Resection Of Left Lobe Research Articles

Responsive neurostimulation of the frontal lobe for the detection and treatment of seizures in intractable epilepsy due to tuberous sclerosis complex: illustrative case.

Responsive neurostimulation (RNS) is often considered to be a palliative therapy for drug-resistant epilepsy (DRE) and is generally not considered to be a treatment for patients with tuberous sclerosis complex (TSC). Here, the authors present the case of a 24-year-old male with TSC who obtained seizure freedom following RNS device implantation. Prior to RNS device implantation, the patient underwent tuberectomies, subependymal giant cell astrocytoma resection, vagus nerve stimulator placement, and left frontal lobe resection but continued to have frequent seizures. An RNS device was implanted, which initially led to a decrease in seizures, but he continued to have 12 seizures per month. He then underwent lead revision for stimulation via a different electrode. After that lead change, he had no seizures for almost 3 years. In the following 3 years, he had two episodes of breakthrough seizures, both of which occurred with medication weans. Although the patient still requires antiseizure medication, he has had years of seizure freedom with RNS therapy. This study exhibits the potential effectiveness of RNS therapy for patients with TSC and DRE. RNS should be considered for patients with TSC when other therapies have not sufficiently treated their epilepsy. https://thejns.org/doi/10.3171/CASE23411.

Recurrence of pulmonary sarcomatoid carcinoma presenting as haemothorax: a case report

Pulmonary sarcomatoid carcinoma (PSC) is a rare and highly invasive malignant tumour. It has similar clinical manifestations and imaging features to ordinary lung cancer. This current case report describes a 65-year-old male patient who had a mass in the apicoposterior segment of the left upper lobe with haemoptysis. Imaging studies revealed a central parenchymal mass surrounded by areas of ground-glass opacity, strongly indicating the presence of a pulmonary malignancy. Intraoperatively, the tumour was discovered to have invaded the chest wall and exhibited a significant propensity for bleeding. Consequently, a left upper lobe resection accompanied by extensive pleural debridement were performed. Subsequent postoperative histopathological examination confirmed the diagnosis of PSC. Unfortunately, 1 month after the surgery, the patient presented with left-sided haemothorax. Despite employing various haemostatic interventions, the patient eventually succumbed to haemorrhagic shock. This study provides a treatment strategy reference for patients with PSC presenting as haemothorax.

Pure laparoscopic left hepatectomy and caudate lobe resection for huge hemangioma on the caudate lobe

Pure laparoscopic left hepatectomy and caudate lobe resection for huge hemangioma on the caudate lobe

P424 MEDIASTINAL ROUND CELL SARCOMA WITH PULMONARY ARTERY STENOSIS: CLINICAL USEFULNESS OF CARDIAC MRI IN CARDIO–ONCOLOGY

Abstract Case description: a previously healthy 26–year–old man presented with dyspnea on exertion and dry cough. CT scan revealed a large mediastinal mass with displacement of great vessels and trachea and pericardial effusion. Cardiac MRI showed the huge mediastinal mass, literally leaning on the heart with signs of compression of the pulmonary artery (Figure 1) with the typical D–shape of inter ventricular septum. Pericardial effusion did not compress the RV due to high intraventricular pressure. At baseline echo the mass simulated pulmonary artery stenosis as a consequence of pulmonary artery “ab extrinseco” compression. Surgical biopsy showed Ewing sarcoma lately redefined into undifferentiated round cell sarcoma so the patient started chemotherapy with VAI (vincristine, adriblastine, and ifosfamide) x6 followed by maintenance etoposide and ifosfamide (no anthraciclines for risk of cardiac toxicity). After induction phase MRI showed a partial response to treatment; mediastinal mass further reduced at the end of maintenance (Figure 2). Pericardial effusion disappeared and peak velocity of pulmonary artery went back to normal level at echo. Our patient underwent surgery with en–block removal of mediastinal mass with pericardium and anonymous vein and partial pulmonary upper left lobe resection with R0 resection. Pathology report confirmed an undifferentiated round cell sarcoma (possible embryonal origin, FISH analysis for EWS/FUS genes and 12p negative). Adjuvant mediastinal radiotherapy was delivered. The patient is alive without disease recurrence at one–year follow–up. Conclusions cardiac MR offer great tissue characterization (differential diagnosis between malignant and benign masses) inside/outside the heart. CMR is non–invasive/non radiation and ideal technique for surgery indication and follow–up imaging.

Lung lobectomy surgical approach and resource utilization differ by anatomic lobe in a statewide discharge registry.

BackgroundAnatomic lobe-specific differences with respect to pulmonary lobectomy have been suggested in the thoracic surgery literature but hard data has been lacking in larger population studies in part due to coding systems that do not distinguish pulmonary lobectomy by anatomic lobe. International Classification of Diseases, Tenth Revision (ICD-10) procedure codes, adopted in the United States in 2015, may provide novel methodologic accessibility for pulmonary lobectomy studies as they classify lobectomy operations by specific anatomic lobe. We queried the Texas Inpatient Public Use Data File (TPUDF) ICD-10 codes for both open and endoscopic approach lobectomy with a specific view to differences based on anatomic lobes.MethodsBetween fourth fiscal quarter (Q4) 2015 and Q4 2017, all pulmonary lobectomy operations performed in Texas state-licensed hospitals were identified by querying the TPUDF for ICD-10 procedure codes for pulmonary lobectomy as classified by anatomic lobe. Surgical approach, additional procedures and diagnosis codes, length of hospital stay (LOS), and discharge status were recorded with aggregate values undergoing statistical analysis.ResultsRight and left upper versus lower lobe resections were more prevalent however minimally invasive surgery was less commonly performed for upper than right lower lobectomy. LOS, irrespective of surgical approach, was longer for upper versus lower lobe resection as was need for transfer to additional inpatient facilities. LOS was longer and need for additional surgical or procedural interventions days after the primary procedure of lobectomy was greater for right versus left upper lobe resection, suggesting some differential properties of the right versus left pleural space.ConclusionsThe marked clinical differences between anatomic lobes in the setting of pulmonary lobectomy observed in this study have the potential to translate to differences in expected hospital and health system costs and surgeon time-expenditure and experience premium that currently have no mechanism for their accounting. These findings highlight the value of ICD-10 coding for analysis of pulmonary lobectomy in administrative databases and suggest a possible path to more informed patient counseling and equitable hospital and surgeon reimbursement based on payment adjustment by anatomic lobe in pulmonary lobectomy operations.

Surgical outcomes of anatomical sublobar resections of left upper lobe and a technique of subsegmentectomy based on bronchovascular patterns

BackgroundAnatomical sublobar resection was widely performed for small-sized nodule located in the deep field of the lung. In this study, we compared surgical outcomes between anatomical sublobar resection in left upper lobe including segmentectomy and subsegmentectomy. We also applied a technique based on bronchovascular patterns for subsegmentectomy. Patients and methodsA hundred and fifty-one patients underwent anatomical sublobar resection of left upper lobe in our hospital in the period from January 2018 to December 2019 and they were retrospectively reviewed. Patients’ characteristics and surgical outcome of the subsegmentectomy group (n = 71) were analyzed and compared to those of patients of the segmentectomy group (n = 80). The bronchovascular patterns of left upper lobe in these patients were also classified, and a technique of subsegmentectomy was introduced by cases description. ResultsCompared to segmentectomy, the subsegmentectomy group had longer operative time [141min, interquartile range (IQR): 125–161 vs. 127.5 min, interquartile range (IQR): 114.75–148.25; P = 0.001] and more estimated blood loss [50 mL, IQR: 30–50 vs. 30 mL, IQR: 20–50; P = 0.02]. Branching pattern of bronchus was classified into 3 types in left upper division, and 2 types in lingular division. Branching pattern of pulmonary artery was classified into 7 types in left upper division and 2 types in lingular division. Branching pattern of pulmonary vein was classified into 3 types in left upper division and V3 b was classified into 4 types. ConclusionSubsegmentectomy is a safe procedure with surgical outcome comparable to the one of segmentectomy except operative time and estimated blood loss. Subsegmentectomy based on bronchovascular patterns in left upper lobe is feasible.

A Novel Hepatectomy Model in Mice Using a Gutta Cutter Tool: A Feasibility Study and Preliminary Results

A simple and reproducible model of hepatectomy provides an essential basis for the study of liver regeneration. However, current rodent models of hepatectomy involve lobectomy, which cannot simulate clinical liver resection with surgical margins. The main purpose of this study was to evaluate a novel murine modeling technique for hepatectomy using a gutta cutter. Seventy-five C57BL/6 mice were randomly divided into 3 groups (n=25 mice per group). Group 1 (control) underwent single ligature of the left lobe. Group 2 underwent left lobe local (5-mm diameter) hepatectomy by gutta cutter. Group 3 underwent partial left lobe resection (1.5 cm) by gutta cutter. Postoperative complications were analyzed. Serum aspartate transaminase, alanine aminotransferase, alkaline phosphatase, urea nitrogen, interleukin 6, and tumor necrosis factor-α were detected using an automatic biochemical analyzer. Hematoxylin-eosin and immunohistochemical staining was used to examine pathology, proliferating cell nuclear antigen, caspase-3, CD34, signal transducer and activator of transcription 3 (STAT-3), and phosphorylated STAT-3 (p-STAT-3). Major postoperative complications, hepatic enzymes, kidney function, interleukin 6, and tumor necrosis factor-α were similar among the groups (all P > .05). Histology showed little necrosis and a clear surgical boundary in groups 2 and 3. Groups 1 and 3 had higher positive cell levels (proliferating cell nuclear antigen, CD34, p-STAT-3) than group 2 (P < .05). There were no significant differences in caspase-3 and STAT-3 positive cells. Hepatectomy in mice using a gutta cutter to better mimic human liver resection shows potential as an alternative and safe animal model. This model may be useful in investigating methods of promoting liver regeneration.

Kupffer cells depletion alters cytokine expression and delays liver regeneration after Radio-frequency-assisted Liver Partition with Portal Vein Ligation

Radio-frequency-assisted Liver Partition with Portal Vein Ligation (RALPP) induces comparable hypertrophy of the liver remnant compared to Associating Liver Partition and Portal vein ligation for Staged hepatectomy (ALPPS) in humans. However, whether it is significantly improved compared to ALPPS is unclear, and the underlying mechanisms of liver regeneration after RALPP need to further investigate. The present study was to develop an animal model mimicking RALPP and explore mechanisms of liver regeneration. The mice in RALPP group received liver radiofrequency ablation and 90% portal vein ligation (PVL), followed by resection of the targeted liver within two days after the first surgery. The mice in ALPPS group underwent 90% PVL combined with parenchyma transection. Controls received liver radiofrequency ablation (RAF group) or PVL (PVL group) or small left lateral lobe (LLL group) resection alone. Liver regeneration was assessed by liver weight and proliferation-associated molecules. The role of Kupffer cells (KCs) in liver regeneration was investigated after RALPP. The results showed that RALPP induced comparable liver regeneration compared to ALPPS, but with less liver injury and mortality in mice. RALPP led to over-expression of TNF-α and IL-6 in the circulating plasma compared with PVL. KCs infiltrating in liver tissues was a characteristic of mice in the RALPP group. KCs depletion markedly depressed cytokine expression and delayed liver regeneration after RALPP. These results suggested that RALPP in mice induced accelerated liver regeneration similar to ALPPS, but safer than ALPPS. KCs depletion altered cytokine expression and delayed liver regeneration after RALPP.

Correlation Analysis of the Lung Volume Reduction and the Lung Function Loss after the Thoracoscopic Lobectomy

背景与目的探讨不同部位的肺叶切除术后患者肺容积减少与患者肺功能损害程度的相关性。方法本研究共纳入苏州大学附属第一医院2019年1月-2020年7月行胸腔镜肺叶切除术的131例患者（包括左肺上叶，左肺下叶，右肺上叶，右肺中叶，右肺下叶切除术；其中男性72例，女性59例）。为了比较患者术后肺功能与术前肺功能的差异，分别于术前7天和术后3个月、6个月及1年记录患者的肺功能测量值。采用1秒用力呼气量（forced expiratory volume in 1 second, FEV1）作为肺功能变化的主要评估参数。采用Mimics Research 19.0软件计算出患者的原始肺容积，各阶段存留的肺容积。分析患者肺容积在上述时间节点与患者肺功能变化的相关性。结果术后患者FEV1较术前降低，下降程度与肺叶的切除体积呈正相关（其中左下肺下降较为明显）。值得注意的是，患者的肺功能降低程度在术后3个月、6个月与1年的差异无统计学意义。结论肺叶切除术后肺组织的容积减少是患者肺功能减少的主要原因，以左肺下叶表现为著，最早可选定术后3个月作为肺叶切除患者残留肺功能的评估节点。

Pure Laparoscopic Living Donor Hepatectomy With/Without Fluorescence-Assisted Technology and Conventional Open Procedure: A Retrospective Study in Mainland China

Background: The application of laparoscopy in donor liver acquisition for living donor liver transplantation (LDLT) has become increasingly popular in the past decade. Indole cyanide green (ICG) fluorescence technique is a new adjuvant method in surgery. The purpose was to compare the safety and efficacy of laparoscopic and open surgery in living donor left lateral hepatectomy, and to evaluate the application of ICG in laparoscopy.Methods: Donors received LDLT for left lateral lobe resection from November 2016 to November 2020 were selected and divided into pure laparoscopy donor hepatectomy (PLDH) group, fluorescence-assisted pure laparoscopy donor hepatectomy (FAPLDH) group and open donor hepatectomy (ODH) group. We compared perioperative data and prognosis of donors and recipients. Quality of life were evaluated by SF-36 questionnaires.Results: The operation time of PLDH group (169.29 ± 26.68 min) was longer than FAPLDH group (154.34 ± 18.40 min) and ODH group (146.08 ± 25.39 min, p = 0.001). The blood loss was minimum in FAPLDH group (39.48 ± 10.46 mL), compared with PLDH group (52.44 ± 18.44 mL) and ODH group (108.80 ± 36.82 mL, p=0.001). The post-operative hospital stay was longer in PLDH group (5.30 ± 0.98 days) than FAPLDH group (4.81 ± 1.03 days) and ODH group (4.64 ± 1.20 days; p = 0.001). Quality of life of donors undergoing laparoscopic surgery was better.Conclusion: Laparoscopic approaches for LDLT contribute to less blood loss, better cosmetic satisfaction. The fluorescence technique can further reduce bleeding and shorten operation time. In terms of quality of life, laparoscopic surgery is better than open surgery. Laparoscopy procedure for living-donor procurement with/without fluorescence-assist can be performed as safely as open surgery.

Ultrasound guided erector spinae plane catheter for thoracotomy: a case report

Major thoracic surgery results in severe postoperative pain. Epidural analgesia is considered the gold standard for pain management after thoracic surgery. However, epidural blocks are contraindicated in certain clinical conditions. Pain management in such patients poses a unique challenge to the anesthesiologists. Erector spinae plane block (ESPB) is a less invasive and relatively new technique, which has shown promising results. This case report describes the use of ESPB as an alternate analgesic technique. A 65-year-old man underwent thoracotomy and left upper lobe resection. Intraoperative and postoperative pain was managed with intermittent boluses of bupivacaine through the erector spinae plane catheter. Effective analgesia was achieved with minimal morphine consumption in postoperative period. Although central neuraxial blocks are considered to be gold standard for major thoracic surgery but where applicable, alternatives can be opted for better patient outcomes.&#x0D; Key words: Analgesia; Erector spinae plane block; Thoracotomy; Pain control; Neuraxial analgesia&#x0D; Citation: Usman A, Khan AW, Ijaz MK. Ultrasound guided erector spinae plane catheter for thoracotomy: a case report. Anaesth. pain intensive care 2021;25(6):812–815;&#x0D; DOI: 10.35975/apic.v25i6.1707&#x0D; Received: August 16, 2021, Reviewed: October 28, 2021, Accepted: October 31, 2021

Partial Resection of Left Upper Lobe on a Right Pneumonectomy Patient −Under Collapsing of Left Upper Lobe with Bronchial Blocker−

Partial Resection of Left Upper Lobe on a Right Pneumonectomy Patient −Under Collapsing of Left Upper Lobe with Bronchial Blocker−

A study of rate of volumetric regeneration of liver after liver resection and its correlation with platelets and synthetic liver function tests: a single tertiary care centre experience

Background: Aim of our study was to evaluate the impact of pre and postoperative platelet counts and synthetic liver function tests on liver regeneration and its correlation with CT volumetry in patients undergoing liver resections with curative intent.Methods: All major and minor liver resections (maximum 30) between July 2016 and May 2019 at our hospital were included in the study according to the inclusion criteria and patients who had data available on preoperative, 2 weeks and 2 months postoperative platelet counts, synthetic liver function tests as well as triple phase CECT images, were identified retrospectively and these tests will be done for patients who are included prospectively.Results: The rate of regeneration expressed as % RFLR is proportional to the extent of resection. It was less than 20% in WLE and less than 100% in left lobe resections and 100 to 300% in patients undergoing right hepatectomies and extended right hepatectomies. There was no statistically significant effect of sex, age, BMI, serum albumin, platelet count, INR, preoperative chemotherapy and presence of cirrhosis on percentage of regeneration as well as rate of regeneration. However, perioperative low serum albumin and platelet count had statistically significant effect on mortality (p&lt;0.001).Conclusions: We conclude that; greater the extent of liver resection, faster is the rate of regeneration. Perioperative low serum albumin and platelet counts have significant effect on mortality.

Evolution and Outcome of First 100 Robotic Donor Hepatectomy

Minimal invasive liver donor surgery was established as a feasible technique with comparable outcome to open liver donor surgery that was mainly for left lateral sectionectomy and left lobe resection. The limitation of conventional laparoscopy was clear in the right hepatectomy due difficult maneuvering and accessibility. Robotic approach was induced as an alternative to conventional laparoscopic approach. Few Paper was published with limited number of cases. Here we present own experience in Robotic Liver Donor Surgery in King Faisal Specialist Hospital and Research Center which the largest number of cases up to our knowledge. A total of 100 Robotic liver resection was carried from November 2018 to October 2019. Male donors 72 and female 28. Median age 27 years. Left lateral was 38, left 19 and right 43. Average hospital stay was 4 days. No mortality was recorded nor conversion. Morbidity only 8 patients mainly in the left and right lobe group. Two bile leak in the right lobe donors and one patient in the left lobe. Three patient had wound hematomas at the extraction incision (Pfannenstiel) incision, one in each group. Over all graft survival was 93%. Here was can say Robotic donor hepatectomy is safe with comparable result to open surgery with better post-operative pain and shorter hospital stay and better cosmesis. Reproducibility and learning carve need further evaluation

Morphological Study of Human Cadaveric Liver and its Surgical Significance

Introduction: The liver is the largest organ of the abdominal viscera. Knowledge of anatomy of liver and its variations is indispensable for accurate diagnosis of cases by radiologists, and prevention of unwanted surgical complications by surgeons. Many researchers have studied the segmental anatomy of the liver, but there are very few studies regarding the surface variations of liver. Aim: To document the surface variations of liver and discuss them from clinical perspective. Materials and Methods: This observational cross-sectional study was conducted from August 2015 to May 2019 on 50 liver specimens in the Department of Anatomy, Vardhman Mahavir Medical College. These livers were observed for any surface variations such as abnormal fissures or lobes, elongation or hypoplasia of lobes, etc. Data were tabulated and stats were calculated in percentages. Descriptive analysis of data has been carried out and mentioned in the study. Results: In the present study, out of 50 liver specimens, variations were observed in 42 (84%) specimens. Accessory fissures were seen in 16 (32%) specimens. Elongated left lobe was present in 7 (14%) specimens. Pons hepatis, which is a bridge of tissue connecting the quadrate lobe and the left lobe was observed in 8(16%) specimens. Caudate lobe variations observed in this study were abnormal fissures and hypertrophied papillary process. Conclusion: The present study documents frequent morphological variations of liver such as elongated left lobe, accessory lobes, etc. Elongated left lobe may be related to fundus of stomach which should be kept in mind during left lobe resection. The radiologists can confuse accessory lobes or projections with pathological mass. Knowledge of these variations will undoubtedly help radiologists and surgeons to prevent misdiagnosis of cases and plan newer and safer surgical procedures.

Extended Sleeve Lobectomy is an Alternative for Centrally Located Lung Cancer With Superior Short- and Long-term Outcomes

IntroductionExtended sleeve lobectomy (ESL) is a feasible alternative to pneumonectomy; however, the survival benefit is unclear, and preoperative selection of potential candidates for ESL remains a problem. Matierals and MethodsESL was performed on selected candidates with double sleeve lobectomy for more than 1 lobe (eg, left upper lobe and S6 segment resection). Three-dimensional (3-D) reconstruction was routinely validated. Patients were candidates for ESL if the predicted distal stump length was > 6 mm and the pulmonary vein of the remaining segments was not invaded. ResultsOf the 1809 patients with centrally located lung cancer for surgical resection, 86 patients with tumors invading more than 1 lobe were enrolled in the study. After evaluation by 3-D reconstruction, 22 (95.7%) of 23 selected candidates underwent ESL, and 63 patients were deemed unsuitable for ESL and underwent pneumonectomy (43 cases) or thoracic exploration (20 cases). Surgical outcomes between the ESL and pneumonectomy groups were similar in terms of complications, blood loss and surgical duration, but the 6-minute walking distance was significantly improved in the ESL group (371 ± 111 m vs. 191 ± 55 m, respectively; P < .001). The mean forced expiratory volume in 1 second was 1.6 ± 0.3 L at the 1-year follow up examination in the ESL group. In the survival analysis, no difference was observed between the ESL and pneumonectomy groups in terms of 3-year overall survival (85% vs. 89%, respectively; P = .626) and 3-year disease-free survival (75% vs. 76%, respectively; P = .625). ConclusionsESL is a feasible and superior surgical procedure in terms of its short-term and long-term outcomes, and we suggest 3-D reconstruction to identify candidates for ESL.

Robotic Total Anatomical Left Hepatectomy and Caudate Lobe Resection With Microwave Tumor Ablation. Minimally Invasive Treatment of Bilobar Colorectal Liver Metastasis.

Robotic Total Anatomical Left Hepatectomy and Caudate Lobe Resection With Microwave Tumor Ablation. Minimally Invasive Treatment of Bilobar Colorectal Liver Metastasis.

Efficacy of Lung Autotransplantation for Central Non-small Cell Lung Cancer

背景与目的全肺切除术和袖状切除术是治疗中央型非小细胞肺癌的常规术式, 但存在肺功能差不能耐受全肺切除或因为肿瘤广泛侵犯支气管和肺动脉而不能进行袖状切除的情况。本研究旨在探讨自体肺移植治疗中央型非小细胞肺癌的可行性。方法回顾性分析2016年12月-2018年12月3例行自体肺移植的中央型非小细胞肺癌患者的诊疗资料。1例双袖状切除左肺上叶, 吻合支气管, 因肺动脉切除过长, 肺动脉吻合口张力大, 遂切断下肺静脉, 将下肺上移后再吻合肺动脉, 最后将下肺静脉与上肺静脉残端吻合。2例行左全肺切除, 体外切除左肺上叶, 将修剪、灌洗后的左肺下叶重置胸腔, 依次吻合支气管、肺动脉、肺静脉。结果平均手术时间333 min, 平均血流阻断65 min, 平均出血量450 mL, 平均住院日18.7 d; 围手术期出现痰栓堵塞支气管1例, 经支纤镜吸痰后好转; 平均随访时间20个月, 癌症死亡1例, 术后吻合口复发及脑转移1例, 4R淋巴结转移1例(经化疗后病情稳定), 无复发生存1例。结论对于肿瘤侵犯广泛, 不能进行袖状切除或无法耐受全肺切除的中央型非小细胞肺癌患者, 自体肺移植可在彻底切除肿瘤基础上最大限度保留肺功能, 提高术后生存质量。

Extended sleeve-lobectomy for centrally located locally advanced non-small cell lung cancer is a feasible approach to avoid pneumonectomy.

BackgroundsThe aim of this study was to report our Institutional experience with extended sleeve lobectomy (ESL) in centrally located non-small cell lung cancer (NSCLC), focusing on technical details, post-operative results, recurrence and survival, to determine whether ESL can be accepted as a favorable alternative procedure to pneumonectomy (PN).MethodsTwenty-two consecutive patients undergoing ESL for centrally located tumors from January 2014 to June 2019 were prospectively enrolled.ResultsSix (27.3%) patients had been preoperatively considered unfit for PN. Neo-adjuvant chemotherapy was administered in 7 (31.8%) out of the 10 patients that showed a cN2 disease. According to Okada classification, 8 cases of type A ESL (resection of right upper plus middle lobe ± segment 6), one case of type B (resection of left upper lobe + segment 6) and 13 cases of type C (resection of left lower lobe + lingulectomy) ESL were performed. Concomitant pulmonary angioplasty was done in 7 (31.8%) patients. Complete resection was achieved in all patients. There was no postoperative mortality. Major postoperative complications developed in 2 (9.1%) patients (one small anastomotic dehiscence healed in few weeks, one pulmonary embolism). Complete long-term patency of the reconstructed airway was documented in all patients by fiber-optic bronchoscopy. At the median follow-up of 21 months (4–57 months), the recurrence rate was 54.5%, with 4 (18.2%) patients developing a loco-regional recurrence but no endobronchial or perianastomotic recurrence occurred. The overall 3-year survival rate was 45% with a median survival of 33 months.ConclusionsESL is a safe and effective procedure that should be considered a favorable alternative to PN whenever it may guarantee a complete resection.

A patient with post-Fontan operation underwent left hepatectomy and caudate lobectomy for hepatocellular carcinoma: a case report

BackgroundThe Fontan procedure has been widely accepted for children with single ventricle physiology and guarantees survival rates of approximately 80% at age 20 years. However, there have been cases of Fontan-associated liver disease (FALD) caused due to congestion, along with recent reports of the development of hepatocellular carcinoma (HCC) in younger patients with FALD. The literature consists of only five previous case reports of patients who underwent hepatectomy for HCC due to poorer cardiac function and liver cirrhosis caused due to congestion.Case presentationThe patient was a 37-year-old woman who presented with epigastralgia. Computed tomography (CT) revealed a liver tumor, 8 cm in diameter, in the caudate lobe. Liver damage was A, with an indocyanine green retention rate of 6% at 15 min. The levels of alpha-fetoprotein (AFP) and protein induced by vitamin K antagonists-II (PIVKA-II) were elevated to 81,663 ng/ml (normal < 10 ng/ml) and 238 mAU/ml (normal < 40 mAU/ml), respectively. Left ventricular ejection fraction was 56%, and central venous pressure (CVP) was 12 mmHg. Left hepatectomy and caudate lobe resection were successfully performed in the reverse Trendelenburg position which reduced the CVP. The total operation duration was 450 min, with a total blood loss of 3200 ml. The patient’s postoperative course was uneventful, and she is still alive 16 months after surgery.ConclusionsFirst left hepatectomy with caudate lobectomy during reverse Trendelenburg position which reduced the CVP was performed in a patient with HCC and FALD.