Resection Of Benign Tumors Research Articles

Solitary fibrous tumors of the pleura: Results of surgical treatment and long-term prognosis

We sought to define the long-term outcome of surgically treated solitary fibrous tumors of the pleura. We performed a retrospective review from December 1972 through December 2002. There were 84 patients (39 men and 45 women) with a median age of 57 years (range, 34-83 years). Forty-six patients were symptomatic. Surgical resection included pulmonary wedge excision in 62 patients, lobectomy in 4 patients, segmentectomy in 2 patients, chest wall resection in 3 patients, isolated pleural resection in 7 patients, and chest wall resection with pulmonary wedge excision, lobectomy, or pneumonectomy in 3, 2, and 1 patients, respectively. Tumors were polypoid in 57 patients, sessile in 20 patients, and intrapulmonary in 7 patients. Histopathology was benign in 73 and malignant in 11 patients. Nine (82%) patient with malignant tumors and 37 (54%) patients with benign tumors were symptomatic (P = .11). The median tumor diameters for malignant and benign tumors were 12.0 and 4.5 cm, respectively (P = .001). Operative mortality and morbidity occurred in 3 (3.6%) and 7 (8.1%) patients, respectively. Median follow-up in survivors was 146 months (range, 23-387 months). Median survival for patients with benign and malignant tumors was 284 and 55 months, respectively, and 5-year survival was 88.9% and 45.5%, respectively (P = .0005). Eight (9.5%) patients had recurrent solitary fibrous tumors of the pleura. Recurrences were malignant in 6 and benign in 2 patients. Localized chest recurrences occurred in 3 patients, all of whom had reresection, with 2 patients again having recurrence. Resection of benign solitary fibrous tumors of the pleura carries an excellent prognosis. Larger tumors are more likely to be malignant. Both benign and malignant tumors can recur. Although prolonged survival after resection of malignant tumors is possible, recurrence is common.

Laparoscopic resection of gastric GIST and benign gastric tumours: evolution of a new technique

Gastrointestinal stromal tumours (GIST) are a distinctive group of mesenchymal neoplasm of the gastrointestinal tract that are best treated by surgical excision without tumour disruption and with a clear resection margin to prevent disease recurrence. However, delivering a posterior gastric tumour through an anterior gastrotomy, laparoscopically, can sometimes risk tumour rupture. We have devised a new technique to avoid this complication. With the patient in supine position, under a general anaesthetic and using a standard three ports, an anterior gastrotomy was performed and posterior tumour identified. An endobag was introduced through a 10-mm port. The retractable metal ring in endobag was closed around the base of the tumour. The tumour was gently lifted, and an endoscopic linear stapler introduced through another 12-mm port was used to resect the tumour with a cuff of normal gastric tissue. Data were analysed on 22 consecutive patients with gastric GIST who were treated laparoscopically. Intra-operative endoscopy was performed in all cases to aid localisation. There were 16 posterior tumours, of which 11 were operated by the new technique (using endobag and linear stapler) while 5 were dealt with using the old method (resection and suturing of defect). Median operating time for the new versus old technique was 70 versus 120 min (p < 0.002, Mann-Whitney test). There was no tumour disruption or incomplete resection margin using the new technique for posterior tumours. There were six anterior tumours treated by laparoscopic resection and suture closure of the defect. There was no significant difference in median operating time for anterior versus posterior tumours (80 vs. 75 min). Gastric GIST can be safely and efficiently resected laparoscopically without rupture or disruption with an adequate resection margin with this technique.

Laparoscopic nephrectomy for Wilms’ tumor

The role of minimally invasive surgery for the treatment of pediatric urological tumors has been limited to biopsies and resection for small neuroblastomas and benign tumors. The purpose of this study is to present the experience of a Brazilian group pioneering laparoscopic nephrectomy for Wilms’ tumor. A total of 15 children with unilateral non-metastatic Wilms’ tumor were preoperatively treated with vincristine and actinomycin D, and afterwards were submitted to laparoscopic nephrectomy and lymph node sampling. A Veress needle umbilical punction was performed and a four-trocar transperitoneal approach was used. The tumor was extracted inside a plastic bag and without morcellation through a Pfannenstiel incision. In all 15 patients the tumor was completely removed, as well as lymph node samples and no ruptures occurred. A fibrous capsule involved the tumor, making the dissection easy to perform. Intraoperative bleeding was minimal. The postoperative course was free of complications and all the patients were discharged early. No recurrences or long-term complications have been detected in 7–61 months or more of follow-up. We conclude that laparoscopic nephrectomy for Wilms’ tumor is a feasible and safe procedure in a selected group of children after chemotherapy. It reproduces all the steps of the open surgical approach required to treat this tumor, with the advantages of a short hospital stay and cosmetically more acceptable incisions.

Outcomes of minimally invasive surgery for phaeochromocytoma

Laparoscopic adrenalectomy is now accepted as the procedure of choice for the resection of benign adrenocortical tumours, but few studies have assessed whether the outcomes of laparoscopic adrenalectomy for adrenal phaeochromocytoma are similar to that of other adrenal tumour types. This is a retrospective cohort study. Clinical and operative data were obtained from an adrenal tumour database and hospital records. A total of 191 patients had laparoscopic adrenalectomy, of which 36 were for phaeochromocytoma, over a 12-year period. Length of hospital stay (4.8 vs 3.6 days, P= 0.03) and total operating times (183 vs 157 min, P= 0.01) were greater in the laparoscopic phaeochromocytoma resection group. Despite the greater size of the phaeochromocytomas compared to the remaining adrenal tumour types (44 mm vs 30 mm, P < 0.01), however, rate of conversion and morbidity were no different. Laparoscopic adrenalectomy for phaeochromocytoma is a safe procedure with similar outcomes to laparoscopic adrenalectomy for other adrenal tumour types.

Mandibular reconstruction after resection of benign tumours using non‐vascularised methods in a series of patients that did not undergo radiotherapy

AbstractAim: A case series analysis of 52 consequent subjects of immediate mandibular reconstruction after tumour resection using non‐vascularised methods, undertaken at U.P. King George's University of Dental Sciences and King George's Medical University, is being reported. To assess the success of reconstruction on subjective and objective evaluation based upon Mandibular Reconstruction Assessment Scale (MRAS) questionnaire.Methods: Patients with benign mandibular tumours irrespective of age, sex, site and socio‐economic status were included. Primary reconstruction was carried out after resection in two surgical units on surgeon's choice using stainless steel wire (6/52; 12%), stainless steel reconstruction plate (10/52; 19%) or titanium reconstruction plate (36/52; 69%) without bone graft (23/52; 44%) or with bone graft (29/52; 56%). Bone grafts were harvested from iliac crest (21/52; 40%), rib (2/52; 4%) and an additional pectoralis major myocutaneous flap with iliac crest bone graft (6/52; 12%) to provide cover to the reconstruction plate was also used.Results: The primary outcome measurements were wound healing, mouth opening, chewing efficiency, jaw movements, cosmetic achievement and speech on a five‐point scale, all of which improved significantly after surgery. The overall complication rate was 17%. Three patients (6%) had loosening of the screw, two (4%) showed dehiscence of the plate, two (4%) showed tumour recurrence and one (2%) had infection of the graft that was subsequently removed.Conclusion: Titanium reconstruction plates with iliac crest graft provided good result in the absence of microvascular reconstruction because of unavailable long operating time and lack of expertise. Long‐term satisfactory rehabilitation can be achieved using removable dentures or prosthesis on dental implants on the contraption provided by the non‐vascularised tissue despite non‐calcified bone visible on the skiagram.

MRI-Guided Focused Ultrasound Surgery

MRI-guided focused ultrasound (MRgFUS) surgery is a noninvasive thermal ablation method that uses magnetic resonance imaging (MRI) for target definition, treatment planning, and closed-loop control of energy deposition. Integrating FUS and MRI as a therapy delivery system allows us to localize, target, and monitor in real time, and thus to ablate targeted tissue without damaging normal structures. This precision makes MRgFUS an attractive alternative to surgical resection or radiation therapy of benign and malignant tumors. Already approved for the treatment of uterine fibroids, MRgFUS is in ongoing clinical trials for the treatment of breast, liver, prostate, and brain cancer and for the palliation of pain in bone metastasis. In addition to thermal ablation, FUS, with or without the use of microbubbles, can temporarily change vascular or cell membrane permeability and release or activate various compounds for targeted drug delivery or gene therapy. A disruptive technology, MRgFUS provides new therapeutic approaches and may cause major changes in patient management and several medical disciplines.

Laparoscopic resection of benign ovarian tumours in children with gonadal preservation

Ovarian tumours are often regarded as an indication for open oophorectomy, especially following torsion. We wish to report our results of laparoscopic ovarian cystectomy with ovarian preservation. Retrospective review of clinical records of patients who where managed with laparoscopic ovarian cystectomy with ovarian preservation. Twelve records were identified over a 3-year period. The average age was 11.8 years (9-15). Presentation was of a mass in nine patients and torsion in three patients. Average size of the mass was 8.2 cm (5-18). Two patients had bilateral lesions. All patients were noted to have normal tumour markers. Successful cystectomy with ovarian preservation was accomplished in all cases using 3-port laparoscopy. The bilateral lesions were addressed at the same surgery with no increased length of stay or morbidity. In the three patients with acute torsion, an initial laparoscopic detorsion was performed with delayed laparoscopic cystectomy and ovarian preservation 7-10 days later. There was one complication of a minor umbilical port site infection. Histology was of a mature teratoma in ten cases and simple cyst in two. Six patients underwent routine ultrasonographic follow-up at 2-5 months at which time the involved ovary assumed a size and shape and blood flow comparable to the contra-lateral ovary in five patients. In one patient the affected side was smaller, 8.6 ml compared to 10 ml on the contra-lateral ovary. The remaining patients have been followed up clinically and remain asymptomatic. Laparoscopic cystectomy with ovarian preservation can be successfully applied to benign ovarian tumours. Acute ovarian torsion is not a contraindication to this technique where a two stage procedure still enables us to offer ovarian preservation.

Conservative resection for benign tumors of the proximal pancreas

To evaluate the safety and long-term prognosis of conservative resection (CR) for benign or borderline tumor of the proximal pancreas. We retrospectively analyzed 20 patients who underwent CR at the Second Affiliated Hospital of Zhejiang University School of Medicine between April 2000 and October 2008. For pancreaticojejunostomy, a modified invagination method, continuous circular invaginated pancreaticojejunostomy (CCI-PJ) was used. Modified continuous closed lavage (MCCL) was performed for patients with pancreatic fistula. The indications were: serous cystadenomas in eight patients, insulinomas in six, non-functional islet cell tumors in three and solid pseudopapillary tumors in three. Perioperative mortality was zero and morbidity was 25%. Overall, pancreatic fistula was present in 25% of patients. At a mean follow up of 42.7 mo, all patients were alive with no recurrence and no new-onset diabetes mellitus or exocrine dysfunction. CR is a safe and effective procedure for patients with benign tumors in the proximal pancreas, with careful CCI-PJ and postoperative MCCL.

The influence of focal cerebellar lesions on the control and adaptation of gait

Cerebellar ataxic gait is influenced greatly by balance disorders, most likely caused by lesions of the medial zone of the cerebellum. The contributions of the intermediate and lateral zone to the control of limb dynamics for gait and the adaptation of locomotor patterns are less well understood. In this study, we analysed locomotion and goal-directed leg movements in 12 patients with chronic focal lesions after resection of benign cerebellar tumours. The extent of the cortical lesion and possible involvement of the cerebellar nuclei was determined by 3D-MR imaging. The subjects (age range 13-39 years, mean 20.3; seven female; ICARS score: mean 5.7, SD 6.3) performed three tasks: goal-directed leg placement, walking and walking with additional weights on the shanks. Based on the performance on the first two tasks, patients were categorized as impaired or unimpaired for leg placement and for dynamic balance control in gait. The subgroup with impaired leg placement but not the subgroup with impaired balance showed abnormalities in the adaptation of locomotion to additional loads. A detailed analysis revealed specific abnormalities in the temporal aspects of intra-limb coordination for leg placement and adaptive locomotion. These findings indicate that common neural substrates could be responsible for intra-limb coordination in both tasks. Lesion-based MRI subtraction analysis revealed that the interposed and the adjacent dentate nuclei were more frequently affected in patients with impaired compared to unimpaired leg placement, whereas the fastigial nuclei (and to a lesser degree the interposed nuclei) were more frequently affected in patients with impaired compared with unimpaired dynamic balance control. The intermediate zone appears thus to be of particular importance for multi-joint limb control in both goal-directed leg movements and in locomotion. For locomotion, our results indicate an influence of the intermediate zone on dynamic balance control as well as on the adaptation to changes in limb dynamics.

Minimally Invasive Surgical Enucleation or Esophagogastrectomy for Benign Tumor of the Esophagus

Experience in surgical resection of benign tumor of the esophagus is limited. Authors performed a chart review of 5 patients who underwent minimally invasive surgical resection of benign esophageal tumor. Main outcome measures included operative approaches, tumor's location and size, and outcomes. Tumor location were middle esophagus (n = 1), distal esophagus (n = 2), and gastroesophageal junction (n = 2). There were 4 females with a mean age of 55 years. Surgical approaches included thoracoscopic enucleation (n = 1), laparoscopic enucleation (n = 1), and laparoscopic and thoracoscopic Ivor Lewis esophagogastrectomy (n = 3). There were no open conversions. Mean operative time for enucleation was 127 minutes and 240 minutes for Ivor Lewis esophagectomy. Mean hospital stay was 5.8 days. There were no major or minor complications. Three patients developed stomal stenosis. The 30-day mortality was zero. Surgical pathology showed leiomyoma in 3 patients and gastrointestinal stromal tumor in 2 patients. Tumor size ranged from 1.1 to 10.5 cm. There has been no tumor recurrence at a mean follow-up of 14 months. Minimally invasive surgical enucleation or esophagogastrectomy for benign esophageal tumor is feasible and safe. The optimal approaches should be tailored based on the location and size of the tumor.

Function‐preserving parotid surgery for benign tumors involving the deep parotid lobe

Parotid deep lobe tumors have usually been removed by total parotidectomy, which has functional and aesthetic side effects. Limited partial parotidectomy may result in fewer side effects. We evaluated functional outcomes in 19 patients undergoing limited partial parotidectomy for benign tumors, 11 with deep lobe tumors and 8 with tumors involving both superficial and deep lobes, who underwent partial parotidectomy with preservation of normal glandular parenchyma and limited dissection of the facial nerve. Complications and salivary and cosmetic functions were evaluated at 6 and 12 months after surgery. Median operation time was 1.5 hr. Five patients experienced temporary facial weakness, and 1 developed Frey's syndrome. All patients experienced full recovery of facial nerve function within 6 months. Mean stimulated parotid salivary flow on the operated side was 74% of the preoperative level. All patients had symmetrical facial contours without sunken defects. No patient had tumor recurrence after a median follow-up of 40 months. Limited resection of benign tumors involving the parotid deep lobe may result in improved functional outcomes, including preserved salivary flow and beneficial cosmetic aspects, without compromising local tumor control.

Evaluation of patients' temporomandibular joint function after mandible reconstruction with free fibula flap

To evaluate the temporomandibular joint (TMJ) function after mandible reconstruction with free fibula flap and with different condyle treatment. Forty-one cases of mandible and condyle defects following benign tumor resection were reconstructed with fibula free flap, with the condyle being reconstructed by three methods: placement of the distal end of the fibula flap into the glenoid fossa, the fibula serving as the condyle (24 cases); attachment of the resected condyle as a nonvascularized transplant to the end of the fibula flap (5 cases); condyle preservation plus vascularized fibular reconstruction (12 cases). The postoperative TMJ function was evaluated by Fricton function index. No TMJ ankylosis occurred in all patients. There were no significant differences in aesthetics, deglutition and speech function among the three groups; but there were significant differences in TMJ function index (DI, CMI) among different condyle treatments. Condylar preservation showed better TMJ function than fibula used as a substitute for condyle. Preservation of condyle during free fibula mandibular reconstruction can improve patients' TMJ function. The location and shape of fibular condyle were important factors that could influence the outcome the condyle reconstruction.

Liver resection for benign liver tumors: indications and outcome

Liver resection for benign liver tumors: indications and outcome

Experience with ultrasonographically guided vacuum-assisted resection of benign breast tumors

To evaluate the feasibility and safety of vacuum-assisted resection of benign breast tumours using an 8 G handheld device. Over a 2-year period, 22 patients with 26 breast tumours diagnosed as benign using aspiration biopsy cytology were enrolled. The mean patient age was 38 years, and the mean maximal diameter of the tumour was 13 mm. A handheld Aloka SSD 6500 ultrasonography device with a linear-type 7.5 MHz transducer was inserted into the posterior aspect of the tumour with the patient under local anaesthesia, and the tumour was resected under ultrasonographic guidance. This method was employed successfully in all patients, and the mean operation time was 33 min. Post-procedure complications included subcutaneous bleeding in 12 cases and haematoma in one. The pathological diagnoses were fibroadenoma in 16 cases, mastopathy in six, and tubular adenoma and pseudoangiomatous stromal hyperplasia in two cases each, respectively. Follow-up ultrasonography revealed residual tumours in four cases (15.4%). Although this method is feasible and safe without severe complications, it is necessary to select appropriate patients, and to obtain informed consent regarding the possibility of recurrence or residual tumour.

Immediate Mandibular Reconstruction of a 5 cm Defect Using rhBMP‐2 After Partial Mandibulectomy in a Dog

To report treatment of a complex odontoma of the mandible by partial mandibulectomy and immediate surgical reconstruction using bridging plate fixation with a synthetic graft. Clinical case report. A 4-year-old male castrated cocker spaniel. Immediate reconstruction of the left mandible (5 cm gap) was performed after complete excision of a complex odontoma. Locking plate fixation was applied immediately before complete excision of the mass. Fixation was removed, then after partial mandibulectomy, including all abnormal tissue, restored to achieve occlusion. The resulting mandibular defect was filled with recombinant human bone morphogenetic protein-2 (rhBMP-2) delivered in an absorbable collagen sponge containing hydroxyapatite/tricalcium phosphate granules (compression resistant matrix [CRM]). New bone growth was evident radiographically and on palpation at 3 months. Bony remodeling was evident during follow-up examinations up to 26 months. Bone collected by biopsy at the graft site at 7 months had robust new bone formation and evidence of continued remodeling. Only minor complications (repeated intraoral plate exposure) were encountered postoperatively and were easily resolved. An osteoinductive factor (rhBMP-2/CRM) was successfully used as a graft substitute in immediate reconstruction of a large mandibular defect. Immediate reconstruction of large mandibular defects with osteoinductive materials as a graft substitute may be a viable alternative to partial mandibular resection or radiation therapy for benign odontogenic tumors in dogs.

Immediate Reconstruction of a Large Mandibular Defect of Locally Invasive Benign Lesions (A New Method)

Locally invasive benign tumor and large lesions such as ameloblastoma, giant cell granuloma, odontogenic keratocyst, and odontogenic myxoma are a benign, invasive, lesions of the jaws that predominantly affects the mandible. Despite the benign nature of these lesions, there is a high rate of local recurrence after curettage, which usually requires resection. The traditional surgical approach for resection of these lesions, via either mandibulotomy or mandibulectomy is extraoral approach which is associated with significant functional and esthetic sequelae. A case series is presented here in which less invasive and intraoral approach. An intraoral approach provides wide and fast access to the mandible. This approach represents a less invasive alternative that provides access to the mandible for curative resection of benign tumors with minimal postoperative sequelae. At 5 years follow-up, there were minimal functional and esthetic defects. We explored the use of the less invasive and more esthetic incision as an approach to resection and reconstruction of the mandible. It is our belief that these concerns have been best addressed by the minimally invasive procedure used in this report. This approach resulted in a minimal esthetic and functional defect even though a massive mandibular resection was performed.

Resection for hepatic hemangiomas

A retrospective analysis of outcomes in 34 patients referred to the Academic Medical Center of the University of Amsterdam for management of hepatic hemangiomas appears in this edition of the Journal.1 Fourteen patients underwent resection of hemangiomas because of severe symptoms or diagnostic uncertainty. Only one patient had persisting abdominal pain after resection; however, the follow-up period in this article was relatively short. Liver surgery is becoming increasingly safe as a result of surgical specialization, improvements in the technology used for liver resection, changes in anesthetic practice, and improvements in postoperative care. Consequently, the indications for liver surgery have been extended beyond malignant disease. Increasingly, there are reports in the literature from large institutions describing experience in the management of hepatic hemangiomas.2 The evolution of safe laparoscopic surgery is likely to further this trend. In skilled hands, the argument is no longer about the morbidity and mortality of operative intervention because open and laparoscopic surgical techniques in such units are now of well proven safety, even in the presence of significant parenchymal liver disease. The issue is now appropriate selection of patients for resection of benign liver tumors. It is important to clearly define the indications for surgery for hepatic hemangiomas. In the Amsterdam experience,1 Erdogan et al. state that the indications for resection of hemangiomas remain controversial. It could also be stated that the indications remain limited. For example, it is not entirely clear from their article what is meant by ‘progressive abdominal pain’. Is this continuous abdominal pain, or worsening of abdominal pain, or both? Nor is it clear what is meant by ‘mechanical complaints’. Certainly, the need to exclude other causes of abdominal pain should be stressed, given that the majority of patients who have hepatic hemangiomas will, in fact, have another cause for abdominal pain if pain is present. Erdogan et al. also recommend surgical intervention in patients where there is diagnostic doubt.1 There is no clear statement about what earlier CT scans or other investigations may have found. No mention is made of the role of PET scanning in cases of diagnostic doubt, particularly where an earlier PET has shown glucose avidity of the primary tumor. Clearly an algorithm is required for the investigation of hepatic hemangiomas, especially where risk factors for hepatocellular carcinoma are present, or when there is a past history of gastrointestinal cancer. Furthermore, the importance of reviewing old investigations, particularly previous imaging and operation reports should be emphasized. All these should be seen as routine aspects of the functioning of appropriately specialized hepatobiliary and liver units. Hepatic hemangiomas tend to follow a benign course and some authors recommend a nonoperative approach for the majority of these lesions.3 Many readers of Journal of Gastroenterology and Hepatology will be part of networks of those involved in detection, investigation, and referral of such patients, yet be outside the specialized units which manage them. Clinicians therefore need to be aware of the appropriate algorithms for investigation of liver lesions thought to be hemangiomas and of the factors leading to selection for surgical intervention. They should also be aware of the risks of invasive investigations, especially fine needle aspiration cytology or core biopsy. Finally, they should be aware of the need to refer such patients to hepatobiliary units able to address all the issues encountered in managing these problems. In doing so, clinicians also need to avoid compromising patient outcomes by inappropriate referrals, delays, or invasive investigations. A recent systematic review has given rise to the recommendation for large long-term randomized clinical trials.4 A trial would have to be focused on the issues of relevance, including the various aspects of case selection and the investigation algorithm, a well-defined use of the concept of ‘diagnostic doubt’, and complications of the underlying disease process rather than the complications of surgical therapy and long-term symptom resolution. Unfortunately, largely for logistic reasons, it is unlikely that such trials will be performed. However, some information will accumulate from reported individual unit experiences and comparisons across these. This will improve our understanding of the management of this disease, provided the units involved are appropriately sophisticated and the data collection is of adequate quality.

Laparoscopic central pancreatectomy: Single institution experience of 6 patients

Medial pancreatectomy is an alternative technique for benign or low-grade malignant tumors of the neck of the pancreas. We describe our experience of laparoscopic central pancreatectomy. We conducted a prospective evaluation of laparoscopic pancreatic resection in the Department of Abdominal Surgery at Haut-Lévêque Hospital, CHU Bordeaux. From January 1999 until February 2006, 397 patients underwent pancreatic resection for pancreatic lesions, of whom 60 (15%) were enrolled for laparoscopic pancreatic resection. Of the 60 patients, 6 underwent laparoscopic central pancreatectomy. Surgical procedure, postoperative course, and follow-up data were collected. Laparoscopic central pancreatectomy was successful in all patients. In 1 case, we had to perform a laparotomy to find the specimen, which had been lost in the cavity during the anastomosis. The median operative time was 225 minutes (range, 180 to 365 minutes). None of the patients required blood transfusion in the perioperative period, and there was no mortality. Symptomatic pancreatic fistula occurred in 2 patients (33%). None of the patients required reoperation or radiologic drainage. Oral feeding was resumed in a median of 11 days (range, 9 to 21 days). The median postoperative hospital stay was 18 days (range, 15 to 25 days). At a median follow-up of 15 months (range, 4 to 34 months), all patients were alive without exocrine or endocrine insufficiency. Laparoscopic central pancreatectomy is feasible and safe. Laparoscopic central pancreatectomy may become the standard approach for resection of benign or low-grade malignant tumors of the neck of the pancreas if performed by highly skilled surgeons.

The value of laparoscopic liver surgery for solid benign hepatic tumors

Laparoscopic liver resection (LLR) has gained wide acceptance for various liver resection procedures, mainly for benign diseases. However, only small series have been reported from a few selected centers. Between January 2001 and January 2006, a total of 629 liver resections were performed at our institution. The indication was solid benign liver tumor in 56 (8.9%) patients. LLR was performed in 20 (35.7%) cases. Data from the LLR group were compared with those from a consecutive control group undergoing open liver surgery (OS) for similar indications in a matched-pair analysis during the same period. The pairs were matched as closely as possible for age, gender, American Society of Anesthesiologists (ASA) score, indication for resection, and type and location of the lesions. The endpoint was to investigate overall morbidity and outcome. All patients but one are alive and well after a mean follow-up of 35 months (range 10-60 months). Conversion laparotomy was required in two out of 20 (10%) cases for uncontrolled bleeding (one requiring temporary hemodialysis). LLR was characterized by faster time to first oral intake and shorter hospital stay compared to OS (p = 0.001 and 0.008, respectively). Incisional hernias (25%) were only recorded in the OS (p = 0.047 vs. LLR). Overall morbidity was 45% in OS versus 20% in LLR (p = 0.3). LLR significantly reduced time to oral intake, hospital stay, and incisional hernias compared to OS. Bleeding is a major risk and should be carefully considered when resecting benign tumors. In the hands of expert surgeons, LLR may become the gold standard for the resection of benign liver tumors located in the anterior and lateral sectors and for minor hepatic resections.

Minimally invasive resection of benign esophageal tumors

Benign tumors of the esophagus are uncommon. Traditionally, resection has required thoracotomy or laparotomy. In this study we present our experience with resection of these tumors using a minimally invasive approach. A retrospective review of patients who underwent resection of benign esophageal tumors between 1990 and 2005 was conducted. Operative approach, tumor size, and outcomes after surgery were recorded. Twenty patients were identified (leiomyoma: n = 15; stromal tumor: n = 3; granular cell tumor, n = 1; schwannoma: n = 1). Four patients underwent an open approach (right thoracotomy); the remainder were resected using minimally invasive techniques (thoracoscopy, n = 9; laparoscopy, n =7). There were no postoperative leaks or other major complications after surgery. Two patients required repair of a mucosal injury during resection. Mean tumor size in the open group was 8.1 cm (range 7-10 cm) compared with 3.5 cm (range 0.9-8 cm) in the minimally invasive group. Median length of stay was 5.5 days in the open group compared with 2.75 days in the minimally invasive group. Five patients subsequently required fundoplication for worsening (n = 3) or new-onset (n = 2) gastroesophageal reflux disease after tumor resection. Minimally invasive resection of benign esophageal tumors is technically safe and associated with a shorter length of stay compared with open approaches. Although no specific cutoff for size could be identified, most tumors greater than 7 cm were removed by thoracotomy. The subsequent development of reflux may be related to the esophageal myotomy required for resection.