A meta?analysis of prognostic factors in patients with left?sided pancreatic cancer

Background: Patients with ductal adenocarcinoma of the body and tail of the pancreas usually remain asymptomatic until late in the course of the disease, and the survival of such patients depends on multiple factors, which may affect the therapeutic approach and patient survival. Hence, the aim of this study was to investigate such risk factors by pooling various available studies. Methods: A systematic review was conducted according to PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines between January 1, 2007, and December 31, 2016, using the following databases: Medline, Scopus, the Cochrane Library, and Google Scholar. Studies were selected according to the predesigned eligibility criteria, and information was extracted for demographics, clinical features, and survival outcomes. Data were pooled using fixed- or random-effects models. Results: Sixteen studies were included (5,660 patients) with a median age of 64.8 years and a median survival of 28.5 (range 13–38) months. Identified significant factors for overall survival were higher age (hazard ratio [HR] = 1.211), men (HR = 1.182), presence of lymph node metastasis (HR = 1.964), multivisceral resection (HR = 1.947), N stage (1 versus 0; HR = 1.601), surgical margin (R0 versus No R0; HR = 0.519) and tumor size (>3 cm; HR = 1.890). Conclusion: The pooled results of this study revealed several risk factors for overall survival in patients with left-sided pancreatic cancer.

Colecistitis aguda en vesícula biliar izquierda. Presentación de un caso resuelto en forma segura por vía laparoscópica / Acute cholecystitis in a left sided gallbladder safely managed by laparoscopic surgery

RESUMEN La vesícula izquierda (VI) es una rara anomalía de la vía biliar que, cuando enferma, no suele dar sín tomas diferentes de aquella normoposicionada, haciendo infrecuente su diagnóstico preoperatorio. Presentamos el caso de una colecistitis aguda en un paciente con VI, resuelto en forma segura por vía laparoscópica. Un paciente ingresa por un cuadro típico de colecistitis aguda. Como hallazgo in traoperatorio se constata una vesícula biliar inflamada, ubicada en posición siniestra. Se modificó la ubicación de los puertos de trabajo y se realizó colangiografía transvesicular por punción, antes de iniciar la disección del hilio vesicular. Luego de identificar el conducto cístico, se realizó colangiografía transcística que confirmó la anatomía de la vía biliar completa y expedita. Se completó la colecistec tomía laparoscópica en forma segura. El hallazgo de una VI obliga al cirujano a cambiar la técnica de una colecistectomía laparoscópica. Esta anomalía incrementa el riesgo de lesiones de la vía biliar. La disección cuidadosa del hilio vesicular logrando una visión crítica de seguridad y el uso de colangiogra fía intraoperatoria son de extrema importancia para una colecistectomía segura.

ABSTRACT Left-sided gallbladder (LSGB) is a rare bile duct abnormality, usually found during a cholecystectomy. Symptoms usually do not differ from those of a normally positioned gallbladder, making the preoperative diagnosis extremely uncommon. We report the case of an acute cholecystitis in a patient whit LSGB, safely managed with laparoscopic surgery. A 24-year-old male patient was admitted to our institution with clinical and radiological signs of acute cholecystitis. The intraoperative finding of an acute cholecystitis in a LSGB made us modify ports positioning and a cholangiograhy was done by direct puncture of the gallbladder before hilum dissection. After the cystic duct was identified, a transcystic cholangiography was performed which confirmed a complete and clear bile duct anatomy and laparoscopic cholecystectomy was safely completed. The intraoperative finding of a LSGB makes the surgeon change some aspects of the usual technique to perform a safe cholecystectomy as LSGB significantly increases the risk of common bile duct injuries. Meticulous dissection of the gallbladder hilum to achieve a critical view of safety and the systematic use of intraoperative cholangiography are extremely important to perform a safe laparoscopic cholecystectomy.

Recent Advances on the Differences between Left- and Right-sided Colorectal Cancer / 中国医学科学院学报

Right-sided colon cancer and left-sided colorectal cancer have significant differences in epidemiology,clinical features,tumor differentiation,response to treatment,prognosis,and molecular characteristics.The former has lower prevalence than the latter and is mainly associated with female and elderly patients,with poor tumor differentiation,strong invasion,poor prognosis,and weak response to epidermal growth factor receptor inhibitors.Thus,it is generally believed that the primary location of colorectal cancer is closely associated with prognosis,acting as an independent prognostic factor for therapeutic efficacy.Recent studies have revealed the genetic differences between right-sided colon cancer and left-sided colorectal cancer,providing explanations for the biological differences.This review summarizes the recent advances on the differences between left-and right-sided colorectal cancer.

Tumour sidedness and clinicopathological features of resected colon cancer in rural population of Northern Pakistan: single institutional analysis / Lateralidade tumoral e características clínico-patológicas do câncer de cólon ressecado na população rural do norte do Paquistão: análise em uma única instituição

ABSTRACT Objectives: Different clinicopathological and molecular features have been demonstrated between right and left sided colon cancers. We aimed to characterize colon cancer and sidedness among a North-Pakistani rural population diagnosed with colon cancer in our institution. Methods: Seventy patients were included in the study that received adjuvant chemotherapy at Bannu Institute of Nuclear Medicine Oncology and Radiotherapy) Bannu, Pakistan from January 2014 to December 2017. Chi-square test was used for significance of categorical variables. p-Values less than 0.05 were considered significant. Results: Mean age at diagnosis for right side colon cancer patients was 43.94 years and for left side colon cancer, it was 49.83 with no significant difference. Male patients were presented more with right (77% vs. 54%, p = 0.044) and females with predominantly left sided tumours i.e. (46% vs. 23%, p = 0.044). Right sided cancer tended to be more poorly differentiated (20% vs. 0%, p = 0.020). Mucinous adenocarcinoma was seen mostly in right sided colon cancer (37% vs. 3%, p ≤ 0.001). There were more locally advanced presentation of right side colon cancer with more node positive (83% vs. 60%, p = 0.025) and lymphovascular invasion (51% vs. 37%, p = 0.016). Sigmoid colon was the most common tumour subsite involved. Conclusion: Our study is the first report of colon cancer in a rural population in North-Pakistan. An earlier onset of tumours (44-50 years) was observed in comparison with global data.

RESUMO Objetivo: Características clínico-patológicas e moleculares distintas foram observadas em tumores de cólon no lado direito ou esquerdo. O presente estudo teve como objetivo caracterizar o câncer de cólon e sua lateralidade em uma população rural norte-paquistanesa diagnosticada com câncer de cólon nesta instituição. Métodos: O estudo incluiu 70 pacientes que foram submetidos a quimioterapia adjuvante no Instituto Bannu de Medicina Nuclear Radioterapia Oncológica (BINOR), Bannu, Paquistão, entre janeiro de 2014 e dezembro de 2017. O teste qui-quadrado foi utilizado para mensurar a significância das variáveis categóricas. Valores de p menores que 0,05 foram considerados significativos. Resultados: A média de idade ao diagnóstico entre pacientes com câncer de cólon no lado direito foi de 43,94 anos e entre aqueles com câncer de cólon no lado esquerdo, 49,83, sem diferença significativa. Os pacientes do sexo masculino apresentaram mais tumores no lado direito (77% vs. 54%, p = 0,044) e as pacientes do sexo feminino apresentaram mais tumores no lado esquerdo (46% vs. 23%, p = 0,044). Tumores mal diferenciados foram mais comumente observados no lado direito (20% vs. 0%, p = 0,020). Adenocarcinoma mucinoso foi observado principalmente em casos de tumores no lado direito (37% vs. 3%, p ≤ 0,001). A apresentação local estava mais avançada em tumores de cólon no lado direito, com mais linfonodos positivos (83% vs. 60%, p = 0,025) e invasão linfovascular (51% vs. 37%, p = 0,016). O cólon sigmoide foi o sublocal mais comum. Conclusão: O presente estudo é o primeiro relato de câncer de cólon em uma população rural no norte do Paquistão. Em comparação com dados globais, observou-se um surgimento mais precoce dos tumores (44-50 anos).

Application of transseptal puncture to radiofrequency catheter ablation in children with left accessory pathway induced paroxysmal supraventricular tachycardia / 中华实用儿科临床杂志

Objective To explore the value of transseptal puncture for left-sided accessory pathway in radio-frequency catheter ablation in children with paroxysmal supraventricular tachycardia(PSVT). Methods Thirty-three patients with PSVT who had underwent radiofrequency catheter ablation in the First Affiliated Hospital,Sun Yat-Sen University from January 2012 to December 2017 were retrospectively analyzed. All the cases were treated by transaortic approach(transaortic group)or transseptal approach(transseptal group). The immediate success rates,total fluoroscopy time and radiation exposure between 2 groups were compared,and the perioperative complications and recurrence rates were observed between 2 groups. Results Thirty-three cases of children were enrolled,22 cases were male and 11 cases were female. Nineteen cases were treated by transaortic approach(transaortic group),while 18 cases were treated by transseptal approach(transseptal group),including 4 recurrent cases in the transaortic group who were switched to transseptal approach because of previous treatment failure. The age was(10. 16 ± 3. 06)years and(10. 67 ± 2. 20) years,and the weight was(37. 68 ± 14. 28)kg and(37. 33 ± 8. 64)kg,respectively. There were no significant diffe-rences in age and weight statistics between 2 groups(all P>0. 05). The total fluoroscopy time was(20. 16 ± 11. 41) minutes and(12. 56 ± 5. 23)minutes,and the median dose of radiation exposure was 67. 0 mGy and 33. 5 mGy,re-spectively. The postoperative recurrence rate was 21%(4/19 cases)and 0(0/18 cases),respectively. There were sig-nificant differences in total fluoroscopy time,radiation exposure and recurrence rate statistics between 2 groups( t ＝2. 627,Z＝ -2. 31,χ2 ＝4. 249,all P<0. 05). No complications were found in both 2 groups. Conclusions It is safe and feasible by transseptal puncture for left-sided accessory pathway in radiofrequency catheter ablation in children with PSVT. Radiofrequency catheter ablation by transseptal approach could significantly reduce the postoperative recu-rrence rate,and should be the first choice for left-side accessory pathway in children.

Correlation between the Depth of the Left-Sided Double-Lumen Tube and Specific Body Landmarks / 中国医科大学学报

Objective To investigate the correlation between the insertion depth of the left-sided double-lumen tube (DLT) and some specific body landmarks in order to guide left-sided DLT intubation. Methods Ninety-five adult patients who underwent thoracic surgery were chosen, and the age (A), sex (S), height (H), weight (W), distance between the cricothyroid membrane and upper notch of the sternum angle (L), size of the left-sided DLT (F), and predicted depth of intubation (y) were recorded. After anesthesia induction, the final corrected insertion depth of the left-sided DLT (Y) were recorded using fiberoptic bronchoscopy. The Y and y were compared.Linear regression and Pearson's correlation analysis were used to analyze the data. Results There was no difference between the Y and y (P＞ 0.05). The Y was significantly correlated with H, W, and L (P ＜ 0.01), and was not correlated with A (P＞ 0.05). Three linear regression equations for H, L, and Y were obtained. H and L were linearly dependent on Y, and the determination coefficients R2 were 0.43 (Y=7.285+0.128 H) and 0.41 (Y=19.305+0.866 L), respectively. Using both H and L as the independent variables, the determination coefficient R2 was 0.56 (Y=8.127+0.087 H+0.559 L). Conclusion The linear regression equation Y=8.127+0.559 H+0.087 L could be used as a rapid method to assess the insertion depth of the left-sided DLT. However, the ideal insertion depth of the left-sided DLT still needs to be confirmed using fiberoptic bronchoscopy.

Korean First Prospective Phase II Study, Feasibility of Prone Position in Postoperative Whole Breast Radiotherapy: A Dosimetric Comparison / Journal of the Korean Cancer Association, 대한암학회지

PURPOSE: This first Korean prospective study is to evaluate the feasibility of prone breast radiotherapy after breast conserving surgery for left breast cancer patients who have relatively small breast size and we present dosimetric comparison between prone and supine positions. MATERIALS AND METHODS: Fifty patients underwent two computed tomography (CT) simulations in supine and prone positions. Whole breast, ipsilateral lung, heart, and left-anterior-descending coronary artery were contoured on each simulation CT images. Tangential-fields treatment plan in each position was designed with total 50 Gy in 2-Gy fractions, and then one of the positions was designated for the treatment by comparing target coverage and dose to normal organs. Also, interfractional and intrafractional motion was evaluated using portal images. RESULTS: In total 50 patients, 32 cases were decided as prone-position–beneficial group and 18 cases as supine-position–beneficial group based on dosimetric advantage. Target dose homogeneity was comparable, but target conformity in prone position was closer to optimal than in supine position. For both group, prone position significantly increased lung volume. However, heart volumewas decreased by prone position for prone-position–beneficial group but was comparable between two positions for supine-position–beneficial group. Lung and heart doses were significantly decreased by prone position for prone-position–beneficial group. However, prone position for supine-position–beneficial group increased heart dose while decreasing lung dose. Prone position showed larger interfractional motion but smaller intra-fractional motion than supine position. CONCLUSION: Prone breast radiotherapy could be beneficial to a subset of small breast patients since it substantially spared normal organs while achieving adequate target coverage.

An effective patient training for deep inspiration breath hold technique of left-sided breast on computed tomography simulation procedure at King Chulalongkorn Memorial Hospital

PURPOSE: To observe the effectiveness of the practical instruction sheet and the educational video for left-sided breast treatment in a patient receiving deep inspiration breath hold (DIBH) technique. Two parameters, simulation time and patient satisfaction, were assessed through the questionnaire. METHODS: Two different approaches, which were the instruction sheet and educational video, were combinedly used to assist patients during DIBH procedures. The guideline was assigned at least 1 week before the simulation date. On the simulation day, patients would fill the questionnaire regarding their satisfaction with the DIBH instruction. The questionnaire was categorized into five levels: extremely satisfied to dissatisfied, sequentially. The patients were divided into four groups: not DIBH technique, DIBH without instruction materials, the DIBH with instruction sheet or educational video, and DIBH with both of instruction sheet and educational video. RESULTS: Total number of 112 cases of left-sided breast cancer were analyzed. The simulation time during DIBH procedure significantly reduced when patients followed the instruction. There was no significant difference in simulation time on the DIBH procedures between patient compliance via instruction sheet or educational video or even following both of them. The excellent level was found at 4.6 ± 0.1 and 4.5 ± 0.1, for patients coaching via instruction sheet as well as on the educational video, respectively. CONCLUSION: Patient coaching before simulation could potentially reduce the lengthy time in the simulation process for DIBH technique. Practicing the DIBH technique before treatment is strongly advised.

The impact of continuous positive airway pressure on radiation dose to heart and lung during left-sided postmastectomy radiotherapy when deep inspiration breath hold technique is not applicable: a case report

Deep inspiration breathing hold (DIBH) compared to free-breathing (FB) during radiotherapy (RT) has significantly decreased radiation dose to heart and has been one of the techniques adopted for patients with breast cancer. However, patients who are unable to make suitable deep inspiration breath may not be eligible for DIBH, yet still need to spare the heart and lung during breast cancer RT (left-sided RT in particular). Continuous positive airway pressure (CPAP) is a positive airway pressure ventilator, which keeps the airways continuously open and subsequently inflates the thorax resembling thoracic changes from DIBH. In this report, authors applied CPAP instead of FB during left-sided breast cancer RT including internal mammary node in a patient who was unable to tolerate DIBH, and substantially decreased radiation dose the heart and lung with CPAP compared to FB.

Comparison of clinicopathological features and survival between patients with left-sided colon cancer and rectal cancer / 中国肿瘤生物治疗杂志

@#[Abstract] Objective: To compare the differences in clinical and pathological features and survival time between patients with left -sided colon cancer and rectal cancer. Methods:Atotal of 323 patients with colorectal cancer (CRC) underwent surgical resection at Changhai Hospital of the Second Military Medical University between January 2011 and January 2012 were enrolled in this study. The clinical data of patients were collected and the follow-up was started from the day of surgery or pathological confirmation with the death of patients as endpoints. The follow-up lasted untilAugust 1,2017. Results: There were significant differences in initial symptoms, pathologic type, tumor stage, anemia before surgery, p53 positive rate, and BRAF mutation (χ2=59.088， 4.188， 24.305， 11.956， 4.221， 4.001， all P<0.05) between patients with left-sided colon cancer and rectal cancer. For all the patients, the median survival time was not observed. The five-year survival rates of patients with left-sided colon cancer and rectal cancer were 79.2% and 74.3%, respectively. The Kaplan-Meier survival curves of patients at StageⅠ-Ⅱshowed that there was no statistical difference between patients with left-sided colon cancer and rectal cancer（P=0.840） and the survival of Stage Ⅲ patients between the two groups also showed no statistical difference (P=0.106). Cox regression analysis showed that both the pathologic types [HR=1.759, P=0.047] and tumor stage [HR=2.104, P<0.001] were independent predictive factors for OS of CRC patients. Conclusion: There were no differences in survival time between patients with left-sided colon cancer and rectal cancer. The pathologic types and tumor stage were factors influencing the OS of CRC patients.

Results of single-patch with elevation of the left-sided atrioventricular valve repair for complete atrioventricular septal defect / 中华胸心血管外科杂志

Objective To analyze retrospectively the results of single-patch with elevation of the left-sided atrioventricular valve repair for complete atrioventricular septal defect(CAVSD) in therapeutic effects and safety.Methods Fourteen consecutive patients (2 males and 12 females) with CAVSD were enrolled in the study from April 2012 to December 2017.All patients underwent single-patch with the elevation of left-sided atrioventricular valve repair for CAVSD by regular sternotomy.The median age at operation was 12.5 months(range,11.7 months to 63 months) and the duration of follow-up was(3.27 ± 2.02)years.Echocardiography and electrocardiogram were used during follow-up according to the protocol.Results Compared with pulmonary arterial pressure(PAP) during pre-and post-operation (65.92 ± 6.91 and 62.97 ± 17.29) mmHg (1 mmHg =0.133 kPa),PAP(53.29 ± 20.99) mmHg decreased significantly during follow-up period.There were significant difference during post-operation and follow-up for LAVVR and RAVVR.The extent of regurgitation of atrioventricular valve statistically decreased during follow-up period.None of patients suffered from atrioventricular block and reoperation during follow-up.Conclusion Single-patch with elevation of the left-sided atrioventricular valve repair for CAVSD yields good outcomes,without occurrence of severe LAVVR,during early and mid-term follow-up period.

Clinical analysis on tricuspid valve replacement for secondary tricuspid regurgitation late after left-sided valve surgery / 上海交通大学学报（医学版）

Objective·To analyse the outcomes of tricuspid valve replacement (TVR) for secondary tricuspid regurgitation (STR) late after left-sided valve surgery during perioperative period and mid-term follow-up,investigate mechanisms of STR and surgical risk factors.Methods·A total of 85 consecutive patients who underwent the TVR surgery were analyzed.The perioperative and mid-term clinical outcomes were retrospectively investigated.The data were divided into bioprosthesis group (n=50) and mechanical prosthesis group (n=35) according to the prosthesis used,and divided into right anterolateral thoracotomy(RALT) group (n=51) and stemotomy(S) group (n=34) according to the surgical incision.Results·In-hospital mortality was 8.2％ (7/85).There was no significant difference in the mortality with different choice of bioprosthetic or mechanical valve (4/50 vs 3/35,x2=0.009,P=1.000);while there was significant difference between S group and RALT group (6/34 vs 1/51,x2=6.642,P=0.015).Seven cases all died of right heart failure and severe low cardiac output syndrome.Five (5.9％) cases died in perioperative within 30 in-hospital days and 2 (2.4％) cases died after 30 in-hospital days.Seventy-four cases were followed up.With the follow-up of (31.5±23.1) months,there were 4 case of late deaths(5.4％),all of whom were mechanical prosthesis,of whom 3 died in cardiac related death and 1 died in later period bowel cancer.Seventy cases survived in New York Heart Association (NYHA) class Ⅰ-Ⅱ with no coagulated accident and redo-TVR.Conclusion·The perioperative and mid-term clinical outcomes are satisfied in timely and reasonable TVR with the standard follow-up for STR late after left-sided valve surgery.Right anterolateral incision is recommend for isolated TVR.

Prognostic factors of patients with stagesI - III left-sided versus rightsided colon cancer receiving radical surgery / 肿瘤

Objective: To investigate the prognostic factors of patients with stages I-III left-sided colon cancer (LCC) versus right-sided colon cancer (RCC) receiving radical surgery. Methods: A retrospective analysis of clinical data from 332 patients with stages I-III colorectal cancer (CRC) who underwent radical surgery in Anhui Provincial Hospital, Anhui Medical University between February 2008 and February 2012 was conducted. The differences in clinicopathological characteristics by tumor location (RCC vs LCC) were examined by using χ2 test. The comparisons of overall 5-year survival rate between RCC and LCC within each stage and for all stages were done by using Kaplan-Meier method. The univariate analysis of prognosis was performed by using log-rank test, and the multivariate analysis was performed by using COX regression model. Results: The overall 5-year survival rate of all patients was 69.9%. The LCC patients had significantly higher overall 5-year survival rate than RCC patients (72.6% vs 66.9%, P = 0.020). The stage III LCC patients had significantly higher overall 5-year survival rate than the stage III RCC patients (62.5% vs 52.2%, P = 0.018), but no significant difference in overall 5-year survival rate was found between stage I or II RCC and LCC patients (P > 0.05). There were significant differences in T stage, histologic type, degree of differentiation, tumor size, hemoglobin, albumin, fibrinogen and carcinoembryonic antigen (CEA) between RCC and LCC patients (all P < 0.05). The univariate analysis showed that tumor location, T stage, N stage, histologic type, degree of differentiation, tumor size, hemoglobin, albumin, fibrinogen and CEA were significantly correlated with overall 5-year survival rate of CRC patients (all P < 0.05). Multivatiate analysis showed that N stage, histologic type, degree of differentiation, hemoglobin, albumin, fibrinogen and CEA were independent prognostic factors of CRC (all P < 0.05). Conclusion: For patients with stages I-III CRC treated with radical surgery, the factors of higher tumor N stage, mucinous adenocarcinoma/signet ring cell carcinoma, poorly differentiated carcinoma, anemia, hypoproteinemia, fibrinogen level more than 4 g/L and CEA level more than 10 ng/mL indicate a poor prognosis. The significant differences in clinicopathological characteristics and prognosis are found between RCC and LCC, but the tumor location is not an independent prognostic factor.

Quadricuspid Aortic Valve Complicated with Severe Aortic Regurgitation and Left-Sided Inferior Vena Cava

No abstract available.

Laparoscopic surgery for left-sided colon cancer: Clinical and long-term oncologic outcomes

PURPOSE: Laparoscopic surgery for left-sided colon cancer is one of the most frequent procedures performed in laparoscopic colorectal surgery. In this study, we analyzed clinical and long-term oncological outcomes of left-sided colon cancer patients who underwent conventional laparoscopic surgery (CLS) and hand-assisted laparoscopic surgery (HALS).METHODS: A total of 172 CLS patients and 72 HALS patients for left-sided colon cancer from July 2001 to December 2011 were included in this study. The collected data included the clinical and oncological outcomes. We analyzed overall survival and disease-free survival by tumor, node, metastasis (TNM) stage.RESULTS: The mean age of the patients was 64 years, and male patients were predominant. The mean follow-up period was 58.1 months. The number of patients that belong in each TNM stage 0, I, II, III, and IV was as follows: 17 (7%), 47 (19.2%), 70 (28.7%), 80 (32.8%), and 30 (12.3%), respectively. Overall 5-year survival rate for TNM stage I, II, III, and IV was 87.1%, 82.8%, 82%, and 12%, respectively. Overall 5-year survival rate for CLS group and HALS group was 90.2% and 66.7%, 86.5% and 77%, 88.7% and 67.4%, and 18.9% and 0%, respectively. Disease-free 5-year survival rate for TNM stage I, II, and III was 97.7%, 90.7%, and 72.8%, respectively. Disease-free 5-year survival rate for CLS group and HALS group was 97.3% and 100%, 100% and 78.8%, and 81% and 55.1%, respectively.CONCLUSION: These data show the feasibility and safety of laparoscopic surgery for left-sided colon cancer in terms of long-term oncological outcomes.

Initial experience with radical antegrade modular pancreatosplenectomy in a single institution

PURPOSE: Radical antegrade modular pancreatosplenectomy (RAMPS) is expected to be favorable for obtaining the negative tangential margin with oncologic feasibility through the horizontal dissection in a right-to-left fashion for radical lymph node dissections. METHODS: From January 2007 to February 2015, a total of 30 RAMPS and 19 conventional distal pancreatectomy (DP) cases were enrolled. The demographics, perioperative and survival outcomes were compared according to the type of surgery. RESULTS: The mean operative time, blood loss and length of hospital stay were similar between 2 groups. Morbidities were reported in 14 cases of RAMPS (46.7%) and 8 cases of DP (42.1%) (P = 0.777). The rate of negative tangential margin (96.2%) and the number of harvested lymph nodes (mean ± standard deviation, 21.5 ± 8.3) were significantly higher in RAMPS group (P = 0.011, P = 0.003, respectively). In terms of survival outcomes, there was no significant difference in regard to the overall 3-year disease-free survival (DFS; 30.4% in RAMPS vs. 35.0% in DP, P = 0.354) or overall survival (OS; 29.9% vs. 29.4%, P = 0.429) between the 2 groups. After exclusion of cases with nodal invasion, however, the RAMPS group had a longer DFS than the DP group (55.6% vs. 27.3%, P = 0.048) although OS was similar without significant difference (42.4% vs. 27.3%, P = 0.197). CONCLUSION: RAMPS is a safe and oncologically feasible procedure in left-sided pancreatic cancer by obtaining a successful negative tangential margin and radical lymph node dissection. The authors suggest it could also be useful for local control, especially for the limited left-sided pancreatic cancer without nodal invasion.

Initial experience with radical antegrade modular pancreatosplenectomy in a single institution

PURPOSE: Radical antegrade modular pancreatosplenectomy (RAMPS) is expected to be favorable for obtaining the negative tangential margin with oncologic feasibility through the horizontal dissection in a right-to-left fashion for radical lymph node dissections. METHODS: From January 2007 to February 2015, a total of 30 RAMPS and 19 conventional distal pancreatectomy (DP) cases were enrolled. The demographics, perioperative and survival outcomes were compared according to the type of surgery. RESULTS: The mean operative time, blood loss and length of hospital stay were similar between 2 groups. Morbidities were reported in 14 cases of RAMPS (46.7%) and 8 cases of DP (42.1%) (P = 0.777). The rate of negative tangential margin (96.2%) and the number of harvested lymph nodes (mean ± standard deviation, 21.5 ± 8.3) were significantly higher in RAMPS group (P = 0.011, P = 0.003, respectively). In terms of survival outcomes, there was no significant difference in regard to the overall 3-year disease-free survival (DFS; 30.4% in RAMPS vs. 35.0% in DP, P = 0.354) or overall survival (OS; 29.9% vs. 29.4%, P = 0.429) between the 2 groups. After exclusion of cases with nodal invasion, however, the RAMPS group had a longer DFS than the DP group (55.6% vs. 27.3%, P = 0.048) although OS was similar without significant difference (42.4% vs. 27.3%, P = 0.197). CONCLUSION: RAMPS is a safe and oncologically feasible procedure in left-sided pancreatic cancer by obtaining a successful negative tangential margin and radical lymph node dissection. The authors suggest it could also be useful for local control, especially for the limited left-sided pancreatic cancer without nodal invasion.

Comparison and treatment of left-and right-side colon cancer / 中国肿瘤临床

Colorectal cancer is one of the most common malignancies. Various studies have focused on differences between colon can-cers on the left and right sides. These types of colon cancer differ in terms of their molecular features, embryologic origin, anatomy, pathogenesis to physiological functions, clinical features, treatment response, and prognosis. Therefore, the left-and right-side colon cancers are regarded as different diseases. These differences have significant effect on clinical decision-making and personalized medi-cine.

Research progress on differences between left-and right-sided colon cancers / 中国肿瘤临床

In recent years, the incidence and mortality of colorectal cancer have gradually increased in China. This review sum-marized the differences in pathogenic factors, clinical manifestations, pathological features, gene expression, therapeutic modalities, and other aspects between left-and right-sided colon cancers. Results showed that the onset of both left-and right-sided colon cancers is associated with gender and age. Significant differences existed among the clinical manifestations and pathological features. Differenc-es in gene expression, allelic deletion, and DNA mismatch repair affected the occurrence, metastasis, and prognosis of left-and right-sided colon cancers. Moreover, the location of primary tumor is a potential predictor of targeted drug efficacy. Differences in survival rates are possibly related to TNM stage. Hence, new ideas for individualized treatment should be provided by analyzing the differences between left-and right-sided colon cancers.

Customized left-sided hepatectomy and bile duct resection for perihilar cholangiocarcinoma in a patient with left-sided gallbladder and multiple combined anomalies

Left-sided gallbladder (LSGB) is a rare anomaly, but it is often associated with multiple combined variations of the liver anatomy. We present the case of a patient with LSGB who underwent successful resection of perihilar cholangiocarcinoma. The patient was a 67-year-old male who presented with upper abdominal pain and obstructive jaundice. Initial imaging studies led to the diagnosis of Bismuth-Corlette type IIIB perihilar cholangiocarcinoma. Due to the unique location of the gallbladder and combined multiple hepatic anomalies, LSGB was highly suspected. During surgery after hilar dissection, we recognized that the tumor was located at the imaginary hilar bile duct bifurcation, but its actual location was corresponding to the biliary confluence of the left median and lateral sections. The extent of resection included extended left lateral sectionectomy, caudate lobe resection, and bile duct resection. Since some of the umbilical portion of the portal vein was invaded, it was resected and repaired with a portal vein branch patch. Due to anatomical variation of the biliary system, only one right-sided duct was reconstructed. The patient recovered uneventfully without any complication. LSGB should be recognized as a constellation of multiple hepatic anomalies, and therefore, thorough investigations are necessary to enable the performance of safe hepatic and biliary resections.