Simple Resection Research Articles

Variability in treatment approaches, outcomes, and recurrence patterns after curative intent treatment for primary retroperitoneal sarcomas in Latin America: A report on 333 patients from LATAMSARC collaborative working group

Background and objectiveRetroperitoneal sarcomas (RPS) are rare tumors with several well-defined histologic subtypes. This study aimed to assess the epidemiology, treatment patterns, and outcomes of patients with retroperitoneal sarcoma in Latin America and analyze patterns of recurrence and treatment variations in a large population of patients treated at reference centers. MethodsThis retrospective descriptive study utilized an electronic database of medical records from LATAMSARC (a group studying sarcomas consisting of different centers in various countries in Latin America, including Argentina, Chile, Costa Rica, Mexico, and Peru). Adult patients (≥18 years) with retroperitoneal sarcoma who underwent surgery at six cancer centers in Latin America were included. Key outcomes were practice patterns, overall survival (OS), and progression-free survival (PFS). ResultsIn this retrospective study, 333 patients diagnosed with retroperitoneal sarcomas met the inclusion/exclusion criteria. The cohort consisted of 157 females (42.3 %) and 176 males (57.7 %), with an average age of 53.9 years (SD 13.37). Histology most commonly included Dedifferentiated Liposarcoma (31.5 %), Well-Differentiated Liposarcoma (29.7 %), and Leiomyosarcoma (9.9 %). The tumors predominantly resided in the retroperitoneum (81.7 %) and showed a mean diameter of 23.53 cm (SD 13.8 cm). Surgical interventions varied, with Complete Compartmental Resection performed in 31.2 % of cases and Simple Complete Resection in 29.4 %. Postoperative complications were documented, with Clavien-Dindo Grade ≥3 complications occurring in 16.8 % of patients. An R0/1 resection was obtained in 91.6 % of cases. The ICU admission rate post-surgery was 18.6 %. Adjuvant treatments included radiotherapy in 8.1 %. Local recurrence occurred in 20.7 % of cases, with the majority being ipsilateral. Distal recurrence was observed in 15 patients, predominantly affecting the liver. The mean overall survival was 65.5 months, and disease-free survival was 47.0 months. ConclusionThis study provides information on the epidemiology, treatment patterns, and outcomes of retroperitoneal sarcomas in a group of reference centers in Latin America. These results represent Latin America's largest body of evidence on retroperitoneal sarcomas.

A method of “Noninjecting Resection using Bipolar Soft coagulation mode; NIRBS” for superficial non-ampullary duodenal epithelial tumor: a pilot study

BackgroundComplete endoscopic resection of superficial non-ampullary duodenal epithelial tumors (SNADETs) is technically difficult, especially with an extremely high risk of adverse event (AE), although various endoscopic resection methods including endoscopic mucosal resection (EMR), underwater EMR (UEMR), and endoscopic submucosal dissection (ESD) have been tried for SNADETs. Accordingly, a novel simple resection method that can completely resect tumors with a low risk of AEs should be developed.AimsA resection method of Noninjecting Resection using Bipolar Soft coagulation mode (NIRBS) which has been reported to be effective and safe for colorectal lesions is adapted for SNADETs. In this study we evaluated its effectiveness, safety, and simplicity for SNADETs measuring ≤ 20 mm.ResultsThis study included 13 patients with resected lesions with a mean size of 7.8 (range: 3–15) mm. The pathological distributions of the lesions were as follows: adenomas, 77% (n = 10) and benign and non-adenomatous lesions, 23% (n = 3). The en bloc and R0 resection rate was 100% (n = 13). The median procedure duration was 68 s (32–105). None of the patients presented with major AEs including bleeding and perforation.ConclusionsLarge studies such as prospective, randomized, and controlled trials should be conducted for the purpose of validating effectiveness, safety, and simplicity of the NIRBS for SNADETs measuring ≤ 20 mm suggested in this study.

Postoperative day 1 discharge following subxiphoid thoracoscopic anatomical lung resection: a single-centre, postoperative enhanced recovery experience.

The goal of this study was to assess the safety and quality of recovery (QOR) after discharge on postoperative day (POD) 1 following subxiphoid thoracoscopic anatomical lung resection within an advanced Enhanced Recovery After Surgery (ERAS) program. A retrospective analysis of prospectively collected data was conducted. Characteristics, perioperative and outcome data, compliance with ERAS pathways and a home-transition QOR survey were analysed using a multivariable logistic regression model. From January 2020 to January 2022, a total of 201 consecutive patients underwent subxiphoid multiportal thoracoscopic anatomical lung resection, comprising 108 lobectomies and 93 sublobar resections (SLRs) (59 complex SLRs and 34 simple SLRs). Among them, 113 patients (56%) were discharged on POD 1, 49% after a lobectomy, 59% after a simple sublobar resection and 68% after a complex sublobar resection. In the multivariable analysis, age > 74 years and duration of the operation were associated with discharge after POD 1, whereas forced expiratory volume in 1 s and complex SLRs were associated with discharge on POD 1. Chest tube removal was achieved on POD 0 in 58 patients (29%), and 138 patients (69%) were free from a chest tube on POD 1. There were 13% with in-hospital morbidity, 10% with 90-day readmission (7% after POD 1 discharge and 14% in patients discharged after POD 1), and 0.5% with 90-day mortality. Patients discharged on POD 1 showed better compliance with the ERAS pathway with early chest tube removal and opioid-free analgesia. The home-transition QOR survey reported a better experience of returning home after discharge on POD 1 and similar pain scores. Postoperative day 1 discharge can be safely achieved in appropriately selected patients after subxiphoid thoracoscopic anatomical lung resection, with excellent outcomes and high quality of recovery, supported by early chest tube removal as a determinant ERAS pathway.

Preoperative Angiographic Protocol for the Surgical Management of Spinal Dural Arteriovenous Fistulas: A Technical Nuance for Safe Minimally Invasive Surgery

BackgroundInterruption of the fistoulus point is the goal of the treatment of spinal dural arteriovenous fistula (dAVFs). Microsurgery still represents a highly efficient treatment in terms of complete occlusion with the lowest risk of recurrence rate. It is reported that the hardest step consists in finding the fistulous site itself, potentially extending surgical access and time, and increasing potential post-operative surgical-related complications. The accurate preoperative detection of the shunt and spinal level together is crucial for guiding optimal, fast and safe microsurgical treatment. MethodsIn the present paper, the authors describe a preoperative angiographic protocol for achieving a safe and simple resection of spinal dAVFs based on a six-year Institutional experience of forty-two patients who underwent minimally invasive. Two illustrative cases are also included in order to support the technical descriptions. ResultsThe suspected artery associated to the vascular malformation of interest is studied in our angiographic protocol through non-subtracted selective acquisitions in the lateral projection. The resulting frames are reconstructed with 3D Rotational Angiography. The implementation of the preoperative angiographic protocol allowed 100% of intraoperative identification of the fistoulus point in all cases with the use of minimally invasive approach. ConclusionsNowadays, neurosurgeons advocate for minimally invasive procedures and low morbidity risk procedures for the treatment of spinal dAVFs.Our preoperative approach for accurate angigoraphic localization of the fistoulus point through non-subtracted and 3D reconstructed angiography allowed to achieve safe and definitive occlusion of the shunt.

Individualised surgical treatment strategy for subaortic stenosis.

The clinical data of patients with subaortic stenosis who underwent surgical treatment in our centre in the past 12 years were reviewed. The short-term and long-term clinical outcomes were analyzed, and the long-term outcomes of different surgical methods for subaortic stenosis were compared to determine the optimal surgical treatment strategy for subaortic stenosis. From December 2010 to December 2022, 90 patients undergoing surgical treatment for subaortic stenosis in our hospital were enrolled. There were 55 males and 35 females with a median age of 72 (46,132) months and an average surgical weight of (21.35 ± 15.84) kg. According to the operation method, 90 patients were divided into group A (50 patients with simple subaortic membrane resection) and group B (40 patients with subaortic membrane and muscle resection or modified Konno procedure). There were three early deaths (3.33%). One late death occurred in group B. There was no significant difference in long-term survival rate between the two groups (p = 0.904). The preoperative left ventricular outflow tract pressure gradient in group B was (91.56 ± 36.98) mm Hg, which was higher than that in group A(51.13 ± 36.04)mm Hg(p < 0.001). There was no significant difference in immediate postoperative left ventricular outflow tract pressure gradient between group B [(5.44 ± 8.43) mm Hg] and group A [(7.82 ± 13.44) mm Hg] (p = 0.343). In the long-term follow-up, left ventricular outflow tract pressure gradient in group B was (5.86 ± 9.53) mm Hg, which was not statistically significant compared with group A (8.83 ± 14.52) mm Hg (p = 0.294). Eleven patients with moderate or greater aortic regurgitation (group A/group B: 3/8) underwent simultaneous aortic valvuloplasty. In group B, moderate or greater aortic regurgitation was significantly improved immediately after operation (p = 0.013) and was not significantly aggravated in long-term follow-up (p = 0.083), and there was no significant improvement in group A after operation and long-term follow-up. According to the different anatomical lesions of left ventricular outflow tract, the individualised surgical treatment strategy for patients with subaortic stenosis can achieve good long-term outcomes. The long-term survival rate and freedom from reoperation due to late left ventricular outflow tract obstruction after simple subaortic membrane resection and extended left ventricular outflow tract resection are comparable. For patients with moderate or greater aortic regurgitation before extended left ventricular outflow tract resection, simultaneous aortic valvuloplasty is beneficial to improve postoperative aortic valve function.

Clinical diagnosis and treatment of 14 cases of scar cancer ulcer wound on head and face

To analyze the clinical characteristics of scar cancer ulcer wound of head and face, and to investigate its diagnosis and treatment. The clinical data of 14 patients with head and facial scar cancer ulcer wounds who met the selection criteria and admitted between January 2021 and March 2022 were retrospectively analyzed. There were 8 males and 6 females. The age of onset ranged from 21 to 81 years with an average age of 61.6 years. The incubation period ranged from 1 month to 70 years, with a median of 4 years. Site of the disease included 7 cases of head, 6 cases of maxillofacial region, and 1 case of neck region. Injury factors included trauma in 5 cases, scratch in 5 cases, scalding in 2 cases, burn in 1 case, and needle puncture in 1 case. Pathological results showed squamous cell carcinoma in 9 cases, basal cell carcinoma in 3 cases, sebaceous adenocarcinoma in 1 case, papillary sweat duct cystadenoma combined with tubular apocrine sweat gland adenoma in 1 case. There was 1 case of simple extensive tumor resection, 1 case of extensive tumor resection and skin grafting repair, 7 cases of extensive tumor resection and local flap repair, and 5 cases of extensive tumor resection and free flap repair. All the 14 patients were followed up 16-33 months (mean, 27.8 months). Two patients (14.29%) had scar cancer ulcer wound recurrence, of which 1 patient recurred at 2 years after 2 courses of postoperative chemotherapy, and was still alive after oral traditional Chinese medicine treatment. One patient relapsed at 1 year after operation and died after 2 courses of chemotherapy. One patient underwent extensive resection of the left eye and periocular tumor and the transfer and repair of the chimaeric muscle axial flap with the perforating branch of the descending branch of the left lateral circumflex femoral artery, but the incision healing was poor after operation, and healed well after anti-infection and debridement suture. The wounds of other patients with scar cancer ulcer did not recur, and the wounds healed well. Scar cancer ulcer wound of the head and face is common in the middle-aged and elderly male, and the main pathological type is squamous cell carcinoma. Local extensive resection, skin grafting, or flap transfer repair are the main treatment methods. Early active treatment of wounds after various injuries to avoid scar repeated rupture and infection is the foundamental prevention of scar cancer.

Recurrent benign fibrous histiocytoma of the bone benefits from denosumab followed by malignant transformation: a case report

Benign fibrous histiocytoma of the bone (BFHB) is a rare mesenchymal tumor, representing less than 1% of all benign bone tumors. This controversial entity is characterized by a mixture of fibroblasts arranged in a storiform pattern, varying amounts of osteoclast-type giant cells and foamy macrophages. Curettage or simple resection is usually curative. However, it was reported that up to 11% of the patients suffer from relapse. Here, we report a case of malignant transformation of BFHB after long-lasting disease stabilization under denosumab therapy.

Laparoscopic transection and partial resection of hernia sac in the treatment of indirect inguinal hernia: A preliminary observation.

This study aimed to investigate the feasibility of applying laparoscopic transection and partial resection of hernia sac in the treatment of indirect inguinal hernia in children. From December 2017 to November 2018, we recruited 20 children, who were aged 1-6 years old, with indirect inguinal hernia. At the time of admission, the participants had already developed an indirect inguinal hernia for 6 months to 1 year. A simple transection and partial resection of hernia sac was performed at the internal ring on each of the recruited children. The procedure was conducted under laparoscopy. Two 5-mm trocars were placed on either side of the umbilicus, one for the camera and the other for a surgical instrument. Another trocar was placed on the right abdomen. Laparoscopic camera curved forceps, and scissors were placed. Along the unclosed internal ring, the peritoneum was cut in a circular fashion to transect the hernia sac and dissociate it from the distal end. About 1-2 cm of the hernia sac was resected. The operation was successfully completed in all 20 cases, who did not experience any complications, such as the absence of spermatic cord, vas deferens injury, scrotal swelling and incision infection. The children were discharged 1 day after the operation. In the post-operative follow-up for the first 3-4 years, recurrence and testicular atrophy did not occur in the study participants. The short-term results obtained from this study showed that the application of laparoscopic transection and partial resection of hernia sac in the treatment of indirect inguinal hernia is feasible. Long-term results and further observation are needed for validation.

Closed Incision Negative Pressure Therapy for Primary Wound Closure After the Simple Resection of A Pilonidal Sinus

Closed Incision Negative Pressure Therapy for Primary Wound Closure After the Simple Resection of A Pilonidal Sinus

Simple and safe resection of the crista galli.

A critical procedure in the transcribriform approach is the resection of the crista galli. However, the standard technique for crista galli resection has several disadvantages. We reviewed the cases of patients with olfactory neuroblastomas who underwent an endoscopic endonasal transcribriform approach using a newly developed technique for crista galli resection. We performed a cadaveric study to measure the superior accessibility limits using the proposed method. We included 38 patients with olfactory neuroblastomas in this study. The tumor invaded the posterior crista galli in four patients. The anterior end of the crista galli was not invaded by the tumor. Our cadaveric study showed that the dura was approachable to the point that was 7.4 ± 1.3 mm superior and 23.2 ± 7.2 mm lateral to the foramen cecum following crista galli removal. By resecting the crista galli in advance, manipulation of the superior dura became feasible.

A modified method for reconstruction of posterior tibial tendon after resection of juvenile painful type II accessory navicular

BackgroundThe surgical treatment of accessory navicular (AN) is divided into simple resection of AN and Kidner surgery used to reconstruct posterior tibial tendon (PTT) after AN resection. However, both of these procedures have certain disadvantages. Herein, we proposed a modified method to reconstruct PTT and compared the short-term clinical effect of our method with the modified Kidner procedure.MethodsWe collected data from 23 adolescent children with painful type II AN treated in our department between January 2015 and June 2020. The American Orthopedic Foot and Ankle Society Ankle-Hind foot (AOFAS-AH) Scores, the Meary Angle, and Pitch Angle of the lateral weight-bearing plain radiographs status were recorded before and after the operation to evaluate the treatment outcomes.ResultsIn the modified Kidner surgery (MK) group, the median AOFAS-AH increased from 61 (59–68) to 87 (83–91) (P < 0.05); the Pitch angle of the lateral weight-bearing plain radiographs increased from 13.0 (8–18) to 17.4 (14–22), and the Meary angle decreased from 18.3 (14–24) to 14.2 (8–20) (P < 0.05). In the PTT preservation folded suture (FS) group, the median AOFAS-AH increased from 61 (59–68) to 87 (85–91) (P < 0.05); the Pitch angle of the lateral weight-bearing plain radiographs increased from 12.3 (7–18) to 18.4 (15–26), and the Meary angle decreased from 17.8 (13–23) to 5.7 (3–8) (P < 0.05). There was no significant difference in AOFAS-AH postoperative scores between the FS group and MK group; however, the improvement on Pitch and Meary angle of the lateral weight-bearing plain radiographs was significantly better in the FS group than in MK group (P < 0.05).ConclusionsFor painful type II AN in juvenile patients, the insertion-preserving folding suture procedure had similar short-term results on AOFAS-AH scores but greater improvement in the Meary angle and the Pitch Angle than the modified Kidner method.Level of Evidence: III

Toronto extremity salvage score-patient reported outcome measures in upper extremity bone tumors treated with limb salvage surgery

Bone and soft tissue tumors of upper extremity are relatively uncommon than those of lower limb. Treating these patients while retaining a functional limb is quite a challenge. Along with musculoskeletal tumor society score, Toronto extremity salvage score (TESS) is most widely used patient-reported outcome measure for sarcomas of upper extremity. Retrospective analysis of patients with upper extremity bone tumors (24) treated with limb salvage surgery (20) from 2014 to 2022 was undertaken. Mean follow-up period was 26 months and mean age was 30.2 years. Out of 20, 11 humerus cases were of tumors arising from humerus, 5 in radius and 3 in ulna. 9 patients were treated with custom mega prosthesis reconstruction, 6 with fibular free flap, 6 radius underwent simple resection and 1 curettage. Majority of the cases were giant cell tumors (8) followed by osteosarcoma (3), fibromatosis (3), aneurysmal bone cyst (2), simple bone cyst (2), 1 Ewing sarcoma and 1 metastatic bone disease. The mean TESS score of the sample population was 69.7 Most of the patients (11) rated their disability to be of moderate degree and considered themselves to be moderately disabled. The mean TESS score for CMP group was 71.1, while that of autograft reconstruction was 68.3. Despite only half the population having received CMP as a reconstructive option, nearly 40% patients with disease of forearm where the results are not so great, our study population reported a reasonably good patient reported outcome score. A dedicated physiotherapy team with tailor made exercise protocol for each patient depending on their needs can help in improving the quality of life.

FRI366 “Carotid Body Tumor” Is A Misnomer For Head And Neck Paraganglioma

Abstract Disclosure: S. Rabiei: None. V. Kantorovich: None. Introduction: Glomus tumors are often treated as benign, hormonally inactive tumors through simple surgical resection. In many cases, full endocrine work-up and post-resection surveillance are overlooked. Endocrine consultation is currently underutilized in patients with glomus tumors because features of paragangliomas (PGs) such as multiple tumors are not always clinically evident at the time of initial presentation. It is important to be aware that carotid body and glomus tumors should be considered a variant of head and neck paraganglioms (HNPGs) and endocrinology consultation should be requested early on to optimize patients’ outcome. Case Presentation: Patient is a 52-year-old female who presented with back pain and difficulty walking. Imaging obtained for back pain work-up revealed a 6.2 x 4.4 x 4.2 cm right paraspinal soft tissue mass at T9 level on MRI with local invasion and cortical destruction of the T9 vertebra and involvement of the spinal canal. She was also found to have a 0.2 cm solid pulmonary nodule within the right lower lobe on chest CT. The history was also significant for resection of a jugular glomus tumor 12 years prior at the age of 40. Pathology findings at the time were consistent with glomus tumor. She also reported history of glomus tumor in her sister. However, the patient did not undergo genetic study at the time of diagnosis of her primary tumor.The patient subsequently underwent T9 corpectomy. Pathology report revealed a 5-cm tumor with characteristic histologic appearance of PG with epithelioid foci growing in distinctive small nests (Zellballen pattern), separated by prominent fibrovascular stroma with moderate cellularity and with slightly elevated (approximately 5%) Ki-67. Genetic study revealed a carrier state for a pathogenic variant of SDHD (c.112C&amp;gt;T; p.Arg38*). Gallium-68 DOTATATE PET/CT demonstrated intense focal DOTATATE uptake at the site of previous left-sided jugular glomus tumor resection as well as small foci of uptake bilaterally in upper and mid neck. Intense DOTATATE avidity was also identified at T8, T9, and T10 levels. Serum metanephrine, catecholamine, and PTH levels were within normal range. Chromogranin A is pending at this time. Discussion: We presented a case of glomus tumor in a young patient with a positive family history for glomus tumor who did not receive genetic study upon initial diagnosis of her primary tumor. The patient presented 12 years later with metastatic thoracic PG. Considering high mortality and morbidity of PGs, it is recommended to request endocrinology consultation at the time of diagnosis of carotid body or glomus tumors to prevent negative effects of disease recurrence. Presentation: Friday, June 16, 2023

MDCT appearances of pancreatic insulinoma as well as the other well differentiated endocrine tumors

Introduction: Pancreatic endocrine tumors (PETs) are primarily well-differentiated tumors composed of cells that resemble normal islet cells but that arise from pancreatic ductal cells. They are classified as functioning or nonfunctioning according to their associated clinical symptoms; insulinomas, gastrinomas and glucagonomas are the most common function­ing PETs Case Report: A 36-years old man presented with a one-month history of fainting attacks and dizziness, symptoms of hypoglycemia such as hunger, sweating, palpitations, loss of consciousness and syncope. We tried abdominal enhanced spiral CT to localize the tumor, but that wasn’t successful. Therefore, we tried a new method of MD spiral CT scanning and localized the tumor. Discussion and Conclusion: Insulinomas are the commonest islet cell tumors of the pancreas, followed by gastrinomas. Preoperative localization is very helpful in planning the operation: it allows the surgeon to determine whether simple tumor resection or partial pancreatectomy is likely to be required.

The Diagnosis and Management of Cutaneous Metastases from Melanoma.

Melanoma is one of the deadliest skin tumors, accounting for almost 90% of skin cancer mortality. Although immune therapy and targeted therapy have dramatically changed the prognosis of metastatic melanoma, many patients experience disease progression despite the currently available new treatments. Skin metastases from melanoma represent a relatively common event as first sign of advanced disease or a sign of recurrence. Skin metastases are usually asymptomatic, although in advanced stages, they can present with ulceration, bleeding, and superinfection; furthermore, they can cause symptoms related to compression on nearby tissues. Treatments vary from simple surgery resections to topical or intralesional local injections, or a combination of these techniques with the most recent systemic immune or target therapies. New research and studies should focus on the pathogenesis and molecular mechanisms of the cutaneous metastases of melanoma in order to shed light on the mechanisms underlying the different behavior and prognoses of different patients.

Is laparoscopic surgery a preferred option for benign conditions in the caudate lobe of the liver?

Laparoscopic hepatectomy has become a common management strategy for liver tumors owing to its less invasive nature and enhanced visual perspective. Yet, its use in the caudate lobe poses challenges. This study evaluates the experiences of patients who underwent laparoscopic hepatectomy for hepatic tumors in the caudate lobe and aims to propose strategies for performing such procedures. We retrospectively analyzed the clinical data of twelve patients who underwent laparoscopic hepatic caudate lobe resection at the Department of Hepatopancreatobiliary Surgery, Second Affiliated Hospital of Kunming Medical University. All twelve laparoscopic procedures were successful, with none requiring conversion to open surgery. The surgical methods varied: five cases involved simple resection of the Spiegel lobe, one case involved total caudate lobe resection, three cases involved paravena cava lobe resection, and three cases involved resection of the caudate process. The operation time ranged from 49 to 319min (mean, 219min). Intraoperative blood loss ranged from 20 to 500ml, averaging 194ml. No patients needed blood transfusions during or after the operation, and there were no instances of postoperative bleeding, bile leakage, or abdominal infection. Given adequate control of hepatic inflow, sufficient exposure to the surgical field, and an appropriate approach, laparoscopic hepatectomy in the caudate lobe could potentially become a standard surgical technique.

Management of eyelids’ primary malignancies

ABSTRACT Purpose: We report our experience in surgical management of primary malignant tumors of the eyelids. We have specified the various surgical techniques used, as well as functional and anatomical results. Patients and methods: A review of patients admitted for malignant tumor of the eyelids in the oculoplastic department of the Hedi Raies Institute of Ophthalmology from January 2012 to December 2021. Results: One hundred and twenty-three patients with malignant eyelid tumors were hospitalized. Surgical treatment involved 114 tumor lesions, which represents 95% of the cases. One hundred and eleven lesions (97.4%) had been operated by simple tumor resection. Safety margins were, respectively, 4 mm in 63.2% and from 5 to 6 mm in 34.2%. Extemporaneous histological examination was performed in three cases (2.6%). Reconstruction involved the anterior lamella (AL) in 92 cases (80.7%), the posterior lamella (PL) in 66 cases (57.9%), the medial canthus in 18 cases (15, 8%), and lateral canthus in 4 cases (3.5%). The excision was oncological in 85 cases (74.6%) and incomplete in 19 cases (16.7%). Tumor recurrence occurred in seven cases (6.1%), after an average delay of 36 months. Conclusion: The anatomical and functional features of the eyelids require a good reconstruction of the transfixion eyelid defect. Many reconstruction methods are available, allowing extensive and complex palpebral repairs. Oncologic prognosis is conditioned by the surgical quality.

Clinical analysis of nodular fasciitis in the head and neck

Objective: To analyze the clinical features, diagnosis, treatment and prognosis of nodular fasciitis (NF) in the head and neck. Methods: Seven cases of primary NF in the head and neck admitted to Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology from 1990 to 2022 were retrospectively analyzed, including 3 males and 4 females, aged from 2 to 67 years, and the location, course of disease, clinical manifestations, imaging findings, and treatment results of the disease were summarized. Results: Of the 7 patients, the primary sites were respectively nasal vestibule, paranasal sinus, nasal dorsum, sella turcica and clivus, neck, subglottis, and tonsil. Three cases presented with rapidly growing subcutaneous painless masses within 2 months, 1 case presented with hemoptysis, hoarseness and asthma for 28 days, 1 case presented with blood in the nasal discharge for 2 months, 1 case presented with headache for 1 month, and 1 case was found to have tonsillar neoplasms on physical examination for 3 days. CT was performed in 5 patients and the lesions showed soft tissue density shadows, and MRI was also performed in 2 of them, which showed T1 isointensity or T2 slightly long abnormal signal shadows. All patients underwent simple surgical resection of the mass. The patients were followed up for 13 months to 10 years, and none had recurrence. Conclusion: Primary NF in the head and neck is rare, with atypical clinical symptoms and imaging findings. Surgery is the mainstay of treatment for NF with good results.

Simple transanal total mesorectal resection versus laparoscopic transabdominal total mesorectal resection for the treatment of low rectal cancer: a single-center retrospective case-control study.

To evaluate the efficacy and safety of simple TaTNE in the treatment of low rectal cancer compared with laparoscopic transabdominal TME. We collected patients with low rectal cancer admitted to our hospital between January 2019 and November 2021 who received simple TaTME or laparoscopic transabdominal TME. The main outcome was the integrity of the TME specimen. Secondary outcomes were the number of lymph nodes dissected, intraoperative blood loss, operative time, surgical conversion rate, Specimen resection length, circumferential margin (CRM), and distal resection margin (DRM), complication rate. In addition, the Wexner score and LARS score of fecal incontinence were performed in postoperative follow-up. Pathological tissues were successfully resected in all patients. all circumferential margins of the specimen were negative. Specimen resection length was not statistically significant (9.94 ± 2.85 vs. 8.90 ± 2.49, P > 0.05). The incidence of postoperative complications in group A (n = 0) was significantly lower than that in group B (n = 3) (P > 0.05). There was no significant difference in operation time between group A and group B (296 ± 60.36 vs. 305 ± 58.28, P > 0.05). Among the patients with follow-up time less than 1 year, there was no significant difference in Wexner score and LARS score between group A and group B (P > 0.05). However, in patients who were followed up for more than 1 year, the Wexner score in group A (9.25 ± 2.73) was significantly lower than that in group B (17.36 ± 10.95) and was statistically significant (P < 0.05). For radical resection of low rectal cancer, Simple TaTME resection may be as safe and effective as laparoscopic transabdominal TME, and the long-term prognosis may be better.

Interest of frozen section procedure in skin tumors other than melanoma

BackgroundSkin tumors are common. Recommended treatment in most cases is surgery, with margins adapted. Except in the case of simple resection and suture, it is necessary to know the status of the margins before reconstructing the defect. A one-stage technique is possible with frozen section analysis, which gives the surgeon an intraoperative assessment of resection quality. The aim of our work is to study the reliability of the frozen section procedure. MethodA retrospective study included 689 patients who underwent surgery for skin tumor (excluding melanoma) between January 2011 and December 2019 at the University Hospital of Caen, France. ResultsIn 639 patients (92.75%), the frozen section analysis found healthy margins. There were 21 cases of discrepancy between the frozen section analysis and final histology. Infiltrating and scleroderma-like basal cell carcinomas showed a significantly higher frequency of affected margins on frozen section analysis (p < 0.001). The tumor size and location played a significant role in the margin status. ConclusionIn our department, the frozen section procedure is the reference examination indicating immediate flap reconstruction. The present study demonstrated its interest and overall reliability. However, it is to be used according to histologic type, size, and location.