División ganglionar posquirúrgica y su efecto en el recuento ganglionar y la estadificación en pacientes con cáncer gástrico / Postoperative lymph node division and its effect on lymph node count and staging in patients with gastric cancer

Introducción. La gastrectomía y disección ganglionar es el estándar de manejo para los pacientes con cáncer gástrico. Factores como la identificación de ganglios por el patólogo, pueden tener un impacto negativo en la estadificación y el tratamiento. El objetivo de este estudio fue comparar el recuento ganglionar de un espécimen quirúrgico después de una gastrectomía completa (grupo A) y de un espécimen con un fraccionamiento por grupos ganglionares (grupo B). Métodos. Estudio de una base de datos retrospectiva de pacientes sometidos a gastrectomía D2 en el Servicio de Cirugía gastrointestinal de la Liga Contra el Cáncer seccional Risaralda, Pereira, Colombia. Se comparó el recuento ganglionar en especímenes quirúrgicos con y sin división ganglionar por regiones anatómicas previo a su envío a patología. Resultados. De los 94 pacientes intervenidos, 65 pertenecían al grupo A y 29 pacientes al grupo B. El promedio de ganglios fue de 24,4±8,6 y 32,4±14,4 respectivamente (p=0,004). El porcentaje de pacientes con más de 15 y de 25 ganglios fue menor en el grupo A que en el grupo B (27 vs 57, p=0,432 y 19 vs 24, p=0,014). El promedio de pacientes con una relación ganglionar menor 0,2 fue mayor en el grupo B (72,4 % vs 55,4 %, p=0,119). Conclusiones. Los resultados de nuestro estudio mostraron que una división por grupos ganglionares previo a la valoración del espécimen por el servicio de patología incrementa el recuento ganglionar y permite establecer de manera certera el pronóstico de los pacientes, teniendo un impacto positivo en su estadificación, para evitar el sobretratamiento

Introduction. A gastrectomy and lymph node dissection is the standard of management for patients with gastric cancer. Factors such as the identification of nodes by the pathologist can have a negative impact on staging and treatment. The objective of this study was to compare the lymph node count of a surgical specimen after a complete gastrectomy (group A) and of a specimen with lymph node by groups (group B). Methods. Study of a retrospective database of patients undergoing D2 gastrectomy in the Risaralda section of the Liga Contra el Cancer Gastrointestinal surgical service, Pereira, Colombia. The lymph node count was compared in surgical specimens with and without lymph node division by anatomical regions, prior to sending them to pathology. Results. Of the 94 patients who underwent surgery, 65 were from group A and 29 patients were from group B. The average number of nodes was 24.4±8.6 and 32.4±14.4, respectively (p=0.004). The percentage of patients with more than 15 and 25 nodes was lower in group A than in group B (27 vs 57, p=0.432 and 19 vs 24, p=0.014). The average number of patients with a nodal ratio less than 0.2 was higher in group B (72.4% vs 55.4%, p=0.119). Conclusions. The results of our study showed that a division by lymph node groups prior to the evaluation of the specimen by the pathology service increases the lymph node count and allows the prognosis of patients to be accurately established, having a positive impact on their staging, to avoid overtreatment.

Recurrence rate of oral melanotic macule treated with Q-switched alexandrite laser versus surgical excision: a retrospective cohort study / 口腔疾病防治

Objective@#To compare the recurrence rates between 755 nm Q-switched alexandrite laser (QSAL) treatment and surgical excision of oral melanotic macules (OMM).@*Methods@#This study was reviewed and approved by the Ethics Committee, and informed consent was obtained from the patients. A retrospective cohort study was designed to collect demographic and clinical characteristics and follow-up data from patients with OMM. Patients who received QSAL or surgical excision in the Department of Oral Medicine, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine from January 2019 to August 2021 were included. The one-year recurrence rate was investigated as the primary outcome. Long-term adverse reaction rates were investigated as safety indicators. Kaplan-Meier analyses were performed to analyze the recurrence-free rates between the groups.@*Results@#A total of 57 patients were enrolled in this study. 16 patients underwent surgical excision, and 41 underwent QSAL. The baseline demographic and clinical characteristics between the groups were not significantly different. No recurrence (0%) of OMM was observed in the surgical excision group, while in the QSAL group, the macule recurred in 12 patients (29.27%). The average duration of recurrence was 6.08 months after treatment. Recurrence was not found to be associated with smoking (P = 1.000), gastrointestinal polyps (P = 1.000), longitudinal melanonychia (P = 0.187), family history (P = 0.552), treatment sessions (P = 0.567) or multiple macule lesions (P = 0.497). Compared with treatment with surgical excision, the odds ratio of recurrence for treatment with QSAL was 4.41, with a 95% confidence interval of 1.27-15.24 (P = 0.020). In the surgical excision group, 3 patients (18.75%) reported depressions and scars on the lesion, while no long-term adverse reactions (0%) were reported in the QSAL group (P = 0.019).@*Conclusion@#Compared with surgical excision, the advantage of QSAL is the low long-term adverse reaction rate, while the disadvantage is the relatively high one-year recurrence rate. It is necessary to communicate the advantages and disadvantages of the two methods with OMM patients to assist in clinical decision-making.

Rare vulvar lesions: A case series

@#Mass of the vulva include both benign and malignant lesions. Benign mass lesions of the vulva include tumors, hamartomas, cysts, infectious disorders, and non-neoplastic epithelial disorders. Some are rare mass lesions. Here, we presented three rare mass lesions of the vulva. The first case presented with the complaint of vulvar lesion since childhood, while the two cases presented in reproductive age and perimenopausal age. All three cases presented as mass lesions in the vulva with pain or uneasiness during work. In all these cases, excision was done. On histopathological examination, the lesions have different diagnoses which are common in other parts of the body, but rarely present at the vulva. A definitive diagnosis of a vulvar mass lesion is difficult to make, especially in the case of rare mass lesion. Histopathology is the principal tool of diagnosis.

La escisión total del mesorrecto transanal en el tratamiento del cáncer del recto como nueva técnica en Cuba / Total Excision of the Transanal Mesorectum as a New Technique for Treating Rectal Cancer in Cuba

Introducción: Las indicaciones de la Microcirugía Transanal Endoscópica han evolucionado desde la cirugía de tumoraciones rectales hasta otras enfermedades pélvicas. La asociación de esta y la escisión total del mesorrecto transanal ofrece una serie de ventajas. Objetivo: Determinar las indicaciones, describir la técnica quirúrgica y mostrar los resultados a largo plazo obtenidos en la realización de la escisión total del mesorrecto transanal en el tratamiento del cáncer del recto medio y bajo. Métodos: Se realizó un estudio observacional descriptivo y prospectivo de los pacientes con cáncer del recto medio y bajo sometidos a esta técnica quirúrgica en el período comprendido entre febrero de 2017 y febrero de 2022 en el Centro Nacional de Cirugía de Mínimo Acceso. Resultados: Se operaron 13 pacientes, 9 con cáncer del recto bajo y 4 con cáncer del recto medio y un promedio de edad de 56,2 años (rango 28-76). El promedio de tiempo quirúrgico fue de 183 minutos (rango 120-270) y las pérdidas hemáticas estimadas de 68 mililitros. La incidencia de morbilidad mayor fue de 15,4 por ciento y la media de estadía hospitalaria de 5,4 días. La media del período de seguimiento fue de 35 (rango 9-69) meses con una recidiva local de 7,7 por ciento y una supervivencia global a los 5 años de 100 por ciento. Conclusiones: La escisión total del mesorrecto transanal combinado con cirugía laparoscópica es una técnica factible y segura. La introducción de la variante técnica utilizando el instrumental de la Microcirugía Transanal Endoscópica es más ergonómica y disminuye los costos(AU)

Introduction: The indications for transanal endoscopic microsurgery have evolved from surgery of rectal tumors to other pelvic diseases. The association between this and total excision of the transanal mesorectum offers a series of advantages. Objective: To determine the indications, to describe the surgical technique and to show the long-term outcomes obtained in the performance of total excision of the transanal mesorectum for treating cancer of the middle and lower rectum. Methods: A descriptive and prospective observational study was carried out of patients with cancer of the middle and lower rectum who underwent this surgical technique in the period from February 2017 to February 2022 at Centro Nacional de Cirugía de Mínimo Acceso. Results: Thirteen patients were operated on, 9 with cancer of the lower rectum and 4 with cancer of the middle rectum, as well as an average age of 56.2 years (range 28-76). The average surgical time was 183 minutes (range 120-270) and estimated blood loss was 68 milliliters. The incidence of highest morbidity was 15.4 percent and mean hospital stay was 5.4 days. The median follow-up period was 35 (range 9-69) months, with a local recurrence of 7.7 percent and an overall 5-year survival of 100 percent . Conclusions: Total excision of the transanal mesorectum combined with laparoscopic surgery is a feasible and safe technique. The introduction of the variant technique using the instruments of endoscopic transanal microsurgery is more ergonomic and reduces costs(AU)

Variaciones anatómicas en la vascularización del colon derecho y su implicancia en la escisión completa del mesocolon con linfadenectomía D3. Estudio de corte transversal / Anatomical variations in right colon vascularization: its implication in complete mesocolic excision with D3 lymphadenectomy. A cross-sectional study

Introducción: La escisión completa del mesocolon con linfadenectomía D3 (CME-D3) mejora los resultados de los pacientes operados por cáncer del colon. Reconocer adecuadamente la anatomía vascular es fundamental para evitar complicaciones. Objetivo: El objetivo primario fue determinar la prevalencia de las variaciones anatómicas de la arteria mesentérica superior (AMS) y sus ramas en relación a la vena mesentérica superior (VMS). El objetivo secundario fue evaluar la asociación entre las distintas variantes anatómicas y el sexo y la etnia de lo pacientes. Diseño: Estudio de corte transversal. Material y métodos: Se incluyeron 225 pacientes con cáncer del colon derecho diagnosticados entre enero 2017 y diciembre de 2020. Dos radiólogos independientes describieron la anatomía vascular observada en las tomografías computadas. Según la relación de las ramas de la AMS con la VMS, la población fue dividida en 2 grupos y subdividida en 6 (1a-c, 2a-c). Resultados: La arteria ileocólica fue constante, transcurriendo en el 58,7% de los casos por la cara posterior de la VMS. La arteria cólica derecha, presente en el 39,6% de los pacientes, cruzó la VMS por su cara anterior en el 95,5% de los casos. La variante de subgrupo más frecuente fue la 2a seguida por la 1a (36,4 y 24%, respectivamente). No se encontró asociación entre las variantes anatómicas y el sexo u origen étnico. Conclusión: Las variaciones anatómicas de la AMS y sus ramas son frecuentes y no presentan un patrón predominante. No hubo asociación entre las mismas y el sexo u origen étnico en nuestra cohorte. El reconocimiento preoperatorio de estas variantes mediante angiotomografía resulta útil para evitar lesiones vasculares durante la CME-D3. (AU)

Background: Complete mesocolic excision with D3 lymphadenectomy (CME-D3) improves the outcomes of patients operated on for colon cancer. Proper recognition of vascular anatomy is essential to avoid complications. Aim: Primary outcome was to determine the prevalence of anatomical variations of the superior mesenteric artery (SMA) and its branches in relation to the superior mesenteric vein (SMV). Secondary outcome was to evaluate the association between these anatomical variations and sex and ethnicity of the patients. Design: Cross-sectional study. Material and methods: Two hundred twenty-fivepatients with right colon cancer diagnosed between January 2017 and December 2020 were included. Two independent radiologists described the vascular anatomy of computed tomography scans. The population was divided into 2 groups and subdivided into 6 groups (1a-c, 2a-c), according to the relationship of the SMA and its branches with the SMV. Results: The ileocolic artery was constant, crossing the SMV posteriorly in 58.7% of the cases. The right colic artery, present in 39.6% of the patients, crossed the SMV on its anterior aspect in 95.5% of the cases. The most frequent subgroup variant was 2a followed by 1a (36.4 and 24%, respectively). No association was found between anatomical variants and gender or ethnic origin. Conclusions: The anatomical variations of the SMA and its branches are common, with no predominant pattern. There was no association between anatomical variations and gender or ethnic origin in our cohort. Preoperative evaluation of these variations by computed tomography angi-ography is useful to avoid vascular injuries during CME-D3. (AU)

Adequacy of surgical margins, re-excision, and evaluation of factors associated with recurrence: a retrospective study of 769 basal cell carcinomas

Abstract Background: Achieving adequate surgical margins and preventing recurrence are important in the treatment of basal cell carcinoma (BCC). Objectives: The objectives of this study were to evaluate the adequacy of surgical margins and the re-excision rates in patients with primary BCC who underwent standard surgical treatment using our proposed algorithm and to define the risk factors in patients with recurrent BCC. Methods: The medical records of patients who were histopathologically diagnosed with BCC were reviewed. An algorithm created based on previous literature was used to determine the distribution of optimal surgical margins adequacy and re-excision rates. Results: Statistically significant differences were observed between the cases with and without recurrence in age at diagnosis (p = 0.004), tumor size (p = 0.023), tumor location in the H zone of the face (p = 0.005), and aggressive histopathological subtype (p = 0.000). When the tumors were evaluated for adequacy of deep and lateral surgical margins and re-excision rates, higher rates of adequate excision (457 cases, 68.0%) and re-excision (43 cases, 33.9%) were noted for tumors in the H or M zone. Study limitations: Inadequate follow-up of newly diagnosed patients in terms of recurrence and metastasis and the retrospective application of our proposed algorithm are the limitations of the present study. Conclusions: Our results showed that if BCC was detected at an early age and at an early stage, recurrence was lower. The H and M zones were the regions with the highest rates of optimal surgical outcomes.

Refixation of the Excised Acetabular Labrum can Affect the Structural Changes of Cartilage Surface in the Hip Joint / La Refijación del Labrum Acetabular Extirpado Puede Afectar los Cambios Estructurales de la Superficie del Cartílago en la Articulación Coxal

SUMMARY: Refixation of the damaged acetabular labrum is a method of surgical treatment of the hip joint that can promote the repair of joint function after injury and prevent premature osteoarthritis. We sought to determine the condition of the hip joint in rabbits 4 months after excision of the acetabular labrum and the condition of the joint after labral refixation. The articular cartilage of the femoral head and acetabulum was examined by histological methods, multipoint measurement of cartilage thickness, and the ratio between cartilage matrix and chondrocytes lacunae, and the condition of cartilage according to the OARSI grading scale was carried out. On this model, a correlation analysis was performed between the results of the OARSI grading scale and the data of linear morphometry. All these parameters made it possible to better assess changes in articular cartilage. The ratio between matrix and chondrocyte lacunae turned out to be a method that allows establishing early cartilage damage when erosion, fibrosis or deformation did not occur. We found significant differences between the condition of the cartilage after exicion of acetabular labrum and after labral refixation, which give hope to confirm that this surgical technique can delay or prevent progressive changes in the cartilage of the damaged hip joint.

La refijación del labrum acetabular dañado es un método de tratamiento quirúrgico de la articulación coxal, que puede promover la reparación de la función articular después de una lesión y prevenir la osteoartritis prematura. Intentamos determinar el estado de la articulación coxal en conejos de 4 meses después de la escisión del labrum acetabular y observar el estado de la articulación después de la refijación del labrum. El cartílago articular de la cabeza femoral y el acetábulo se examinó por métodos histológicos, se midió a través de multipunto el grosor del cartílago y se realizó la relación entre la matriz del cartílago y las lagunas de condrocitos, y se llevó a cabo la condición del cartílago según la escala de clasificación OARSI. Sobre este modelo se realizó un análisis de correlación entre los resultados de la escala de calificación OARSI y los datos de la morfometría lineal. Todos estos parámetros permitieron evaluar mejor los cambios en el cartílago articular. La relación entre la matriz y las lagunas de condrocitos resultó ser un método que permite establecer temprano el daño del cartílago cuando no se presentó erosión, fibrosis o deformación. Encontramos diferencias significativas entre la condición del cartílago después de la extirpación del labrum acetabular y después de la refijación del labrum, lo que da la esperanza de confirmar que esta técnica quirúrgica puede retrasar o prevenir cambios progresivos en el cartílago de la articulación coxal dañada.

Evaluation of wound healing activity of topical nicotine in an excision wound model in rats

Background: Wound can be defined as disruption of cellular, anatomical, or functional continuity of living tissues. Nicotine causes damage to the epithelial layer of blood vessel and delays wound healing. It plays an important pathogenic role in impaired wound healing. Although in the last millennium, topical use of nicotine has been reported. It promotes collagen synthesis and, in turn, promotes wound healing. The role of topical nicotine on wound healing is controversial. Therefore, it was planned to evaluate and compare wound healing activity of various doses topical nicotine in rats. Aim and Objectives: The objectives of this study were to evaluate the effect of topical nicotine on wound healing in an excision wound model in rats. Materials and Methods: For evaluation of the wound healing effects of the nicotine, excision wound model was used. Nicotine was applied topically in a dose of 1.5 g%, 3.0 g%, and 6.0 g% petroleum base. Petroleum jelly served as control for topical nicotine. Dressing done by applying topical nicotine until (20 days) complete wound healing was observed. Parameters evaluated were surface area of wound and percentage closure. Results: Findings of this show that, on day 4, nicotine 3.0 g% and 6 g% the wound surface area were more as compared to control. On day 12, nicotine 6.0 g% showed significantly more wound surface area than control (P < 0.05). Percentage wound contraction with topical nicotine (6.0 g%) was less as compared to control on day 4, 8, and 12 (P < 0.001). On day 16, percentage wound contracture with topical nicotine (6.0 g%) contraction was significantly less as compared to control (P < 0.05). Although percentage wound contraction with topical nicotine (all preparations) and control was similar on day 20. Conclusion: Finding shows that topical nicotine impairs wound healing in a dose related pattern during initial stages of healing in an excision wound model. However, there is no delay in wound healing with any dose of topical nicotine.

Non-melanoma skin cancer: an analysis of compromised margins in excisions / Câncer de pele não melanoma: uma análise do comprometimento de margens em excisões

Introduction: Non-melanoma skin cancer is the most frequent neoplasm in Brazil, with an estimated 176,930 new cases during the 2020-2022 period, with basal cell carcinoma (BCC) and squamous cell carcinoma (SCC) as the most common subtypes. Surgical treatment of the lesions is effective, with a recurrence rate varying between 3 and 23%, with compromised margins being an important prognostic factor for this recurrence, increasing the importance of complete excision of the tumor. Method: To prepare this work, 1127 lesions treated at the Hospital de Amor Amazônia were analyzed, seeking to quantify cases and analyze surgically compromised margins through a retrospective analytical descriptive study. For this, histopathological reports of the operated patients were reviewed, dividing them according to sex, age, lesion topography, date of excision, lesion diameter, lesion depth, presence of ulceration, compromised margins, and histological type. Results: Among the lesions treated, 65% were BCC and 35% SCC, both histological types presenting a low incidence of compromised margins. In cases of CPB impairment, treatment via exeresis was chosen in 100% of cases. Concerning BCC impairment, the majority opted for clinical follow-up, with reapproach in only 9% of cases. Conclusion: This study demonstrates that the cases treated at the Hospital de Amor Amazônia align with the epidemiological data in the main literature, except for finding a higher incidence of non-melanoma skin cancer in men. In addition, this work demonstrates good results in the clinical approach of compromised margins in BCC lesions.

Introdução: O câncer de pele não melanoma é a neoplasia mais frequente no Brasil, com uma estimativa de 176.930 novos casos durante o triênio 2020-2022, tendo o carcinoma basocelular (CBC) e o carcinoma espinocelular (CEC) como subtipos mais presentes. O tratamento cirúrgico das lesões é efetivo, apresentando taxa de recorrência variando entre 3 e 23%, sendo o comprometimento de margens importante fator prognóstico para essa recorrência, aumentando a importância da excisão completa do tumor. Método: Para a elaboração deste trabalho, foram analisadas 1127 lesões abordadas no Hospital de Amor Amazônia, buscando quantificar casos e analisar margens cirurgicamente comprometidas por meio de um estudo descritivo analítico retrospectivo. Para isso, foram revisados laudos histopatológicos dos pacientes operados, dividindo-os de acordo com sexo, idade, topografia da lesão, data de excisão, diâmetro da lesão, profundidade da lesão, presença de ulceração, comprometimento de margens e tipo histológico. Resultados: Dentre as lesões abordadas, 65% eram CBC e 35% CEC, ambos os tipos histológicos apresentando baixa incidência de margens comprometidas. Nos casos de comprometimento em CEC, optou-se pelo tratamento via exérese em 100% dos casos. Já em relação ao comprometimento em CBC, optou-se majoritariamente pelo acompanhamento clínico, com reabordagem em apenas 9% dos casos. Conclusão: Este estudo demonstra que os casos abordados no Hospital de Amor Amazônia vão ao encontro dos dados epidemiológicos presentes nas principais literaturas, com ressalva, apenas, ao encontrar uma maior incidência de câncer de pele não melanoma em homens. Além disso, esse trabalho demonstra bons resultados na abordagem clínica de margens comprometidas em lesões de CBC.

Primer caso de escisión mesorrectal total transanal (TaTME) para el tratamiento del cáncer de recto medio en un centro docente universitario: descripción de la técnica / First case of transanal total mesorectal excision (TaTME) for middle rectal cancer in a teaching tertiary center: technical aspects / Primeiro caso de excisão total do mesorreto transanal (TaTME) para tratamento de câncer de reto meio em um centro universitário de ensino: aspectos tecnicos

La escisión mesorrectal transanal (TaTME: transanal total mesorectal escision) es la última de una larga lista de desarrollos técnicos y tecnológicos para el tratamiento del cáncer de recto medio y bajo. Incluso para los cirujanos colorrectales experimentados, lograr una escisión mesorrectal total (emt) de calidad en cirugía oncológica no siempre es sencillo, por la dificultad de obtener un adecuado acceso a la pelvis. Los estudios realizados han mostrado resultados comparables al abordaje laparoscópico, con tasas elevadas de escisiones mesorrectales completas y bajo porcentaje de margen circunferencial radial (CRM: circumferential radial margin) y distal positivos, con un adecuado número de ganglios resecados. Como toda técnica nueva, su implementación puede traer consecuencias no intencionales. La complejidad del abordaje, la dificultad en la identificación de nuevos repères y planos anatómicos, ha llevado a complicaciones graves como la lesión uretral o la siembra tumoral pelviana. Por ello, la comunidad quirúrgica ha retrasado la implementación masiva de la técnica y desarrollado estrategias de enseñanza y monitorización de este procedimiento para su realización en centros de alto volumen. El objetivo de esta publicación es presentar el primer caso de TaTME en un centro docente universitario y difundir en nuestra comunidad científica el fundamento de la técnica, sus indicaciones, describir los principales pasos técnicos, complicaciones, resultados oncológicos y funcionales.

Transanal total mesorectal excision (TaTME) is the last of a long list of technical and technological developments for treatment of middle and low rectal cancer. Even for skilled colorectal surgeons, achieving a good quality total mesorectal excision (TME) in oncology surgery is not always simple, due to the difficulty of obtaining optimal access to the pelvis. So far, studies have shown similar results to laparoscopic surgery, with high rates of complete mesorectal excisions and low rate of circumferential radial margin (CRM) and distal margin with an appropriate number of resected lymph nodes. Like every new technique, its implementation can bring unwanted consequences. The complexity of the approach, the difficulty in the identification of new landmarks and anatomic planes, has led to serious complications such as urethral injury or tumoral seeding. This has made slowdown the massive implementation of the technique among the surgical community, addressing the need of developing training programs and mentoring of this procedure that belongs to high volume centers. The aim of this publication is to present the first case of TaTME in a teaching tertiary center and spread, in our scientific community, the principles of the technique, its indications, main technical steps, complications and functional and oncologic results.

A excisão mesorretal transanal (TaTME: transanal total mesorectal escision) é o mais recente de uma longa linha de desenvolvimentos técnicos e tecnológicos para o tratamento do câncer retal inferior e médio. Mesmo para cirurgiões colorretais experientes, nem sempre é fácil obter uma excisão total do mesorreto (EMT) de qualidade em cirurgia de câncer, devido à dificuldade de obter acesso adequado à pelve. Os estudos realizados mostraram resultados comparáveis ​​à abordagem laparoscópica, com altas taxas de excisões completas do mesorreto e baixo percentual de margem radial circunferencial positiva (CRM: circumferential radial margin) e distal, com número adequado de linfonodos ressecados. Como qualquer nova técnica, sua implementação pode ter consequências não intencionais. A complexidade da abordagem, a dificuldade em identificar novos repères e planos anatômicos, levou a complicações graves, como lesão uretral ou semeadura de tumor pélvico. Por esse motivo, a comunidade cirúrgica atrasou a implementação massiva da técnica e desenvolveu estratégias de ensino e acompanhamento desse procedimento para sua realização em centros de alto volume. O objetivo desta publicação é apresentar o primeiro caso de TaTME em um centro de ensino universitário e divulgar em nossa comunidade científica as bases da técnica, suas indicações, descrever as principais etapas técnicas, complicações, resultados oncológicos e funcionais.

Valve-Sparing Excision of Multiple Papillary Fibroelastomas in the Aortic Valve and Left Ventricular Outflow Tract / 日本心臓血管外科学会雑誌

Primary cardiac fibroelastoma is a relatively rare tumor and is often detected incidentally by echocardiography. We report a case of multiple fibroelastomas that were found incidentally by follow-up echocardiography for hypertrophic cardiomyopathy and were treated with valve-sparing excision. The patient was a 71-year-old man, in whom a 10-mm tumor on the ventricular septum below the right coronary cusp and 3-mm tumors on the left ventricular side of the left and right coronary cusps were detected. Although he had no symptoms, because the tumors were mobile, surgery was performed for preventing embolization and making a definitive diagnosis. The tumor on the ventricular septum was excised together with the surrounding endocardium and part of the myocardium. The tumors on the valve leaflets were excised with the aortic valve cusps spared. Histopathologically, all the tumors were fibroelastomas. The postoperative course was uneventful.

Câncer de reto: qual a melhor técnica para excisão total do mesorreto laparoscópica ou robótica? / Rectum cancer: which is the best technique for total excision of the mesorectum laparoscopic or robotic?

Introdução: As operações laparoscópicas, assistidas por robô e a abertas são técnicas cirúrgicas comumente utilizadas na vida diária. A viabilidade e os resultados em curto e longo prazos dos procedimentos laparoscópicos e robóticos têm sido amplamente relatados. Objetivos: Comparar os dados clínicos e oncológicos da cirurgia assistida por robô e laparoscópica no câncer retal. Métodos: Foram pesquisados o Pubmed/Medline, Embase, e Cochrane Library para artigos relevantes publicados até 2021. Estudos baseados na comparabilidade entre operação assistida por robô e laparoscópica para câncer retal foram designados. Os parâmetros analisados incluíram tempo operatório, conversão para procedimento aberto, perda estimada de sangue, tempo de recuperação da função intestinal, tempo de internação, vazamento da anastomose e complicações pós-operatórias. Resultados: Operação assistida por robô foi associada com maior tempo operatório (342 vs.192 min na cirurgia laparoscópica, p<0,001), menor conversão para procedimento aberto, menor tempo de internação hospitalar e recuperação mais rápida da função intestinal, menores complicações pós-operatórias de forma significativa (p=0,041). A perda estimada de sangue, a taxa de vazamento da anastomose e os resultados oncológicos, incluindo o número de linfonodos extraídos, não mostraram diferenças significativas entre os grupos. Conclusão: A cirurgia assistida por robô para câncer retal mostrou maior tempo operatório, menor conversão, taxas de recuperação da função intestinal mais rápidas e menor permanência no hospital. Seus resultados oncológicos forram semelhantes à cirurgia laparoscópica.

Introduction: Laparoscopic surgery, robot-assisted surgery and open surgery are the most commonly used surgical techniques in daily living. The feasibility and short- and long-term results of laparoscopic and robotic procedures have been widely reported. Objectives: To compare the clinical and oncological results of robot-assisted and laparoscopic surgery for rectal cancer. Methods: PubMed/Medline, Embase, The Cochrane Library were searched for relevant articles published until 2021. Studies based on comparability between robot-assisted and laparoscopic surgery for rectal cancer were designed. The parameters analyzed included operative time, conversion to open surgery, estimated blood loss, bowel function recovery time, length of hospital stay, anastomosis leak, and postoperative complications. Results: The robot-assisted surgery group was associated with longer operative time (342 vs. 192 min in laparoscopic surgery,p <0.001), lower conversion to open surgery, shorter length of hospital stay, faster bowel function recovery and lower postoperative complications significantly (p=0.041). Estimated blood loss, anastomosis leak rate, and oncological outcomes including the number of lymph nodes extracted showed no significant differences between groups. Conclusion: Robot-assisted surgery for rectal cancer showed longer operative time, lower conversion, faster bowel function recovery rates, shorter hospital stay, and similar oncological outcomes compared to laparoscopic surgery.

Robotic approach to remove four tailgut cyst cases in Brazil: a case series

ABSTRACT Tailgut cysts are rare congenital lesions that are remnants of the embryonic hindgut. This abnormality presents with non-specific symptoms or no symptoms; therefore, misdiagnosis is common. Here, we present four cases of tailgut cysts that were successfully removed using a robotic surgical approach. A 42-year-old woman with tenesmus, pain in the right gluteal region, and discomfort in the rectal region during evacuation was referred to our medical center. Another patient was a 28-year-old woman who presented with the same symptoms to our general practitioner. Both patients underwent upper abdominal and pelvic magnetic resonance imaging that revealed a tailgut cyst. Further, a 36-year-old woman was referred with coccyx and hypogastric pain. Magnetic resonance imaging revealed two pararectal cystic formations. She underwent robot-assisted surgery, and after analysis by a pathologist, the conclusion was that the tailgut cyst was associated with scarring fibrosis. A 55-year-old woman with posterior epigastric pelvic pain associated with heartburn underwent robot-assisted surgery to resect a retroperitoneal tumor. These cases highlighted the importance of tailgut cysts in the differential diagnosis of rectal lesions. Surgical treatment is preferred because malignant transformations can occur. The difference between laparoscopic and robotic approaches is the better visualization and stability of the latter, inducing less tissue damage. Robotic resection is a safe procedure, especially in patients with a narrow pelvis, because it reduces tissue damage.

Spray de barreira para prevenir o apagamento da marcação cirúrgica na cirurgia micrográfica de Mohs / Barrier spray to prevent surgical marking erasure in Mohs micrographic surgery

A preservação do desenho das margens cirúrgicas é essencial durante a realização da cirurgia micrográfica de Mohs. Contudo, a degermação cutânea no ato da antissepsia e o uso da gaze durante a anestesia local, com frequência, promovem a remoção dessas marcações. A utilização da película protetora Cavilon® 3M, ao fixar a tinta da caneta marcadora, mostrou-se eficaz na preservação do mapa cirúrgico, permitindo uma remoção precisa do espécime cirúrgico

The preservation of the surgical margins marking is essential during Mohs micrographic surgery. However, skin degermation during antisepsis and the use of gauze during local anesthesia often remove these markings. The use of the protective film Cavilon® 3M to fix the marking pen ink was effective in preserving the surgical map, allowing an accurate removal of the surgical specimen.

Scarless two-stage delayed coloanal anastomosis: a technique description

Introduction: In current clinical practice, immediate coloanal anastomosis (ICA) remains the standard technique for restoring the gastrointestinal tract following coloproctectomy for low rectal cancer. This anastomosis still requires a temporary diverting stoma to decrease the postoperative morbidity, which remains significantly high. As an alternative, some authors have proposed a two-stage delayed coloanal anastomosis (TS-DCA). This article reports on the surgical technique of TS-DCA. Methods: The case described is of a 53-year-old woman, without any particular history, in whom colonoscopy motivated by rectal bleeding revealed an adenocarcinoma of the low rectum. Magnetic resonance imaging showed a tumor ~ 1 cm above the puborectalis muscle, graded cT3N +. The extension workup was negative. Seven weeks after chemoradiotherapy, a coloproctectomy with total mesorectal excision (TME) was performed. A TS-DCA was chosen to restore the digestive tract. Conclusion: Two-stage delayed coloanal anastomosis is a safe and effective alternative for restoring the digestive tract after proctectomy for low rectal cancer. Recent data seem to show a clear advantage of this technique in terms of morbidity. (AU)

From left to right. para-aortic lymph nodes sampling during pancreatoduodenectomy for pancreatic cancer / Da esquerda para a direita. ressecção de linfonodos para-aórticos durante duodenopancreatectomia para câncer pancreático

ABSTRACT BACKGROUND: Para-aortic lymph nodes involvement in pancreatic head cancer has been described as an independent adverse prognostic factor. To avoid futile pancreatic resection, we systematically perform para-aortic lymphadenectomy as a first step. AIMS: To describe our technique for para-aortic lymphadenectomy. METHODS: A 77-year-old female patient, with jaundice and resectable pancreatic head adenocarcinoma, underwent pancreaticoduodenectomy associated with infracolic lymphadenectomy. RESULTS: The infracolic anterior technique has two main advantages. It is faster and prevents the formation of postoperative adhesions, which can make subsequent surgical interventions more difficult. CONCLUSIONS: We recommend systematic para-aortic lymphadenectomy as the first step of pancreaticoduodenectomy for pancreatic head adenocarcinoma by this approach.

RESUMO RACIONAL: O envolvimento dos gânglios linfáticos para-aórticos no câncer da cabeça do pâncreas tem sido descrito como um fator prognóstico adverso independente. Para evitar a ressecção pancreática inútil, realizamos sistematicamente linfadenectomia para-aórtica. OBJETIVOS: Descrever a técnica de linfadenectomia para-aórtica. MÉTODOS: Paciente do sexo feminino, 77 anos, com quadro de icterícia e adenocarcinoma da cabeça do pâncreas ressecável, submetida à duodenopancreatectomia associada à linfadenectomia infracólica. RESULTADOS: Esta técnica anterior infracólica tem duas vantagens principais: é mais rápida e evita a formação de aderências pós-operatórias, o que pode dificultar as intervenções cirúrgicas subsequentes. CONCLUSÕES: Recomendamos a linfadenectomia para-aórtica sistemática como o primeiro passo da duodenopancreatectomia para o adenocarcinoma da cabeça do pâncreas por esta abordagem.

Clinical efficacy of graded and staged treatment on keloid / 中华医学美学美容杂志

Objective:To explore the staged treatment of keloid scars and to optimise treatment options.Methods:From June 2005 to June 2019, 629 keloid patients, 253 males and 376 females, aged 9 to 78 years, with a mean age of 31.3±16.8 years, were admitted to the Department of Aesthetic Plastic Surgery of Weifang People＇s Hospital. Three-stage comprehensive treatment was administered according to the stage of the disease from low to high, and the treatment effect was observed regularly, and the recurrence rate was counted.Results:In stage Ⅰ, 251 patients had local recurrence in 14 cases (5.5%) and 4 cases (1.6%) at 2 years 6 months after treatment, all of whom were cured after re-injection; in stage Ⅱ, 302 patients had local recurrence in 56 cases (18.6%) at 6 months after treatment, 49 patients (87.5%) were cured after re-treatment and 35 patients (11.6%) at 2 years; in stage Ⅲ, at 6 months after treatment, 36 patients (47.3%) had recurrence and 19 patients (25%) had recurrence at 2 years after re-treatment.Conclusions:The results and recurrence rate of keloids after comprehensive treatment are related to their severity, and a more satisfactory outcome can be achieved by staging the treatment according to the stage of the disease.

Effect of improved partial graft excision in the treatment of infected arteriovenous grafts / 中华肾脏病杂志

Objective:To investigate the effect of improved partial graft excision (iPGE) in the treatment of infected arteriovenous grafts (AVG).Methods:It was a single-center retrospective study. A cohort database study of patients who underwent surgery for infected AVG from January 2019 to July 2022 was conducted. The cases were divided into total graft excision (TGE) group and iPGE group, and the postoperative reinfection rate and surgery-related complications, such as bleeding, nerve injury and limb ischemia, in the two groups were analyzed. The primary patency rate and the secondary patency rate at 3 months and 6 months after the surgery in the iPGE group were analyzed.Results:(1) General information: A total of 47 cases were included in the study. Among these 47 cases, 14 cases had undergone iPGE of infected AVG, and 33 cases had undergone TGE. The study population was of an average age of 59 years (21-81 years), including 18 males and 29 females. Dialysis age was 36 (14, 72) months. AVG age was 18 (4, 36) months. The shortest AVG age was half a month, and the longest AVG age was 72 months. (2)Comparative analysis of the two groups: The reinfection rate of the iPGE group was 21.4% (3/14), and the reinfection rate of the TGE group was 0 (0/33). The reinfection rate of the iPGE group was higher than that of the TGE group, and the difference was statistically significant (Fisher exact test, P=0.022). For 11 patients in the iPGE group (excluding 3 cases with reinfection), the shortest follow-up period was 5 months and the longest follow-up period was 18 months. In the iPGE group, the primary patency rate at 3 months was 72.7% (8/11), and the primary patency rate at 6 months was 72.7% (8/11); the secondary patency rate at 3 months was 100% (11/11) and the secondary patency rate at 6 months was 90.9% (10/11). There was no brachial artery rupture, nerve injury or limb ischemia in the iPGE group. In the TGE group, 1 case underwent secondary repair of brachial artery due to brachial artery rupture, and there was no nerve injury or limb ischemia in other cases. Conclusions:During the treatment of infected AVG, iPGE can preserve the original fistula, and avoid central venous catheterization. At the same time, the operation difficulty and risk are relatively low. Although the reinfection rate of iPGE is slightly higher than that of TGE in this study, the reinfection rate of iPGE is lower than that reported in the previous study. The key to prevent reinfection is to grasp the reasonable surgical adaptation signs in preoperative evaluation, perform intraoperative reevaluation and control surgical operation details. The iPGE represents an acceptable method for the treatment of some particular patients with infected AVG.

Research progress in predicting the difficulty of surgery for middle and low rectal cancer based on pelvic measurement / 中华消化外科杂志

Total mesorectal excision (TME) has become the basic principle of surgical treat-ment for middle and low rectal cancer. Some of patients with ultra-low rectal cancer require under-going intersphincteric resection (ISR). Due to the limitation of the narrow pelvis, TME and ISR put forward higher requirements for the precise separation of the anatomical level and the protection of neurological function during the operation. At present, evaluation of the difficulty of surgery for middle and low rectal cancer is mainly based on the subjective judgment of chief surgeon, and there is no unified and objective scoring system or prediction model that can classify the difficulty of surgery for middle and low rectal cancer before surgery. The authors review relevant literatures and summarize the existing studies related to pelvic measurement for predicting the difficulty of surgery for middle and low rectal cancer, in order to provide significant guidance for the selection of surgical approach for patients with middle and low rectal cancer.

Quality analysis of surgical specimens of rectal cancer in the Chinese taTME registry coll-aborative database: a nationwide registered study / 中华消化外科杂志

Objective:To analyze the quality of surgical specimens of rectal cancer in the Chinese transanal total mesorectal excision (taTME) registry collaborative (CTRC) database.Methods:The retrospective and descriptive study was conducted. Based on the concept of real-world research, the clinicopathological data of 1 761 patients with rectal cancer in the CTRC database who underwent taTME in 40 medical centers, including the Beijing Friendship Hospital of Capital Medical University et al, from November 15, 2017 to December 31, 2022 were collected. There were 1 212 males and 549 females, aged 62(range, 53-68)years. Observation indicators: (1) preoperative examinations; (2) neoadjuvant therapy; (3) postoperative examinations. Measurement data with skewed distri-bution were represented as M(range). Count data were described as absolute numbers. Results:(1) Preoperative examinations. Of the 1 761 patients, 1 324 patients underwent preoperative pelvic magnetic resonance imaging examination, and the results showed that 4 cases as clinical T0 stage, 30 cases as clinical T1 stage, 250 cases as clinical T2 stage, 828 cases as clinical T3 stage, 141 cases as clinical T4 stage, 11 cases as clinical Tx stage, 60 cases missing clinical T staging data, 490 cases as clinical N0 stage, 373 cases as clinical N1 stage, 311 cases as clinical N2 stage, 86 cases as clinical Nx stage, 64 cases missing clinical N staging data, 156 cases with mesorectal fascia invasion, 223 cases with extraintestinal blood vessels invasion. The distance from lower margin of tumor to anal margin of 1 324 patients was 50(range, 40-60)mm. (2) Neoadjuvant therapy. Of the 1 761 patients, 873 patients underwent neoadjuvant therapy, including 17 cases receiving radiotherapy alone, 155 cases receiving chemotherapy alone, 43 cases receiving short-course simultaneous chemoradiotherapy, 26 cases receiving short-course simultaneous chemoradiotherapy and delayed surgery, 1 case receiving contact radiotherapy, 277 cases receiving long-course simultaneous chemoradiotherapy, 9 cases receiving other treatments, and 345 cases missing neoadjuvant therapy data. (3) Postoperative examinations. Of the 1 761 patients, 1 584 cases achieved R 0 resection, 23 cases achieved R 1 resection, 1 case achieved R 2 resection, and there were 153 cases missing surgical margin data. The tumor diameter, number of lymph nodes harvest and positive rate of intravascular tumor thrombus were 30(range, 20-45)cm, 13(range, 10-17) and 20.794%(330/1 587) in 1 761 patients. There were 1 647 patients with circumferential margin records, which showed positive in 51 cases, and the minimum distance from deep part of tumor to circumferential margin was 5(rang, 3-13)mm in 1 647 patients. There were 547 cases with distal margin records, which showed positive in 4 cases, and the distance from lower margin of tumor to distal margin was 20(10-25)mm in 547 cases. There were 1 698 patients with specimen integrity records, which showed intact specimen in 1 436 cases, fair specimen in 233 cases, poor specimen in 8 cases, unevaluated specimen in 21 cases, and there were 20 cases with rectal tube perforation. Of the 1 761 patients, cases as pathological T0 stage, Tis stage, T1 stage, T2 stage, T3 stage, T4 stage was 103, 23, 145, 515, 712, 179, respectively, and there were 4 cases of pathology that could not be evaluated and 80 cases missing pathological T staging data. Of the 1 761 patients, cases as pathological N0 stage, N1a stage, N1b stage, N1c stage, N2a stage, N2b stage was 1 117, 189, 133, 66, 109, 68, respectively, and there were 79 cases missing pathological N staging data. Of the 1 761 patients, there were 79 cases with distant metastasis, 1 591 cases without distant metastasis, and 91 cases without data of tumor metastasis. Of the 873 patients undergoing neoadjuvant therapy, there were 405 patients with tumor regression grade records including 105 cases as grade 1, 142 cases as grade 2, 91 cases as grade 3, 43 cases as grade 4, 24 cases as grade 5. Conclusions:In China, the quality of surgical specimens of taTME for rectal cancer is good with low positive rate of resection margin. It is recommended that using a formatted postoperative pathological report for good quality control of pathological report of surgical specimen.