Soft Tissue Resection Research Articles

A pilot study comparing three-dimensional models of tumor histopathology and magnetic resonance imaging

Three-dimensional (3D) modeling is often used to provide better visual understanding. This has become an everyday tool especially in medical imaging. However, modeling soft tissue histopathology in 3D is in its early stages, thus making 3D comparison between radiology and histopathology difficult. Here, we sought to create a model that combines a model based on histopathological tumor borders and a model reformatted from magnetic resonance image (MRI). The 3D models were constructed from an oral squamous cell carcinoma (OSCC) resection specimen and a preoperative MRI scan. Potential challenges were identified, and respective solutions proposed. The 3D model based on histopathological tumor borders was constructed by a method that uses a 3D table scanner and modeling software. The 3D MRI model was constructed using 3D Slicer software. The two models were fitted together by anatomical landmarks in each model. We compared the volume and dimensions between the two 3D models. As a result, we created an image fusion that presents the soft-tissue resection specimen, its histopathological findings, and the MRI findings combined in a digital 3D form. Presenting these two 3D models within the resection specimen can serve as a tool to improve the multidisciplinary discussion of patient management. To create these models, only a few additional steps to a normal protocol are required.

Transoral C2 osteotomy for treatment of severe irreducible atlantoaxial dislocation after odontoid fracture: about 3 cases.

To report the outcomes of transoral C2 osteotomy (or partial odontoidectomy) and posterior fixation, regarding efficacy and safety, in patients with severe irreducible atlantoaxial dislocation (IAAD) following odontoid fracture. Transoral C2 osteotomy, soft tissue resection, with or without facet joint release, followed by posterior fixation were performed on 3 patients (2012, 2016, 2023) who were suffering from severe IAAD after an odontoid fracture with spinal cord compression. The radiological and clinical outcomes were then assessed. All 3 patients had satisfactory release of their spinal cord compression and good reduction of their IAAD. No neurological or vascular complications were reported. No instrumentation failure, radiolucent zone formation around the screws, infection, or recurrence of dislocation were encountered neither. Bony fusion was successfully achieved in every patient. Transoral C2 osteotomy (or partial odontoidectomy), soft tissue resection, with or without facet joint release, followed by posterior fixation is an effective and reliable method to treat severe IAAD after odontoid fractures.

Odontogenic carcinosarcoma of the mandible: A case report.

Odontogenic carcinosarcoma, a rare and challenging diagnosis, was identified in a 60-year-old male through histopathology, revealing a biphasic neoplasm with malignant epithelial and mesenchymal components. Surgical resection is crucial for management, highlighting the importance of vigilant postoperative follow-up to ensure early detection of any recurrence. One rare mixed malignant odontogenic tumor is odontogenic carcinosarcoma, which comprises malignant epithelial and mesenchymal components. Diagnosing odontogenic carcinosarcoma is challenging due to its rarity and atypical clinical presentation. This study reports a 60-year-old male patient who presented with a painless swelling on the right side of his face and experienced facial asymmetry for 6 months, ultimately diagnosed with odontogenic carcinosarcoma. A biphasic neoplasm with malignant alterations in both epithelial and mesenchymal components was identified upon histopathological examination. MRI imaging showed an expansile multilobulated lytic lesion with cortical erosion and extraosseous extension in the posterior region of the right mandibular body and ramus. Following contrast administration, homogeneous lesion enhancement was observed, with a few small non-enhancing necrotic areas in central parts. The patient subsequently underwent a right hemi-mandibulectomy with resection of adjacent soft tissues and neck dissection due to lymph node involvement. The resulting defect was reconstructed using a pectoralis major flap. No recurrence or metastasis was reported during the 6-month follow-up, reinforcing the positive results. This case highlights the importance of recognizing odontogenic carcinosarcoma and underscores the challenges in diagnosing and managing this rare tumor. Early identification and aggressive treatment can lead to positive outcomes, as evidenced by the absence of recurrence or metastasis in this patient during the follow-up period.

Surgical Excision of a Cyclops Lesion After ACL Reconstruction in an Elite College Athlete

Background: Cyclops lesion after anterior cruciate ligament (ACL) reconstruction can appear on magnetic resonance imaging (MRI) in up to 30% of patients and is symptomatic in up to 9%. Arthroscopic cyclops removal can help restore motion and limit recurrence. Indications: Patient is an 18-year-old male high-level collegiate athlete with a mechanical block to full extension. Patient underwent ACL reconstruction with bone–patellar tendon–bone autograft 15 months prior by an outside physician. The patient had a stable Lachman and pivot-shift examination, but there was a palpable clunk when attempting to extend his knee the final 10°. Patient was unable to perform sport due to symptoms. Postoperative MRI demonstrated a large cyclops lesion. Technique: Bilateral ligamentous examination under anesthesia was performed prior to draping. Standard arthroscopy portals were used. Diagnostic arthroscopy was performed by assessing all critical structures in the knee (ie, meniscus, cartilage, and ligaments). The cyclops lesion was visualized in the intercondylar notch with clear evidence of superior notch impingement with knee extension. Using a standard shaver and radiofrequency ablation, the cyclops lesion was resected with care not to injure the ACL graft or disrupt its integrity. A small superior soft tissue resection was then performed with resection of scar tissue that had formed within the notch. A repeat examination with an arthroscope in the knee revealed no further impingement. Results: Patient was able to return fully to sport at 8 weeks postoperatively with no limitations, with no return of clicking or loss of motion. Discussion/Conclusion: Symptomatic cyclops lesion after ACL reconstruction can be effectively treated with arthroscopic debridement. Postoperatively, patients can return to full sport at 6 to 8 weeks. Patient Consent Disclosure Statement: The author(s) attests that consent has been obtained from any patient(s) appearing in this publication. If the individual may be identifiable, the author(s) has included a statement of release or other written form of approval from the patient(s) with this submission for publication.

Synthetic Electrospun Fiber Matrix May Resemble Fungal Hyphae Over the Course of Tissue Regeneration: A Retrospective Review

Peripheral soft tissue resections offer unique wound care challenges, often leaving large surgical deficits that are slow to heal and prone to infection. Musculoskeletal surgeons have taken to utilizing a synthetic electrospun fiber matrix (SEFM) to aid in soft tissue repair. SEFM is an engineered, fully resorbable, electrospun fiber matrix engineered to mimic human extracellular matrix supporting cell ingrowth, retention, and differentiation. In addition, in vitro studies have shown SEFM to be effective at inhibiting growth of the most common bacterial and fungal organisms found in surgical site infections. However, little is reported about the histologic features of intact and resorbing SEFM in vivo. Upon investigation, it was observed that the SEFM may resemble fungal hyphae during its 1-3 week degradation via hydrolysis. Special stains for fungi and acid-fast bacilli display positivity in SEFM, further complicating precise diagnosis. Although these specimens should still be carefully evaluated for fungal organisms, it is important to note these potential pitfalls to avoid misdiagnosis, avoid the premature removal of SEFM, and avoid initiation of inappropriate anti-fungal therapy.

Postmastectomy Late Breast Reconstruction with Transverse Rectus Abdominis Flap after Primary Closure with Latissimus Dorsi

AbstractLocally advanced breast cancer (LABC) is common in countries where organized screening is not effective. Although neoadjuvant therapy increases resectability, many patients undergo mastectomy and, in some cases, flaps are necessary for primary closure of the chest wall. Despite a worse prognosis, some of these women will achieve long-term survival and may require breast reconstruction. The literature on the subject is scarce. We present the cases of two patients with LABC undergoing neoadjuvant chemotherapy, mastectomy with extensive soft-tissue resections in the anterior chest wall, and closure with extended V-Y latissimus dorsi (LD) myocutaneous flaps. After 2 years of follow-up, they were without recurrence. They were submitted to a delayed breast reconstruction using a bipedicled transverse rectus abdominis myocutaneous (TRAM) flap. To our knowledge, this is the first publication reporting secondary reconstruction with TRAM flap after primary closure of the chest wall with LD for LABC.

Liposarcoma del cordón espermático

Introduction: liposarcoma of the spermatic cord (LSC) is a rare condition and accounts for about 3 to 7% of all paratesticular sarcomas. A case is presented in an 80-year-old patient who consulted for a left inguinoscrotal painless swelling, that had been present for several years. Physical examination revealed a soft left hemiscrotal tumor that appeared not to be adherent to the testicle. Ultrasonography showed a solid, heterogeneous hyperschoic paratesticular mass with central calcifications and peripheral hypervascularity. During surgery, a diffuse lipomatous tumor was found in the spermatic cord on the superior pole of the left testicle, separated from it. Anatomopathological examination revealed a well-differentiated liposarcoma of the spermatic cord. Discussion: this neoplasm features a slow-growing palpable paratesticular mass. This site of occurrence is rare and represents 7 to 10% of all scrotal tumors. Imaging differentiation between LSC and benign lesions is sometimes challenging. Surgical treatment should include radical orchiectomy wide local excision, and spermatic cord and inguinal ring surrounding soft tissue resection. Conclusion: spermatic cord liposarcoma is a rare and unusual mesenchymal tumor and should be considered among the differential diagnoses of scrotal tumors.

Refractory Post-Operative Wound Infection by Arthrographis Kalrae: A Case Report and Review of Literature

Arthrographis kalrae (A. Kalrae) infections, although rare, have often demonstrated an extended clinical course. We report a case of refractory post-operative wound infection with A. Kalrae after radical soft tissue and femur resection following total femoral replacement. Identification of A. Kalrae was done based on detailed microscopic and phenotypic characteristics and biochemical tests. Additionally, it was confirmed with sequencing. Although antifungal therapy was started on the basis of the breakpoints observed, clinical failure was met. However, wound infection was subsequently controlled with extensive tissue debridement and a combination of antifungal drug therapy over a period of 33 weeks. The rarity of global data about such unusual fungal infections adds to diagnostic and therapeutic challenges.

Patient-specific guides for consistently achieving R0 bone margins after resection of primary malignant bone tumors of the pelvis

AimsPrimary malignant bone tumor of the pelvis is an uncommon lesion, the resection of which via freehand osteotomy is subject to inaccuracy due to its three-dimensional anatomy. Patient-Specific Guides (PSG), also called Patient-Specific Instruments (PSI) are essential to ensure surgical planning and resection adequacy. Our aim was to assess their use and effectiveness.MethodsA monocentric retrospective study was conducted on 42 adult patients who underwent PSG-based resection of a primary malignant bone tumor of the pelvis. The primary outcome was the proportion of R0 bone margins. The secondary outcomes were the proportion of overall R0 margins, considering soft-tissue resection, the cumulative incidence of local recurrence, and the time of production for the guides. A comparison to a previous series at our institution was performed regarding histological margins.ResultsUsing PSGs, 100% R0 safe bone margin was achieved, and 88% overall R0 margin due to soft-tissue resection being contaminated, while the comparison to the previous series showed only 80% of R0 safe bone margin. The cumulative incidences of local recurrence were 10% (95% CI: 4–20%) at one year, 15% (95% CI: 6–27%) at two years, and 19% (95% CI: 8–33%) at five years. The median overall duration of the fabrication process of the guide was 35 days (Q1–Q3: 26–47) from the first contact to the surgery date.ConclusionsPatient-Specific Guides can provide a reproducible safe bony margin.

Primary Lymphovenous Anastomosis After Extended Soft Tissue Resection in the Medial Thigh for Reduction of Lymphocele and Lymphedema.

Postoperative chronic lymphocele and lymphedema represent severe burdens for soft tissue sarcoma patients who are already physically handicapped after an extensive surgery and a long recovery time. Incidences are high in the upper medial thigh. We have shifted our focus to lymphedema and lymphocele risk reduction with immediate lymphovenous anastomosis (LVA) after sarcoma resection. We performed immediate lymphatic reconstruction in 11 patients after soft tissue sarcoma resection in the upper medial thigh. The postoperative course was followed up closely, and postoperative occurrence of lymphocele and lymphedema was clinically assessed. A literature search outlining the latest clinical data, current treatment strategy landscape, and their application into clinical practice was added to the investigation. A total of 19 LVA and 2 lympho-lymphatic anastomoses were performed in 11 patients immediately after tumor resection in an end-to-end manner. We found a postoperative lymphedema rate of 36% and a postoperative lymphocele rate of 27%. Mean follow-up time was 17 months. Average tumor volume was 749 cc. Our literature search yielded 27 articles reporting on immediate LVA in cancer patients. Incidences of secondary lymphedema after LVA for lymphedema prevention vary between 0% and 31.1%. Lymphocele prevention with LVA is poorly studied in sarcoma patients. Immediate lymphatic reconstruction improved the overall postoperative course of our patients. The current literature does not serve with high-quality studies about primary LVA preventing lymphedema and lymphocele formation. We conclude that this technique should be seen as an additional concept to achieve overall better postoperative outcomes in these challenging surgical settings. We strongly recommend to either anastomose or ligate severed lymphatics under the microscope primarily after sarcoma resection in the upper medial thigh area.

The Trans-facial Approach for Simultaneous Resection and Reconstruction of Retromolar Trigone Tumors: A Pilot Study

IntroductionEarly retromolar trigone (RMT) lesions are difficult to access and free tissue transfer is often an overkill for such small lesions. The aim was to devise a novel surgical approach that would aid the resection without raising a cheek flap and simultaneously provide a local reconstructive option for small lesions in the RMT.MethodologyThis study was to demonstrate the outcomes of the “trans-facial” approach used to simultaneously access and reconstruct small RMT tumors through an islanded nasolabial flap. Patients with histologically proven squamous cell carcinoma of RMT requiring surgery were included from January 2021 to September 2022. Case selection was done based on the location of the disease and its size (cT1/T2). All needed bone and soft tissue resection via per oral trans-facial approach, along with an ipsilateral neck dissection. The technique is described along with their post-operative and pathologic outcomes.ResultsOut of the eight patients included in this study, six underwent a bi-alveolar marginal resection and reconstructed using the trans-facial approach. No major complications were noted in the post-operative period. 50% were pT1 tumors and 75% were pN0 status. One patient had a close margin; while, the others had adequate resection margins. All patients were followed up for a median of 18 months with a locoregionally controlled status.ConclusionThe trans-facial approach can be a suitable option with a reasonable oncologic outcome to address small RMT lesions.

Anlotinib versus placebo as adjuvant therapy for completely resected high-grade soft tissue sarcomas: Interim results of a phase 2, double-blinded, randomized controlled trial.

Anlotinib versus placebo as adjuvant therapy for completely resected high-grade soft tissue sarcomas: Interim results of a phase 2, double-blinded, randomized controlled trial.

The radiomorphological appearance of the invasive margin in pancreatic cancer is associated with tumor budding

PurposePancreatic cancer (PDAC) is characterized by infiltrative, spiculated tumor growth into the surrounding non-neoplastic tissue. Clinically, its diagnosis is often established by magnetic resonance imaging (MRI). At the invasive margin, tumor buds can be detected by histology, an established marker associated with poor prognosis in different types of tumors.MethodsWe analyzed PDAC by determining the degree of tumor spiculation on T2-weighted MRI using a 3-tier grading system. The grade of spiculation was correlated with the density of tumor buds quantified in histological sections of the respective surgical specimen according to the guidelines of the International Tumor Budding Consensus Conference (n = 28 patients).Results64% of tumors revealed intermediate to high spiculation on MRI. In over 90% of cases, tumor buds were detected. We observed a significant positive rank correlation between the grade of radiological tumor spiculation and the histopathological number of tumor buds (rs = 0.745, p < 0.001). The number of tumor buds was not significantly associated with tumor stage, presence of lymph node metastases, or histopathological grading (p ≥ 0.352).ConclusionOur study identifies a readily available radiological marker for non-invasive estimation of tumor budding, as a correlate for infiltrative tumor growth. This finding could help to identify PDAC patients who might benefit from more extensive peripancreatic soft tissue resection during surgery or stratify patients for personalized therapy concepts.

The Orbicularis Oculi Muscle Sparing Full-Incision Double-Eyelid Blepharoplasty.

Double-eyelid blepharoplasty was the most prevailing cosmetic procedures in China. To reduce the visible scar and unnatural crease after the removal of the OOM in the traditional full-incision double-eyelid technique. This research tried to introduce and promote the orbicularis oculi muscle sparing full-incision double-eyelid blepharoplasty with more conservative resection of upper eyelid soft tissue. The orbicularis oculi muscle sparing full-incision double-eyelid blepharoplasty was operated and evaluated in 227 patients (454 eyes), and the esthetic results, the satisfaction of patients and complications were scored and analyzed at 6-12months postoperative. Of the 227 patient, 164 (72.25%) patients were very satisfied, and 49 (21.59%) patients were satisfied, 14 (6.17%) patients were unsatisfied mainly because of the loss of palpebral fold or shallow folds. The average subjective scar score was 4.92 with 209 (92.1%) patients scored very satisfied, 18 patients scored satisfied. No patients experienced the eyelid numbness, dry eyes, and stitch abscess. 8 patients (3.52%) developed mild eye irritation in early postoperative period, however the symptoms resolved spontaneously in 2weeks. The orbiculars oculi muscle sparing full-incision double-eyelid blepharoplasty contributes to the conservation of the physiology of the eyelid structure, producing a reliable, nature, dynamic double-eyelid crease with a light scar and less complication. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Lumbar parafacetal cyst-spinal segmental instability is the cause and stabilization is the treatment: A clinical report of eight surgically-treated patients.

The authors report the results of "only-fixation" of the affected spinal segment without any decompression of the bones or soft tissue or manipulation of the cyst wall or contents in eight cases having lumbar parafacetal cyst (LPFC). This surgical strategy was based on the concept that LPFCs are secondary to spinal instability, has a protective or adaptive role, and is reversible following stabilization. During the period from January 2018 to January 2023, eight consecutive patients having LPFC were surgically treated. There were 5 males and 3 females, and their ages ranged from 48 to 72 years (average 63 years). Seven patients had a single cyst and one patient had multiple cysts. The patients presented with symptoms classically attributed to lumbar canal stenosis. Apart from the cyst-affected spinal segment, degenerative alterations were observed in adjoining spinal segments in six out of seven patients having a single cyst. All patients underwent "only fixation" of the unstable spinal segments without any kind of bone or soft-tissue resection and without any manipulation or handling of the cyst wall or contents. During the follow-up period that ranged from 12 to 57 months (average 29 months), all patients improved from their symptoms. The recovery was observed in the immediate postoperative period and was lasting. LPFCs are one of the several secondary alterations observed in spinal degeneration. Identification of unstable spinal segments and their fixation constitutes rational treatment of lumbar parafacetal cysts. Direct handling and resection of cysts are unnecessary.

Resection status and margin control in intraoperative frozen sectioning analysis of oral squamous cell carcinoma

PurposeIntraoperative frozen section analysis (IFSA) is a well-established procedure for determining the intraoperative soft tissue resection status in patients with oral squamous cell carcinoma (OSCC). Margin status is a major predictor of the patient´s outcome, histologically free margins of ≥ 5 mm are demanded. This study evaluates the accuracy of IFSA, the impact of margin status and the impact of intraoperative margin revision on disease-free survival (DFS) and overall survival (OS).MethodsThis retrospective study included 213 patients with OSCC. IFSA results were compared with definitive histopathological reports, Kaplan–Meier analysis was performed. Cut-off values were calculated for resection margins considering known risk factors.ResultsIFSA showed positive margins in 8 cases (3.8%). Kaplan–Meier analysis revealed no significant differences for OS or DFS if R0-status was achieved by initial resection or immediate re-resection.Final histopathological evaluation revealed false-positive IFSA in 3/8 cases (37.5%) and false-negative IFSA in 1/205 cases (0.5%). Sensitivity was 83.3% and specificity was 98.6%.Analysis of optimal cut-off values showed no general need for larger resection margins in patients with risk factors. Cut-off values were slightly higher for patients with the risk factor alcohol consumption (7 mm for OS and DFS) or pN + ECS- disease (7 mm for DFS). Optimal cut-off values for tumour-margin-distance were around 6 mm.ConclusionIFSA provides a valuable assessment method for intraoperative soft tissue resection margins. Risk factors seemingly do not significantly influence the extent of tumour resection.

Pedicled flap transfer after chest wall malignant tumor resection and potential risk of postoperative respiratory problems for patients with low FEV1.0.

Musculoskeletal transfer for chest wall tissue defects is a crucial method, and pedicled flaps around the chest wall are preferred in terms of location and simplicity of transfer. These require special care because of complications such as partial necrosis, fistula, wound dehiscence, infection, hematoma and restricted function of the arm or shoulder. However, studies of respiratory function are rare. In the present study, we investigated the complications including respiratory problems after wide resection for malignant chest wall tumors with musculoskeletal pedicle transfer. A total of 13 patients (15 operations) who underwent wide resection of primary, recurrent, or metastatic malignant chest wall tumors and musculoskeletal pedicle transfer for coverage of tissue defects were enrolled in the present study. A retrospective review of all patients was performed using data collected from hospital records and follow-up information. The complications of musculoskeletal transfer after chest wall wide resection, including respiratory problems, are evaluated. Rib or sternal resection was performed in 12 operations, and only soft tissue resection was performed in 3 operations. Latissimus dorsi (LD) pedicle transfer was performed in 13 operations, and pectoralis major (PM) pedicle transfer was performed in 2 operations; basically, wounds were closed primarily. Surgical complications were observed following 5 of the 15 operations (33.3%). Respiratory complications were seen in 7 of the 15 operations (46.7%). Patients with respiratory complications showed significantly lower preoperative FEV1.0% values than those without respiratory complications (p = 0.0196). Skin resection area tended to be higher in the complication group than in the no complication group (p = 0.104). Pedicled myocutaneous flap transfers such as LD, PM, and rectus abdominus can be used following multiple resections. After harvesting LD or PM, the wound can be closed primarily for an 8-10-cm skin defect in patients with normal respiratory function. However, for patients with low FEV1.0%, after primary closure of LD or PM transfer for wide soft tissue defects, attention should be paid to postoperative respiratory complications.

Innovative Reconstruction Techniques for Extensive Head and Neck Tumors

In the challenging landscape of malignant head and neck tumors, surgeons grapple with intricate obstacles to achieve effective reconstruction. When facing extensive involvement of soft and bone tissue, reestablishing acceptable aesthetics and function to patients should always be focused on restoring both form and function, we encountered a compelling case—a significant squamous cell carcinoma deeply rooted in the anterior mandibular region, necessitating substantial soft tissue and bone resection. Our innovative approach involved a carefully tailored extended prosthesis designed for the mandible and its temporomandibular joint, accompanied by a skillfully deployed deltopectoral myocutaneous flap. This surgical intervention successfully brought about the triumphant resurgence of reconstruction of mandibular function, marking a state of disease-free well-being for the patient. This narrative unfolds at the forefront of transformative reconstruction, where the synergy of innovation and expertise redefines the narrative, showcasing victory over adversity in the intricate realm of head and neck tumor surgery.

Measuring Parallelism to the Ground in Bipedal Stance Phase: Mechanical Versus Kinematic Alignment in Total Knee Arthroplasty.

Introduction The goal of total knee arthroplasty is to replace diseased cartilage and bone with an artificial implant to improve the patient's quality of life. The knee has historically been reconstructed to the patient's mechanical axis (MA). However, kinematically aligned techniques have been increasingly used. Kinematic alignment requires less soft-tissue resection and aligns the knee with what is anatomically natural to the patient, while there is concern that kinematically aligned knees will lead to earlier failure due to potential unequal weight distribution on the implant. The purpose of this study is to compare the parallelism from the floor of the joint-line cuts using kinematic and mechanical alignment and understand if the MA is a proper estimation of the tibial-ankle axis (TA). Methods A retrospective study was conducted by recruiting all high tibial osteotomy and distal femoral osteotomy recipients operated on by two surgeons in two MedStar Health hospitals from 01/2013 to 07/2020 with full-length films in preparation for restorative procedures. Baseline osteoarthritis was graded using the Kellgren-Lawrence classification system with all patients presenting as Grade 0. The TAand the joint-line orientations of the MAand kinematic axis (KA) were measured on 66 legs. The average distance from parallelism to the ground was compared between the MA and the KA and between the MA and the TA using a paired t-test. Results KA joint-line orientation (1.705° deviation) was more parallel to the floor in the bipedal stance phase than the MA (2.316° deviation, p=0.0156). The MA (2.316° deviation) was not a proper estimation of the TA (4.278° deviation, p=0.0001). Conclusion By utilizing the KA technique, the restoration of the natural joint line, as well as a joint that is more parallel to the floor in the stance phase compared to the MA, is achieved.The parallelism to the ground of the KAduring the bipedal stance phase suggests an even load distribution across the knee.In addition, due to its similarity to the KA and anatomical significance in weight-bearing distribution, further investigation into the hip-to-calcaneal axis as an approximation of the joint line is warranted.

Comparing robotic with laparoscopic beyond total mesorectal excision for advanced rectal cancer-a propensity-matched analysis.

Robotic surgery is increasingly being used for rectal resection, with short-term benefits such as reduced hospital stay, faster bowel recovery and fewer complications. However, its utility for advanced rectal cancers requiring beyond total mesorectal excision has not been adequately evaluated. The aim of this study was to compare robotic and laparoscopic approaches for extended rectal resection, with postoperative and short-term oncological outcomes as endpoints. A retrospective, single-centre study of patients with advanced rectal cancer requiring extended rectal resection between January 2017 and December 2022 was carried out. Beyond total mesorectal excisions included pelvic exenteration, en bloc soft tissue or partial organ resection with the rectum, and lateral pelvic node dissection. Propensity score matching in a 4:1 ratio of laparoscopic to robotic was performed with age, sex, comorbidities, body mass index, organs involved, clinical T stage and colonoscopic obstruction. A total of 425 beyond total mesorectal excisions were performed by minimally invasive approaches during the study period, and after propensity matching 228 laparoscopic operations were compared with 57 robotic resections. All baseline characteristics were balanced. No difference in blood loss, postoperative complications, length of hospital stay, positive resection margin or nodal yield was found, but there was a somewhat longer operating duration in robotics. The 2-year disease-free and overall survival were also similar. No differences in postoperative or short-term oncological outcomes were found between robotic and laparoscopic beyond total mesorectal excisions for advanced tumours when performed by teams experienced in both robotics and laparoscopy.