve complete resection rates and reduce operating times.

Comparison between Submucosal Tunneling Endoscopic Resection and Endoscopic Submucosal Dissection for Prepyloric Submucosal Tumors: A Case-Matched Controlled Study.

Endoscopic submucosal dissection (ESD) has become a well-established treatment method for gastric submucosal tumors (SMTs). However, there existed some challenges to perform ESD for prepyloric SMTs on account of the special location. Recently, submucosal tunneling endoscopic resection (STER) provided a novel option for prepyloric SMTs. This study aimed to make a comprehensive comparison between prepyloric STER (P-STER) and ESD for the treatment of prepyloric SMTs. Patients with prepyloric SMTs undergoing P-STER treatment between January 2016 and October 2021 were retrospectively reviewed and individually matched at 1 : 1 ratio with those with ESD treatment according to lesion size, lesion location, pathologic diagnosis, lesion origin, and surgery date, forming P-STER and ESD group, respectively. A sample size of 12 patients was collected for each group. Treatment outcomes including resection time, en bloc resection rate, complete resection rate, and postoperative hospital stay as well as occurrence of complications were evaluated. Compared with ESD group, P-STER group got shorter resection time (52.50 minutes for ESD group vs. 38.67 minutes for P-STER group, P = 0.001), shorter postoperative hospital stay (7.00 day for ESD group vs. 5.50 day for P-STER group, P = 0.008), and lower rate of postoperative abdominal pain (50.00% for ESD group vs. 8.33% for P-STER group, P = 0.025). No complication was encountered in P-STER group, whereas one patient with postoperative bleeding was found in ESD group. For the treatment of prepyloric SMTs, P-STER appeared to be a more effective endoscopic technique compared with ESD, although further randomized controlled trials were warranted.

Endoscopic submucosal dissection for large early squamous cell carcinoma—traction assisted methods

: Endoscopic resection is a minimally-invasive treatment for superficial esophageal tumors compared with surgery or chemoradiation therapy. Endoscopic submucosal dissection (ESD) is a well-established method with accurate histological evaluation and favorable procedural outcomes. However, ESD requires a high level of skill, and is therefore technically challenging and time-consuming. Traction-assisted ESD has been introduced to facilitate ESD and provides adequate submucosal visualization and satisfactory tissue traction. We reviewed the scientific literature in English to evaluate the efficacy of traction-assisted ESD for esophageal lesions, including the clip-with-thread (CT) method and the submucosal tunneling (ST) method. The CT method is a simple and affordable technique that uses commercially available hemoclips. Two randomized controlled trials and two retrospective studies showed that the CT method resulted in shorter procedure times and reduced local injection compared with conventional ESD, and no cases of perforation. The ST method does not require specific devices and facilitates the procedure by securing a stable submucosal visual field and maintaining a submucosal liquid cushion. Two retrospective studies reported shorter procedure times with similar en bloc resection rates and complete resection rates using the ST method compared with conventional ESD. Although a combination of the ST method with the CT method seems to be effective for large lesions, its efficacy and safety should be confirmed by a large-scale study. In the future, robotic traction has a great potential to be a breakthrough for esophageal ESD, providing appropriate and multi-directional traction to the lesions via an operator-controlled robotic arm. There is no doubt that traction assistance is key to facilitating esophageal ESD. Further studies are needed to elucidate the best method from the perspective of efficacy, safety, and cost.

Surgical treatment of cardiac lipoma: 20 years' experience in a single center.

Primary cardiac lipoma is very rare, and no consensus has been developed regarding its ideal treatment strategy. This study reviewed the surgical treatment of cardiac lipomas in 20 patients over 20 years. Twenty patients with cardiac lipomas were treated at Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College from January 1, 2002, to January 1, 2022. The patients' clinical data and pathological reports were retrospectively analyzed, and the follow-up with a range of 1 to 20 years was conducted. The cardiac lipomas were located in the right atrium (RA) or superior vena cava (SVC) in seven patients (35%) (atrium in six patiets and SVC in one patient), left ventricle in eight patients (40%) (left ventricular chamber in four patients and left ventricular subepicardium and myocardium in four patients), right ventricle in three patients (15%) (right ventricular chamber in one patient and right ventricular subepicardial layer and myocardium in two patients), subepicardial interventricular groove in one patient (5%), and pericardium in one patient (5%). Complete resection was achieved in 14 patients (70%), including seven patients with lipomas in the RA or SVC. Incomplete resection occurred in six patients (30%) with lipomas in the ventricles. No perioperative deaths occurred. Long-term follow-up was conducted for 19 patients (95%), including two (10%) who died. Both patients who died had lipomas incompletely resected due to ventricles involvement, and preoperative malignant arrhythmias persisted post-operatively. The complete resection rate was high, and the long-term prognosis was satisfactory in patients with cardiac lipomas that did not involve the ventricle. The complete resection rate was low in patients with cardiac lipomas in ventricles; and complications, including malignant arrhythmia, were common. Failure of complete resection and post-operative ventricular arrhythmia are correlated with post-operative mortality.

A novel cap-assisted endoscopic resection device for resection of a rectal lesion in an in vitro pig model.

In a previous study, we proved that modified cap-assisted endoscopic mucosal resection (mEMR-C) is non-inferior to endoscopic submucosal dissection (ESD) for rectal neuroendocrine tumors smaller than 10 mm with a similar complete resection rate. In addition, mEMR-C had a shorter procedure duration time and lower hospitalization costs [1]. However, a snare needs to be precisely placed into the inner groove of the cap during the mEMR-C procedure, which is time-consuming and difficult for an inexperienced doctor. To solve this problem, we proposed a novel cap-assisted endoscopic resection device for resecting of a rectal lesion that might make the procedure much simpler and easier. In the current study, we initially explored the feasibility of this device for endoscopic resection in an in vitro pig model.

The Resection Rate of Synchronously Detected Liver and Lung Metastasis from Colorectal Cancer Is Low-A National Registry-Based Study.

Population-based data on the incidence and surgical treatment of patients with colorectal cancer (CRC) and synchronous liver and lung metastases are lacking as are real-life data on the frequency of metastasectomy for both sites and outcomes in this setting. This is a nationwide population-based study of all patients having liver and lung metastases diagnosed within 6 months of CRC between 2008 and 2016 in Sweden identified through the merging of data from the National Quality Registries on CRC, liver and thoracic surgery and the National Patient Registry. Among 60,734 patients diagnosed with CRC, 1923 (3.2%) had synchronous liver and lung metastases, of which 44 patients had complete metastasectomy. Surgery of liver and lung metastases yielded a 5-year OS of 74% (95% CI 57-85%) compared to 29% (95% CI 19-40%) if liver metastases were resected but not the lung metastases and 2.6% (95% CI 1.5-4%) if non-resected, p < 0.001. Complete resection rates ranged from 0.7% to 3.8% between the six healthcare regions of Sweden, p = 0.007. Synchronous liver and lung CRC metastases are rare, and a minority undergo the resection of both metastatic sites but with excellent survival. The reasons for differences in regional treatment approaches and the potential of increased resection rates should be studied further.

Radioguided occult lesion localisation: A retrospective audit at a single tertiary academic breast unit

Background: The radioguided occult lesion localisation (ROLL) technique was introduced at Groote Schuur Hospital in 2003 replacing the wire-guided localisation (WGL) technique. In the case of preoperative histologically proven impalpable breast cancers, a sentinel lymph node (SLN) biopsy was done simultaneously (sentinel node [SN] with occult lesion localisation or SNOLL).Aim: To assess the efficacy of the ROLL and SNOLL techniques for diagnostic and therapeutic excisions.Setting: A retrospective record analysis of 190 patients who underwent a ROLL procedure for diagnostic or therapeutic excision of occult breast lesions was performed at a large tertiary hospital in the Western Cape.Methods: Data were collected on patient and tumour characteristics, successful localisation rates, the volume of tissue removed, complete tumour resection rates, the number of re-operations performed and the proportion of SLN detection. The Pearson’s chi-squared test was used to test for significance between variables at α = 0.05.Results: Correct radiopharmaceutical placement was achieved in 177/190 (93.2%) lesions. Histologic examination of excised specimens confirmed 115/190 (61.0%) malignant and 75/190 (39.0%) benign lesions. Involved margins were found in 37/115 (32.2%). Complete excision with adequate margins occurred in 50/70 (71.4%) of cases of invasive cancer and in 11/45 (24.4%) of ductal carcinoma in situ (DCIS). The SN was successfully identified in 30/37 (81.1%) of SNOLL cases.Conclusion: Radioguided occult lesion localisation is an effective tool in the preoperative localisation of occult lesions for surgical biopsy as well as the removal of impalpable breast cancers. A single intratumoural injection with 99mTc nanocolloid combined with lymphoscintigraphy is a reliable method of localising the SN.

Early versus delayed surgery following neoadjuvant chemoradiation for esophageal cancer: a systematic review and meta-analysis.

Neoadjuvant chemoradiotherapy (nCRT) followed by surgery, is the mainstay of managing locally advanced esophageal cancer. However, the optimal timing of surgery after neoadjuvant therapy is not defined clearly. A systematic search of PubMed, Embase and Cochrane databases was conducted. 6-8weeks were used as a cut-off to define early and delayed surgery groups. Overall Survival (OS) was the primary outcome, whereas pathological complete resolution (pCR), R0 resection, anastomotic leak, perioperative mortality, pulmonary complications, and major complication (> Clavien-Dindo grade 2) rates were secondary outcomes. Cohort studies and national registry bases studies were analysed separately. Survival data were pooled as Hazard Ratio (HR) and the rest as Odds Ratio (OR). According to heterogeneity, fixed-effect or random-effect models were used. Twelve retrospective studies, one RCT, and six registry-based studies (13,600 participants) were included. Pooled analysis of cohort studies showed no difference in OS (HR 1.03, CI 0.91-1.16), pCR (OR 0.98, CI 0.80-1.20), R0 resection (OR 0.90, CI 0.55-I.45), mortality (OR 1.03, CI 0.59-1.77), pulmonary complications (OR 1.26, CI 0.97-1.64) or major complication rates (OR 1.29, CI 0.96-1.73). Delayed surgery led to increased leak (OR 1.48, CI 1.11-1.97). Analysis of registry studies showed that the delayed group had a better pCR rate (OR 1.12, CI 1.01-1.24), with no improvement in survival (HR 1.01, CI 0.92-1.10). Delayed surgery was associated with increased mortality (OR 1.35, CI 1.07-1.69) and major complication rate (OR 1.55, CI 1.20-2.01). Available RCT reported surgical outcomes only. National registry-based studies' analysis shows that delay in surgery is riskier and leads to higher mortality and major complication rates. Further, well-designed RCTs are required.