Surgical Resection Techniques Research Articles

Treatment Modalities for Non-Muscle Invasive Bladder Cancer: An Updated Review

The landscape of treatment for non-muscle invasive bladder cancer is rapidly changing. A complete and careful transurethral resection is the mainstay of initial treatment and is followed by intravesical therapy in intermediate or high-risk cases. The standard of care is intravesical BCG. Many alternative or additive approaches to this are being explored. We divided this review into three relevant spaces to consider these novel treatment approaches: (1) low-risk disease, for which intravesical therapy is not usually considered, (2) BCG-naïve disease (i.e., considering alternatives to the standard therapy), and (3) BCG-unresponsive disease. We performed a review of published literature and summarized ongoing trials in the United States. Novel approaches that we explored include surgical techniques for resection, alterations in dwell time for intravesical therapy, delivery method and schedule of intravesical therapies, new intravesical therapy agents, and systemic therapies (especially immunotherapy). These are thoroughly outlined throughout this review article, and the numerous modalities being studied demonstrate significant promise for the future treatment of the expanding space of NMIBC.

Comparative Assessment of Laparoscopic and Endoscopic Cooperative Surgery with Laparoscopic Wedge Resection for the Treatment of Gastric Submucosal Tumors

Abstract Background The most commonly performed surgical resection technique for gastric submucosal tumors (gSMTs) is laparoscopic wedge resection (LWR). Notably, laparoscopic and endoscopic cooperative surgery (LECS) is a surgical procedure that combines laparoscopic gastric resection with an endoscopic submucosal dissection for the local resection of gastric tumors, which provides appropriate and minimal surgical resection margins. Methods Seventy-nine gSMT patients who underwent surgical resection at our department between January 2004 and January 2023 were retrospectively assessed. LWR and LECS were performed in 61 and 18 patients, respectively. Clinicopathological features and short-term surgical outcomes were assessed between the two groups. A 2:1 propensity score matching was performed to mitigate the effects of selection biases. Regardless of the surgical procedure, all the patients underwent curative resection with negative margins. Results The LWR and LECS groups included 24 and 12 patients, respectively. The mean operative duration was significantly shorter in the LWR group than in the LECS group (LWR, 131.1 min; LECS, 195.2 min; p < 0.05). The mean ratio of tumor diameter to resected specimen diameter was significantly higher in the LECS group than in the LWR group (LWR, 60.3%; LECS, 78.9%; p < 0.05). The mean ratio of tumor area to resected specimen area was significantly higher in the LECS group than in the LWR group (LWR, 44.7%; LECS, 66.3%; p < 0.05). Conclusion LECS was performed safely with a minimal and optimal safety margin compared with LWR. The findings suggest that LECS can be a feasible option for the treatment of gSMTs.

Multimodality therapy and innovative surgical techniques for successful resection and reconstruction of a rare and aggressive pleomorphic liposarcoma

Managing rare thoracic liposarcomas, accounting for < 1% of soft tissue sarcomas, demands tailored strategies. We explore effective approaches, considering tumor attributes and innovative techniques, and compare NCCN-guided therapies and surgeries. Using PubMed, Embase, and Cochrane Library, we identified studies on thoracic liposarcomas. Data synthesis summarized findings, acknowledging rarity's evidence limitations. This study reports a successful resection of a rare thoracic soft tissue sarcoma. Overcoming challenges through innovative techniques like hyperthermic pleural lavage and Gore-Tex® reconstruction, it underscores neoadjuvant therapies and surgical precision. Thoracic liposarcoma management demands tailored multidisciplinary approaches. Neoadjuvant chemotherapy, surgery, and adjuvant therapies are fundamental. Surgical ingenuity, like extrapleural pneumonectomy and novel reconstructions, ensures thorough tumor removal with minimal complications. Hyperthermic pleural lavage and Gore-Tex® offer promising refinements. Successful outcomes highlight potential for improved prognoses. Further research will optimize strategies for this rare, aggressive cancer.

Flat Aesthetic Mastectomy Closure with the Angel Wing Technique to Address Lateral Adiposity: Technique and Outcome Analysis

Introduction. Oncologic mastectomy in the setting of obesity poses challenges in achieving a flat closure that includes the lateral adiposity. The angel wing (AW) technique was developed to address this issue. We aim to demonstrate the safety of AW by evaluating incidence of arm lymphedema (AL) and decreased range of motion (dROM) in patients postmastectomy with and without the AW closure. Methods. We performed a single-center retrospective cohort study at an academic referral center of patients who underwent mastectomy with and without the AW technique from May 2014 to October 2022. Those who received breast reconstruction (immediate or delayed), partial mastectomy, and male patients were excluded. The presence of postoperative AL and dROM was evaluated. Subgroup analysis was performed for patient factors including BMI, extent of axillary surgery, PMRT, and pathologic stage. Results. A total of 390 patients met inclusion criteria. Of those, 173 (44.4%) underwent AW and 217 (55.6%) had non-AW mastectomy. Expectedly, the average BMI was significantly higher in the AW cohort (p&lt;0.0001). The overall rate of AL was 51/390 (13.1%), seen in 27 (15.6%) undergoing AW and 24 (11.1%) non-AW (p value = 0.18). While the rate of dROM within the cohort was 52/390 (13.1%), 27 (15.6%) underwent AW vs. 24 (11.1%) non-AW (p value = 0.22), resulting in no statistical significance between AW and non-AW mastectomy upon subsequent development of AL or dROM. Conclusion. Our study demonstrates the AW technique does not convey an increased risk of overall AL or dROM, even when considering known risk factors such as obesity, PMRT, and extent of axillary surgery. As we strive to provide our patients with improved surgical techniques for oncologic resection, we submit that this technique is a viable and safe option for achieving the goals of cosmesis with oncologic safety.

Impact of the Size and Depth of Pulmonary Nodules on the Surgical Approach for Lung Resection in the Treatment of Early-stage Lung Cancer ≤2 cm

Current studies suggest that for early-stage lung cancers with a component of ground-glass opacity measuring ≤2 cm, sublobar resection is suitable if it ensures adequate margins. However, lobectomy may be necessary for some cases to achieve this. The aim of this study was to explore the impact of size and depth on surgical techniques for wedge resection, segmentectomy, and lobectomy in early-stage lung cancer ≤2 cm, and to determine methods for ensuring a safe resection margin during sublobar resections. Clinical data from 385 patients with early-stage lung cancer ≤2 cm, who underwent lung resection in 2022, were subject to a retrospective analysis, covering three types of procedures: wedge resection, segmentectomy and lobectomy. The depth indicator as the OA value, which is the shortest distance from the inner edge of a pulmonary nodule to the opening of the corresponding bronchus, and the AB value, which is the distance from the inner edge of the nodule to the pleura, were measured. For cases undergoing lobectomy and segmentectomy, three-dimensional computed tomography bronchography and angiography (3D-CTBA) was performed to statistically determine the number of subsegments required for segmentectomy. The cutting margin width for wedge resection and segmentectomy was recorded, as well as the specific subsegments and their quantities removed during lung segmentectomy were documented. In wedge resection, segmentectomy, and lobectomy, the sizes of pulmonary nodules were (1.08±0.29) cm, (1.31±0.34) cm and (1.50±0.35) cm, respectively, while the depth of the nodules (OA values) was 6.05 (5.26, 6.85) cm, 4.43 (3.27, 5.43) cm and 3.04 (1.80, 4.18) cm for each procedure, showing a progressive increasing trend (P<0.001). The median resection margin width obtained from segmentectomy was 2.50 (1.50, 3.00) cm, significantly greater than the 1.50 (1.15, 2.00) cm from wedge resection (P<0.001). In wedge resections, cases where AB value >2 cm demonstrated a higher proportion of cases with resection margins less than 2 cm compared to those with margins greater than 2 cm (29.03% vs 12.90%, P=0.019). When utilizing the size of the nodule as the criterion for resection margin, the instances with AB value >2 cm continued to show a higher proportion in the ratio of margin distance to tumor size less than 1 (37.50% vs 17.39%, P=0.009). The median number of subsegments for segmentectomy was three, whereas lobectomy cases requiring segmentectomy involved five subsegments (P<0.001). The selection of the surgical approach for lung resection is influenced by both the size and depth of pulmonary nodules. This study first confirms that larger portions of lung tissue must be removed for nodules that are deeper and larger to achieve a safe margin. A distance of ≤2 cm from the inner edge of the pulmonary nodule to the nearest pleura may be the ideal indication for performing wedge resection.

The regulatory role of autophagy between TAMs and tumor cells.

Cancer has become a global public health problem and its harmful effects have received widespread attention. Conventional treatments such as surgical resection, radiotherapy and other techniques are applicable to clinical practice, but new drugs are constantly being developed and other therapeutic approaches, such as immunotherapy are being applied. In addition to studying the effects on individual tumor cells, it is important to explore the role of tumor microenvironment on tumor cell development since tumor cells do not exist alone but in the tumor microenvironment. In the tumor microenvironment, tumor cells are interconnected with other stromal cells and influence each other, among which tumor-associated macrophages (TAMs) are the most numerous immune cells. At the same time, it was found that cancer cells have different levels of autophagy from normal cells. In cancer therapy, the occurrence of autophagy plays an important role in promoting tumor cell death or inhibiting tumor cell death, and is closely related to the environment. Therefore, elucidating the regulatory role of autophagy between TAMs and tumor cells may be an important breakthrough, providing new perspectives for further research on antitumor immune mechanisms and improving the efficacy of cancer immunotherapy.

Comparing Endoscopy and Surgery: A Systematic Review of Early Colorectal Cancer Treatments

Colorectal cancer is a major type of gastrointestinal cancer that significantly contributes to disease burden and mortality, particularly among younger people. Early colorectal cancer refers to the early stages of the disease that require early detection and treatment to improve the overall prognosis and survival. There are various treatment options available for early colorectal cancer, such as endoscopic resection, including methods like transanal endoscopic microsurgery (TEMS), endoscopic mucosal resection (EMR), or submucosal dissection (ESD), as well as surgical resection, including open and laparoscopic techniques. However, to make informed decisions about which approach is best, it is crucial to thoroughly understand the long-term outcomes associated with each option. We systematically reviewed the PubMed and Google Scholar databases from 2013 to August 11, 2023, to obtain such knowledge. We selected nine for in-depth analysis after carefully reviewing 2761 articles, including those written in English and focusing on human studies. The review focused on individual benefits, merits, and drawbacks, considering the extent of the disease, clinical outcomes, survival, and complication rates. Although endoscopic resection has the advantage of being less invasive and promoting faster patient recovery, it should be noted that its primary objective may not necessarily be achieving complete excision (R0). This is because there are potential obstacles, including inadequate lymph node removal and inaccurate T staging that may prevent the achievement of R0. Nevertheless, it is important to stress that both endoscopic and surgical resection ultimately share the goal of complete excision and curing the patient. Finally, this systematic review emphasizes the need for additional research to fill knowledge gaps, improve clinical decision-making, and promote the application of sophisticated technology. As the landscape of early colorectal cancer treatment evolves, a balanced integration of endoscopic and surgical resection procedures, together with emerging technologies, can improve patient outcomes and increase treatment efficacy.

Portal vein wedge resection and patch venoplasty with autologous vein grafts for hepatobiliary–pancreatic cancer

BackgroundAdvanced hepatobiliary–pancreatic cancer often invades critical blood vessels, including the portal vein (PV) and hepatic artery. Resection with tumor-free resection margins is crucial to achieving a favorable prognosis in these patients. Herein, we present our cases and surgical techniques for PV wedge resection with patch venoplasty using autologous vein grafts during surgery for pancreatic ductal adenocarcinoma (PDAC) and perihilar cholangiocarcinoma (PhCC).Case presentationCase 1: 73-year-old female patient with PDAC; underwent subtotal stomach-preserving pancreatoduodenectomy, with superior mesenteric vein wedge resection and venoplasty with the right gonadal vein. Case 2: 67-year-old male patient with PDAC; underwent distal pancreatectomy and celiac axis resection, with PV wedge resection and venoplasty with the middle colic vein. Case 3: 51-year-old female patient with type IV PhCC; underwent left hepatectomy with caudate lobectomy and bile duct resection, with hilar PV wedge resection and venoplasty with the inferior mesenteric vein (IMV). Case 4: 69-year-old male patient with type IIIA PhCC; underwent right hepatopancreatoduodenectomy, with hilar PV resection and patch venoplasty with the IMV. All patients survived for over 12 months after the surgery, without local recurrence.ConclusionsPV wedge resection and patch venoplasty is a useful technique for obtaining tumor-free margins in surgeries for hepatobiliary–pancreatic cancer.

Peritonectomy and resection of mesentery during Visceral-Peritoneal Debulking (VPD) in patients with stage IIIC-IV ovarian cancer: A phase I-II trial

ObjectiveTo describe the surgical technique, assess feasibility, efficacy, and safety of peritonectomy and/or resection of mesentery (P-Rme) during Visceral-Peritoneal Debulking (VPD) in patients with stage IIIC-IV ovarian cancer (OC). MethodsIn April 2009 we registered a protocol study on the safety and feasibility of P-Rme. In the period April 2009–December 2022, 687 patients with FIGO stage IIIC-IV ovarian cancer underwent VPD. One hundred and twenty-nine patients (18.7%) had extensive disease on the mesentery and underwent P-Rme. Feasibility was assessed as the number of procedures completed. Efficacy was measured as the rate of Complete Resection (CR). Safety was defined by the intra- and post-operative morbidity rate specifically associated with these procedures. ResultsIn all patients P-Rme was successfully completed. P-me was performed in 82 patients and R-me in 47, both procedures in 23 patients. CR was achieved in all 129 patients with an efficacy of 100%. Intra-operatively 5 patients out of 129 experienced small bowel loop surgical devascularization. They required small bowel resection and anastomosis. The procedure specific morbidity was 3.8%. No post-operative complication was related to P-Rme. At 64 months median follow-up, survival outcomes in the study group were similar to patients in the control group. ConclusionOverall, almost 20% of the VPD patients needed P-Rme to obtain a CR. P-Rme was a safe and effective step during VPD. The rate of CR in the study group was 100% achieved thanks to the addition of the P-Rme. No procedure specific post-operative complications occurred but 3.8% of the patients had unplanned additional surgery related to these procedures.

Improving surgical technique for tracheal resection with anastomosis

To present modern aspects of improving surgical techniques in tracheal resection developed in recent years. The authors have the most extensive experience in tracheal surgery (>2.000 patients over the past 50 years). Diagnostic capabilities, perioperative management and surgical techniques have changed over such a long period. This concerns the proposed classification of cicatricial tracheal stenosis, features of endoscopic and X-ray diagnostics, indications for various surgeries, choice of surgical approach, technique of tracheal tube mobilization and anastomosis after tracheal excision. Preventive measures for severe postoperative complications are described. Such an extensive experience allowed the authors to develop an algorithm for the treatment of patients with tracheal stenosis. This significantly reduced the incidence of postoperative complications and mortality. Replication of such equipment is associated with technical support of hospitals and professional level of specialists consisting of endoscopist, anesthesiologist, intensive care specialist and thoracic surgeon.

Single-port intragastric wedge resection using the tunnel method: a novel surgical approach for treating endophytic gastric subepithelial tumors.

Intragastric wedge resection is an effective method for treating endophytic gastric subepithelial tumors (SETs). However, retracting the stomach wall to the umbilicus is difficult in certain patients. In response, we developed a novel surgical technique for single-port intragastric wedge resection, which we termed the "tunnel method." A transumbilical incision is made, and a wound retractor is applied. After diagnostic laparoscopy, a gastrostomy is made on the greater curvature, lower body. Another small wound retractor is inserted into the gastrostomy, and extracted through the transumbilical incision, creating a tunnel from the gastrostomy site to the umbilicus. Articulating laparoscopic instruments are inserted via the tunnel, and intragastric wedge resection is performed. We collected and analyzed the clinicopathologic and operative data of patients who underwent intragastric wedge resection via the tunnel method. Twenty-seven patients who underwent single-port intragastric wedge resection via the tunnel method in a single tertiary referral hospital were included in this study. The mean age of the patients was 54.6 ± 11.4years, body mass index was 26.5 ± 3.4kg/m2. Twenty-four (88.9%) patients had tumors located in the upper third of the stomach. The average operative time was 65.0 ± 24.2min. None of the patients experienced Clavien-Dindo grade IIIa or higher postoperative complications. The average postoperative hospital stay length was 2.5 ± 0.8days. Thirteen gastrointestinal stromal tumors, nine leiomyomas, and one neuroendocrine carcinoma, schwannoma, lipoma, spindle cell proliferative lesion, and fibrotic lesion were pathologically diagnosed. The average tumor size was 2.6 ± 1.3cm. All cases had negative resection margins. Single-port intragastric wedge resection by the tunnel method is a feasible and safe approach for treating endophytic gastric SETs.

Анализ эффективности дозированной хирургической резекции леватора верхнего века при лечении врожденного блефароптоза у детей

Purpose. Analysis of the clinical efficacy of dosed resection of the upper eyelid’s levator in congenital blepharoptosis in children. Material and methods. 54 children with congenital blepharoptosis (54 eyes) from 4 to 14 years old. It was diagnosed mild form in 4 eyes, moderate form in 11 eyes, and severe form in 29 eyes. In 47 children, blepharoptosis was complicated by obscurative amblyopia of various degrees (87%), in 21 children it was combined with concomitant monolateral strabismus: from +10° to +25° Hirschberg. Method of surgical resection of the upper eyelid’s levator with preservation of Whitnall’s ligament: linear skin incision along the orbito-palpebral fold, followed by isolation of the levator and it’s cutting off from the place of attachment to the tarsal plate by 5–18 mm (depending on the degree of ptosis). Three U-shaped sutures were placed through the levator with their subsequent fixation to the tarsal plate, with resection of the levator and two interrupted sutures on the skin with the capture of the underlying tissues in the areas of the outer and inner corners of the eye. All surgeries went as planned with no complications. Results. On the 10th day, 51 children had the correct position of the upper eyelid, in both eyes it became symmetrical. The palpebral fold was well contoured, it also became symmetrical in both eyes. The excursion of the upper eyelids in this group of children corresponded to that in paired eyes. In two children, the width of the palpebral fissure in the operated eyes turned out to be 1–2 mm less than in the healthy ones, in one child hyper effect of the operation was noted, he underwent reoperation. After 3 years, the initially achieved effect of the operation was preserved in 52 children (96.3%). Conclusion. The use of the technique of surgical resection of the upper eyelid’s levator in the treatment of blepharoptosis of various degrees of severity in children showed high clinical efficacy – 96.3% after 3 years of observation. Key words: congenital blepharoptosis in children, ptosis of upper eyelid, dosed resection of upper eyelid’s levator

Long-Acting Nanohybrid Hydrogel Induces Persistent Immunogenic Chemotherapy for Suppressing Postoperative Tumor Recurrence and Metastasis.

Despite the continuous advancement of surgical resection techniques, postoperative tumor recurrence and metastasis remain a huge challenge. Here, we constructed an injectable curcumin/doxorubicin-loaded nanoparticle (NanoCD) hydrogel, which could effectively inhibit tumor regrowth and metastasis via reshaping the tumor immune microenvironment (TIME) for highly effective postsurgical cancer treatment. NanoCD was prepared by the controlled assembly of curcumin (CUR) and doxorubicin (DOX) via π-π stacking and hydrogen bonding in the presence of human serum albumin. To facilitate prolonged treatment of postsurgical tumors, NanoCD was further incorporated into the temperature-sensitive Poloxamer 407 gel (NanoCD@Gel) for intracavity administration. Mechanistically, DOX induced the generation of intracellular reactive oxygen species (ROS) and CUR reduced the ROS metabolism by inhibiting thioredoxin reductase (TrxR). The synergy of DOX and CUR amplified intracellular ROS levels and thus resulted in enhanced immunogenic cell death (ICD) of tumor cells. Upon being injected into the tumor cavity after resection, the in situ-generated NanoCD@Gel allowed the local release of CUR and DOX in a controlled manner to induce local chemotherapy and persistently activate the antitumor immune response, thereby achieving enhanced immunogenic chemotherapy with reduced systemic toxicity. Our work provides an elegant strategy for persistently stimulating effective antitumor immunity to prevent postsurgical tumor recurrence and metastasis.

Leiomyoma of the Trachea: A Rare Tracheal Tumor

This is a case of a rare tracheal tumor, in a 45year old male farmer who presented with recurrent dyspnea for four years, initially misdiagnosed as asthma. The patient experienced worsening symptoms, including cough, hemoptysis, weight loss, and respiratory failure. Imaging and bronchoscopy revealed a tracheal mass, later identified as leiomyoma. The patient underwent tumor resection via rigid bronchoscopy, resulting in successful removal and tracheal recanalization. Postoperatively, the patient showed improvement, and follow-up examinations confirmed resolution of symptoms and absence of tumors, such as leiomyoma, are rare, often causing airway obstructions. Treatment approaches vary, including surgical resection and endoscopic techniques. In the case of wide-based tumors, surgical intervention is recommended to reduce recurrence risks. Anesthesia management is crucial due to potential airway compromise during the procedure. Although recurrence rates for leiomyoma are unknown, incomplete bronchoscopic resection has been associated with reoccurrence, necessitating surgery and carinal reconstruction.

Optimal surgical techniques for curative resection of the rectal cancer

Abstract The aim of rectal cancer surgery is to achieve a curative resection by completely removing the rectum involved with cancer surrounding the mesorectum, obtaining a safe adequate resection margin, and preserving important structures crucial for the patient's quality of life. Optimal dissection along the avascular embryological fusion line and among deep invisible structures is essential. Whereas a minimally invasive surgical approach allows for better visibility of deep pelvic structures compared with the open surgery period, the sequence of dissection and anatomical knowledge about pelvic fascia and relevant nerve structures are crucial for safe pelvic dissection in terms of oncologic and functional outcomes. In this review, we represent practical technical tips based on personal experience and previous studies to achieve the mentioned goals.

Pediatric Spinal Giant Cell-rich Osteosarcoma: Case Report and Brief Literature Review.

Osteosarcoma, the most common primary malignant bone tumor in childhood, very rarely occurs in the spine. Criteria of complete tumor resection/stable reconstruction of osteosarcoma and the latest protocol of neoadjuvant chemotherapy of the spine have not been reported because of its rarity, technical difficulties, and its continued severe surgical risk. A 11-year-old female complained of back pain for several months and walking disability. The workup discovered a large destructive bone lesion in the thoracic 12th (Th12) with vertebral body collapse and subluxation, large amount of associated anteroposterior soft tissue components, and narrowing of the spinal canal. Histology at the 1st decompression and emergent instrumentation surgery revealed giant cell-rich osteosarcoma. Following the 1st surgery, we performed three cycles of neoadjuvant chemotherapy based on the osteosarcoma 95J (NECO95J) protocol and evaluated efficacy of chemotherapy on the Th12 tumor. The tumor was isolated only to Th12 spine following chemotherapy. Therefore, following vascular embolization of the Th12 tumor, we performed surgical resection by single posterior approach that included total en bloc spondylectomy (TES). She recovered well postoperatively, without motor or sensory deficit and no back pain. Six cycles of postoperative neoadjuvant chemotherapy were administered after the 2nd surgery and TES. The patient was disease-free at the 8-months clinical and radiological follow-up and showed no neurological involvement at 8-months. We reported a case of pediatric spinal osteosarcoma, the surgical technique of complete tumor resection, and stable reconstruction of spinal osteosarcoma. We also discussed the recent neoadjuvant chemotherapy protocol for osteosarcoma.

First Brachial Cleft Anomalies in Children: An Innovative Surgical Technique Preventing External Auditory Canal Stenosis.

First branchial cleft anomalies (FBCAs) are rare congenital malformations that require complete surgical removal. A stenosis of the external auditory canal (EAC) may be the consequence of the disease and its treatment. The aim of this study is to present the details and results of an innovative surgical technique using part of the abnormality for reconstruction purposes. This study covered 28 surgically treated children with FCBA between 2014 and 2021. The analysis included the clinical manifestation form of the abnormality, presence of the EAC deformity, histopathological results, complications, and distant results. On the basis of Work's classification system, 15 pediatric patients with type II FBCA and 13 children with type I FBCA were included in the further study. One child with type II FBCA and two with type I FBCA had a normal EAC. The preoperative appearance of the EAC was classified into three main types, each potentially accompanied by a skin ostium of the sinus/fistula in the EAC. Reconstruction with our technique was performed in 14 children (1 with type I FBCA and 13 with type II FBCA). Wound healing was uncomplicated in all cases. No recurrences were observed. This innovative surgical technique of the subtotal resection of FBCAs with simultaneous reconstruction is safe and prevents postoperative EAC stenosis. Despite the deliberate use of part of the abnormality wall for reconstructive purposes, it remained free of recurrences.

The transfrontal isthmus approach for insular glioma surgery.

The classic transopercular or transsylvian approach to insular gliomas removes the tumor laterally through the insular cortex. This study describes a new anteroposterior approach through the frontal isthmus for insular glioma surgery. The authors detailed the surgical techniques for resection of insular gliomas through the transfrontal isthmus approach. Fifty-nine insular gliomas with at least Berger-Sanai zone I involvement were removed with the new approach, and extent of resection and postoperative neurological outcomes were assessed. Fifty-nine patients were enrolled in the study, including 35 men and 24 women, with a mean (range) age 44.3 (19-75) years. According to the Berger-Sanai classification system, the most common tumor was a giant glioma (67.8%), followed by involvement of zones I and IV (18.6%). Twenty-two cases were Yaşargil type 3A/B, and 37 cases were Yaşargil type 5A/B. The average angle between the lateral plane of the putamen and sagittal line was 33.53°, and the average width of the isthmus near the anterior insular point was 33.33 mm. The average angle between the lateral plane of the putamen and the sagittal line was positively correlated with the width of the isthmus near the anterior insular point (r = 0.935, p < 0.0001). The median (interquartile range [IQR]) preoperative tumor volume was 67.82 (57.64-92.19) cm3. Of 39 low-grade gliomas, 26 (66.67%) were totally resected; of 20 high-grade gliomas, 19 (95%) were totally resected. The median (IQR) extent of resection of the whole group was 100% (73.7%-100%). Intraoperative diffusion-weighted imaging showed no cases of middle cerebral artery- or lenticulostriate artery-related stroke. Extent of insular tumor resection was positively correlated with the angle of the lateral plane of the putamen and sagittal line (r = -0.329, p = 0.011) and the width of the isthmus near the anterior insular point (r = -0.267, p = 0.041). At 3 months postoperatively, muscle strength grade exceeded 4 in all cases, and all patients exhibited essentially normal speech. The median (IQR) Karnofsky performance score at 3 months after surgery was 90 (80-90). The transfrontal isthmus approach changes the working angle from lateral-medial to anterior-posterior, allowing for maximal safe removal of insular gliomas.

Progress and reflection of conversion therapy for locally advanced pancreatic cancer

With the improvement of nonsurgical treatment in pancreatic cancer, the increasing accuracy of subclassification of anatomy, and the continuous refinement of surgical resection techniques, more and more locally advanced pancreatic cancer(LAPC) patients have the opportunity to undergo conversion surgery and achieve survival benefits,which has attracted the attention of scholars in this field. Despite the numerous prospective clinical studies conducted, there is still a lack of high-level evidence-based medical evidence in terms of conversion treatment strategies, efficacy evaluation, surgical timing and survival prognosis, and there are not yet specific quantitative standards and guiding principles for conversion treatment for these patients in clinical practice, and the indications for surgical resection rely more on the experience of each center or surgeon, lacking consistency. Therefore,the indicators for the evaluation of the efficacy of conversion treatment in patients with LAPC were summarized to reflect on the different modes of conversion treatment and clinical outcomes currently being explored, expecting to provide more accurate recommendations and guidance for the clinic.

The prognostic significance of early troponin levels in patients undergoing aortic ridge surgery.

Subaortic stenosis is a CHD that can lead to left ventricular hypertrophy, heart failure, and aortic valve damage if left untreated. The gold standard treatment for subaortic stenosis is septal myectomy. However, there is no clear consensus on the surgical margins required for adequate muscle resection. In this retrospective study, we reviewed the records of 83 patients who underwent subaortic stenosis surgery between 2012 and 2020 to investigate the effect of early troponin levels on prognosis. We excluded patients with additional cardiac pathologies, hypertrophic obstructive cardiomyopathy, and valvular aortic stenosis.Troponin levels were recorded in the early post-operative period, and patients were monitored for complications such as ventricular arrhythmia, left ventricular systolic dysfunction, infective endocarditis, and pacemaker implantation. The troponin levels were significantly higher in the patients who had septal myectomy. The degree of myectomy affected the risk of complications in the early post-operative period and recurrence in the later period. However, when the gradient was substantially or completely removed by myectomy, patients experienced significant symptom improvement in the early post-operative period, and their late survival was equivalent to that of healthy individuals of the same age.Our findings suggest that monitoring troponin levels in patients undergoing septal myectomy may be beneficial in predicting the risk of complications. However, further studies are needed to establish the optimal surgical technique and extent of muscle resection required for subaortic stenosis treatment. Our study adds to the existing knowledge of the benefits and risks associated with septal myectomy as a treatment option for subaortic stenosis.