Different limited resection of pulmonary lobe methods under the thoracoscopy in the treatment of early nonsmall cell lung cancer occurred in the old age.

OBJECTIVES: The objective was to explore clinical effect of limited resection of lung lobe under the thoracoscopy in the treatment of early nonsmall cell lung cancer occurred in the old age. METHODS: A total of 150 patients with nonsmall cell lung cancer in the old age is treated by limited resection of lung lobe under thoracoscope. It can be divided into segmental resection group and wedge resection group by surgical methods, to make a comparative analysis of operation time, intraoperative blood loss, hospital stays, and complications during the perioperative period. And there will be postoperation follow‑up on survival, relapse and death situation etc., RESULTS: 10 cases are changed to make other operation because of maladaptation to limited resection, and a total of 140 patients have undergone limited resection. Operation time and hospital stays of wedge resection group are shorter than those of segmental resection group (P < 0.05); compared with the bleeding and indwelling drainage tube time in two groups, differences have no statistical significance (P > 0.05). Compared with cases of complications, recurrence and death for groups of segmental resection and wedge resection group, the differences have no statistical significance (P > 0.05). CONCLUSION: Limited resection of lung lobe in the early treatment of nonsmall cell lung cancer occurred in the old age under the thoracoscopy is safe and feasible.

Treatment of Locally Advanced Thyroid Cancer / 대한내분비외과학회지

Thyroid cancer is an indolent condition that usually presents as a limited disease in the neck. Invasion to vital organs is rarely observed; however, it can be a major cause of mortality, even in well-differentiated thyroid cancers. The common sites of local invasion are strap muscle, recurrent laryngeal nerve, laryngo-tracheal tree, esophagus, and great vessels in the lateral compartment and mediastinum. Uncontrolled invasion to vital organs in the neck and mediastinum can cause significant morbidity and affect quality of life and survival. Limited involvement of the aero-digestive tract can be controlled by conservative surgical treatments such as shaving-off procedures, while radical resection and subsequent reconstructive procedures are the best choice for more serious cases. In planning the treatment, the risk-benefit ratio should be carefully evaluated to reduce the morbidity, as well as achieve maximal therapeutic effects. Postoperative adjuvant therapies have been the subject of controversy, but there is a general consensus, especially for high-risk patients, that radioiodine therapy and TSH suppression after radical resection are beneficial. The benefits of external beam radiation therapy are unclear, but it should be considered in patients with microscopic residual disease. In conclusion, radical eradication of lesions followed by proper adjuvant therapy is the treatment of choice for locally advanced thyroid cancers.

Comparative Analysis of Limited Resection and Conventional Resection for Pancreatic Benign Lesions Focused on Perioperative Diabetes and Pancreatic Fistula

PURPOSE: Pancreaticoduodenectomy (PD) or distal pancreatectomy (DP) are treatments used for pancreatic benign neoplasms even though both of these treatments result in significant loss of normal pancreatic parenchyma; this leads to subsequent impairment of exocrine and endocrine pancreatic function. The purpose of this study is to provide short-and long-term result of limited resection (LR) in a single center. METHODS: Two-hundred thirty patients who had undergone pancreatic resection between April 1998 and September 2008 for benign neoplasms were reviewed retrospectively. DP was performed in 102 patients, LR in 77, PD in 51 patients. The definitions of the International Study Group of Pancreatic Fistula (ISGPF) were applied to postoperative pancreatic fistulas (POPF), perioperative endocrine function was evaluated through oral glucose tolerance test. RESULTS: LR includes 42 enucleation, 24 central pancreatectomy, and 11 uncinate process resection. No deaths occurred to patients during the study review period; POPF was detected in 50 patients (65%), 37 patients with grade A and 13 patients with grade B or C. POPF occurred 65% of the time after LR, more frequently compared to the occurrance after PD or DP (58%), but this was not statistically significant (P =.322). After LR, there were 2 patients with new onset diabetes (3%), while 26 (17%) patients developed diabetes after DP or PD (P = .002). CONCLUSION: LR may preserve endocrine and exocrine function. While mortality is low with the use of LR, it is associated with a higher pancreatic-leakage rate. The precise management of benign pancreatic lesions remains in evolution.

Limited Resection for Lung Cancer

Lesser resection than lobectomy for lung cancer has been discussed for years and there has been world consensus in that the indication is only acceptable for compromised patients. However, the present wide use of high resolution computed tomography (HRCT) has resulted in an increased detection of tumors less than two centimeters in diameter. In spite of a randomized study reported by LCSG in 1995, which concluded that intentional limited resection was inferior to standard lobectomy, studies supporting the use of limited resection for early cancer continue to be published, especially from Japan, and currently even from the US. Improved surgical technique that allows the identification of the intersegmental plane has facilitated the application of segmentectomy beyond an affected segment with wide margin, which decreases the risk of local recurrence. The ratio of characteristic tumor shadow with ground glass opacity (GGO) to whole tumor size on HRCT is a good indicator of malignancy. In selected patients with a small-sized peripheral tumor with 100% GGO can be removed even with wedge resection. It is time to start a randomized, large series trial of patients with a peripheral tumor less than 2 cm, and in the near future, subsets of patients who could be successfully treated by sublobar resection should be identified

Treatment of Locally Advanced Thyroid Cancer

Thyroid carcinoma is a slowly growing tumor and rarely invades adjacent tissues or organs. However, up to 21% of the patients with well-differentiated thyroid cancers show local invasion, and of those 10 to 15% of patients with papillary cancer who eventually die of the disease, active local disease has been the most common finding at the time of death. The common sites of local invasion are strap muscle, recurrent laryngeal nerve, laryngotracheal tree, esophagus, and great vessels in the lateral compartment and mediastinum. Uncontrolled local invasion to vital organs in the neck causes significant morbidity, affects the quality of life, and finally influences the survival. In cases with limited involvement of the larynx or trachea, the option of treatment includes limited shaving-off resection or radical resection followed by reconstructive procedures. When operation is planned, the level of acceptable morbidity and the achievement of therapeutic outcomes should be determined in advance. In cases with aggressive invasion to the adjacent tissues, radical resection is the treatment modality of choice with favorable prognosis. Postoperative adjuvant therapies have been the matter of controversy, however, there is a general consensus, especially for the high-risk patients, that radioiodine therapy and TSH suppression after radical resection are beneficial. The benefits of external radiation therapy in locally advanced thyroid cancers are unclear, however, it can be effective in patients with microscopic residual disease postoperatively. Radical eradication of locally advanced thyroid carcinoma followed by appropriate adjuvant therapy should be considered to be the treatment of choice in locally advanced thyroid cancers.