Surgical Management Research Articles

Skull Base Chordoma and Chondrosarcoma: Neuroradiologist’s Guide to Diagnosis, Surgical Management, and Proton Beam Therapy

Skull Base Chordoma and Chondrosarcoma: Neuroradiologist’s Guide to Diagnosis, Surgical Management, and Proton Beam Therapy

Use of 3D-printed model to plan the surgical management of a patient with isolated orbital floor fracture: a case report

Use of 3D-printed model to plan the surgical management of a patient with isolated orbital floor fracture: a case report

Combined gastroscopic and laparoscopic resection of gastric metastatic adenosquamous carcinoma from lung: A case report

BACKGROUND Primary lung cancer is the leading cause of cancer-related death worldwide. Common metastatic sites include the brain, liver, bones, and adrenal glands. However, gastric metastases from lung cancer are rare. This case may be the first report of a combined gastroscopic and laparoscopic resection for gastric metastatic adenosquamous carcinoma (ASC). CASE SUMMARY We report a case of gastric metastasis from lung cancer. The patient was a 61-year-old Han Chinese female who first attended our hospital complaining of a persistent cough, leading to the diagnosis of advanced-stage lung adenocarcinoma. After more than four years of chemotherapy, the patient began to experience epigastric pain. Endoscopy was performed, and pathological examination of biopsy specimens confirmed that the gastric lesion was a metastasis from lung cancer. The lesion was successfully resected by combined gastroscopy and laparoscopy. Histopathological examination of the resected gastric specimen revealed ASC. CONCLUSION Gastric metastases from lung cancer are rare. Endoscopy, histological and immunohistochemical staining are useful for diagnosing metastatic lesions. Surgical management may provide extended survival in appropriately selected patients.

Surgical management for the case of scrotal myiasis in a 7-day-old neonate: a case report

IntroductionNeonatal myiasis is a rare condition, with few reports available on the subject. Surgical management is recommended in some cases. In this study, we present the case of a 7-day-old male neonate with larvae in his scrotum who underwent surgery.Case presentationA full-term 7-day-old male infant (Aryan race) was referred to a children’s hospital. On the sixth day after birth, three 3–4 mm long larvae crawled out from his scrotum, with the number increasing over time. He was given intravenous antibiotics and topical mupirocin to combat secondary infections. The surgical treatment involved two steps: first, the larvae were extracted, and then the infection site was washed with betadine and hydrogen peroxide to help remove any possible remaining larvae.ConclusionScrotal myiasis is a rare disease that occurs in infants and requires immediate treatment. Surgical treatment is effective in removing dead or decaying larvae from a deep-seated location and washing the infection site to prevent secondary infection.

Bilateral orchidopexy for intermittent testicular torsion

AbstractObjectivesTo assess the effect of bilateral orchidopexy in preventing future torsion and testicular loss in patients with intermittent testicular torsion. Secondarily, this study aims to assess the rate of pain improvement following orchidopexy.MethodsThis is a prospective cohort of patients. Participants were men who underwent elective bilateral orchidopexy for intermittent testicular torsion. All consecutive cases were treated by a single surgeon in a single centre between 2015 and 2023. The primary outcomes were prevention of torsion and testicular loss. The secondary outcome was the resolution or improvement in pain.ResultsThe success rate of bilateral orchidopexy in preventing testicular loss due to torsion was 100%, at a follow‐up of mean 33.5 months. Of the 50 patients, 88% were pain‐free following orchidopexy, and 12% had an improvement in their pain. There were no cases of hydrocoele or haematoma in this series. To our knowledge, this is the largest series reported in the literature.ConclusionsElective bilateral orchidopexy prevents torsion and preserves testicular viability. Pain is resolved in most but not all cases. This is important in counselling men who are considering surgical management of intermittent torsion of the testicle.

Functional and subjective outcomes after surgical management of complex elbow dislocations: a retrospective study

Functional and subjective outcomes after surgical management of complex elbow dislocations: a retrospective study

Pituitary Apoplexy: Comorbidities, Management and Outcomes. A Spanish Observational Multicenter Study

Abstract Background Pituitary apoplexy (PA) is the paradigm of endocrine and neurosurgical emergency. Objective To evaluate the comorbidities, risk factors, clinical presentation, pituitary apoplexy score (PAS) and the outcomes of surgical vs. conservative management of PA in Spain. Methods Spanish multicenter, observational study of 301 patients with acute PA. Statistical analyses compared risk factors, clinical presentation and outcomes between the surgical and conservative treatment groups, adjusting for potential confounders. The prevalence of cardiovascular risk factors in patients with pituitary apoplexy was compared with the Spanish population and with patients with non-functioning pituitary adenomas. Results Median age was 59.3 years, 201 (66.8%) were men and non-functioning adenomas (77.9%) were the most common tumor type. The prevalence of diabetes (20.3% vs 13.9%, p<0.01), hypertension (48.8% vs 33.4%, p<0.01) and dyslipidemia (44.2% vs 23.3%, p<0.01), exceeded the Spanish age-adjusted population prevalence. Overall, 209 (69.4%) underwent surgery and 92 (30.6%) received conservative treatment. Surgical patients had larger tumors (26.2 vs 21.0 mm, p<0.01), chiasmal compression more frequently (77.2% vs 53.4%, p<0.01) and higher values of PAS. In the follow-up, while there were no statistically significant differences in anterior pituitary hormonal deficits between treatments, permanent vasopressin deficiency was more frequent after surgery (14.8% vs 3.3%, p<0.01). Conclusion There is a high burden of cardiovascular risk factors among patients with PA suggesting that metabolic factors may play a potential role in the development of PA. This underscores the need for comprehensive management of these conditions in addition to treating the apoplexy itself in this population. Surgical management has a relevant place in PA approach mainly in patients with higher PAS. However, it leads permanent vasopressin deficit more frequently than conservative approach.

Role of Fine Needle Aspiration Cytology in Paratesticular Neoplasms-A Case Reports-Based Systematic Review.

The cytology features of neoplastic paratesticular lesions are mostly documented as case reports. Thus, we conducted a case report-based literature review to identify the characteristics of paratesticular neoplasms and tried to determine the significance of FNAC in these tumors. The studies were searched using PubMed and Scopus. The quality assessment was done using the JBI critical appraisal checklist for case reports. The articles that received an overall rating of "Include" underwent data extraction. The data were extracted from the articles and analyzed. We included 34 case reports from 33 published articles. The mean age of patients was 44.74 (13-85) years, and the most common clinical manifestation was scrotal swelling (70.59%, 24/34). Lesions were commonly observed on the right side (65.63%, 21/32), and the most common tumor site was epididymis (35.29%, 12/34). A total of 38.24% (13/34) cases were nonmalignant, and 61.76% (21/34) were malignant on the cytological diagnosis. The adenomatoid tumor (53.85, 7/13) was the most common nonmalignant tumor. Other entities were schwannoma, benign spindle cell neoplasm with atypia, nerve sheath tumor, lipoma, undifferentiated pleomorphic sarcoma, rhabdomyosarcoma, epithelioid sarcoma, liposarcoma, malignant rhabdoid tumor, pigmented neuroectodermal tumor of infancy and mesothelioma. Considering the malignant and nonmalignant groups, the sensitivity, specificity, and diagnostic accuracy of cytology were 95.00%, 84.62%, and 90.91%, respectively. Cytopathologists should be familiar with the cytological features of various malignant and nonmalignant paratesticular tumors to prevent unnecessarily invasive surgical management. The current systematic review emphasizes usefulness of FNAC in the preoperative cytological identification of paratesticular tumors.

A Comparative Study of Postoperative Outcomes: Open Cholecystectomy versus Laparoscopic Cholecystectomy

Background: Surgery is usually necessary to treat gallstones, or cholelithiasis. Because laparoscopic cholecystectomy is less intrusive than open cholecystectomy, it is now the treatment of choice. Objectives: To evaluate and compare the postoperative results of open and laparoscopic cholecystectomies with regard to duration of hospital stay, complication rates, and amount of discomfort experienced during the procedure. Methods: A prospective comparative study was conducted on one hundred patients with symptomatic cholelithiasis who were to undergo elective cholecystectomy. Patients were randomized into two groups: Among the patients, 50 patients were operated for Laparoscopic Cholecystectomy and 50 for Open Cholecystectomy. The data on the postoperative results of the operation, including the time spent during the operation, as well as the time spent on pain, the length of stay in the hospital, and complications were collected and compared using statistical methods with the chosen level of significance equals to p ≤0.05. Results: The mean operative time of Laparoscopic Cholecystectomy was less than Open Cholecystectomy (48. 5 ± 12. 4 vs. 68. 5 ± 15. 3 minutes; p≤0.05). The overall postoperative pain was less in patients who undertook Laparoscopic Cholecystectomy with the mean pain period of (18. 3 ± 5.2) hours compared with 30. 7 ± 7. For Open Cholecystectomy patients the time taken was 1 hours. The length of the hospital stay was also lesser in Laparoscopic Cholecystectomy group which was (1.8 ± 1.2) days compared to Open Cholecystectomy group of (4.8 ± 1.5) days. Also, the Laparoscopic Cholecystectomy group had less complication rate at 12% compared to the Open Cholecystectomy at 38% with p ≤0.05 Conclusion: Laparoscopic Cholecystectomy is shown to be more beneficial in terms of postoperative results than Open Cholecystectomy in terms of the operating time, pain, hospital stay, and complications. Thus, these results shows Laparoscopic Cholecystectomy as the most appropriate surgical management for patients with symptomatic cholelithiasis; however, Open Cholecystectomy will still be required for cases that are not suitable for Laparoscopic Cholecystectomy.

A mini-update on chronic rhinosinusitis

Chronic rhinosinusitis (CRS) is an inflammatory disorder of the paranasal sinuses and the nasal cavity lasting longer than 12 weeks. This disease is a common clinical syndrome with significant monetary burden due to the high costs of medical visits, diagnostic tests, medications, and surgical therapies. CRS without nasal polyposis (CRSsNP) is the most common subtype of CRS, accounting for about 70% of all patients. Other subtypes include CRS with nasal polyposis (CRSwNP) and allergic fungal rhinosinusitis (AFRS). CRSwNP has the worldwide prevalence of 2% to 4% and is often accompanied by type 2 inflammation and asthma as a comorbid condition. Pediatric chronic sinusitis is distinct from adult chronic sinusitis and is currently considered an infectious process, characterized by persistent inflammation representing an exaggerated immune response to an external stimulus. The medical and surgical management of CRS has been remarkably modified in the past two decades. The aim of this study was to present an update on CRS based on the recent years’ literature.

A comprehensive prediction model for central lymph node metastasis in papillary thyroid carcinoma with Hashimoto’s thyroiditis: BRAF may not be a valuable predictor

PurposePapillary thyroid carcinoma (PTC) frequently coexists with Hashimoto’s thyroiditis (HT), which poses challenges in detecting central lymph node metastasis (CLNM) and determining optimal surgical management. Our study aimed to identify the independent predictors for CLNM in PTC patients with HT and develop a comprehensive prediction model for individualized clinical decision-making.Patients and methodsIn this retrospective study, a total of 242 consecutive PTC patients who underwent thyroid surgery and central lymph node dissection between February 2019 and December 2021 were included. 129 patients with HT were enrolled as the case group and 113 patients without HT as control. The results of patients’ general information, laboratory examination, ultrasound features, pathological evaluation, and BRAF mutation were collected. Multivariate logistic regression analysis was used to identify independent predictors, and the prediction model and nomogram were developed for PTC patients with HT. The performance of the model was assessed using the receiver operating characteristic curve, calibration curve, decision curve analysis, and clinical impact curve. In addition, the impact of the factor BRAF mutation was further evaluated.ResultsMultivariate analysis revealed that gender (OR = 8.341, P = 0.013, 95% CI: 1.572, 44.266), maximum diameter (OR = 0.316, P = 0.029, 95% CI: 0.113, 0.888), multifocality (OR = 3.238, P = 0.010, 95% CI: 1.319, 7.948), margin (OR = 2.750, P = 0.046, 95% CI: 1.020, 7.416), and thyrotropin receptor antibody (TR-Ab) (OR = 0.054, P = 0.003, 95% CI: 0.008, 0.374) were identified as independent predictors for CLNM in PTC patients with HT. The area under the curve of the model was 0.82, with accuracy, sensitivity, and specificity of 77.5%, 80.3% and 75.0%, respectively. Meanwhile, the model showed satisfactory performance in the internal validation. Moreover, the results revealed that BRAF mutation cannot further improve the efficacy of the prediction model.ConclusionMale, maximum diameter > 10mm, multifocal tumors, irregular margin, and lower TR-Ab level have significant predictive value for CLNM in PTC patients with HT. Meanwhile, BRAF mutation may not have a valuable predictive role for CLNM in these cases. The nomogram constructed offers a convenient and valuable tool for clinicians to determine surgical decision and prognostication for patients.

Clinico-demographic profile and visual outcomes of pseudophakic bullous keratopathy in a multi-tier eyecare network in India

Abstract Purpose: The purpose of this study is to present the clinico-demographic characteristics of pseudophakic bullous keratopathy (PBK), its visual outcomes, factors associated with the choice of treatment, and poor visual outcomes of PBK. Methods: In this hospital-based retrospective study, electronic medical records data of new patients who presented to a multi-tier ophthalmology hospital network in India (November 2010–June 2022) were extracted. Patients with at least 4 weeks of follow-up were analyzed for visual outcome data. Bivariate analysis and multivariate logistic regression were used to determine the factors associated with the treatment choice and poor visual outcomes. Results: Of the 3,323,247 electronic records (with an average follow-up of 293 days) examined, 10,522 eyes of 10,158 patients (0.3%) had PBK. The majority were managed non-surgically (n = 7372; 70.1%), with increased odds of poor visual outcome by 3.46 times (AdjOR: 3.04–3.92, P < 0.001). Those belonging to the non-paying category had higher odds of poor visual outcome (AdjOR: 1.48, 95%CI: 1.29–1.69; P < 0.001). Surgical management improved vision by 0.72 logMAR (95%CI: 0.60–0.73; P < 0.001). A total of 41.2% (n = 113/274) of cases that underwent Descemet’s membrane endothelial keratoplasty and 18.4% (n = 285/1551) of Descemet’s stripping endothelial keratoplasty attained last follow-up visual acuity (LVA) of 6/18 or better. Conclusion: About three in every thousand patients had PBK. Surgical interventions improved visual acuity significantly. About four in ten patients who underwent DMEK attained a vision of 6/18 or better at the last follow-up visit. Markers of lower socioeconomic strata were independently associated with poor visual outcomes.

Odontoid fractures in the pediatric population: a systematic review and management algorithm

Purpose: The management of odontoid fractures in adult patients has been widely described. However, there is sparse literature about this injury in the pediatric population. This study aimed to review published literature regarding the management and outcomes of pediatric odontoid fractures to develop a stepwise treatment algorithm. Methods: A literature review was conducted using PRISMA guidelines on PubMed to identify studies between 1960 and 2023 that reported on the management and outcomes of odontoid fracture in pediatric patients. Studies were included if they were published in English and if their sample included at least four patients aged 0–18, minimum follow-up of 6 weeks, and outcomes for each patient clearly differentiated. Results: In total, 15 studies including 125 pediatric patients with odontoid fractures were included. Treatment options varied from non-operative management with immobilization in rigid collars, halo vests, cervicothoracic orthosis, or soft collars to surgical management with fixation and/or arthrodesis. There were 73 patients initially treated nonoperatively, 47 initially treated surgically, 2 who healed with observation alone, and 3 who died acutely of concomitant injuries. The nonunion rate for nonoperative management was 5.5%. Surgery was successful, demonstrating bony union at final follow-up, in 94.6% of cases treated via a posterior approach and 85.7% of cases treated with an anterior approach. Conclusions: Odontoid fractures must be considered in pediatric patients with cervical spine trauma. This is the largest literature review of pediatric odontoid fractures. Various management strategies exist and can be considered. The proposed algorithm offers an evidence-based framework for the management of pediatric odontoid fractures.

Surgical Management of Canine Transmissible Venereal Tumor with Adjunctive Chemotherapy Combination

One male and a female 2-year-old Neapolitan Mastiff dogs weighing 41 and 40 kg, respectively, were presented to the University Veterinary Teaching Hospital, Jos, Nigeria, with complaints of continuous bleeding from the prepuce and vulva which were first observed about 2 months before presentation. Clinical examination revealed preputial bleeding of the male dog and serosanguinous vulva discharges with the presence of palpable masses with multiple nodules that were cauliflower-like. Cytological evaluations of smears from preputial and vaginal swabs revealed characteristic round cells with large eccentric nuclei, large nuclear-cytoplasmic ratio, and intracytoplasmic vacuolations as well as anisocytosis and anisokaryosis. Based on these cytological features, a diagnosis of canine transmissible venereal tumor (CTVT) was made in each case. Blood samples were collected for hematology and clinical chemistry. Debulking of the masses was carried out under general anesthesia using atropine sulfate and chlorpromazine as pre-anesthetics and Ketamine hydrochloride as induction and maintenance anesthetics. Following debulking, the resulting defect was reconstructed and the surgical wound was managed by daily wound cleaning and the administration of vincristine sulfate (0.025 mg/kg) slowly intravenously, ivermectin (0.3 mg/kg) subcutaneously, and piroxicam (0.3 mg/kg) and 20% amoxicillin (20 mg/kg) intramuscularly. There were no observed known vincristine sulfate-associated adverse effects as the dogs recovered and were discharged 3-week post-tumor debulking with no recurrence within 6 months of follow-up examinations. The debulked mass histologically showed several sheets of round neoplastic cells with prominent nuclei, mitotic figures, and infiltrating lymphocytes. Based on these findings, a diagnosis of CTVT was further confirmed. The hemogram showed moderate leukocytosis at day 1 in the bitch with a mild left shift at days 1 and 14 while clinical chemistry showed a marked increase in alkaline phosphatase, moderate increase in serum creatinine, and mild hypoproteinemia. In conclusion, management of CTVT with adjunctive vincristine sulfate and ivermectin combination resulted in complete healing with amelioration of known associated adverse effects.

When an inguinal hernia is more than just a hernia with ovary and fallopian tube involvement: a case report

BackgroundFinding an ovary and/or fallopian tube within an indirect inguinal hernia is a rare occurrence that can be detected incidentally during elective surgery or present as a medical emergency requiring immediate intervention. Hence, it poses a difficult clinical picture in a reproductive-age woman with groin mass.Clinical presentationWe describe the case of a 45-year-old Ethiopian woman of Amhara ethnicity who presented with a left inguinal swelling that persisted for 5 years. Physical examination revealed an irreducible, non-tender lump in the left groin and an ultrasonography scan confirmed the presence of an indirect inguinal hernia. The patient was then scheduled for elective hernia repair. During the surgery, both her left ovary and fallopian tube were found within the hernial sac. The contents were released from the sac, high ligation performed, and the inguinal floor repaired with mesh.DiscussionInguinal hernias in women are rare and often present a diagnostic challenge. Although the exact pathogenesis of inguinal hernias containing female genital organs is unknown, some risk factors have been postulated. Diagnosis should start with a physical exam and imaging, but many of the cases have been intraoperative surprises. Management is primarily surgical, ranging from simple reduction and hernia repair to salpingo-oophorectomy depending on the status of the hernia contents.ConclusionThis report emphasizes the importance of maintaining a high index of suspicion when examining females with inguinal hernias to ensure accurate diagnosis and management of tubo-ovarian hernias. Although rare, inguinal hernias containing female genital organs should be considered in the differential diagnosis of inguinal hernias, as early detection and appropriate surgical management can prevent potential complications.

A rare case of early abdominal pregnancy (EAP)

Introduction: Abdominal pregnancy comprises 1% of ectopic pregnancies and is challenging to manage due to the associated significant morbidity and mortality. Abdominal pregnancy may be classified according to gestation and implantation site. Ultrasound imaging is the mainstay of diagnosis. Confirmatory tests include magnetic resonance imaging (MRI) and diagnostic laparoscopy. Case Report: A 36-year-old patient, amenorrheic for 9–10 weeks, presented to the early pregnancy unit complaining of a one-day history of abdominal pain associated with an episode of vomiting. She denied vaginal bleeding and examination revealed left lower quadrant tenderness. Ultrasound imaging demonstrated a live abdominal pregnancy around 12 weeks’ gestation implanted on the left uterine surface. Following appropriate counselling, she opted for surgical management and consented to the termination of pregnancy. She underwent diagnostic laparoscopy which confirmed that the gestational sac was arising from the left lateral uterine angle and was densely adherent to the omentum and bowel. The procedure was converted to laparotomy to enable safe adhesiolysis and excision of the entire gestational sac. Postoperatively, she represented on day 12 with abdominal pain, fever and bleeding. Computed tomography of abdomen and pelvis (CT-AP) suggested left ureteric injury and she underwent retrograde double J urethral stent (JJ stenting) of the left ureter. Fortunately, the same healed with conservative management. Conclusion: Abdominal pregnancy is rare and poses challenges in diagnosis and management. Once diagnosed, urgent surgical management is recommended given the high risk of complications including intra-abdominal bleeding and visceral injury. Therefore, each case requires a careful and considered treatment approach by a multi-disciplinary team.

Surgical indication and management of obstructive colonic metastasis from primary lung adenocarcinoma: report of a case and review of the literature

BackgroundColonic metastasis from lung cancer is very rare and is typically associated with poor prognosis. Herein, we report the case of a patient who achieved intermediate-term survival using a multimodal treatment approach, including chemotherapy, immunotherapy, radiotherapy, and surgical resection for obstructive colonic metastasis from primary lung adenocarcinoma.Case presentationA woman in her 50s presented with anemia and a positive fecal occult blood test. Computed tomography revealed a tumor in the right upper lobe of the lung with mediastinal lymphadenopathy and wall thickening in the transverse colon. Colonoscopy revealed a stricture involving 50% of the colonic lumen. Biopsy revealed a poorly differentiated adenocarcinoma positive for CK-7 and TTF-1, very focally positive for napsin A, and negative for CK-20 and CDX-2. Furthermore, positron emission tomography/CT (PET/CT) showed a high maximum standardized uptake value (SUVmax) of 8.2 in the iliac bone. Based on these findings, the patient was diagnosed with primary lung adenocarcinoma with simultaneous metastasis to the transverse colon and iliac bone (cT4N3M1c, cStage IVB).After receiving first-line chemotherapy with atezolizumab, pemetrexed, and carboplatin, the tumors shrank after 4 courses. Subsequently, the patient received maintenance therapy with atezolizumab and pemetrexed. However, the tumor enlarged after 10 courses. Second-line chemotherapy with docetaxel and ramucirumab (3 courses) failed to achieve tumor reduction. Colonoscopy revealed an impassable colonic tumor. Nineteen months after diagnosis, surgery was planned for imminent intestinal obstruction.We determined that the colonic tumor was resectable, because laparoscopic exploration revealed no other metastases. The tumor was resected by partial colectomy with ileocolonic anastomosis. The postoperative course was uneventful. Pathological examination revealed a resection margin that was negative for malignancy, and the histological type was consistent with metastatic lung adenocarcinoma.The patient then received nab-paclitaxel therapy; however, she developed symptoms of superior vena cava syndrome after 3 courses. The patient received palliative irradiation (30 Gy/10 fr) followed by nivolumab. She soon developed a solitary brain metastasis, and stereotactic irradiation was planned. After 3 courses of nivolumab, the metastasis was reduced significantly, and stereotactic brain irradiation was canceled. The lung tumor and mediastinal lymphadenopathy gradually shrank, and the patient survived for 13 months after surgery without disease progression.ConclusionsIn this case, surgical resection of colonic metastasis from primary lung adenocarcinoma may have contributed to the short-term prognosis as a bridge-to-next available multimodal treatment.

A Prosthetic Conduit can be Used Safely for TransCarotid Artery Revascularization Under Local Anesthesia in High-Risk Patients.

Surgical management of carotid stenosis has evolved from open carotid endarterectomy (CEA) to include multiple alternative procedures including transfemoral carotid artery stenting (tfCAS) and transcarotid artery stenting. In recent years, Transcarotid Artery Revascularization (TCAR) has emerged as a third option, combining open cut down to the common carotid artery (CCA) with endovascular stenting and neuroprotection via reversal of cerebral blood flow. In this case series, a modified TCAR procedure using a prosthetic conduit was successfully performed exclusively under local anesthesia in a total of 10 patients with carotid artery stenosis, high cardiac risk, and anatomical contraindications to a traditional TCAR.

Splenic flexure adenocarcinoma: A national cohort analysis of extent of surgical resection and outcomes.

The optimal extent of resection for splenic flexure adenocarcinoma remains debated. These tumours straddle the left- and right-sided vasculature with lymphatic drainage in a watershed area; current guidelines recommend either segmental or extended colectomy. We analysed surgical management of splenic flexure tumours and compared outcomes between approaches. The Surveillance, Epidemiology and End Results database was searched for adults with Stage I-III splenic flexure adenocarcinoma, 2004-2019. Of 5238 patients, 55% underwent extended colectomy. Compared to segmental colectomy, these patients were more likely to have advanced stage. On multivariable analysis, age ≤ 65 years remained independently associated with extended colectomy. Although fewer nodes were examined in segmental colectomy (median 14 vs. 16, p < 0.001), the number of positive nodes (both, median 0 [interquartile ratio 0-2], p = 0.20) and the lymph node ratio were similar between cohorts. Surgical approach was not significantly associated with increased positive nodal yield in adjusted analyses. Five-year overall and disease-specific survival were 73% and 84% for segmental and 72% and 83% for extended colectomy (p > 0.4); these remained comparable after adjustment. Nationally, we observed similar rates of segmental and extended colectomy for splenic flexure adenocarcinoma. Extended colectomy was not more common in Stage III disease, indicating lack of stage migration, and was not associated with better oncological outcomes. These observations support current practice involving either approach, which should be tailored to patient-related factors and preferences, while considering technical aspects and quality of life.

Bilateral decompressive craniectomy as a damage control strategy for a preschooler multilobar bihemispheric firearm injury: a case report and systematic review.

The absence of guidelines for managing gunshot wounds to the head (GSWH) with bihemispheric lesions in pediatric patients highlights the need for prompt and diverse damage control strategies. This article aims to systematically evaluate the evidence surrounding the management of GSWH in preschoolers and to report a novel approach. We present a case of a 4-year-old girl who sustained a gunshot wound to the left parietal region. She was admitted to a level 1 trauma center 90min post-injury with stable vital signs, a Glasgow coma scale (GCS) of 12 (E3, V3, M6), and grade III hemiparesis in her right upper limb. Initial surgical management included left hematoma decompression and right frontotemporoparietal decompressive hemicraniectomy in two stages under the same anesthesia. Due to massive brain swelling during the left-sided procedure, it was converted to a left frontotemporoparietal decompressive hemicraniectomy. Both procedures included autologous pericranium augmentation duraplasty and watertight suturing. A right-side decompressive hemicraniectomy followed without exploring bullet lodging, using bilateral Kempe incisions. Bone flaps were stored under cryopreservation. During a 30-day hospital stay, neurological assessments showed a gradual recovery of right upper limb strength to grade IV + , with no other deficits or operative complications. Postoperative CT scans at 7, 14, and 28days showed minor pseudomeningoceles and a reduction of intraparenchymal edema. Multidisciplinary care continued throughout the stay. The patient showed no signs of endocrinological, infectious, or residual neurological issues and underwent bilateral autologous cranioplasty on day 35. She was discharged on day 38 with a GCS extended of 8 (full recovery/minor deficits not affecting daily activities) and minor right upper limb apraxia. A systematic review identified nine patients under 6years old with GSWH, with only one previously reported case of a 3-year-old patient with bihemispheric lesions undergoing bilateral craniectomies and achieving positive outcomes. Our case and the review suggest that bilateral decompressive hemicraniectomy is a feasible strategy for managing multilobar bihemispheric GSWH in preschoolers. However, the evidence of management for this population remains of low quality, highlighting the need for further research, and justifying this case report.